Is grief different following a sudden death as opposed to an expected death?

Although all loss is painful, people tend to react differently to sudden death than they do to an expected death. Both losses engender grief and all of the emotions that grievers tend to feel — sadness, helplessness, anger, guilt, regret, to name just a few. But an anticipated death typically does not come as a complete surprise. When a person has been ill for a long time, loved ones have had time to prepare themselves and to begin to process the loss. They have had time to absorb the idea that their loved one is going to die. 

Sudden death, on the other hand, always comes as a shock. The loss is overwhelming and traumatic, and loved ones typically have a much harder time processing the fact that the person has died. Their grief is not necessarily more intense than the grief of people who expected the death of their loved one, but their ability to cope with the loss is greatly reduced because they are totally unprepared. 

Grief Following an Expected Death 

About 70 percent of Americans who die each year die from a chronic illness, such as heart disease, cancer, chronic respiratory disease, diabetes, kidney disease and Alzheimer’s disease. In many but not all of these deaths, the person who died was ill for some time. And while that doesn’t always mean that their death was “expected” at the time it occurred, it generally means that their loved ones had some time to prepare. 

At the same time, families of loved ones who die after a long illness often experience many losses along the way, which can lead to a type of grief known as anticipatory grief.

For example, they may grieve for the loss of their loved one’s companionship; the loss of the future they planned together; or the loss of the sense that their own future was certain and secure. In many ways, this anticipatory grief feels just like grief after someone dies. The griever may feel intense sadness, depression, anger, guilt, and regret. 

Another factor that often affects the loved ones of someone who is dying from a chronic illness is caregiver stress. Today for the first time in almost a century, more Americans are choosing to die at home rather than in a hospital. And while hospice[link to hospice care] provides some support in the home, much of the burden of physical care falls on family caregivers,(link to definition) who are typically ill-equipped to meet the needs of someone who is very ill. The physical and emotional demands of this caregiving can seriously impact caregivers’ physical and emotional health. And caregiving for those with dementia may prove to be even more stressful. 

Grief Following a Sudden Death

Although everyone’s response to loss is unique, research shows that the shock of an unexpected death of a previously healthy (or believed to be healthy) person is often so intense that it overwhelms the griever’s ability to cope. Although moving forward is possible, the process follows a different trajectory than grief after an expected death. Many people experience a prolonged period of shock and disbelief. Even though they know the person has died, they may be unable to accept the fact that they are truly gone.They may also experience other intensely distressing feelings, including:

• Guilt because they were unable to prevent the death or weren’t there when it happened 
• Regret over things said or not said before the person died 
• Anger at the person who died for “leaving” 
• Helplessness because they can’t change the situation or bring back the person who died
• Sadness 
• Despair

Additionally, a small percentage of people will experience symptoms of post-traumatic stress disorder [ link to Q5, What is PTSD?]following the sudden death of a loved one, especially that of a child or a spouse, according to a study published in the journal Depression and Anxiety in 2017 These symptoms may be similar to a “normal” grief response but are typically more intense and marked by some emotional reactions generally not seen in people who are mourning a death. 

Grieving a Suicide

When a person takes their own life, those left behind face a number of distressing emotions that are not typically associated with other manners of death. In addition to the terrible pain of suddenly losing someone they love, they often experience feelings of guilt for not being able to anticipate the death and self-blame for not intervening to prevent it. There is also a well-documented social stigma attached to those who survive after a loved one’s suicide. According to a study published in PLoS One in 2016, this stigma leaves suicide survivors more at risk for social withdrawal, low self-esteem, depression, suicidal thoughts, and prolonged grief disorder or complicated grief.

Sources

“National Vital Statistics Reports – Deaths: Leading Causes for 2017”. NVSS. https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_06-508.pdf 

“Posttraumatic stress disorder associated with unexpected death of a loved one: Cross-national findings from the World Mental Health Surveys”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC5661943/ 

“The Stigma of Suicide Survivorship and Related Consequences—A Systematic Review”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC5033475/