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Survivor’s Guilt: The Burden of Emotional Survival

Survivor's guilt: a cuffed hand waving with one of the cuff's shattering.

Survivor’s guilt is a complex psychological phenomenon experienced by individuals who have survived a traumatic event, such as a disaster, accident, war, or illness when others involved in the same event did not. It often emerges when individuals feel undeserving or overwhelmed by the guilt of being alive while others perish or suffer. Survivor’s guilt is not a diagnosable mental health condition alone, but it can significantly impact an individual’s mental well-being and necessitate professional intervention and support.

Survivors’ guilt affects more people than we admit. With over one million Americans dying from Covid-19 related complications, many feel raked with vague but real anguish and confusion about having lived when others died.

At Integrative Healthcare Center, we believe you deserve to be happy. We aim to help you or a loved one overcome mental health difficulties. This article highlights this often-felt but rarely-discussed state of mind. We will explore the nature of survivor’s guilt, its types, its effects on mental health, and the importance of mental health treatment in addressing this complex emotional struggle.

Understanding Survivor’s Guilt

Survivors’ guilt is deeply rooted in empathy, compassion, and the need to belong and connect with others. Individuals experiencing survivor’s guilt might ask themselves, “Why did I survive when others did not?” or “What could I have done differently to save them?” Feelings of shame, self-blame, and a sense of injustice often accompany these thoughts. It can manifest in various forms with unique triggers and characteristics.

Research studies have investigated the psychological factors associated with survivor’s guilt, particularly in traumatic events like combat experiences, natural disasters, or medical crises. There are many disparate theories to explain this peculiar psychological phenomenon.

Experts have linked survivors’ guilt to ideas of fairness, an evolutionary strategy to ensure group cohesion or symptoms like post-traumatic stress disorder (PTSD). It can be specific, where the survivor believes they directly affected someone’s death, or existential, where the very act of surviving produces guilt.

How Survivor’s Guilt Works

The cognitive model of survivor’s guilt helps us understand how this peculiar condition develops. By understanding these cognitive processes, mental health professionals can develop targeted interventions, such as cognitive-behavioral therapy, to help individuals cope with survivor’s guilt and facilitate healing.

1. Pre-existing Beliefs

Pre-existing beliefs refer to the individual’s cognitive framework and internalized values that shape how they view the world and themselves. These beliefs may include responsibility, deservingness, self-worth, and fairness. For instance, individuals with a strong sense of responsibility for others may believe they should protect or care for those around them.

2. Traumatic Event

The traumatic event is the critical trigger for survivor’s guilt. It involves exposure to a distressing and potentially life-threatening situation where others did not survive. With the proliferation of worldwide communication technology and video, many don’t need to experience a traumatic event to feel its shock personally.

3. Nature of Traumatic Event

The nature of the traumatic event plays a role in how the survivor’s guilt unfolds. Things like survival odds or morality rate affect whether it will develop. Trauma induced by events with high casualty chances and small survival chances is the worst, as they bring forth feelings of profound inequality. Circumstances where the survivor perceives they were in the same situation as the individual that died, such as ICU patients suffering from the same condition, are also highly triggering.

4. Appraisal of Unjust Equity

Following the traumatic event, the individual engages in cognitive appraisals, which involve interpreting and making sense of the situation. In the context of survivor’s guilt, the survivor appraises the outcome of the traumatic event as unjust and inequitable. They may feel that it is unfair for them to have survived while others did not, and their pre-existing beliefs and attitudes toward life are damaged.

5. Shame/Guilt

The appraisal of unjust equity leads to the experience of shame and guilt. Shame arises from a belief that one is inherently flawed or inadequate, while guilt stems from feeling responsible for causing harm or failing to prevent damage. In survivor’s guilt, the survivor may experience shame and guilt, feeling inadequate for being alive and blaming themselves for the event’s outcomes.

6. Attempts to Repair the Balance

To alleviate the guilt and shame, the survivor may attempt to repair the perceived balance or injustice. These attempts may include engaging in self-punishing behaviors, self-sacrifice, or seeking ways to help others to make up for their survival. For example, earthquake and wildfire survivors are more likely to open their homes to people without housing.

7. Secondary Appraisals

Secondary appraisals refer to ongoing evaluations and interpretations of the survivor’s guilt experience. These appraisals involve continuously assessing the emotional and psychological consequences and believing guilt is a punishment or a way to remember the deaths. These appraisals make treatment difficult.

8. Rumination

Rumination refers to persistent and repetitive thinking about the traumatic event, the outcomes, and the survivor’s role in a quest for meaning. Individuals with survivor’s guilt may meditate on questions like “Why did I survive?” or “What could I have done differently?” Rumination can intensify feelings of guilt and shame, prolonging the emotional distress associated with survivor’s guilt.

Impact on Mental Health

Survivor’s guilt can significantly impact mental health, leading to various emotional and psychological struggles. Some of the common effects include:

1. Depression: Feelings of sadness, hopelessness, and a loss of interest in previously enjoyable activities can emerge.

2. Anxiety: Survivors may experience heightened anxiety, worrying about the future, their safety, and the well-being of loved ones.

3. Post-Traumatic Stress Disorder (PTSD): In severe cases, survivor’s guilt can contribute to developing PTSD, especially if the traumatic event was particularly distressing.

4. Social Withdrawal: The guilt and shame experienced may lead individuals to isolate themselves from others, hindering their ability to seek support.

5. Physical Symptoms: Survivor’s guilt can manifest in physical symptoms, such as headaches, stomachaches, or other stress-related ailments.

6. Suicidal Ideation: In extreme cases, survivor’s guilt can lead to suicidal thoughts or behaviors as individuals struggle to cope with the overwhelming emotional burden.

Treatment of Survivor’s Guilt

Just as survivor’s guilt can manifest in many ways, treatment for the condition can also be varied. Cognitive-Behavioral Therapy (CBT) is a practical approach for addressing survivor’s guilt by targeting the cognitive distortions, negative thought patterns, and maladaptive behaviors contributing to the distressing emotions associated with survivor’s guilt. CBT focuses on helping individuals identify and challenge their unhelpful beliefs, develop coping strategies, and promote healthier emotional processing.

CBT encourages individuals to practice gratitude for their survival and to cultivate self-compassion. Survivors are guided to acknowledge their guilt and recognize that it is normal to experience these emotions in the aftermath of a traumatic event.

Integrative Healthcare Center and Mental Health

If you or a loved one struggles with depression, anxiety, or any anguish that makes life difficult, we are here to help. Integrative Healthcare Center employs the top psychiatric talent, and together, we can develop an individualized therapy plan to ensure your wellness.

We offer talk therapy, Cognitive Behavior Therapy, Dialectical Behavior Therapy, Solution Focused Brief Therapy, and prescription management, among more innovative techniques like Transcranial Magnetic Stimulation (TMS). Whatever your condition is, our team can address it and ensure you get better.

Call (855) 599-9987 or click here to schedule a free consultation today.

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