Grief

Anticipatory grief in relation to AIDS is another area that shows differential benefit for the griever. Several variables, similar to those related to Alzheimer's disease and dementia, are operative for those with HIV/AIDS. The duration of the illness and the stigmatization that accompanies it are prominent factors. The course of HIV/AIDS often extends beyond the eighteen months designated as a beneficial length of time for anticipatory grief for the caregiver. In addition the multiple losses and the alternating periods of relative good health and battles with opportunistic diseases potentially abort the process of anticipatory grief. As a further complicating factor in the anticipatory grief trajectory is the relationship between the caregiver and the patient, a relationship that may not be sanctioned by society (i.e., homosexual relationships). In his 1989 book, Kenneth J. Doka used the term "disenfranchised loss" to describe a loss that is not recognized or validated by others. For those caring for the AIDS patient, completing some of the tasks of anticipatory grieving may be compromised by the lack of an official, socially sanctioned connection to the dying patient.

For practitioners working with patients and caregivers, the challenge is to combine the various elements of anticipatory grief. Practitioners must recognize that anticipatory grieving does not necessarily involve a pulling away from the patient; that there are multiple losses that span a period of time; that the process of anticipatory grieving goes through stages; and that it is a time of working on and working through the "unfinished business" for both patient and caregiver. Practitioners must be attuned to the tendency for premature detachment and diminishing communication between patient and caregiver and encourage discussion of fear, loss, and anger. Ideally, according to Walker and her colleagues, a practitioner "can help the caregiver both hold on to hope while letting go of the patient, thereby completing the very complicated work of anticipatory grief" (Walker et al. 1996, p. 55).

CHILD'S DEATH

The death of a child, regardless of age, is one of the worst possible losses adults can experience. Grief over a child's death is particularly severe compared to the loss of a spouse, parent, or sibling. The parent-child bond is uniquely strong and enduring. Children are extensions of parents; they hold parents' dreams, aspirations, and hopes for the future and promise the continuity of parents' life after their death. They define parents' sense of self and give meaning and a sense of purpose to their lives. When a child dies, parents feel mortally wounded; it is as though part of them is torn away by force. The family also loses its wholeness. A child's death is perceived as untimely at any age because parents are "supposed to" die before children. Moreover, miscarriage, stillbirth, and death in childhood and adolescence are often sudden and unexpected and in some cases violent, which traumatizes survivors.