When tragedy strikes and we are untouched by its’ full force, the pangs of Survivor Guilt can plague us.  We are grateful on one hand, but filled with thoughts of “Why not me?” We ask ourselves what we might have done to prevent this from happening.  How could we have not seen this coming? There is a sense that we are responsible for remaining intact and living on. The self-condemnation can be crippling.

“The problem with surviving was that you ended up with the ghosts of everyone you’d ever left behind riding on your shoulders.” ~ Paolo Bacigalupi

How Can We Begin to Understand and Cope With Survivor Guilt?The awful weight of self-indictment is the main characteristic of Survivor Guilt.  People experience a seemingly endless loop of the gut-wrenching belief that they did something wrong or failed to do what they could have done.  It happens to war veterans, accident survivors, those who live through natural disasters, cancer survivors, police officers, and Holocaust survivors. It is also common among friends and family members who have suffered the loss of a loved one to suicide.I am no stranger to Survivor Guilt.  My sister died of neuroblastoma when she was four years and nine months old.  Mother was grief-stricken as one might imagine.  Her beautiful little child had been taken and she was left to cope with the terrible loss feared by almost every parent.  We should not have to survive our children.She slipped deeper and deeper into dark sadness and depression. Her continual demand was to know why God would take Mary Kathryn instead of her. She had begged to be the one to die in my sisters’ stead only to be forsaken. There was no comforting her.  Despite opening her own business and trying to carry on with family and friends, she could not.  Our family doctor told Dad that the only thing that might help would be for Mom to get pregnant again.She did, and I was the replacement kid. Sixteen months after my sisters’ death, I was born into a house replete with Survivor Guilt. I have learned that many kids who survive the death of their siblings also experience this phenomenon.  I will never forget an occasion while playing on the living room floor with my Aunt Lucille. She was a registered nurse and had spent many hours with my sister.  At one point she mistakenly called me Mary Kay.  I could hear my mother break down into sobs in the kitchen.  I wondered why I was alive when my sister was not.  A wave of shame swept over me. I wished we could trade places. I was only three years old.Symptoms, Indicators and Healing ToolsSurvivor Guilt has been linked with PTSD in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which recognizes the role of negative emotions such as guilt and shame.  The following are symptoms associated with those negative emotions;

• Avoidance
• Feeling on edge
• Hypervigilance
• Detachment
• Easily startled

Other associated indicators not included in DSM are;

• Feeling disoriented, confused and unworthy
• Obsessing over the tragedy
• Being ambivalent about living
• Overwhelmed by the sense that you’re never really safe

Measuring Survivor Guilt

A good instrument for measuring Survivor Guilt and PTSD is the Trauma and Loss Spectrum Self-Report instrument (TALS-SR).It explores the lifetime experience of a range of loss and traumatic events and lifetime symptoms, behaviors and personal characteristics that might represent manifestations or risk factors for the development of a stress response syndrome.This tool is of great value to those like Police Chaplains, who deal with survivors.  Police Week reported in www.officer.com that one of the most important things an LEO who is experiencing Survivor Guilt can do is to “share your story with someone you trust and who will actually hear you rather than judge you.” The Chaplain fulfills such a role for many officers. First responders witness some of the most unimaginable sights in unfiltered, graphic situations. Police officers, firefighters, and paramedics also need to be given action-oriented methods of healing to cope with all they experience.

Survivors Continue to Suffer

The Associated Press reported that Survivor Guilt and symptoms of PTSD continues to plague those New Yorkers who lived through the attack on The World Trade Center on September 11, 2001. Dr. Nomi Levy-Carrick, mental health director of World Trade Center Environmental Health Center program reported that; "There was tremendous Survivor Guilt, so people who survived didn't feel worthy of wanting to seek care.The fact that they had survived, they felt, should have been enough." She said people who tried moving on despite the lingering psychological effects of 9/11 realized they weren't getting better. 9/11 is perhaps the national tragedy that most of us remember in vivid detail.  We were devastated on a personal and community level beyond anything since the bombing of Pearl Harbor.Think what it must be like for those who continue to suffer as if it happened yesterday. It never seems to leave. In a real sense, this is the essence of understanding Survivor Guilt PTSD.  When it brings the darkness once again, unannounced, that unspeakable yesterday suddenly becomes today…here and now.

Not Limited to Tragedies Surrounding Death.

We have learned that Survivor Guilt is not limited to tragedies surrounding death.  I have provided counseling services for both adult men and adolescent boys who were victims of sexual abuse. The effects of the abuse are lasting. They have complicated feelings and vivid memories that haunt them relentlessly.  One of the most heartbreaking revelations is that so many feel that they were somehow responsible for what happened.“I was cute and kind of a sexy kid,” said Shane “He (the abuser) probably couldn’t help it.  I could have stopped it.  If I would have, other boys wouldn’t have been hurt.  It’s all my fault.”  He begins to sob uncontrollably. Shane is reduced to the little boy in a dark bedroom under the blanket of violence in the monstrous act at the hand of a trusted adult. My response is to try and carry light into their darknesses.I have found that the most valuable thing we can bring to those who experience Survivor Guilt PTSD is the listening ear and open heart of one willing to accompany them without judgment and with unconditional acceptance and love.  When the victim is no longer alone in the memory healing can begin.

Our Veterans and the Burden of their Experiences

Veterans of war carry the burden of their experiences in silence like so many victims of sexual abuse.  Their service is often marred by the loss of comrades and buddies in bloody scenes that none of us can imagine.  They come home to families who have longed for their return only to feel estranged.  A different person seems to be living in the body of their loved one.  Repeated inquiries about what happened ‘over there’ are met with silence and denial.  I remember men, including my Dad, who were soldiers and sailors in WWII.[embed]https://youtu.be/0HUf68gFGEE?t=2m24s[/embed]They rarely, if ever, talked about their combat experiences.  There was a wall of unknowing behind which nobody could come.  One of my friends fought in Vietnam and was known to have witnessed something horrific over there.  It was not until thirty years later when we read his suicide note that we found he had held the body of his wounded best friend for hours.  Merciful death or help from medics was not coming so Billy did what he had to do and ended the suffering with his service revolver.The note said he could no longer bear the decades of pain.  Billy was alone for all of those years. I was never able to bring him a torch for the darkness.Some Truths and Some Hope for Survivor Guilt PTSDWe know of so many things can cause Survivor Guilt and how to cope or heal.  The one who lives on after a loved one takes their own life, the one who survives after a sibling dies and the one who stays alive in an otherwise fatal auto accident are among the many who might shoulder the weight of Survivors Guilt.  There are two facts which are universal when it comes to this;

• It always comes when something happens which brings an extreme state of feeling previously unexperienced
• It must be dealt with or will persist for a lifetime

Here is some good news that comes to us from the most unlikely of situations. A most remarkable thing is happening for survivors of the Marjorie Stoneman Douglas High School mass shooting. Social media, protest marches and the honoring of fallen friends seem to have empowered the young people who survived, helping them in ways that were not available to earlier such tragedies.  They tweet to huge audiences of thousands about their pain and about actions they are taking to prevent further violence.Their #NEVERAGAIN page on FaceBook has more than 165,000 followers. These kids bravely stand up to criticism by adults and persist in their efforts day after day. They are courageous. Though probably unaware, they are doing almost all of the things that are offered by experts on Survivor Guilt PTSD to heal from their tragic losses.We can learn a lot from these young people. They seem to be carrying light to each other (and to us) in the darkness.  Not in the form of a torch but in hundreds of thousands of little beams coming from their cell phone flashlights.Robert Kenneth Jones is an innovator in the treatment of addiction and childhood abuse.In a career spanning over four decades, his work helping people recover from childhood abuse and addiction has earned him the respect of his peers.His blog, An Elephant for Breakfast, testifies to the power of the human spirit to overcome the worst of life’s difficulties. We encourage you to visit and share this rich source of healing, inspiration, and meditation.Contact Bob Jones on LinkedinBob Jones’ blog An Elephant for Breakfast