Anticipatory Grief: Would you stay with me?

DEATH is something that is inevitable. With time ticking, the pain of losing someone may sink into people too late or too soon.

It is also a reality that people are having a hard time processing, witnessing their loved ones suffer from illness, or becoming gradually fragile. This experience often leaves individuals feeling emotionally and mentally drained as if their world shifts.

According to Philippine Statistics Authority (PSA), there were 78 deaths recorded every hour in 2022, which means more than one person passes away per minute.

Associated with death is a universal emotion— grief. Typically, grieving comes after losing someone dearest to you. However, another type of grief is ‘anticipatory grief’, where you can experience bereavement even before someone dies.

Exploring anticipatory grief

According to Dr. Marilou B. Francisco, PhD, RGC, RPsy, an Associate Professor in the Department of Psychology at the Polytechnic University of the Philippines, anticipatory grief differs from conventional grief. While conventional grief is a reaction to a loss, anticipatory grief involves contemplating a future without someone who is still alive but suffering from a terminal illness.

In an interview with Republicasia, she also explained that while it is natural to worry about losing someone who is currently healthy, this type of concern does not qualify as anticipatory grief. “Yung nagwo-worry ka [kung] para kanino pinaghirapan mo dahil sa old age nila, I think that’s not more of a grief but it’s more of a worry, and worry is a natural emotion,” she said.

Gen Z who are currently transitioning to adulthood often feel the weight of this type of grief because they are not getting any younger— so are their loved ones. They are slowly recognizing their parents, grandparents, or loved ones falling and getting extremely sick as they age.

For Megan Butt, 23, this anticipatory loss started with her grandfathers. “All of my grandfathers [two biological grandfathers and 1 step-grandfather] were ill or had complications for a long time before passing away, so I felt like I had partly lost them before they had passed away— as a way of preparing myself. It felt grueling, but also numb at the same time. It feels as if it is constantly there in the background, so you can partly ignore it and get used to it but at the same time are constantly hurting,” she recalls.

Butt’s journey through anticipatory grief began at 16 when one of her grandfathers was diagnosed with bowel cancer. With each day passing, she found herself mourning not just for his presence but for the life they once shared together. She would lay awake, wondering if the next morning she would wake up with a news she dreads.

Additionally, she struggled with feelings of guilt for not visiting and spending enough time or showing enough gratitude to them as a granddaughter, especially during their time in hospice. Yet, there was also a bittersweet sense of relief, knowing that their pain had ended.

The weight of grief

Dr. Francisco noted that individuals who have close relatives or friends facing serious health challenges are particularly vulnerable to this form of grief. Common indicators of anticipatory grief include:

• Sadness
• Anxiety about what the future may bring
• Depression
• Emotional numbness
• Guilt
• Active imagination of what life will be after the loss of that person

Furthermore, this type of grief can also stem from different forms including the impending loss of a friendship, careers, and relationships.

This may also affect an individual’s mental health, relationships, and outlook.

“I still feel guilt, but overall it has helped me to cherish the people I do have in my life. I try to visit my grandmothers as much as possible and share my gratitude with people so that I feel some type of comfort knowing that I showed that I care for and love them,” Megan reflects on how this experience reshaped her life and routines.

Even though she recognizes the importance of talking about grief with her loved ones, she sometimes finds the subject too intense to speak about, leading her to have regrets for invalidating her own feelings. “I have not shared intense feelings with people about grief as I tend to shy away from it. I want to speak about it but I fear that it will overwhelm others,” she shares.

To cope with the challenges of grief, Butt has resorted to avoidance while also keeping old photos of her loved ones in memory boxes, listening to music, and having some of her grandfather’s paintings, which inspire her creativity.

This experience has also encouraged her to explore her relationship with grief, fostering an appreciation for life and a sense of community during times of sorrow, rather than fearing death itself.

Phases of anticipatory grief

According to the University of Rochester Medical Center, anticipatory loss have phases which  includes:

1. Phase 1

This stage allows an individual to recognize that death is unavoidable, particularly in the face of an untreatable diagnosis. Individuals in this stage can often feel helpless and depressed, leading to a withdrawal from reality.

2. Phase 2

Upon receiving devastating news, emotions can escalate dramatically. Some may resort their anger in arguments, while others may express their love and appreciation, and some may fear for the future. The patient may also experience heightened anxiety about their condition and concern for their loved ones.

3. Phase 3

As individuals come to terms with the reality of death, they might ponder about their life after the loss. They may take steps such as discussing final wishes, funeral arrangements, or any conversation aimed at seeking and gaining closure and future plans after the impending loss.

4. Phase 4

In the last stage, left-behind loved ones already envision their daily lives without the person they cherished. Feelings of loneliness can arise as they encounter reminders of the deceased such as their favorite items, foods, places, and events. At this point, individuals may continually worry about the future or they will find ways to adapt to their new reality.

Recognizing these phases of anticipatory grief can help you understand the process of grieving and that it differs for each human. Therefore, offering emotional support and care to the patients and their loved ones can significantly impact their ability to face this reality head-on.

How to cope with anticipatory grief

Individuals have their ways of navigating this emotional experience. This process can be particularly challenging due to overwhelming emotions and feelings of hopelessness.

Hence, Dr. Marilou outlines four strategies for managing anticipatory grief. This includes:

1. Finding the opportunity to spend time with your loved ones

Despite being in one of the hardest times of your life, especially if your loved ones are ill, it should not stop you from creating memories with them.

Even if they cannot participate in physical activities, you can still spend time together by enjoying the fresh air on the balcony or outside, listening to music, playing minimal games, or doing anything memorable.

2. Addressing unfinished businesses

Alongside spending time with your loved ones, it’s crucial to resolve any unresolved issues.

Settle your arguments and engage in conversations about final wishes, financial matters, and other important topics that may affect the future.

This will help clarify any lingering questions and strengthen your relationship more.

3. Help find practical preparation for the future.

Understanding the possible outcomes, treatments, or diseases of someone you love may help you take control in managing your feelings and expectations.

This knowledge enables you to assist your loved ones in facing their future, including the possibility of death.

4. Reconcile

Avoid future regrets by making peace and memories, and communicating with your loved ones.

Listening and allowing yourself to express your emotions will not just mend relationships but also foster a supportive environment during difficult times.

It is okay not to be okay. You do not have to suppress or avoid these feelings, as the situation is out of your control. Acknowledging these emotions is the first step toward processing them.

Dr. Marilou also emphasizes that coping with anticipatory loss does not necessarily lessen the intensity of grief after the actual loss occurs. She noted, “Kapag namatay na talaga ‘yung tao, mas tumataas pa ‘yung intensity niya [grieving].”

It is not too late

Anticipatory grief can be overwhelming but it offers you an opportunity to reconnect and create more memories with your loved ones. 

In anticipatory loss, time is your enemy. That is why, live with no regrets and enjoy every second of your time with them. It may not be enough, but it is something.

While they are still here, express your feelings. Say your ‘I love you’ and ‘Thank you’ sincerely to avoid any regrets.

The question now is not just “Would you stay with me?” but “Can we make the most out of our time while you are still here?”.

With reports from Ashly Mae Nabus