Grief is the emotional reaction to loss, which arises when it occurs; but when the loss is already anticipated, we experience anticipated grief, a type of grief that we go through before the loss actually occurs (days, months, or even years before). It is especially common in patients and relatives with degenerative and/or terminal diseases.
Through this emotional reaction, the person is “preparing” psychologically for an outcome, although the truth is that we do not know how the loss will affect us until it really happens, if it ends up happening.
We are talking about a finite duel, which can last a long time but which always takes place before the loss; when this happens, then we enter the “normal” mourning phase. A peculiarity of this type of mourning is that, unlike normal mourning, anticipated mourning tends to intensify as time goes by and, in addition, denial tends to appear more easily (first phase of mourning).
Anticipated grief can coexist with interspersed phases of hope, in which people connect with this emotion, with this state of faith and belief that things can go well, and that ultimately the loss may not come because the person or the loved one recovers. What else do we know about the anticipated duel? In this article we tell you the characteristics and phases of the duel before the loss.
Early mourning: what is it?
- As we have seen, grief is the emotional reaction to any significant loss in our lives, be it the loss of a loved one or a pet, or other situations such as experiencing a breakup, moving, or even a job change.
- We are talking about a healing and recovery process towards emotional acceptance of the new reality, and above all, in cases of death or breakup, adaptation to the new reality without that person. This emotional process manifests itself immediately after any loss.
- However, sometimes the mourning begins before the loss; It is then when we talk about early mourning, also known as pre-mourning or anticipatory mourning. But what exactly are we talking about?
- We are talking about the grieving process that begins before the loss of the loved person or object takes place, a loss that, it is known, will come sooner rather than later. Although it is a duel that is little known, there are various studies that reflect on this process at a theoretical and philosophical level.
Characteristics of anticipated mourning
Early grief begins before the loss in question (it can be days, months, or even years before). This type of grief shares signs with regular grief (which arises after the loss), and for this reason the person who goes through it can go through the same 5 stages that the Swiss-American psychiatrist and writer Elisabeth Kübler already described at the time. -Ross.
Let’s remember, these phases can occur in a cyclical (it does not have to be linear) and disorderly way, and the person does not have to go through all of them (in addition, they can go “forward and backward” through each of these phases); we talk about:
- The denial or shock phase
- the anger phase
- The phase of sadness
- The negotiation phase
- The acceptance phase
The stages and symptoms of anticipated grief
However, although these phases can also occur in anticipated mourning, some authors have spoken of even more specific phases in this type of mourning. In relation to this, Umair Majid and Adedoja Akande, in a 2021 article published in The Family Journal, propose the following 4 phases, which happen at different times:
Time of diagnosis
The possibility of losing a loved one (or of being us who suffer from a serious illness, for example) is discovered. At these moments denial, anger, bewilderment, frustration, sadness may appear …
Transition to hospital care
The home routine is lost, in case of admission, and a totally new and unknown reality is faced, which generates a lot of stress. It may happen, over time, that a sense of familiarity develops in the hospital, although the opposite may also happen, and the exhaustion may increase.
Near death
The death of the loved one, or of oneself, is approaching, which generates mixed feelings: fear, sadness, relief (when one is suffering a lot…). In these cases, faith can help believers. The person continues to “prepare” for this loss or for leaving.
Time of death
Finally, if death comes and therefore loss occurs, emotions from previous phases such as fear of the future, fear of loneliness, sadness, anger or despair usually reappear here. Acceptance comes at the end of the grieving process, just like normal grieving.
Of course, it is important to know that, as in usual mourning, the person in an anticipated duel will go through each of these phases in a unique way, and that we have talked about very general symptoms, not applicable to everyone.
When does the anticipated duel arise?
According to current research and due to its particular characteristics, anticipated mourning occurs more often in some situations and contexts than in others, such as:
In relatives and patients with terminal illnesses
- According to research such as that of Christina Yeni Kustanti and collaborators, anticipated grief arises in 25% of people exposed to life-threatening contexts.
- This type of context includes medical situations such as: severe trauma or injury, organ transplants, surgical interventions with a wide range of complications, patients undergoing dialysis, premature births, limb amputations, or various chronic diseases. Mourning can be developed by the person who is about to die, or by their close relatives.
- On the other hand, this type of mourning can also develop in “less serious” situations, such as the warning of a dismissal, an upcoming move or instability in a relationship.
In caregivers, family members and cancer patients
In caregivers and cancer patients, a specific situation derived from the previous example, anticipated grief is also common, as suggested by other studies. This duel is more common in episodes of advanced or terminal cancer, although people who experience less aggressive cancer can also experience it, of course. During this duel, what the person with the disease fears is not only losing their physical abilities, but also their identity, their independence and their roles in life.
In caregivers and relatives of patients with dementia
- In caregivers or relatives of patients with dementia (Alzheimer’s, Parkinson’s…) this type of mourning is also common, as reflected in some research. And it is that the progressive deterioration of the cognitive and physical capacities of the person imply a progressive acceptance of the new reality that is arriving, and the emotional manifestations that this process entails begin long before the total deterioration of the person.
- It is important, however, to differentiate anticipated mourning from other processes or conditions such as caregiver syndrome. Finally, note that the greater the closeness or interaction with the patient, as well as the intensity of the bond with him, the greater the symptoms associated with the anticipated loss.
- Remember, if you are going through a duel, whether it is an anticipated duel or pre-duel, or a normal duel, and you feel that you need help, ask for it! You’re not alone.