Grief

Phases of Anticipatory Grief

In a 1983 book called The Anatomy of Bereavement, Beverly Raphael discussed phases of anticipatory grief for both the dying person and those close to the person that parallel actual bereavement. Building on the work of Elisabeth Kübler-Ross, Raphael noted that for both the patient and caregiver(s) the first response to news of a fatal condition is shock, numbness, disbelief, and denial. In time, the news is faced, distressed feelings can no longer be fended off, and a period of fear, anxiety, and helplessness ensues. Bargaining and the anguish raised by the question "Why me?" mark this phase. Hope may fend off some of the anguish, but as the loss is acknowledged, the process of anticipatory grief may become pronounced. Anger, regret, resentment, a sense of failure, a feeling of being cheated, guilt, and depression are common responses. Some reach the calm and acceptance described by Kübler-Ross. The dying person may withdraw as the family/caregivers struggle with the opposing pulls to remain close to the dying person and to relinquish the bond to the person to mitigate the pain of the impending loss.

Both Raphael and Rando contended that anticipatory grief is a process—an experience that takes time to unfold and develop. During the process, the work is to slowly dispel the denial and to develop an awareness of what is happening. In this way, the griever(s) can begin to experience optimum amounts of anticipatory grief to reach a level of benefit.

For a terminal illness, researchers have repeatedly raised the question of whether there is an optimum length of time before the positive effects of anticipatory grief diminish. Rando, in a 1983 study, and C. M. Sanders, in a 1982 study, both found that there was an optimum length of time for anticipatory grief as it affected the survivor's postdeath adjustment: six to eighteen months.

The Impact of Special Situations

In several situations, the benefits and disadvantages of anticipatory grief can be questioned. One such situation is that of children facing the death of a parent. Given the child's developmental level and the profound nature of the loss, the limited ability of children to understand death and its finality, and the reality that the dying parent is unable to attend to the needs of the child, the benefits of anticipatory grieving may be mitigated. In a 1999 study of parentally bereaved children conducted by Amy Saldinger and her colleagues, anticipated death was consistently associated with less adaptive outcomes and poorer mental health outcomes, using a variety of measures. According to Vanderlyn Pine and Carolyn Bauer, for parents who anticipate the loss of a child, "there is no way to know just how much anticipatory grief is too much. It does not appear that there is an optimum amount" (Pine and Bauer 1986, p. 86–87).

For those struggling with the varied losses imposed by Alzheimer's disease, there is a differential benefit to anticipatory grieving, depending on the duration of the illness. In a 1994 article for the Journal of Gerontological Social Work, Rebecca Walker and her colleagues attributed this to a combination of variables: the social stigma related to the disease as an illness of the aged, and the loss of cognitive ability and self-sufficiency; the progressive nature of the disease and the associated incapacitation; the multiple losses that the care-giver has to face; and the eventuality that the care-giver may have to relinquish care of the patient to others. From their 1996 study, Ponder and Pomeroy reported that for those dealing with patients with dementia and Alzheimer's disease, the benefits of anticipatory grief were limited, noting that this group of individuals is at high risk for complicated mourning.