Anticipatory Grief and Overdose Death

Both of my significant losses were sudden.  My mom died of a sudden heart attack in her home.  She was in her forties, and I remember the intensity of the shock and denial when I got that phone call.  My brain worked very hard to protect me from the onslaught of pain that was to come when it finally allowed me to acknowledge her death.  

When I got the call that my 23-year-old brother was dead, I knew before answering the phone.  My heart knew.  My soul knew.  The words barely made it through the phone to confirm the awful news as I slid down the hallway wall outside of my office.  The pain was there again, as it had been with the news of my mom’s death, but something was different.  The intensity of the shock, the utter denial that it could be true, wasn’t the same.  

It would take me a long time to understand why it felt so different.  Even longer to put words to it.  Anticipatory grief.  I had heard of it before, but I had never considered it to be part of my experience.  Every definition and explanation of anticipatory grief I had read would use examples of patients with cancer, patients on hospice, or at the end of a long terminal illness.  Their families would experience parts of the grieving process before the actual death, thus “Anticipatory Grief.”  

As humans, we love to categorize everything.  Loss is talked about in two distinct forms.  Sudden or expected.  I knew I had experienced sudden loss and all that comes with it when my mother died.  She was healthy, vibrant, hilarious, and alive one day.  The next day she was gone.  There was no warning, and there was plenty of disbelief.  My shock and denial were palpable as I repeatedly asked everyone there if they were SURE she had died.  My brain couldn’t grasp it right away.  Her death fits nicely into the bucket of sudden loss.  

When my youngest brother James died, it was also sudden.  We spent that summer camping, having family reunions, and visiting with him after completing a long-term rehab program in late spring.  He talked to us about books and inner peace; he found a great job and seemed happy and clear-headed for the first time in a long time.  Then, one day, he didn’t answer his phone.  The next day I got the call; he had died of an accidental overdose at 23 years old.  It was sudden and unexpected. 

I already knew what sudden loss felt like, and I couldn’t identify why this felt different.  The shock and the denial were not nearly as strong.  I struggled immensely with that.  Did this mean I loved him less?  Did this mean that I never truly believed he could remain sober?  Had I given up on him somewhere in my subconscious?  Those questions hurt.  They complicated my grief in new ways.  I knew they weren’t true, and yet I shamed and criticized myself.  

Years later, I began to realize that his death was both sudden and expected.  It was an experience my body had begun to feel, begun to grieve, many years before his death.  

Addiction is so shrouded in stigma, shame, misunderstandings, and blame that it requires a lot of work to unpack it fully.  To unpack the complexities that come with loving someone who struggles with addiction.  It takes overcoming the societal knee-jerk insensitive reactions to realize that addiction is sometimes a terminal illness.  Of course, it is not always terminal; there is a big beautiful world of recovery that many people find their way to, but it can also be fatal.  

Families of those who struggle with addiction experience grief of many kinds, often for years.  I was only a pre-teen when my older brother first went to rehab.  It was the beginning of a life that I measured in many ways by my brother’s health—rehabs, jails, periods that he was missing, suicide attempts.  I was so young, but I understood very clearly that he could die.  I would imagine it in a million different ways, hoping that I would somehow prevent it by imagining it.  These experiences unknowingly were part of my anticipatory grief, over 20 years before my youngest brother would die of an overdose.  I grieved my older brother in so many ways—the lost years of growing up together with typical sibling shenanigans and disagreements.  The lost holidays we spent apart.  The loss of the future he could have had.  The loss of the family dynamic I wish we had, and later, the loss of him to the criminal justice system and incarceration.  

Years later, when my youngest brother went down a similar road with familiar struggles, I grieved some more.  It mixed with the loss of our mother.  It mixed with anger and frustration, and immense sadness.  

I did not sit at my brother’s bedside as he died of cancer, but my heart knew he might die.  Even when I didn’t want to acknowledge the possibility, it was always there- present and looming. At one point, we had an intervention for him.  It was uncomfortable, and I didn’t say much. I was fighting the lump in my throat, the tears burning my eyelids, and the urge to run.  For all I didn’t say, I am grateful that I did say these words, “I don’t want you to die.” I said them out loud, and we both cried. We both acknowledged the outcome we knew could happen.  

One night, about a year before the call, he was not well.  He came for a visit, and he looked the worst I had ever seen.  I hugged him tightly before he left, believing it would be the last time I saw him alive. The following week was Halloween. I dressed up in a silly Lorax costume complete with a big bushy yellow mustache and then proceeded to get very drunk. I sobbed on a friend’s couch so hard that I could barely breathe.  I could only get out the words, “my brother is going to die.”  These experiences, along with so many more, were part of my anticipatory grief.  

Anticipatory grief does not mean that we expect death and therefore are not as impacted by the actual loss.  In the rollercoaster that is addiction, my brother James had reached a place we had all hoped and dreamed of.  He came out of a treatment program with such a clear, wise, and hopeful outlook on life.  Our guards fell with every interaction.  He was so good.; he was better.  Finally, he was back with us.  I am eternally grateful for this time with him.  

I did not expect him to die.  After all, I had been on the sidelines of my older brother’s addiction for twenty years, worrying about him dying, and it had never happened.  I believed that summer that James was going to go on to live a full and long life.  I believed in him and recovery wholeheartedly.  

After his death, two conflicting truths were troublesome to me. 

I did not expect him to die. 

I had been grieving and expecting him to die in small ways for years.  

Cognitive dissonance is real, and the reconciliation of these equally true and opposing realities is difficult.  

The simple recognition of anticipatory grief and its role in my life, particularly my experience of losing my brother, has been significant.  Writing about it is painful.  The very concept of anticipatory grief is greatly misunderstood.  It is wrongly assumed that there will be less grief after the death occurs where there has been anticipatory grief.  Yet, we cannot quantify our grief any more than we can quantify love.  When I feel the fear of judgment and misunderstanding, I look internally to where I know the truth.  I know my love and my grief more intimately than anyone who will ever read this.  

Categorization is not always helpful.  Loss comes in every shade and variety we can imagine.  Sudden, expected, or on some spectrum in between, grief is grief.  The mixture of the components we are taught to expect (denial, bargaining, depression, anger, and acceptance) is not carefully measured and given to every bereaved person as a common elixir.  They are haphazardly thrown into our glasses in varying amounts for the rest of our lives, and they are uniquely ours.  

The concept of anticipatory grief in mental health and addiction circumstances is one that I am incredibly interested in.  If you have thoughts or experiences regarding this or any aspect of this article, I invite you to share.  As always, please comment respectfully.  For more articles about overdose and addiction, check out When Death has a Stigma.