He Survived. His Friends Didn’t.

When it comes to my veteran husband’s PTSD, there’s one symptom that haunts him more than the others. It follows him into his dreams and pounces without warning. Some nights it’s all he can talk about. What hurts him the most is his survivors’ guilt.

“Two [of his friends] were lost in Iraq, and the other two were killed in Afghanistan. When that last one went down, it just undid him.”

Susan Selke, mother of a veteran with survivorsguilt

Survivors’ guilt is like someone using their own empathy as a weapon against themselves. Timothy J. Legg, a geriatric and psychiatric mental health nurse practitioner, tells us that survivorsguilt happens when someone feels guilty after surviving an atrocity that other people didn’t survive, or she might feel guilty because other people got left behind. She may ask herself, “What could I have done differently? Why didn’t I suffer as much as other people did? Why didn’t I die?”

People with survivors’ guilt may feel guilty about what they did or didn’t do during a traumatic experience, or they may feel ashamed for simply living through it, assigning selfish, impure motives to the very act of survival.

For instance, Fox News recounts how some Holocaust survivors thought they were somehow morally flawed after surviving atrocities that killed so many other people. They may have asked themselves, Did I survive simply because I was only worried about myself? Did I deserve to get so lucky? For them, the world felt unsafe and unfair, not least of all because they were in it.

“Maybe many [vets] are more hobbled by guilt than by terror, awakened in the night not by flashbacks to their own near-death experiences, but to the deaths of others; not by terror, but by guilt–by the very fact that they somehow do not deserve to be alive, even that others died because of something lacking in them.”

Fox News

While most people recover within a year, approximately a third of people struggle with survivors’ guilt for three years or longer. Although it is a symptom of PTSD, someone can have one without the other, and intensity varies from person to person.

Survivors’ guilt is poorly defined, but in addition to feelings of guilt and shame, symptoms may include:

  • flashbacks
  • suicidality
  • irritability
  • physical symptoms like heart palpitations, stomach aches, and headaches
  • insomnia
  • overwhelming fear
  • feelings of immobility, disconnection, numbness, or apathy
  • feelings of helplessness
  • amotivation
  • anxiety
  • nightmares
  • racing heartbeat
  • hostility
  • feelings of hatefulness
  • violent impulses
  • anger
  • problems focusing
  • a preoccupation with what life means

Who Gets Survivors’ Guilt?

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According to Kendra Cherry, author of The Everything Psychology Book: Explore the Human Psyche and Understand Why We Do the Things We Do, and Steven Gans, PhD, an attending physician at the Community Reintegration Unit at McLean Hospital, the term “survivorsguilt” was coined in the 1960s after researchers discovered common feelings of shame among Holocaust survivors. Other people who may suffer from survivors’ guilt include:

  • veterans
  • parents who lose a child
  • first responders
  • relatives of suicide victims
  • family members of people who get fatal genetic disorders
  • survivors of September 11th
  • people who see traumatic events
  • people who survive cancer
  • those who survive natural disasters
  • those who survive car accidents
  • transplant recipients
  • people who survive mass shootings
  • people who aren’t there when someone they love dies
  • AIDS survivors
  • people involved in some non-life-threatening situations, such as people who keep their jobs during massive layoffs

As you can see, the phenomenon of survivors’ guilt is quite common. In a 2018 study of 108 lung cancer survivors, 55 percent said they’d experienced survivorsguilt. In a sample taken from patients at a traumatic stress clinic in the United Kingdom in 2019, 90 percent of those who survived a traumatizing event that other people did not live through reported survivorsguilt. It’s another common response to uncommon circumstances.

Causes of Survivors’ Guilt

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We know that survivors’ guilt is common, but why? What predisposes people to it, and which factors in and outside of the self aggravate it?

People are more prone to survivors’ guilt if:

  • They have family histories of mental health problems.
  • They don’t have a lot of social support.
  • They abuse alcohol and drugs.
  • They have depression or poor self-esteem. If someone doesn’t feel good about himself, he might ask himself if he deserved to survive when others didn’t, which feeds into any guilt he might already feel.

What happens when people are kids may also shape their propensity to survivors’ guilt later in life. Diana Raab, Ph.D., an author, poet, and speaker who writes for Psychology Today, talks about a 2005 study that focused on firestorm survivors’ dreams and found that subjects who underwent trauma in childhood were more prone to dreams about death once they survived life-threatening experiences.

There are also certain traits and behaviors closely associated with survivors’ guilt. In the 2019 UK study, living through a traumatic experience was associated with more suicidality and more severe PTSD. Another study showed that refugee subjects between the ages of 11 and 20 with the most intense PTSD tended to have more feelings of guilt and shame. They also had more exaggerated beliefs about:

  • their role in the traumatic experience
  • their role in wrongdoing in general
  • how well they can predict what will happen

“People look back and overestimate their ability to have known the outcome of an event. Because they feel like they should have predicted what happened, people may become convinced that they should have also been able to change the outcome.”

Kendra Cherry, MA, and Steven Gans, PhD

As you can see, ruminating over what happened and what they could’ve done differently is common and makes survivors’ guilt worse for our spouses. Locus of control plays a role in survivors’ guilt, too. Some people tend to blame themselves for things more than they blame factors outside of themselves. When they do this, they’re more likely to wrestle with survivors’ guilt.

A 2000 study of 199 college students suggested that submissiveness was also related to survivorsguilt. Afflicted subjects were concerned about protecting themselves or someone else, so they backed down from confrontation as a protective measure. Evolutionary theory says this is because survivors’ guilt is meant to support group living. Sufferers protect the group because they feel responsible for the group.

“The guilt begins an endless loop of counterfactuals–thoughts that you could have or should have done otherwise, though, in fact, you did nothing wrong.”

Nancy Sherman, Ph.D., a Distinguished University Professor and Professor of Philosophy at Georgetown University

Personal resilience affects the onset of survivors’ guilt, as well. In fact, young people may be more prone to guilt and shame after a traumatic experience than older people because they have less confidence in their capabilities to handle obstacles and adversity.

Survivors’ guilt in veterans is a very unique phenomenon with unique causes. In war, it isn’t always clear who the enemy is, so sometimes innocent people die. Soldiers are mentally wounded not only by what was done to them but by what they did to other people. To make matters worse, some soldiers are exposed to so much war that they may get overly aggressive and violate rules of engagement, giving them even more reason to feel guilty.

Some veterans also think they should’ve been able to rescue their fallen brothers. From what I’ve seen, this is a kind of guilt that isn’t easily subdued. It melds into a person’s psyche and forges a loyalty to his lost comrades that becomes a part of him.

How much someone believes he violated his values can also make survivors’ guilt worse. It’s even more intense when someone believes a traumatic event happened for no reason or a reason that doesn’t justify the outcome. It’s a random event in a random world, and now good men are gone forever.

Effects of Survivors’ Guilt

Image by Hamed Mehrnik from Pixabay

Survivors’ guilt changes people. It can have a major impact on how people live their lives, especially if other PTSD symptoms are present. The 2005 study on firestorm survivors found that survivors’ guilt can become an emotional handicap, stunting a person’s ability to cope with life. It whittles away at quality of life and emotional well-being, not to mention blaming herself for things outside of her control slowly destroys her self-esteem.

According to studies, veterans with PTSD or survivorsguilt also tend to think about suicide more than other people do, and some of them become ashamed of who they are because of what they did during the war. They might consider themselves tainted, damaged, or damned, deserving of whatever heartache comes their way.

I think survivors’ guilt gets worse as veterans get older and better at burying and medicating their feelings. Their brains can’t process their emotions immediately following trauma. It takes a few years for that to happen. In the almost six years I’ve been with my husband, I’ve watched his survivors’ guilt surface more often and cause more problems as the years have gone by. The more he tries to drown it in whiskey or sex or avoidance or whatever else he can grasp, the deeper and wider his guilt grows.

“As I aged, my PTSD turned into ‘flashbacks,’ nightmares, and three suicide attempts. The last was the worst. I sat on our kitchen floor at midnight, mad and scared.”

Dave, a Vietnam vet with survivorsguilt

How to Cope With Survivors’ Guilt

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Sometimes survivors’ guilt can feel bigger than everyone in the room, but it isn’t. There are things our spouses can do to manage their feelings of shame, such as:

  • Let the feelings flow, even if they don’t make sense. Our loved ones probably aren’t as responsible as they feel, but trying to block and bury feelings only makes them linger. Eventually, one way or another, they will ooze to the surface.
  • Turn to family, friends, support groups, or online communities. This is one war your spouse may not be able to fight on his own.
  • Take advantage of mindfulness, which, according to Legg, can be very helpful during flashbacks, too. Your veteran can try focusing on her breathing or something soothing in the environment (music, a favorite blanket, etc.).
  • Keep a dream journal. Raab suggests that recording and analyzing dreams might help people who’ve survived natural disasters process their guilt.
  • Do something that feels good, like bathing, writing, reading, experimenting with aromatherapy, getting a massage, eating a favorite snack, making art, getting lost in a movie or video game, playing with pets, or resting.
  • Keep a check on self-talk. In Guilt, Shame, and Anxiety, Peter Breggin suggests replacing negative, irrational thoughts with positive, rational, loving ones.
  • Give everyone time to heal. It will take however long it takes.
  • Set up a daily routine.
  • Explore different ways of coping with daily stressors.
  • Try to separate feelings from reality. Feelings are fallible. Just because our veterans feel guilty doesn’t mean they are guilty.
  • Remember that anyone in our spouses’ positions would grieve. If they remind themselves of this, they don’t have to berate themselves for feeling their emotions for what they are.
  • Do something kind for someone else. Dave, a Vietnam vet with survivors’ guilt, found his liberation by serving other psychologically maimed veterans. That’s where he found his purpose, a reason for why he went through everything he endured.
  • Seek therapy, such as group therapy or medication. Dave got relief from his survivors’ guilt with the help of prolonged exposure therapy (PE), which enabled him to live a life free of suicide attempts, flashbacks, and nightmares.

Our veterans can also change the way they think about what happened. They can ask themselves who was actually responsible for the event or try looking at it from the point of view of someone who loves them. Does that person blame them for what happened? Does God blame them, too?

Our partners can also explore factors outside themselves. Which factors in the environment shaped how the event turned out? Were other people involved? Did the whole event hinge on a giant dose of luck? Could anyone have predicted or changed the outcome?

The thought patterns that culminate in survivors’ guilt are automatic, so our partners might need help changing them. Cognitive-behavioral therapy (CBT) is one path they can choose towards more realistic, self-compassionate thinking.

Self-forgiveness, too, can change the way people think about themselves and a traumatic event. Forgiveness should be addressed from our veterans’ perspective, whether that be in relation to a Higher Power or as a more secular concept.

Instead of feeling guilty, our partners can give themselves permission to be grateful for having survived and make the most of this time they’ve been given. Then they can remind themselves that they aren’t alone with their shame. They have people who love them and want to help them through this.

Our soldiers need to take care of themselves, too, by eating well, getting healthy sleep, exercising a little, and trying to avoid using alcohol or drugs, since people with PTSD are more prone to substance abuse.

How to Help Someone With Survivors’ Guilt

Fortunately, our partners aren’t powerless when it comes to their survivors’ guilt, and there are things we can do, too, when our veterans are overcome with shame:

  • Don’t argue with survivors’ guilt, even if it doesn’t make sense. Your person feels guilty, so let him express that guilt if he chooses to do so.
  • Encourage him to try some of the tips listed above. He might not know about them or might forget them when he needs them the most, or he may need you to motivate him to try something new to see if it works.
  • Don’t rush the healing process. Our soldiers don’t need to feel guilty for feeling guilty.
  • Remind them that we don’t blame them for what happened, and neither does anyone else, least of all their fallen brothers.
  • Reiterate how lucky they are to be alive and that there must be a reason for their survival.
  • Be careful not to assign unearned blame to your spouse. I think my husband’s PTSD and survivors’ guilt gets triggered by current feelings of shame, so I try not to blame him for things that aren’t his fault. Sometimes it’s even worth letting go of the little stuff that clearly is his fault if it means I get to keep him in the here and now, safe and loved.
  • Offer sex. Sex makes people feel good about themselves, even if only for a little while. When my man is down, I like to include lots of compliments, too. Intense sensations can also keep someone grounded in the present moment.
  • Stop trying to fix the problem and just do what you can do to help your person feel loved and forgiven right now.
  • Encourage professional help but don’t push the issue too much. People get help when they want it.

Perhaps most importantly, isolation puts people in places in their heads where they feel trapped, like there’s no way out of the pain overwhelming them. Luckily, the most comforting, healing thing you can give your partner is yourself. If you can think of nothing else to do, then just be there.

How to Cope With Your Partner’s Survivors’ Guilt

Photo by Luis Galvez on Unsplash

After we’ve taken care of our hurting loved ones, we need to take care of ourselves, too. Caring about a veteran with PTSD can change us as much as it does the veteran, so we need to make sure we’re keeping ourselves healthy. Here are some tips on how to cope with someone else’s survivors’ guilt.

  • Take a little pressure off of yourself by remembering what happened then and what’s happening now isn’t your fault. You don’t have to feel guilty just because your person feels guilty. In fact, you should feel proud of yourself, not ashamed.
  • Be patient with yourself for a couple of days after an episode. You might feel foggy, depressed, tired, and worried. This will pass, but you might have to give yourself a little time.
  • Stay as grateful as possible. If you’re anything like me, then you’re the most important person in your partner’s life. That’s a privilege that comes with as many blessings as it does burdens.

Blessings and Burdens

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The most important relationship in my life is the one I share with my soldier, so learning about his struggles and how to help him through them is an honor, not an inconvenience. None of the sacrifices I’ve made outweigh what we’ve built together. I will learn about my person until the day I die.

Sometimes, though, loving him hurts because I hurt for him, and his survivors’ guilt is his one PTSD symptom that causes both of us the most pain. It comes from such a deep, hidden place that’s buried under so much secrecy and so many coping mechanisms. Most of the time, the only indication he’s being haunted is he either wants to fight, or he wants to be held.

I can’t imagine the depth of my man’s guilt and shame or how it feels to be him. I know what it’s like to empathize with him to the point I’m struggling to stay strong, but I’ll never know what it’s like to be him. I don’t know if I want to know because I don’t think I could survive as gracefully as he has.

All I know is I love him with a love I can’t always understand or control. I wish I could tear out the part of my veteran that hates himself and thinks of himself as fundamentally wrong. I wish I could heal the piece of him that believes he doesn’t deserve a fulfilling life, that his life is doomed to pain and meaninglessness because of what he’s done. I can’t fix that for him, but I can be here the next time he needs me, which is exactly what I plan to do.

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