Ray sat slouched on the couch, his hair full of ash, burnt papers clenched in his hands and a blank stare on his face. He had just survived a terrorist-induced disaster of unbelievable magnitude. In the days that followed, Ray experienced a pervasive feeling of sadness and an emotional numbness. He noticed a gnawing sense of guilt that was growing within him. He continually asked himself, "why did I live when so many others died?" "Why did I just stand there while buildings crumbled around me?" "Why didn't I help somebody instead of just running?" Ray had trouble sleeping, became withdrawn, was bothered by intrusive thoughts and flashbacks of the disaster. He felt inadequate and full of shame because he did not have "a story to tell" about how he helped someone. Ray saw himself as a strong, capable man who acted like a coward in a time when others needed him.

What Ray was experiencing is known as survivor guilt -- a phenomenon often experienced by those who escape from a disaster that seriously injures and kills others. An individual dealing with this particular type of guilt may believe that they experienced a good fortune at the expense of others and that by attempting to save their own lives, they intentionally harmed others.

Guilt is believed to serve four functions: defending against helplessness, effecting self-punishment, inhibiting impulses, and preventing the event from becoming meaningless (Opp & Samson, 1989). Cognitive (thinking) and affective (feeling) components are at play in survivor guilt. Cognitively, the individual thinks that s/he was responsible for the tragic outcome that others suffered. In the case noted above, Ray accepted total responsibility for not helping hundreds, perhaps thousands, of others. Rather than blame the terrorists for the deaths caused by the disaster, he blamed himself for saving his own life instead of returning to the burning buildings to help others. He held the irrational belief that if he "wasn't such a coward" he could have acted in some heroic or superhuman manner to save lives. Affectively, an individual experiencing survivor guilt may feel helpless, powerless, sad and full of shame. In essence, their sense of self and competence has been violently shattered.

So how does Ray deal with his survivor guilt? Here are some suggestions:

1. Talk, talk and then talk some more. One of the most effective ways to reduce feelings of isolation, withdrawal and helplessness is to share our experiences with one another. The recent terrorist attack was experienced by millions of people -- some from ground zero and some from 3,000 miles away. Nonetheless, we all have a "story" to share. One did not necessarily need to be at the World Trade Center or the Pentagon at the time of the disaster to experience survivor guilt. The point is that there are lots of people out there to talk with in both personal and professional arenas.
2. Restore a sense of safety and stability. Return to routines as soon as you can. Routines provide a sense of familiarity and competence to our daily lives. Engage in work and play. Return to exercise routines and hobbies. Initially, the usual joy that accompanies these activities may not be present, but the physiological effects will increase endorphin levels that in turn may lead to reduced feelings of fatigue and powerlessness.
3. Challenge irrational thoughts. Ask yourself what you truly could have done at the time of the disaster. Remind yourself who is to blame -- you are not to blame. Grieve for those who perished and for the loss of innocence. But, do not accept responsibility for that loss. Often in revisiting the details of a disaster, one realizes that they did engage in actions to preserve life and safety. In recounting his experience, Ray realized that he not only helped others out of the building, but made several stops as he ran from the crumbling building to visually track colleagues who were running behind him.
4. Take an asset/strength inventory. What qualities or strategies have helped you through times of stress or crisis before? Call upon those strengths. Remember that you were strong and resilient in your efforts to survive. If you did not have this resolve the magnitude of the disaster would have been even greater.
5. Help in the recovery effort. Take action -- action makes us feel real and alive again. Action helps to alleviate feelings of guilt because it prompts us to change our focus from events of the past to events of the present. It feels good to do something in the effort to recover from a disaster (i.e., donate blood, food or clothing; volunteer time; write about your experience, etc.).
6. Connect with your support network. Through connection with others we feel alive, understood and meaningful. Whether it is your partner, gym, place of worship, job, or family -- get connected. Remind yourself of the things and people that are important in your life.

Aaron Hass (In Lemberger, 1995) said that, "guilt is the penance one pays for the gift of survival." Rather than focus on the burden of guilt, remind yourself that you and your loved ones have been given a gift -- the gift of your survival. Embrace your will to survive and fight the forces that challenge your way of being.

References

Hass, A. (1995). Survivor guilt in Holocaust survivors and their children. In J. Lemberger (Ed.), A global perspective on working with Holocaust survivors and the 2nd generation (pp. 163-183).

Opp, R.E., & Samson, A.Y. (1989). Taxonomy of guilt for combat veterans. Professional Psychology: Research and Practice, 20, 159-165.

09/24/01

Donna Marzo, Psy.D. is a licensed psychologist in the District of Columbia and Maryland. She is the clinical supervisor of a nonpublic day school for emotionally disturbed adolescents and maintains a private practice in the District. Dr. Marzo works with children, adolescents and adults using individual, couples and group approaches. She can be reached at (202) 841-1007.