When we think about grief, we almost always associate it with loss, whether it’s the death of a loved one, a separation, or even the end of an important life stage that forces us to bury a role we had integrated as part of our personality. We talk about the pain that comes when we have lost someone or something significant, but there is another type of suffering that often goes unnoticed and yet can be much more complex: anticipatory grief.
What exactly is anticipatory grief?
In the mid-1910s, Freud noted that when people recognize or understand that something they love or find beautiful will perish, they anticipate the loss and withdraw. This laid the foundation for understanding the phenomenon of anticipatory grief.
Later, in the early 1940s, psychiatrist Erich Lindemann began observing the emotional reactions of soldiers’ families during the war. Faced with the threat of death or separation from a loved one, people reacted with suffering and anguish, even before the loss had occurred. In 1944, he first referred to this phenomenon as “anticipatory grief.”
Decades later, we now understand anticipatory grief as the emotional response to an expected or inevitable loss. It doesn’t simply involve feeling sadness, but is usually a complex mix of emotions: fear, anger, guilt, anxiety, helplessness…
It occurs when a family member receives a terminal diagnosis, for example, or when we witness a neurodegenerative disease gradually erasing the person we knew. It also appears when we sense that a relationship, whether romantic or platonic, is coming to an end, or when an inevitable change forces us to say goodbye prematurely to something or someone we loved.
In such cases, the mind jumps to the future and begins to grieve for what is to come, which often generates a strange feeling, as if we were living in two times at once: the present, where the person is still, and the future, where we imagine their absence.
The pain of losing little by little
The heart doesn’t always wait for the farewell to begin to grieve. Sometimes grief begins the moment we receive the news. Other times it arrives in slow motion, when we see someone gradually changing. Or when we understand that the time we shared will no longer be infinite.
In fact, one of the hardest aspects of anticipatory grief is that the loss doesn’t usually happen all at once. In diseases like Alzheimer’s, for example, many families experience a paradoxical feeling because the person is still physically present, but certain aspects of their identity gradually disappear.
It’s a kind of gradual farewell. Each loss, whether a forgotten memory, a conversation that can no longer be held, or a fading ability, forces a readjustment of the relationship, a process that is often emotionally exhausting.
According to Lindemann, anticipatory grief gives us the possibility of beginning the farewell before the loss, which, in principle, would help us to deal better with that situation and resume our usual pace of life more quickly.
However, reality often differs significantly from theory, and knowing that a loss will occur doesn’t always make it easier. Sometimes the opposite is true: prolonged uncertainty can be especially draining.
And the understandable sadness of the loss is often compounded by the fact that the person experiences an invisible grief because those around them don’t always acknowledge it. They have to hear phrases like “He’s still here” or “Don’t dwell on it,” which tend to increase feelings of loneliness and being misunderstood.
Those experiencing anticipatory grief find themselves in a difficult position because they can’t fully say goodbye, but neither can they continue living as if nothing is happening. This emotional ambiguity, fluctuating between hope and acceptance, is also exhausting. We want to believe in a miracle, but at the same time, we are aware that we must prepare for the inevitable.
How does anticipatory grief manifest itself? Its symptoms and phases
Although each person experiences anticipatory grief in a unique way, clinical practice suggests that this process tends to follow certain relatively common emotional patterns. Identifying these experiences will help us better understand what we are feeling and, above all, remember that it is part of the normal human response to a loss that has already begun, even if it has not yet fully occurred.
1. The impact: “This can’t be happening”
The first stage usually begins with acknowledging the evidence; that is, we realize that there is irreversible deterioration. We may receive news that disrupts the continuity of life as we knew it, or simply realize that separation is now inevitable.
Several feelings predominate in this phase:
- Disbelief
- Partial denial
- Compulsive search for information
- Hope that we are wrong
- Feeling of unreality
In many cases, a denial mechanism is activated that protects us and allows us to gradually assimilate a reality that is too painful.
2. Awareness of the losses: “It’s not the same anymore”
Little by little, we begin to realize that the loss isn’t future, but rather, in a way, has already begun. Essentially, we don’t lose the person or the role all at once, but piece by piece. And each of these changes will entail a small grief within the larger grief. We realize that “Nothing is the same anymore, nor will it ever be again.”
3. Emotional ambivalence: loving and becoming exhausted at the same time
This is perhaps one of the most complex and least understood phases of anticipatory grief because we can feel sadness and, at the same time, be exhausted by the impact of the situation.
At this stage we can feel:
- Guilt for feeling exhausted
- Irritability
- Anger at the situation
- Conflicting desires
- Feeling of losing one’s own identity
In the case of terminal illnesses, for example, we may want the person to remain by our side but, at the same time, we don’t want them to continue suffering. These conflicting emotions are a normal reaction to an extraordinarily demanding situation from an emotional standpoint.
4. Ambiguous grief: it’s here, but not quite
Psychologist Pauline Boss coined the term “ambiguous loss” to refer to a person who is physically present but seems psychologically or relationally absent. This ambiguity creates a great difficulty because we cannot say a complete goodbye, but at the same time, it is impossible to maintain the previous relationship.
5. The reorganization of life and roles
Over time, many people begin to adapt to a new reality. This means that we gradually accept the loss and reorganize our roles accordingly. For example, a child takes on a parental role, a partner becomes a caregiver, and family responsibilities are redistributed. Many people begin to live a completely different life in which their identity also changes as they assume these new roles.
6. Preparation and meaning
Unlike grief after the fact, anticipatory grief offers something that can be very painful, but also valuable: time. That time can be used to
- Resolve pending issues
- Express affection
- Having difficult conversations
- Create memories
- Prepare yourself emotionally
Obviously, that doesn’t eliminate the suffering, but for some people it helps them find closure.
7. Imperfect acceptance
Acceptance in anticipatory grief isn’t really the final stage, but rather something that comes and goes. One day we might feel more serene, as if we’ve fully accepted it, and the next day we might collapse.
Therefore, the best way to understand anticipatory grief is not as a ladder that is climbed step by step, but as a spiral: sometimes we move forward and sometimes we move backward.
In general, anticipatory grief is usually marked by symptoms that come and go:
- Persistent sadness or depression before the loss occurs
- Anxiety about the future and fear of what is to come
- Feeling powerless because you can’t change the situation
- Guilt for continuing to enjoy everyday moments
- Irritability or emotional exhaustion
- A need to seize every moment and, at the same time, a feeling that it is never enough
- Recurring thoughts about what life will be like after the loss
How to cope with anticipatory grief?
There is no magic formula for getting through these situations, but it is important that you develop psychological tools that help you deal with those feelings in the best way possible.
- Allow yourself to feel conflicting emotions. To love and to be tired. To have hope and to feel fear. To wish for more time and to want the suffering to end. Complex emotions are normal at this stage and do not make you a bad person.
- Talk about it. A study conducted at Indiana University found that sharing grief with family, friends, or professionals can reduce feelings of isolation and help us cope with loss. Suffering often becomes more bearable when we stop carrying it in silence.
- Live in the present whenever possible. The mind tends to wander to the future and anticipate painful scenarios. Creating small, meaningful moments in the here and now can be an important source of comfort later on.
- Take care of yourself without feeling guilty. Caregivers often forget their own needs. However, resting, asking for help, or setting aside time for yourself isn’t selfish; it’s a way of taking care of yourself so you can continue caring for others.
- Accept that you can’t control everything. One of the most difficult tasks of anticipatory grief is learning to live with uncertainty. We can’t prevent some losses, nor do we know exactly when they will occur. The only thing we can do is decide how we want to navigate that path.
Anticipatory grief reminds us of a profoundly human truth: sometimes we begin to miss someone before we’ve even lost them. And while that pain can be disconcerting, it also speaks to the bond we shared, because where there is love, the shadow of grief often lurks as well, even before the final farewell.
References:
Thulstrup, B. et. Al. (2025) Anticipatory grief – A neglected phenomenon among relatives of patients with incurable cancer: A qualitative study. European Journal of Oncology Nursing; 74: 102730.
Rogalla, K. B. (2020) Anticipatory Grief, Proactive Coping, Social Support, and Growth: Exploring Positive Experiences of Preparing for Loss. Omega (Westport); 81(1): 107-129.
Lindemann E. (1944) Symptomatology and management of acute grief. Am J Psychiatry; 151(6 Suppl): 155-160.
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