Although excruciating and all-consuming at times, grief is a natural psychological state common to all humanity; all humans feel grief at some point during their lifetime.
Grief is most commonly thought of in terms of our response to the death of a loved one.
But what does it mean when you’re grieving a loved one who’s still alive?
First of all, you’re not alone in this state. In fact, this phenomenon – known as anticipatory grief – is all too common, especially in the day and age of global pandemics. It’s very common among caregivers of those suffering from memory-related disorders, cancer and other terminal illnesses, frequently triggered at various stages of the end-of-life trajectory of a loved one.
What is anticipatory grief?
Research says anticipatory grief is the result of intense distress called separation distress. And in a caregiver, separation distress is caused by two things: the caregiver’s anticipation of their loved one’s passing and the ongoing losses within the relationship between the caregiver and their loved one. As the loved one continues to decline, memory impairment, mobility deficiencies and overall age-related decline change the relationship between caregiver and loved one, which, unto itself, creates an additional sense of loss, thus compounding their grief over the eventual death of their loved one.
Further, the family caregiver is required to bear this separation distress over a long time period while also tending to the day-to-day needs of their loved one, which quite understandably places undue stress on the caregiver’s ability to regulate their emotions.
How is anticipatory grief different from normal grief?
Anticipatory grief is dynamic, which differentiates it from other types of grief. When a loved one dies, the loss is final, and you can accept that loss and begin to move forward with a sense of closure.
But with anticipatory grief, separation distress is ongoing. It’s also constantly evolving as the loved one’s condition continues to decline. The presence of the loved one triggers this distress and makes it more difficult for a caregiver to process due to the distractions of the heavy day-to-day demands of caregiving.
Anticipatory grief is common among caregivers, and it can feel overwhelming. So, caregivers need to know the self-care strategies to prevent anticipatory grief from consuming their precious remaining time with their loved one.
Things caregivers can do to manage their anticipatory grief
In a recent interview with the Harvard Business Review, David Kessler, the world’s foremost expert on grief, provided coping strategies for anticipatory grief. Kessler has authored several books on grief, including “On Grief and Grieving: Finding the Meaning of Grief through the Five Stages of Loss,” and “Finding Meaning: The Sixth Stage of Grief.” Also the founder of Grief.com, a leading grief recovery resource for people all over the globe, he emphasizes the importance of acknowledging the grief you are feeling. He then offers the strategies below, which can help you manage your grief and maybe even find meaning in it.
Find balance in the things you’re thinking
For many caregivers, it’s easy to catastrophize and endlessly replay your expectations of worst-case scenarios. Rumination such as this is simply the anticipatory grief talking, and Kessler encourages caregivers not to battle with such thoughts, but instead to neutralize them by bringing them toward midline.
“Our mind begins to show us images … We see the worst scenarios,” he said. “That’s our minds being protective. Our goal is not to ignore those images or to try to make them go away—your mind won’t let you do that, and it can be painful to try and force it. The goal is to find balance in the things you’re thinking.”
Experts recommend several solutions to rumination and catastrophic thinking:
- Focus on the specifics: Start small. Ask yourself, “What aspects of my home, my daily routine, and my loved ones continue to bring me joy and comfort?” or “What is the next thing I need to do today?”
- Sleep: Sleep deprivation is fodder for catastrophic rumination. In fact, there is evidence that sleep deprivation makes us more hypersensitive to threats. Try developing a sleep hygiene routine, or a series of actions you take each night before going to bed.
- Your new mantra: My thoughts don’t define me: You are more than your thoughts. Remember this when you become upset about having catastrophic thoughts in the first place. If you start to say things like, “Why do I always think like this? What is wrong with me?”, remember that they’re just thoughts—electric firing of brain synapsis. Acknowledge the thought, remind yourself, “I am not my thoughts,” then let the thought pass. If the thought comes back around, just repeat the process.
- Get physical: Exercise is immensely helpful. In particular, any type of activity that requires you to interact in the here and now with your surroundings will keep you in the present and make it harder to dwell on the past or the future. So go chop vegetables, hammer a nail, go for a run, or pull weeds.
Come into the present
Anxiety is a large component of anticipatory grief. And when anxiety rears its ugly head, it’s easy to feel helpless in its shadow. When you feel yourself overcome by anxiety, come into the present.
Kessler offers a very quick way to do this: “You can name five things in the room. There’s a computer, a chair, a picture of the dog, an old rug, and a coffee mug. It’s that simple. Breathe. Realize that in the present moment, nothing you’ve anticipated has happened. In this moment, you’re okay.”
Let go of what you can’t control
Learning how to let go of what you can’t control is a particularly empowering antidote to grief’s toxic effects. What the doctors do or nurses don’t do is out of your control. Focus instead on what is within your control, and do those things mindfully.
What to do when these strategies don’t help
When asked this question, Kessler’s response was, “Keep trying. There is something powerful about naming this as grief. It helps us feel what’s inside of us.”
Part of the “trying” is purposely feeling what we feel: “Your work is to feel your sadness and fear and anger whether or not someone else is feeling something,” he said. “Fighting it doesn’t help because your body is producing the feeling. If we allow the feelings to happen, they’ll happen in an orderly way, and it empowers us. Then we’re not victims.”
And in doing so, he said this will help you remove the image of a “gang of feelings” from your head. He explained, “Sometimes we try not to feel what we’re feeling because we have this image of a ‘gang of feelings.’ If I feel sad and let that in, it’ll never go away. The gang of bad feelings will overrun me. The truth is a feeling that moves through us. We feel it, and it goes, and then we go to the next feeling.”
So, in moments when the anticipatory grief feels overwhelming, attempt to take control of your response to it.
Pause, and, in the words of Kessler, “Let yourself feel the grief and keep going.”