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Anticipatory Grief

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Grief and its effects is considered in this paper with the purpose of better understanding how it affects a person. Grief is a natural reaction to loss and change which affects all aspects of a person’s life: the physical, emotional, psychological, behavioral, and spiritual. Grief is not expected but will be experienced in a variety of ways such as experienced, sudden, gradual or anticipated. While most people will experience loss at one time in their lives, not everyone responds in the same way or goes through the same process to recover and heal.

Grief and its Effects
Life does not come with a manual on how to cope with grief. Is it possible to escape grief? Unfortunately, grief is one of those inevitable experiences that the majority of people will not escape. Knowledge of the inevitability does not make it easier to accept. Grief is a universal experience and it as unique as each individual that has ever lived. Grief does not discriminate on age, race, or ethnicity. Coping with life becomes more challenging when grief strikes. Although no one wants to experience grief, when it arrives there is hope in healing.

There are various things that can cause grief. Some of the reasons for grief are loss of a loved one, a new life direction due to a move, a divorce, a career change or even the loss of a dream (Grief, 2011). Coping and healing from grief can be one of the most difficult things a person will deal with in their life and there are resources to aid those who experience it’s effects. First of all, there is hope in healing when grief is expressed . Helpguide.org put it this way, “Grief that is expressed and experienced has the potential for healing which can eventually strengthen and enrich life (“Grief,” n.d., para. 1).

A holistic look on how grief can affect a persons’s life can give the best picture when describing the process of grief. In her paper, titled On grief and loss, Pomeroy (2011) defines grief as, “ a multidimensional experience that results from a significant loss of person or object (Pomeroy, 2011).” She noted that grief “ can involve the emotional, cognitive, physical, social, behavioral, and spiritual components of a person’s life (Pomeroy, 2011).” The way we grieve will be as unique as we are and influenced by our culture gender and circumstances of our loss each of us grieves in our own way, (Grief, 2011). The Physical effects of Grief

Some people see grief strictly as an emotional process, however; it often involves physical problems of, “ nausea, lowered immunity, weight loss or weight gain, aches and pains, and insomnia (Smith, M., & Segal, J., 2012).” A person who is experiencing grief can have physical problems which range from troublesome to serious. According to the Harvard Medical School Family Health Guide website (Dealing with grief and bereavement, n.d), Grief can cause loss of appetite, insomnia, chest pain, headache, fatigue and cause muscle tension (Dealing with grief and bereavement, n.d, para. 3). A tremendous amount of energy may be used in the grieving process which can lead to fatigue which is common but not serious, unless it becomes chronic. Fatigue is usually self-limiting and will improve over time (Sandra, 2009). Others physical issues that can arise due to grief include, anxiety, panic, and fear (Sandra, 2009).

Another physical risk to the grieving person is that of experiencing a heart attack because there is a greater risk for this occur during the first week of going through a loss (“Grief increases heart attack risk,” 2012). Grief can also cause physiological stress which can increase the chances of developing a blot clot and raise blood pressure (“Grief increases heart attack risk,” 2012). One of the best ways to avoid many of these physical problems is to take good care of your self by taking time to exercise, sleep well, and eat a balanced diet (Creagan, 2012).

Grief can also have subtler effects on health which over time will be apparent due to illness (“Dealing with grief and bereavement”, n.d para. 3). The gradual effects of grief may be manifested in various ways, such as higher levels of stress. Added stress then leads to a higher level of cortisol, which will compromise the immune system if it lingers for an extended amount of time (“Dealing with grief and bereavement”, n.d, para. 3). Untreated persistent stress can also lead to high blood pressure, cholesterol and abnormal heart rhythms (“Dealing with grief and bereavement”, n.d para 3). The Emotional effects of Grief

Some of the emotions that may be experienced due to grief include shock, helplessness and numbness (Sandra, 2009). Sometimes the most obvious signs of grief are seen by the expressions and emotions a person demonstrates while they grieve. Trauma may be experience due to the death of a loved one in a violent or unexpected way (Pomeroy, 2011). Shock may occur as an initial responses to the death of a loved one since it is the body’s protection from the onset of grief (“LIFE:When a loved one dies: coping with grief”, n.d.).

According to Kübler-Ross (as cited in Feldman, 2011), there are five steps taken toward death (Feldman, 2011, p. 609). These steps are denial, anger, bargaining, depression, and acceptance (Feldman, 2011, p.615). Denial is a defense mechanism that gives the person time to adjust their thinking in-order to cope (Feldman, 2011, p. 610). Anger is a normal method of diverting pain and usually indicates an emotional release needed to adjust to your loss (“LIFE:When a loved one dies: coping with grief”, n.d.). As cited by Feldman (2011), Bargaining can be effective in that some people make goals to delay death and actually achieve them according to Phillips & Smith (1990, Phillips, 1992) (Feldman, 2011, p.611).

Once a person accepts that death is inevitable and that bargaining will not change their circumstances, they move on to depression (Feldman, 2011, p.611). There are two possibilities of depression that people may experience, reactive and preparatory (Feldman, 2011, p.611). Reactive depression is experienced due to a realization that life will not be the same and grief is felt for what was (Feldman, 2011, p.611). Preparatory depression is felt due to the realization that they will have future losses (Feldman, 2011, p.611). This is the second to the last phase in Kobres five step theory.

The final step in Kubler-Ross’s theory is acceptance. Acceptance is achieved when the person is at peace with the fact that death is imminent and inevitable (Feldman, 2011, p.611). At this stage the person no longer has desire or cares to continue to live, they are just waiting for death. The Psychological effects of Grief

Losses can lead to discord in relationships, substance abuse, and trauma which in turn can lead to chronic mental and physical health problems. (Pomeroy, 2011). (Keesee, Currier, & Neimeyer, 2008). (Keesee et al., 2008). The feeling of going crazy is a common feeling for people dealing with loss (Noel,2001). During normal grief, the bereaved person moves toward accepting the loss and is able to continue normal day-to-day life even though it is hard to do (“Grief, Bereavement, and Coping With Loss”, 2011). Common grief reactions include, emotional numbness, shock, disbelief, or denial. Anxiety over being separated from the loved one. A person expressing grief may experience feelings of “distress, crying, illusions and hallucinations of the deceased may be experienced during grief (“Bereavement”, 2012).” Normal grief reactions may consist of, “periods of sadness, loss of sleep, loss of appetite, extreme tiredness, guilt, and loss of interest in life (“Grief, Bereavement, and Coping With Loss”, 2011). “ The Behavioral effects of Grief

Bereavement may be the one, nearly universal, stressor for human beings and evidence is clear that, for a substantial minority, the associated grief may become nearly a life sentence (Neimeyer et al., 2010). Making the decision to accept that the pain you’re feeling is part of dealing with grief and moving toward a state of healing helps the process of grieving (Creagan, 2012). Not allowing grief to be expressed may lead to dire consequences and becoming stuck in the grieving process. Reactions to the loss of loved ones can lead to depression, anxiety, sadness a lack of interest to re-engage in the world or in forming new relationships (as cited by Neimeyer et al., 2010). Purpose for life can be altered due to terminal illness which can cause the loss of independence and a change in the capacity to continue to work (Hottensen, 2010). Spiritual effects of Grief

Coping with grief can have a religious component for the grieving person. While the dying process may be seen as a medical event, some also see the spiritual aspects which can be a great source of comfort to both the dying person and his loved ones (Singh, 2012). Belief in God provides us with the opportunity of relinquishing our grief to God in hope of relief. The bible has a lot to say about grief , such as, “The LORD is close to the brokenhearted; he rescues those who are crushed in spirit.” Psalm 34:18 (NLT). In order to be comforted by the bible a person must believe in what it says.

The nature of God, as seen by a person, determined how religious beliefs comforted the grieving person, according to Pargament et al., (as cited by Cowchock, Lasker, Toedter, Skumanich, & Koenig, 2010). Not everyone believes in God or an after life and this affects how someone grieves. According to Cowchock, et al., (2010) “Religious coping has been divided into negative and positive forms of coping (Cowchock, et al., 2010).” One reason that this is important is that it demonstrates that believing in God can make an impact on how someone grieves. Research found that women who used negative religious coping were at higher risk of chronic or pathological grief (Cowchock, et al., 2010). (Rynearson, 2010). Christian view of death

For a Christian death is more welcoming because their is hope of reuniting with loved ones who have already experienced death. One of the most encouraging passages on why Christian’s should not fear death is found in Psalm 23:4 “Even though I walk through the valley of the shadow of death, I will fear no evil, for you are with me; your rod and your staff, they comfort me (NIV).” Christians hold on to the promise of being in the presence of God upon death as found in 2 Corinthians 5:8, “Yes, we are fully confident, and we would rather be away from these earthly bodies, for then we will be at home with the Lord (NLT).”

The death of a Christian is precious to God (Fairchild, n.d.). Psalm 116:15 tells us, “Precious in the sight of the LORD is the death of his saints (NIV). “ The bible tells us the death will eventually come to an end as found in the book of Revelation 21:1-4, Then I saw a new heaven and a new earth, for the first heaven and the first earth had passed away … I saw the Holy City, the new Jerusalem, coming down out of heaven from God … And I heard a loud voice from the throne saying, “Now the dwelling of God is with men, and he will live with them. They will be his people, and God himself will be with them and be their God. He will wipe every tear from their eyes. There will be no more death or mourning or crying or pain, for the old order of things has passed away (NIV).” Finally, in the book of Luke 23:43, Jesus tells the prisoner who is nearer death nest to him, “Truly I tell you, today you will be with me in paradise (NIV). Types of Grief, Sudden, Gradual or Anticipated

Sudden Grief. Sudden, accidental, unexpected, or traumatic loss shatters changes our world at a moments notice. The finality of loss can cause a vulnerability that was not there prior to the sudden loss (Sandra, 2009). For example, the death of an unborn child or death of an infant due to sudden death syndrome, or Sids is a form of sudden grief (Feldman, 2011). Death due to SIDS can also cause undeserved suspicion for the grieving parents (Feldman, 2011). Initial acceptance is greater for those who are grieving the unexpected, sudden, and untimely death of a loved one (as cited by Riches, & Dawson, 1998).

Another way in which grief is sudden is due to murder. The grief process is complicated when it is accompanied by the criminal courts system due to a murder (Riches, & Dawson, 1998). According to Keesee, Currier & Neimeyer (2008) there is an increased risk of poor bereavement adaptation for parents who have lost a child by a violent death (Keesee, Currier & Neimeyer, 2008).

Sudden grief may appear as a complete absence of grief or an inability to express normal reactions. Major depression may be developed due to grief the is expressed abnormally (“Life When A Loved One Dies: Coping With Grief”, n.d., para 1).

Gradual Grief. This type of grief can come when a diagnosis is given for a life changing disease such as Alzheimer’s, cancer and AIDS. In an interview given by Guthrie (2004), Robertson McQuilkin reflected on his wife’s long battle with Alzheimer’s and his process of gradually grieving her death. To McQuilkin, “grieving someone with Alzheimer’s is so gradual, so incremental that there wasn’t time to think about [grieving her loss] (Guthrie,2004).” Advancements in medicine have made is possible for people to live longer. “Despite decades of research, cancer fatalities in the past thirty years have increased 22 percent,” writes Kiernan, a newspaper reporter. “We used to die primarily of heart attacks, strokes, and accidents. Now we die mostly of cancer, Alzheimer’s, and aids (Moll, 2007)”

Anticipated Grief. According to Cincotta (as cited in Hottensen, 2010), anticipatory grief is described as a “range of intensified emotional responses that may include separation anxiety, existential aloneness, denial, sadness, disappointment, anger, resentment, guilt, exhaustion, and desperation (Hottensen, 2012). Loved ones often experience anticipatory grief when learning of a diagnosis of advanced or terminal cancer of their loved one. Devastating diagnoses affect the patient and their families in a profound way in which the spouse may be overwhelmed with a sense of hopelessness, loss of control and be unable to cope (Milstein, 2008). Also, too much grief can be one of the drawbacks for the person who is dying which can lead to withdrawal and detachment (Hottensen, 2010).

Another issue that can come up, in an attempt to prepare for death, is isolation which can increase the grief in the patient and his support system (Hottensen, 2010). Edward Myers (as cited by Hodson, 2005) in his book “When Parents Die,” compares the burden of anticipatory grief as a slow decline to an advancing glacier (Hodson, 2005). This kind of grief can be overwhelming especially since it lingers with uncertainty. The waiting period can be used to mend bridges, possible restitution, and make the most of the time that is left in this life (Hottensen, 2010). Having time to say good-bye, getting financial data in order, updating or creating a will, letting the family know what is desired for a memorial service or medical end of life options for care, as well as any other issue which may be pertinent (Gable, n. d.).

Completing Grief
Grief will forever change the life of those who suffer the death of a loved one. Everyone will grieve differently but the one thing we have in common is the need to connect with others. Belief in God can bring hope for an afterlife and comfort in the word of God. For Christian’s reading bible verses about suffering can be comforting. One such passage is found in Lamentations 3:22-26; 31-32, “For the Lord does not abandon anyone forever. Though he brings grief, he also shows compassion according to the greatness of his unfailing love (NLT).” Another effective way to overcome grief is by receiving social support. A support system may already be in place but if that is not enough, professional help should be sought. Conclusion

Grief According to Dr. Dowling, “Most of us have done very little to prepare ourselves emotionally and psychologically and spiritually for our own deaths (Singh, 2012).” Being prepared can take some of the burden from out loved one’s and give them a clear understanding of what we expect when our time comes to die. There is hope for those who are going through grief that life will get better. According to Tomita, & Kitamura (2002) the ability to engage in new interests, pleasurable activates, and healthy relationships will eventually return to the grieving individual after experiencing a period of significant emotional distress due to the loss of a loved one (Tomita & Kitamura, 2002). Research has found that recovery from grief is possible as stated by Shear (2008) who found studies which demonstrate that most people recover from acute grief by focusing on positive memories and thinking more positively. (Shear, 2008). Further research needs to made to better understand the process of grieving along with which treatments offer the best results. Criticism of Dr. Elisabeth Kubler-Ross’s grieving process of predictable stages is proof of how more needs to be done in the area of grief and death. Her theory has limitations on the concept of dying but she opened the door to transforming the way death is approached in this country (Feldman, 2011, p. 611).


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