Grief before Goodbye: Understanding Anticipatory Grief

June 2nd 2026
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WellBeing Magazine
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Trigger warning: This story contains themes readers may find upsetting.

The phone call comes at 2am. Your 82-year-old father has had a fall and is in hospital with a broken hip. As you drive through empty streets, something shifts inside you — a recognition that this might be the beginning of the end. In that moment, grief arrives not after loss, but alongside the growing awareness that loss is coming.

This is anticipatory grief, and it affects millions of people caring for ageing parents, partners with life-limiting diagnoses or loved ones living with dementia. Despite being universal, it remains poorly understood, leaving people feeling isolated and unprepared for the emotional complexity of loving someone while simultaneously preparing to lose them.

What is anticipatory grief?

Anticipatory grief is what happens when we start grieving before a loss has occurred. It’s the sorrow, the fear of what’s coming, the worry about life without them — and it often begins much earlier than we realise. It can start suddenly, in the moment that we receive a life-changing diagnosis. That phone call from the doctor, the scan results, the words “I’m sorry, but …” These moments mark the beginning of anticipatory grief, because suddenly everything has changed. Sometimes, however, it starts more quietly. Maybe it’s when you notice your loved one asking the same question three times or getting confused about which day it is. Perhaps it’s the phone call from your sister, “Mum’s had a fall, she’s fine, no broken bones but now she’s hesitant on the stairs and mentions feeling a bit ‘wobbly’.” It’s that heavy feeling when you watch your once-vibrant parent struggle with dementia, or the tears when you realise your terminally ill partner will never see your children graduate.

Clinical psychologist Dr Emily Musgrove explains that people experiencing anticipatory grief are “grieving the anticipated loss of this person in real time”. This process carries awareness that this is just the beginning of ongoing loss. You’re not just grieving who they were or are now, but bracing for who they will become as illness progresses.

“Grief and love are two sides of the same coin,” explains Musgrove. “Where we love, we will grieve and where we grieve, we have loved.”

Neuroscientist Dr Mary Frances O’Connor, author of The Grieving Brain, explains the difference between grief — the intense emotional waves we feel — and grieving, which is how those feelings evolve. In anticipatory grief, both happen simultaneously: powerful emotions alongside the gradual process of adjusting to losses while the person is still alive.

Recent Australian research reveals families often begin grieving as soon as their relative enters aged care, with grief intensifying over time. The decision unleashes complex emotions: fear about their loved one’s wellbeing, guilt about not managing at home, anger at the unfairness of ageing, sadness for lost routines and sometimes unexpected relief. The grief feels particularly confusing … how can something so necessary hurt so much?

How grief lives in the body

Grief activates the same brain regions as physical pain, the anterior cingulate cortex and right ventral prefrontal cortex. This overlap explains why we describe grief physically: a “broken heart”, feeling “crushed”, or experiencing “aching” loss. The brain processes emotional pain through the same pathways as physical injury, which is why anticipatory grief genuinely hurts.

The brain acts as a prediction machine, constantly anticipating familiar patterns. When someone we love declines, the brain still expects them there: predicting their voice on the phone, their presence at dinner. When these predictions fail repeatedly, the brain experiences threat, triggering stress responses: chest tightness, fatigue, digestive issues and that hollow stomach feeling.

This explains why denial and avoidance prolong pain. When we push grief away, the brain continues sending distress signals. Like covering an infected wound and expecting it to heal, suppressing grief intensifies its physical impact. We know that the body keeps the score. Unprocessed grief often emerges through chronic headaches, sleep disturbances, weakened immunity or persistent anxiety.

Why it can feel harder than expected

Anticipatory grief presents unique challenges. You must navigate between hope and acceptance, often feeling guilty for grieving someone still alive.

“This can feel very confusing for people,” says Musgrove. “This person is still alive and yet I’m feeling all these things.” The confusion intensifies because anticipatory grief mimics post-death grief — despair, emptiness, heartache, anger — but without finality.

Unlike traditional grief, anticipatory grief lacks established rituals or social recognition. It’s like being forced to sell the family home where your children grew up. Everyone understands it’s necessary, but there’s no ceremony for grieving what you’re losing, no equivalent of a housewarming party for this kind of ending. Society provides frameworks for mourning after death, such as funerals and bereavement leave, but offers little acknowledgment for the long goodbye of watching dementia progress or caring for terminally ill partners. You’re expected to focus on practicalities while privately mourning the life that’s slipping away.

The “sandwich generation”, predominantly women aged 40–60, faces particular challenges. They’re simultaneously managing children’s needs, career demands and increasing care responsibilities, all while beginning to grieve losses that haven’t fully occurred. Each decline triggers anticipatory grief: when Mum can’t drive safely, when Dad forgets familiar faces, when parents need help with personal care.

“When the brain is trying to reimagine this new map — okay, so now Mum is not able to walk or now Mum is in a home — it is constantly reupdating,” explains Musgrove. “That reupdating elicits a stress response, and in prolonged anticipatory grief, we’re constantly exposed to chronic stress activation.”

How to care for yourself during anticipatory loss

Understanding anticipatory grief as normal and necessary, rather than something to overcome, is key. Here are some ways to help you through.

Acknowledge dual feelings: You can simultaneously hold hope for remaining time while grieving what’s lost. These aren’t contradictory emotions. They’re part of anticipatory grief’s landscape.

Practise the dual-process model: Healthy grieving involves moving between loss-oriented activities (allowing sadness, yearning, pain) and restoration-oriented activities (adapting to new circumstances, finding meaning). Both are necessary.

Create small rituals: Write letters to be shared later, take photographs and have tender conversations while the person can still engage.

Validate physical impact: Anticipatory grief causes genuine symptoms including exhaustion, brain fog, sleep disturbances. These aren’t weaknesses but normal stress responses. Adequate rest, nutrition and gentle movement become crucial.

Set boundaries: The urge to spend every moment with a declining loved one is understandable but unsustainable. Regular breaks aren’t selfish. They’re necessary for long-term health.

Name the experience: Simply acknowledging “I’m experiencing anticipatory grief” provides relief and validation.

Supporting others who are grieving before goodbye

Well-meaning supporters often struggle with appropriate responses. Offering hope (“they might get better”) or minimising the situation (“at least they’re still here”) typically isn’t helpful. Instead:

• Follow their lead: Let them express feelings without trying to fix their emotional state.

• Avoid time-based expectations: Comments like “you should be over this” show a fundamental misunderstanding. Don’t make this mistake.

• Offer specific support: Rather than “let me know if you need anything”, suggest concrete help.

• Acknowledge complexity: Phrases like “this must be really hard” validate without attempting to solve.

• Remember their other roles: They’re still parents, employees, community members etc.

• Be patient with mood changes: Emotional volatility is normal, not concerning. Anticipatory grief is what happens when we start grieving before a loss has occurred.

When to seek extra support

While anticipatory grief is normal, certain indicators suggest professional support can help.

Persistent inability to function: This is when grief consistently interferes with eating, sleeping or working for extended periods. Research shows grief affects emotional, mental and physical health long-term.

Complicated family dynamics: Families with trauma, addiction or estrangement histories may find anticipatory grief particularly challenging.

Caregiver burnout: Emotional distress combined with practical responsibilities can overwhelm. Support groups, counselling and respite care provide essential relief.

Previous unresolved losses: Those with complicated grief histories may find anticipatory grief triggering. Understanding that 20 per cent of people cannot “move on” after loved ones’ deaths emphasises the importance of seeking support when needed.

The permission to grieve while loving

Perhaps the most important message: mourning while someone is still alive isn’t betrayal. It’s a profound expression of love.

Understanding anticipatory grief as normal provides permission to feel the full spectrum of emotions when facing impending loss — sadness and gratitude, fear and love, exhaustion and deep appreciation for remaining time.

“There is nothing about you that is broken,” emphasises Musgrove. “This pain tells us you’re alive and human. This grief says you’ve cared deeply and loved this person so much.”

Acknowledging anticipatory grief opens possibilities for authentic conversations about ageing, caregiving, illness and mortality. These difficult conversations can deepen relationships and create space for meaning-making that might otherwise be lost.

For those walking this path, anticipatory grief isn’t giving up hope or failing to stay positive. It’s evidence of being human, caring deeply and having the courage to love fully while knowing loss is inevitable.