Anticipatory grief: The emotional toll of a death can be felt even before it’s happened

I’ve only ever been to therapy three times in my life. Once, in college, when I had to sit exams so gruelling I developed chronic anxiety and lost my sense of self. Then again in the height of Covid restrictions when, living alone, I was enduring quarantine while reporting daily on how many people were sick and how many had died. And then last year, when I couldn’t stop thinking about my parents dying.

I will preface this by saying: my parents are completely fine. In their late 50s and early 60s, they’re the picture of health. They have that resilience passed down from immigrants the world over. They exude vitality, continuing to work full-time without the need for medication. They are healthy, well, and very much alive.

That hasn’t stopped me from thinking about their deaths every day. Those therapy hours were nothing short of glorified crying sessions. My therapist would ask me how I was, I would burst into tears, then I would explain to her that I’m scared of my parents dying. And then the hour would be over. The end. 

But in between my sobs and elephantine nose-blowing, I did gain some insight. What I was experiencing had a name: pre-grieving or anticipatory grief.

Although grief is often associated with the aftermath of loss, anticipatory grief can afflict individuals long before any actual loss occurs. This emotional experience involves pre-emptively mourning the eventual departure of a loved one, even when they are still very much present in our lives, and perhaps even in good health. 

How does anticipatory grief manifest?

As I discovered through therapy, anticipatory grief is a deeply personal and often isolating experience. It defies logic – how can you mourn someone who’s not yet gone? – but that doesn’t make the feeling any less profound.

It most typically manifests in situations where death is inevitably on the horizon. “Family members and friends know that this person is going to pass. They know that [their condition] is terminal and that this person is not going to live,” explained psychologist Dr Mark Rackley. “The person then starts to be thrown into a reality that death is imminent, but they haven’t actually lived the death.” 

This situation can create a confusing and emotionally charged environment. Mark, who hosts the I Have Issues podcast, recommends that you allow yourself to experience the grief, illogical as it may seem.

“Ideally, what you want is for somebody to actually accept the reality of what’s happening,” he said. “Some people might not do that. They might go into denial and literally go into avoidance.” This denial often stems from a desperate hope for a miracle, which can further complicate the grieving process once the loss occurs.

Even for those who face the reality of the impending loss, a range of emotions can surface, including anger. “Anger at the injustice of the death, and asking, ‘Why me? Why is this happening?’” said Mark. “They might also get angry at the person dying: ‘How can you do this to me? This is terrible. I’m going to go through such a mess when you go.’” 

Additionally, guilt can arise from unresolved issues or the feeling of wanting the person’s suffering to end. This can lead to an internal conflict between not wanting them to die but also needing relief from the emotional burden.

Many worry how they will cope after the loss. “They try to position themselves post-death and think about what that grief will look like,” said Mark. This forward-thinking can lead to anxiety and stress, with some individuals feeling that they won’t be able to move on or fearing a complete breakdown.

How to cope with anticipatory grief

During my sessions to manage my anticipatory grief, my therapist offered a crucial piece of advice: focus on gratitude for the moments I still have with my parents. Mark reinforced this sentiment, highlighting the importance of staying present and accepting reality as it unfolds. “We take the story where the story’s at, and that’s what we focus on. We don’t try and write the story because that’s around trying to control what’s coming, which of course you can’t,” he advised. 

Mark also stressed the importance of seeking support, whether from a therapist or a broader support network, to navigate these emotional challenges.

Interestingly, Mark also pointed out that there is a potential silver lining in this cloud of pre-emptive grief: “If there’s any positive thing around anticipatory grief, it’s that it gives you time, and not everybody gets time.” 

This time allows for meaningful conversations and the resolution of unresolved issues, which can provide comfort in the long run. “It’s helping them deal with the reality, but also saying this is an opportunity as well to be able to manage the grief after the person has died,” said Mark.

The human psyche is a complex landscape, and anticipatory grief is not a sign of weakness or irrationality but rather a testament to the depth of our emotional connections and a reminder that our time is borrowed. I still feel sad when I think about living life without my parents one day, but I’ve also learned to embrace and cherish the beauty of the moments that I get to share with them, every day that I can.

Find support links and resources for your mental health and wellbeing here.