(Part 1) (Part 3)
By definition, “anticipatory grief’ includes many of the symptoms of that grief which follows actual loss. It is simply the process of normal mourning that begins before the death of a loved one. (It should also be noted that the terminally ill also experience some aspects of anticipatory grief. [1])
In this section we will follow the classic “model” of anticipatory grief developed by those who have long years of experience and study in the field–in particular, but not limited to, Dr. Therese Rando’s Grief, Dying and Death: Clinical Interventions for Caregivers, (Research Press Company, 1984).
A. The Characteristics of Anticipated Grief (or “what the priest should look for and ask about”) are as follows:
1. Depression on the part of family and friends;
2. Heightened concern for the terminally ill person;
3. “Rehearsal of death” (i.e., relatives begin quite naturally to wonder and think about what the approaching death will be like, and may feet unnecessarily guilty about this);
4. Attempts to adjust to the consequences of the death (i.e., thinking about what life will be like after the loved one dies and sometimes feeling guilty about this, too);
B. The Purpose of Anticipated Grief (the psychological reason why family and friends are having these feelings):
1. Anticipatory, grief assists in absorbing the reality of the coming loss;
2. It spurs family and friends to complete any “unfinished business” with the dying (for an Orthodox Christian this means exchanging of forgiveness, etc.);
3. Family and friends begin slowly to change their assumptions about life and their own identity-for death and dying are also times for the living to re-examine their own spiritual life and health, with their priest’s help;
4. Family and friends start to make plans for the future in a way that avoids feelings of betrayal of the one who is dying.
C. The Four Steps of Anticipatory Grief (which are mental/emotional/spiritual “behaviors”):
1. Acknowledgment: relatives of the dying patient become increasingly convinced that death is approaching–in other words, they cease to deny, pretend, or have false hope;
2. Grieving: the family and friends begin to express the emotional turmoil they are experiencing over the impending loss. This cannot happen until denial stops. Individuals also begin to grieve for that part of themselves that will die with their loved one,
3. Reconciliation: the family and friends develop a strong and final sense of value about the life of the person who is dying;
4. Memorialization: a fixed mental image of the dying family member is developed–one that will endure beyond death,
The task of the priest–whether a patient is dying in the hospital or at home–is to encourage the family to maintain open communication amongst themselves and with the patient. Sometimes he might notice that a particular family member is avoiding the dying person. He can then focus on that member and help him to express his feelings.
At the same time, the priest is in a unique position to help a family adapt to role changes brought about by the illness of one of their number. A dying parent, in particular, will no longer be fully able to fulfill the demands of parenthood, but other members of the family can be guided into taking on this responsibility without resentment or anger.
The priest can best accomplish all of this under the grace of Confession. But if that is not possible, he can provide safe times and places to talk with family members and help them to express the emotional turmoil they are experiencing If necessary, this can take place in the home setting, when the priest comes to visit the sick member He can draw aside the spouse or others and talk to them privately? But frankly about what’s going on The pastor should not be surprised to sometimes hear, either confessionally or in private conversation, that a family member is secretly hoping that their loved one would die and “get it over with.” He may even feel angry and resentful with the patient because of the up-and-down, day-to-day, unpredictability of the situation. In these cases , is important for the priest to explain that while this member must strive to trust in God, at the same time these feelings come not from a lack of love, but because his own emotional and spiritual resources are at present depleted.
This is also the context in which a pastor can help a family in planning for the immediate and distant future whether it be practical plans regarding patient care at home (with assistance and support from a hospice program), in a nursing home or hospital, funeral plans, the use of “heroic measures to artificially prolong the process of dying, etc.
By the very fact that the priest visits (and he should do so, even if not invited, by simply saying “I’d like to bring Holy Communion to your sick mother next Sunday afternoon”), the family will know that this is an acknowledgement of the seriousness of the situation. A pastoral visit means that the process of “leave-taking” getting ready for death–is beginning. However painful at the moment, this is helpful to both patient and family, for it sets a significantly different “tone” and signals the end of denial on the part of all.
One of the reasons why it is important for the priest to help family members identify and legitimize their powerful feelings during anticipatory grief is so that they can make good use of the time that remains to them with the dying person. Sometimes a priest will hear an individual say that he is “losing control” or afraid of a “breakdown.” By encouraging him to talk, and by refraining his fears in more positive terms–such as “intense feelings” or “emotional release”–a priest can help a family member to avoid emotional explosions. During the time of dying–which can sometimes be quite lengthy and draining for the whole family–it is only unexpressed emotions that can lead to a “loss of control.”
The priest will continually, lovingly, and with calm assurance, express his firm expectation that, however painful are the feelings and fears being experienced, the family will be able to bear these. And since suffering is pain without meaning, the priest is in an ideal position, spiritually-speaking, to help family members place their feelings in a meaningful spiritual context.
With both patient and family members, the priest will encourage them to experience the joys and innocent pleasures that are still available to them, even while one of them is dying and the rest are struggling under incredibly stressful conditions.
Fr. Alexey Young
[1] Many of the symptoms of anticipatory grief occur–but less intensely before losses other than death of a loved one e.g., before a surgical amputation, retirement from a life-long career, divorce, a move to another city, parish, home, etc. The priest can be sensitive to this and assist his spiritual children, where possible, in identifying these feelings.