We Need To Talk About Survivor's Guilt

The condition is incredibly common, yet under-discussed.
Those who lived through horrific tragedies may deal with mental health effects long after the event. One the potential issues is survivor's guilt.
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Those who lived through horrific tragedies may deal with mental health effects long after the event. One the potential issues is survivor's guilt.

Trauma stemming from a horrific event like a mass shooting can linger long after the incident. Particularly when deaths occur, it’s common for people to struggle and wonder why they survived while others did not. This debilitating issue, known as survivor’s guilt, is a real mental health problem that deserves sensitivity and treatment.

“Survivor’s guilt is when a person believes they have done something wrong by surviving a traumatic event when others did not. As a result, they often feel self-guilt,” said Dara Bushman, a licensed clinical psychologist who treated students and others in the aftermath of the deadly 2018 mass shooting at a high school in Parkland, Florida.

Survivor’s guilt is common in the face of extreme trauma and it absolutely can be treated. If you or someone you know needs help dealing with this, first and foremost reach out to a mental health professional or call the National Suicide Prevention Lifeline at 1-800-273-8255 or text 741741 to reach the Crisis Text Line.

Additionally, HuffPost chatted with experts and survivors on what we all need to know about the mental health condition and how to manage it (or help others manage it):

Survivor’s guilt doesn’t just occur after a mass shooting

Bushman said that in addition to mass shootings, the condition may occur after rapes, murders terrorism, combat duty or natural disasters. It can also be experienced after loved one has died by suicide.

Praveen Kambam, a clinical assistant professor in psychiatry and biobehavioral sciences at the University of California, Los Angeles, and co-founder of Broadcast Thought, said the condition can also occur in cancer survivors who “survive a diagnosis but others don’t.”

It can also happen to those living with addiction when someone dies from an overdose. It can even occur when someone receives an organ transplant and questions, “Did I deserve it?”

Victor Schwartz, a clinical associate professor of psychiatry at New York University’s School of Medicine and chief medical officer at The Jed Foundation, said survivor’s guilt is an idea that emerged in the psychological treatment of Holocaust survivors.

“It was noticed that many people who lost numerous friends and family members were plagued by the question of why had they survived when so many others [did not],” he said. He added that the condition can “potentially add to risk for self-destructive behaviors and suicide.”

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Survivor’s guilt alone may not result in a larger risk of suicide, but if it’s associated with other mental health conditions like post-traumatic stress disorder, major depressive disorder or substance abuse, then the risk is higher, Kambam said. He noted, however, that “the vast majority of people are able to bounce back with their current supports or with the right supports.”

Survivor’s guilt can manifest in a multitude of ways. Kambam typically sees the condition fall into one of the following categories:

Guilt over not dying: This, according to Kambam, includes thoughts such as, “I don’t deserve to be alive” and, “That should have been me.” These types of thoughts can burden a person with a tremendous amount of guilt and also keep people from talking about what they’ve gone through, he said. “It’s like, ‘I have guilt over not dying, this other person died, so why should I complain about feeling sad?’ So it can potentially become a problem for treatment,” he said.

Erin Fuller Brian, 31, who survived the October 2017 mass shooting in Las Vegas, said she experienced these types of thoughts in the aftermath of the incident.

“I felt the first symptoms of survivor’s guilt within moments of learning the facts about what happened, after the chaos was over and we were safe,” she said. “I was still completely in shock and called my parents back home and all I could say repeatedly in between sobs was, ‘Why did we get so lucky and they didn’t? It’s so unfair.’”

Guilt over actions that were taken: Survivor’s guilt can also stem from how a person behaved during a tragedy. Thoughts like, “Maybe I rushed to get out of an active shooting situation, I kind of pushed past some others” are common, Kambam said.

Guilt over what wasn’t done: This is essentially when a survivor feels like they didn’t do enough in the moment, Kambam said. This form of survivor’s guilt may happen when a person tries to take on responsibility for the incident as a means of gaining some control over the situation, “which can be very overwhelming,” he said.

Jaime-Lee Fraser, who survived a bombing attack in Bali in 2002 in which more than 200 people died, said she found herself questioning whether she ignored red flags before the tragedy.

“The survivor’s guilt began when I started to connect the pieces after the event. I started thinking about [if] there were signs I perhaps ignored,” Fraser, 39, said. “Everything was so vivid in our minds that we tried to comprehend questions like, ‘What did we miss?’ and, ‘Should have we known better?’ ... I kept recreating the scenarios and possibilities like a movie in my head as if I could change it.”

The condition is incredibly common, yet under-discussed

Survivor’s guilt is not an unusual reaction among those who have experienced a traumatic event.

“Many survivors experience some aspect of survivor’s guilt or find themselves struggling with these questions. However, there is a range of severity of these reactions,” said Amy Nitza, director of the Institute for Disaster Mental Health at the State University of New York in New Paltz.

Some people, for instance, may experience a few intrusive thoughts early on after the event that subside over time. “For others, it may become a debilitating set of beliefs … that are related to depression and [Post-Traumatic Stress Disorder],” she added.

Jeffrey A. Lieberman, chair of the department of psychiatry at Columbia University, said young people are particularly susceptible to the after-effects of trauma. “These are adolescents who are already dealing with a lot because they are going through a massive change. Psychologically they are moving from adolescence to adulthood, which particularly in this day and age is quite a complex and challenging process,” he said.

“So they were already in a state of some degree of instability and flux when this massive traumatic event was superimposed upon them, which makes them even more vulnerable to the adverse consequences and the potential for survivor’s guilt or any other form that this might take,” he said.

There are telltale symptoms

According to Bushman, the main symptoms of survivor’s guilt are similar to other trauma conditions. This can include flashbacks, irritability, change in eating patterns, difficulty sleeping, feeling helpless, lack of interest in activities previously enjoyed, feeling unmotivated, stomach aches, headaches, fatigue, changes in friends and social interactions, nightmares, feeling numb or disconnected, continuously talking about the trauma and loss of memory.

There are ways to manage and treat survivor’s guilt

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The majority of people can get through survivor’s guilt with the right support, Kambam stressed. He offered the following tips for navigating it:

Accept what you’re feeling: Sometimes people feel as though they don’t have a right to be upset because the outcome could have been worse. But your right to having such feelings isn’t taken away just because you survived, Kambam said. Know that it’s OK to be grateful for the outcome. Your gratitude can coexist with grief and it doesn’t diminish anything, he added.

Know that you are not alone: Many people have these types of thoughts and feelings in the aftermath of a horrific event. You aren’t isolated in your experience and you don’t have to do it alone.

Be patient: Dealing with trauma and grief is something that takes time, and the process isn’t always linear.

“For me, survivor’s guilt was immediate and it has been constant, even after a year-and-a-half,” Fuller Brian said. “It is what I have struggled the most with since (the Las Vegas shooting). I don’t know that it is something that will ever subside, I have just had to learn how to turn it into something productive so that the pain isn’t so crippling.”

Try to keep some form of normalcy: Kambam recommended keeping up your routines as best as possible. This can include exercising, cooking or even just doing the laundry. You should also try to stay connected to others.

Seek help from a support group or therapist: Find a local grief group to engage with, connect with other survivors or engage with an online support form. There are also trauma specialists and therapists who are trained to help manage this specific issue. If you’re insured, your insurance company should be able to provide a list of professionals who are in-network. If you need another route, this list details affordable therapy options.

Realize the incident was not your fault: Sometimes people get trapped into feeling responsible for a traumatic event or thinking they could have controlled the situation, Kambam said. But it’s important to tell yourself that the situation was not your fault and was out of your control.

And finally, don’t be afraid to speak up: Nitza said that anyone experiencing survivor’s guilt or any other post-traumatic stress symptoms should recognize it’s not weak to ask for help.

“If not treated, the symptoms can become highly distressing and can also impair functioning. But they are absolutely treatable,” she said.

If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.

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