When loss is less definite but lingering in the balance, one can begin to feel like life is a fog and one is living with a ghost. This is very common with family and friends of the terminally ill. The sentence has been passed and the loss is being experienced but it has yet to occur. This type of anticipatory grief can cause confusion and create obstacles in loving the person who is still alive. Instead of appreciating what time is left, one mentally is thinking of the funeral and the tomb. This prevents the few joys that remain and the beautiful conversations that still can be shared. In addition, this can later lead to complications of the loss after it occurs, as one may feel guilt over the final days. Others may feel relief that the state of limbo is over but still feel guilty for feeling relief. Many times Grief Counselors are needed to help individuals through the crisis.
Anticipatory grief happens to many individuals and while it is natural during trying and stressful times, individuals must be alert enough to understand the presence and better able to navigate. Primary caregivers, such as spouses, face caregiver burnout during this time. They are not able to mourn or feel happiness, but instead deal with a magnitude of emotions. Resentment, mental fatigue, grief, and guilt can all occur. After the actual death, many primary caregivers feel a relief. This is especially true of loved ones who no longer could communicate or barely function.
Ambiguous grief can be very similar to Anticipatory in that usually also deals with terminally ill but in most of these cases the loved one is no longer physically or mentally present. So in many ways both griefs can exist. However, there is no true way to find complete closure. This is also the case with loved ones who are lost in war or go missing. The individual is unable to find complete closure.
The article, “When There’s No Hallmark Card for Your Grief”. by Jessica Fein looks closer at ambiguous grief. As the title describes, without closure or a loss event, there are no condolence cards because the death has yet to occur but nonetheless the grieving individual is experiencing and expecting a loss at the same time. This type of confusion causes many conflicting emotions. The article states,
“Coined by therapist Dr. Pauline Boss in the 1970s, ambiguous grief means mourning the loss of someone who hasn’t died but is no longer physically present or mentally present. In the former, your loved one might have gone missing in war, for example. In the latter, your loved one might be suffering from dementia or drug addiction or, as in my daughter’s case, a degenerative disease that slowly took away her ability to communicate. With ambiguous grief, there’s no closure because the grieving remains unresolved.”
“When There’s No Hallmark Card for Your Grief”. Jessica Fein. March 9th, 2023. Psychology Today.
To access the entire article, please click here
Anticipatory as well as Ambiguous grief causes many conflicting emotions as stated. It is a place of limbo. The loss itself is has yet to occur but it has been declared. This can cause early reactions to loss or force individuals into a isolation and numb mode of existence. The individual awaits the impending death sentence. The issue at hand is the loss has yet to occur and time remains to experience love with the terminally ill person.
This can cause multiple emotions. Grief Counselors can help individuals sort out the meaning of many of these emotions.
In regards to relief, many find a relief for a loved one who finally passes. Seeing a loved one become more ill and less capable makes seeing the existence of the loved one more painful. In many cases, individuals hope for the end. As ironic as this is, the fear of the loss has been lessened by the pain and suffering of the loved one. This in turn can cause relief in the actual death. This relief can also be felt by those who have expended excessive energy in care of the loved one. For some the experience of this relief can be an anchor of guilt. Grief Counselors can help individuals see that this relief is natural and acceptable and that one should experience guilt.
In addition to relief, others may feel guilt based upon how they interacted with the loved one while the deceased was still alive. They may regret their isolation or lack of communication due to their ambiguous grief. They may feel like they needed to be there more for the loved one. They may also feel guilt for during those times, seeking to enjoy life itself. These types of guilt are very common with long drawn out terminal illnesses. The person after the death begins to analyze every thing he or she did or do not do. This analyzation can cause distress and complicate the loss itself. It is important to identify this type of guilt in grief counseling and dispel it.
In regards to ambiguous grief, the lack of closure is decided due to the terminal illness not the individual who cares about the person. The person is mentally or physically incapable of discussion or resembling who he or she once was. This leads to a another type of limbo. In addition, ambiguous grief can also affect individuals who lose loved ones to war or those who go missing. There is no closure.
The inability to communicate to a ill loved one or say a coherent goodbye, or never to know where a loved one is who has been displaced or assumed dead at war are painful events that can impede healing and also rise to complications in the grieving process. In relation to those who are missing, there is a torturing decision between abandoning hope and accepting loss. One cannot simply dismiss the emptiness but one is tortured with doubt about what happened? Nightmares can haunt these individuals.
The viciousness of this type of grief prevents healing and closure, it permits a constant torture between hope and despair. The survivor is subjugated to perpetual suffering. Many feel the need to find hope that someone will awaken from a coma, or return home from missing. Others contribute to causes that reflect the nature of their loss. Yet, the splinter of hope that one will return always exists and this in turn leaves the grief wound constantly open.
Some experience guilt in ever experiencing happiness again after a loss of a loved one. Others feel guilty for losing hope and giving into despair. There is a definite feeling of helplessness and this contributes to the prolonged and complications of grief itself.
Both anticipatory grief and ambiguous grief can cause complications and prolonged grief. Ambiguous grief though is far more toxic because in all cases there is no resolution or closure which leaves a permanent emptiness. Individuals can keep hope, if they need it, but ultimately the unknow and ambiguity haunts the survivor. Finding causes or promoting social awareness to issues surrounding the issue may help give purpose but the grief wound cannot heal without concrete closure. With this in mind, emotions such as guilt, helplessness and utter despair can dominate.
Anticipatory grief offers closure but closure can become more difficult due to how one handled the terminal illness prior to the death. Hence emotions of guilt and relief are very common. Anticipatory grief can exist in ambiguity as well as one awaits impending news. Relief of knowing whether one is alive or dead can equally confusing when the bad news does finally arrive.
Grief Counselors can help with the loss but in most cases a licensed counselors are needed to offer deeper form of cognitive grief therapies to help individuals cope from prolonged grief due to the complications found in both of these types of losses.
Please also review AIHCP’s Grief Counseling Certification and see if it matches your academic and professional goals. The program is online and independent study and open to qualified professionals seeking a four year certification in Grief Counseling.
Locked in grief: a qualitative study of grief among family members of missing persons in southern Sri Lanka. Amila Isuru, Padmakumara Bandumithra & S. S. Williams. BMC Psychology volume 9, Article number: 167 (2021). BMC Psychology. Access here
“The Pain of Grieving for a Missing Person”. María Alejandra Castro Arbeláez. December 21st, 2022. Exploring Your Mind. Access here
“Coping With Not Knowing What Happened to a Missing Loved One”. Raj Persaud, M.D. and Peter Bruggen, M.D. June 17th, 2017. Psychology Today. Access here
“What Is Anticipatory Grief?”. Cynthia Vinney. November 10th, 2021. VeryWellMind. Access here
“Anticipatory Grief: Are You Mourning Before a Loss?”. Hillary Lebow. January 7th, 2022. PsychCentral. Access here
“Grieving Before A Death: Understanding Anticipatory Grief”. Litsa Williams. What’s Your Grief. Access here