Anticipatory grief

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Have you ever felt both love and hate for someone you care deeply about?

If so, you are not alone.

This complex emotional experience is common but rarely discussed or fully understood. So, what does it have to do with grief?

Just like other emotions, grief can involve conflicting feelings. In fact, we may experience grief even while our loved ones are still alive—a phenomenon called anticipatory grief. This type of grief often occurs when someone is facing changes in a loved one’s health, life circumstances, or freedom.

What is anticipatory grief?

Anticipatory grief refers to the grief experienced in advance of an expected loss, whether due to illness, disability, aging, imprisonment, or significant life changes (Rando, 1986). It is common among caregivers of people with chronic or terminal illnesses—research suggests up to 70% experience anticipatory grief—but it can also arise in other contexts, such as:

• Loss of freedom: When a loved one is imprisoned or otherwise restricted, family members may grieve the loss of shared time and the person’s autonomy.
• Life changes or environmental shifts: Relocation, job loss, or the death of a pet can trigger anticipatory grief, especially if it alters daily routines or family dynamics.
• Disability or mental health conditions: Caregivers of people with disabilities or chronic mental health issues often grieve the life they expected for their loved one, even as they continue to care for them.

When a loved one experiences a major life change, we mourn the loss of the life we expected for them. Alongside this grief, we may face difficult behaviours or personality changes that result from circumstances beyond their control, such as illness, trauma, or environmental stressors.

The emotional impact

It is natural to emotionally distance ourselves when a loved one’s behaviour or circumstances change dramatically. Mourning this detachment is as real as mourning someone who has died. You may still love your child in prison, or a partner struggling with mental illness, but feel grief for the person they have become. They are alive, yet a part of the life you expected to share is gone.

Just as love and hate can coexist, so can grief while a person is still alive. We grieve the loss of what we expected them to be. Unfortunately, society often does not recognize this type of grief. Research shows caregivers and family members experiencing anticipatory grief often feel isolated, misunderstood, or guilty for their emotions, which can exacerbate stress, depression, and even physical health problems (Schulz & Hebert, 2008; Stroebe et al., 2007).

Anticipatory grief can affect mental and physical health, causing anxiety, sadness, sleep disturbances, and tension (Kübler-Ross & Kessler, 2005). It is important to remember that the loved one’s behaviour is a symptom, not the cause, of this grief. Even when we acknowledge conflicting feelings, there may never be a time when complete peace is possible.

Managing anticipatory grief

Evidence suggests that psychological interventions—such as cognitive-behavioural therapy, supportive counselling, and mindfulness-based interventions—can reduce distress and improve coping for people experiencing anticipatory grief (Hudson et al., 2010).

Practical strategies include:

• Focus on the present: Take each day as it comes rather than worrying about the future.
• Set achievable goals: One small task a day—finishing a chore, enjoying a self-care activity, meeting a friend—can provide structure and moments of satisfaction.
• Seek social support: Family, friends, or support groups can buffer the emotional strain of grief.

Accepting that anticipatory grief may not fully resolve is also important. Some losses—like the changes in a loved one’s personality due to illness, imprisonment, or disability—may be ongoing. A trained therapist can provide strategies, support, and validation in a safe environment.

Conclusion

Anticipatory grief is real, valid, and often as intense as grief after death. While it may not always resolve completely, with understanding, coping strategies, and support, individuals can navigate these emotions, maintain relationships, and find moments of meaning and peace in their lives.

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References

• Rando, T. A. (1986). Loss and anticipatory grief. Lexington Books.
• Nagy, M., et al. (2018). “Anticipatory grief in caregivers of chronically ill patients: A systematic review.” Palliative Medicine, 32(1), 27–37.
• Schulz, R., & Hebert, R. S. (2008). “Family caregiving in palliative care.” Clinical Geriatrics, 16(2), 21–31.
• Kübler-Ross, E., & Kessler, D. (2005). On Grief and Grieving. Scribner.
• Hudson, P., et al. (2010). “Interventions for anticipatory grief in family caregivers.” Cochrane Database of Systematic Reviews, 12.
• Stroebe, M., Schut, H., & Stroebe, W. (2007). “Health outcomes of bereavement.” The Lancet, 370(9603), 1960–1973.

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