Anticipatory grief: a theoretical challenge.

The theories of loss and grief described by Freud and Bowlby have provided considerable interest in anticipatory grief. Anticipatory grief is assumed to be akin to post-death grief, but commencing prior to the loss of the loved one. 'Grief work' completed during the anticipatory period is purported to mitigate against abnormal grief reactions after death and enhance adjustment to loss. Research conducted to investigate the link between anticipatory grief and postbereavement adjustment has not, however, yielded conclusive findings. It is argued that the intellectual vision of researchers has been obscured by the traditional view of grief leading to conceptual confusion in the theoretical literature and equivocal findings of the empirical investigations. The limited view of the 'death event' as the only loss incurred fails to consider the past, present and future losses that may occur as a result of terminal disease. The physiological, psychological, interpersonal and sociocultural factors evident in the terminal situation serve to highlight the existence of many previously unconsidered variables which may determine the anticipatory grief experience. Until the influence of these determining variables is acknowledged and researchers learn to look beyond the parameters of the traditional models of grief, the costs and/or benefits of the anticipatory period will remain largely undefined. A good starting point may be the adoption of the alternative label, 'terminal response'.