It’s common for people to feel like they didn’t do enough to prevent a tragedy, such as an unforeseen death that occurred to a loved one. Often called survivor’s guilt, the feelings of self-blame and regret can accompany a variety of traumas to others, such as health issues, financial losses and suicide. Survivors of the concentration camps used by the German Nazis to exterminate Jews prior to, and during WWII, have often reported feeling guilty about living.

One of my closest friends, a man who served in the U.S. Army during the Vietnam War, told me about his recurrent bad dreams and inability to shake intrusive thoughts that he should have died instead of a fellow soldier. “Joe” said his Army buddy was killed during a reconnaissance mission after volunteering to take Joe’s place because he wanted Joe to prepare for a scheduled furlough the next day.

Joe couldn’t forgive himself until he sought counseling through the VA 40 years after the troubling event. That’s when Joe finally found enough personal peace that he could reconcile his memories satisfactorily in his mind, and share them with his wife and family.

It’s normal for people like Joe, who have a strong sense of responsibility, such as spouses, parents, healthcare providers, soldiers and farmers, to be prone to survivor’s guilt following a tragedy that affected others.

Persons who are not directly affected, or are only partly affected in a direct fashion by the tragedy, may question themselves with thoughts of “What if I had done this or that to prevent the loss,” and “I wish it had been me instead.” The survivors may rationalize that “I can’t change what is in the past,” but that doesn’t diminish the other feelings of guilt and unworthiness.

The Diagnostic and Statistical Manual Disorders, 5th edition, considers survivor’s guilt to be a symptom of Post Traumatic Stress Disorder. When is survivor’s guilt of such severity as to require professional assistance, or at a minimum, discussion with someone who understands the turmoil, like a physician?

The chief signs of survivor’s guilt syndrome, include these:

- Persistent – more than periodic – personal questioning about what might have been done to prevent the tragedy

- Recurrent wishes that “it should have been me instead” of who suffered or died

- Social withdrawal to avoid questioning by others and instead to indulge in self-examination 

- Sleep disturbances, recurrent nightmares, excessive emotional “ups” and “downs,” fears of places and people that heighten anxiety, guilt and depression

- Disruptions of daily functioning, work and relationships with others to the degree that the distressed person and others notice these impairments

- Thoughts of self-harm and/or wishes to join the deceased victim

Survivor’s guilt seldom dissipates without its recognition and taking steps to alleviate the distress. There are steps that a distressed person can take, such as the following:

- Talking with others who have experienced similar trauma

- Meditation, prayer, psychological mindfulness, and other personal activities can be beneficial, but usually don’t provide as much relief as talking with others who understand survivor’s guilt

- Emotional healing is best handled by allowing feelings associated with self-blame to surface when verbalizing the remorseful thoughts, expressing anger, crying, and other associated behaviors to someone who understands and can offer useful feedback and advice, such as a trained pastor, counselor, or peer supporter

- Participation in support groups or grief groups is sometimes offered by funeral homes, hospitals, organizations such as Survivors of Suicide and Hospice, and churches; these services may be free of charge

 - Many behavioral healthcare professionals offer support groups to persons working through issues of grief and survivor’s guilt which may be covered by healthcare insurance

- Veterans Administration hospitals and programs use trained peers to offer assistance to Veterans experiencing survivor’s guilt

- Individual professional assistance from behavioral healthcare providers such as psychologists, counselors, and psychiatrists may be required when other forms of assistance don’t resolve the survivor’s guilt

- Turning the guilt into constructive activities such as helping others deal with and prevent suffering to others in similar circumstances, is particularly helpful to some people who struggle with survivor’s guilt

A widow whom I know well has come to terms with the purposeful death of her farming husband. He didn’t give clear signals about his internal deliberations to end his life. She has contributed to articles in magazines, farm news, and workshops to train professional caregivers and others who might encounter similar circumstances.

Among the actions that she learned after her husband took his life are to pay attention to gut feelings, to talk with the person who is sending signals that something isn’t right, and to not let that person be alone.

Although this widow is not be the same as before her loss, she has found she can go on with her life productively and with inner peace. She is a model of the hope, faith, and care about others that all survivors of guilt can experience.

Dr. Mike Rosmann is a psychologist/farmer. Email inquiries can be sent to him at: mike@agbehavioralhealth.com.