What is preparatory grief?

Preparatory grief is the type of grief that people who are dying go through. They feel this grief as they go through the physical and emotional changes that are part of the dying process.

What happens during this process?

When people know they're going to die soon, they usually go through one or more of the five phases of the preparatory grief process. The phases may not occur in any certain order. People can skip phases or even be in more than one phase at a time.

• Shock: During this phase, people are often in a state of shock. Their feelings go back and forth between agony and disbelief. They often feel that they are in a state of misery that isolates them from the world. Dealing with the bad news takes up most of their physical and emotional energy. They have very little energy or interest in day-to-day activities.

  Sympathy from loved ones is very healing. Talking to a doctor to learn more about the dying process can help.

• Chaos: People often try to live their lives as they did before. They don't accept the limitations or the time constraints set by the disease. As the disease progresses, people slowly and painfully learn to accept the changes enforced by the disease. This process of constant change may cause uncertainty and anxiety.

  Setting realistic goals that they can accomplish can be helpful during this phase.

• Introspection: As the disease progresses, people become weaker. Simple day-to-day tasks become harder to do. This can cause huge frustration. They look at their situation and try to understand what happened or what went wrong. They often ask “Why did this happen to me?” or “What did I do to deserve this illness?”

  During this phase, people balance the past with the future. People ask themselves, “How can I make the most of the time I have left?”

• Re-adaptation: During this phase, people slowly start to re-adapt to their situation. They may even start focusing on the future. They may spend time looking at their entire life in this new context. They may think about things they want to accomplish before they die.

  It can help to understand that most pain and discomfort can be controlled. Patients should talk to their doctor about their fears.

• Restitution: Sadness may become less intense as the people start to slowly accept and understand the dying process. Waves of grief and sorrow and even spells of denial or disbelief may be felt from time to time. Most people who are dying accept their fate. They may find new meaning in their life. With expert care and good support, the dying process is often very peaceful.

  Access to hospice or comfort care and a social support network are helpful.

What are the signs of depression in terminally ill people?

Feeling very sad and crying often is a very normal part of the dying process. However, feeling down or depressed most of the time is not normal. Thinking a lot about death or suicide and feeling guilty or worthless are often signs of depression. Depression is common in people who are dying and should be treated. Treating depression can greatly decrease suffering. People who think they might be depressed should contact their doctor.