Anticipatory grief: grieving before a loss

Anticipatory grief is grief you feel before a loss has happened, most often while someone you love is living with a terminal or life-limiting illness such as cancer or dementia. It can bring sadness, anxiety, anger, guilt and exhaustion, much like grief after a death. Many people do not realise that what they are feeling is grief. It is a natural response, and support is available for you as well as for the person who is ill.

Key points

• Marie Curie describes anticipatory grief as common among people whose loved one is nearing the end of life.
• Its feelings can mirror grief after a death, including shock, numbness, anger and guilt.
• Not everyone experiences it, and it does not mean you have given up hope.
• Grieving beforehand does not necessarily make grief afterwards easier or harder; everyone’s experience is different.
• Support for you matters too, from hospices, charities, your GP or a counsellor.

What is anticipatory grief?

Anticipatory grief, sometimes called pre-death grief, is the grief that begins before someone dies. Cruse Bereavement Support describes it as a feeling of loss before a death, which you might experience if a friend or relative has dementia, cancer or another illness that you know will lead to their death.

It is not only about the death itself. You may already be grieving many smaller losses along the way: the person they used to be, the conversations you used to have, your shared plans, the roles you each played in the family, and the future you imagined together. With dementia in particular, Cruse notes that people often mourn the person they knew long before the death.

Marie Curie’s bereavement counsellors note that many people do not realise they are grieving, because their loved one has not yet died. Naming it can bring some relief, as it helps make sense of feelings that might otherwise seem confusing.

What does anticipatory grief feel like?

There is no right way to feel. Marie Curie and Cruse describe a wide range of reactions, including:

• Sadness that comes in waves, sometimes triggered by something small and unexpected.
• Anxiety and fear about the death, about what will happen, and about coping afterwards.
• Anger, at the illness, at the situation, or even at the person for leaving.
• Guilt, for example about not doing enough, or about imagining life after they have gone.
• Numbness or denial, as though it is not really happening.
• Loneliness, especially as friends may not recognise that you are already grieving.
• Exhaustion, often alongside caring responsibilities.
• Physical effects such as poor sleep, an upset stomach or difficulty concentrating.

Marie Curie notes that grief often deepens as a loved one’s health declines. Cruse adds that some days can feel very hard, while others bring little grief at all. Both are normal.

Is it wrong to grieve someone who is still alive?

No. Some people resist grieving because it feels like giving up hope or being disloyal. Cruse notes that it is common, and normal, to imagine life after your loved one’s death, even though that can bring guilt. Wanting their suffering to end and dreading losing them can sit side by side.

Hospice UK makes a related point about the time after a death: when someone has suffered or had a drawn-out illness, their death can bring a sense of relief, and it is important not to feel guilty about this. Relief and love are not opposites.

Does grieving early make the loss easier later?

Not necessarily. Everyone’s grief is different. Cruse notes that for some people the grief beforehand can feel even more intense than the grief afterwards. Others find that the death still brings a fresh wave of loss, however prepared they felt. Marie Curie suggests that the ways of coping you find beforehand can help you after the death too.

Our page on grief and bereavement looks at grief after a loss, and our guide to grief at Christmas may help with the harder times of year.

How can I cope with anticipatory grief?

Drawing on guidance from Cruse and Marie Curie, some things that may help:

1. Recognise it as grief. Telling yourself “this is grief” can make your feelings less frightening.
2. Talk to someone you trust. Cruse suggests giving yourself time and space to express your feelings.
3. Write things down. A journal can hold thoughts you are not ready to say out loud.
4. Find people who understand. Online forums or support groups can ease the isolation.
5. Learn about the illness, if it helps. Cruse notes that understanding what to expect can help some people feel more in control.
6. Look after your body. Rest, food and gentle exercise matter, even when they feel like the last priority.
7. Be realistic and accept help. Ask friends and family for practical support. If you are a carer, the NHS explains that you can ask your council for a carer’s assessment and about respite care.
8. Make room for what matters. Cruse notes that this time can also bring chances to say goodbye, share memories or resolve old issues, if that feels right for you.

Where can I find support?

Marie Curie points out that some people feel it is selfish to seek support for themselves while someone else is ill. It is not. Support can give you the strength to keep going.

• Hospices. Hospice UK explains that hospice care can include emotional support, is free for patients, their carers and family, and can be offered at any stage of an illness, not only at the very end. You can find local hospice services through Hospice UK’s website.
• The free Marie Curie Support Line on 0800 090 2309.
• Cruse Bereavement Support helpline on 0808 808 1677.
• Your GP, who can help with referrals to local support and talk with you about your own health.
• NHS Talking Therapies. In England, you can refer yourself if you are 18 or over (16 or over in some areas). The NHS suggests seeing a GP if low mood lasts more than two weeks.

How can counselling help?

Counselling gives you a confidential space to say the things that may feel impossible to say to the person who is ill or to the rest of the family: the fear, the anger, the guilt, the exhaustion, and sometimes the wish for their suffering to end. Marie Curie notes that having somewhere to speak these thoughts can itself bring relief.

In my integrative approach, drawing on person-centred, psychodynamic and CBT-informed ideas, we can make room for your feelings, look at what this loss stirs up from your own history, and think about how to look after yourself through it. Sessions can be in person in Farringdon or online, which some people find easier to fit around caring, and in English or Turkish.

If you are in crisis, call 999, go to A&E, call NHS 111, or contact Samaritans on 116 123 (free, 24/7).

If you are grieving someone who is still here and would like a space that is just for you, you are welcome to get in touch to arrange an initial consultation. We can go gently, at whatever pace feels right.