Posts Tagged With: Survivor Guilt

One time, a few years ago, someone I love had cancer. And it has forever changed me, too.

Why I Feel Guilty After My Husband Survived Cancer

By Lesley Miller as it appeared in “The Mighty”


One time, a few years ago, someone I loved had cancer.

He caught it the way most people do, unexpectedly and without warning. Just months before his diagnosis, I’d been the one in a hospital gown. He faithfully attended my prenatal appointments and then held my hand while I pushed a seven-pound baby into the world, changing our lives forever. Little did we know it would be one of two life-changing moments over the course of three months, because suddenly the roles reversed. Now cancer was growing in our house instead of my growing belly. He’d officially become a cancer patient, and I’d officially become the person at his side. The person they call wife but also caregiver; the person who could become a widow if everyone isn’t careful.

It’s hard these days to talk about his cancer. With time, you’d think it would become easier, but I’m finding the opposite to be true.

There’s this thing called survivor’s guilt — maybe you’ve heard of it? Survivor’s guilt is a mental condition where someone feels bad because they’ve survived a traumatic event when others did not. Survivor’s guilt can take on a lot of different forms, and people can feel it after walking away from a deadly car crash, making it home after war or even in something as simple as keeping your job during company wide layoffs.

My husband, Jonathan, had stage IV cancer, but even he experiences survivor’s guilt. I remember leaving chemotherapy with him one Friday, and he commented that he shouldn’t complain because his cancer was so treatable, and he was young.

A few months later I bought him a bold yellow shirt that said “survivor” across the front. He wore it once to please me and never put it on again. “Survivor,” in his mind, is nothing to tell the world about. He didn’t do anything to claim survivor status; his body just had a treatable cancer that happened to respond to drugs. He’d rather wear his Seattle Seahawks shirt than call any more attention to himself. His bald head and missing eyebrows had been enough of a conversation starter.

I feel guilty a lot these days, too. When I talk or write about cancer, I tell myself I have no place to do so. He is the one who had chest pain, not me. He is the one who saw the doctor’s concerned face, not me. He is the one with scars on his chest, not me. He is the one who actually, literally, survived, not me. I am, I was, simply the caregiver.

I showed up to chemotherapy with him, I made him mild dinners, I helped give him shots when he needed them and I accompanied him to the emergency room a few times. At the end of it all, he became a survivor, and I went back to being simply, wonderfully, his wife. He dodged death, and I dodged becoming a widow. I didn’t earn an official title, but I took back the one I’d been given on our wedding day. There’s no T-shirt to wear, not that I’d want one if there was.

istock_photo_of_two_people_talking1But although my role as caregiver was supposed to be a temporary identity changer, I am forever marked by the dreaded, whispered six-letter word we fought together.

I may not have a shirt, but I wear “survivor” on my mind and heart. I survived in a different way. I survived the awkward “’What’s new with you?’ ‘Oh, my husband has cancer’” conversations. I survived being our family’s PR agent, managing communication with our friends and families and the pitied looks from strangers. I survived the what-ifs and the won’t-go-theres. I survived that terrible flight when he was throwing up in the security line while I juggled our luggage, baby, stroller and Christmas presents. I survived pumping breast milk in a tiny sterile doctor’s office while he received chemo outside the door. I survived the greatest scare of my life — that I might lose him.

I can’t describe to you exactly how it made his chest hurt, but I can tell you about that night we pulled off a freeway at 11 p.m. because he was in too much pain to drive. I couldn’t tell you what it’s like to think you might be dying, but I can tell you what it’s like to think about becoming a widow. I can’t explain the pain of a bone marrow biopsy, but I can tell you how white his knuckles got as the doctor screwed a huge needle into his back. Cancer never lived in my body, but pain sure did. My pain came from the watching and the waiting.

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The Positive Angle of “Survivor Guilt”

The positive side of survivor’s guilt is that it can serve as motivating force for change. Many end up making a donation, volunteering, or joining one or more campaigns to address cancer research and assistance for cancer survivors, including affected caregivers and family members. The psychological toll that cancer treatment takes on patients and those around them is very significant. Depending how one reacts to the consequences of survivorship, however, people might find themselves overextended and overcommitted. This in turn could cause undue stress due to the inability to meet the self-imposed tasks and responsibilities.


I’ve been there

On the other hand, the drive, devotion, and true dedication to making a difference provide a sense of fulfillment to the individual, and many benefits to the organizations or persons with which the survivors work. Having “being there” gives the survivor a sense of identification with those patients, caregivers, and family members “going through it” right now. Here is a little story:

“This guy is walking down the street when he falls in a hole. The walls are so steep he can’t get out.”A doctor passes by and the guy shouts up, ‘Hey you! Can you help me out?’ The doctor writes a prescription, throws it down in the hole and moves on.”Then a priest comes along and the guy shouts up, ‘Father, I’m down in this hole can you help me out?’ The priest writes out a prayer, throws it down in the hole and moves on”Then a friend walks by, ‘Hey, Joe, it’s me can you help me out?’ And the friend jumps in the hole. Our guy says, ‘Are you stupid? Now we’re both down here.’ The friend says, ‘Yeah, but I’ve been down here before and I know the way out.'”

Sometimes it takes one who has been there to help those in need, who are in similar circumstances. Survivor guilt can be a medium and motivator to satisfy feelings of personal responsibility.

A Sense of Responsibility

Individuals with a sense of responsibility for those around them may be particularly vulnerable to guilt feelings. Among this group are individuals in positions of authority (e.g., administrators, supervisors), positions charged with rescuing or maintaining the well-being of others (e.g., police, firepersons), or who habitually feel responsible for others (parents, siblings, children of ill parents, spouses, close friends). For some, responsibility for others is defined as part of the job or part of who they are. People often readily relinquish responsibility to these individuals adding to the sense that it is their charge not only to keep things right but to make things right. As a result, members of this group may feel a sense of failure and guilt even when rescue or well-being are impossible.

Julie, a bank manager, was in her office when a novice and frightened bank robber accidently shot a bank customer and ran out of the bank. Hearing the shot, Julie had her secretary call for help, and she ran out to find the wounded woman bleeding from nose and mouth. Her staff breathed a sigh of relief that she was there. They readily relinquished responsibility to Julie and went with bank patrons to a quiet, safe location in the bank. The wounded woman died before reaching the hospital. Julie’s post-traumatic stress reaction was severe. She entered therapy, and her preoccupation with what she should have done dominated her early treatment experience. Her refrain became, “If only…” (e.g., she had been in the banking area instead of doing paperwork, she could have calmed the young man or talked him out of what he was doing, or even taken the gun away). Rumination about how she could have taken charge of the situation kept her focused on the time before the robber fired his gun.


After a traumatic event, some joyful thoughts or relief about surviving are normal and reasonable for those who were not directly affected: “Thank God it wasn’t me!” “Thank God it isn’t happening here.” For some of those directly exposed to life threatening events, at least temporarily, there may be elation over having survived. For those affected by the event, traumatic symptoms may appear initially or after the elation subsides. For example, Edgardo had to keep moving, as quickly as possible, down the Pentagon hallways in order to survive after the fire erupted in his office as consequence of the plane that struck the building on September 11, 2001. Initially, thinking there was no danger after a few minutes, some well-meaning individuals (including supervisor) sent people back to their offices. Edgardo followed a “gut feeling” and kept going. A large group of other people rushed out along side of him. At one point, a number of people were killed behind him when fire came blazing out of an elevator shaft. Edgardo barely escaped injury and kept rushing down the endless hallways. After assisting some of the injured and for the first few hours after making it home, Edgardo was elated to be alive. It was after watching the news coverage that night of the events at the Pentagon and New York that he realized what he had just experienced. Nightmares, repeated mental images and sounds of the horrors he had witnessed and other symptoms began to undermine his life.

After someone dies and after traumatic events, “survivor guilt” may occur because

  • individuals feel guilty for surviving or being uninjured when others were killed or injured
  • they were unable to rescue someone or had to leave someone dying in the disaster; or
  • it was not possible to overcome the events

Survivors who went through the event may feel guilt because of lack of understanding of why bad things happen to people who do not deserve them, or because of feelings of helplessness or lack of action (“I did not do enough”).

Doing more

Some survivors continue with rescue work or other efforts and regain a more balanced perspective about what is possible and what is not. Finding a positive approach and positive gains has been of help to some. Long ago, Lucia was given a plaque of a beautiful scene with the words, “Bloom where you’re planted.” written on it. At first, she did not like the plaque. Later, she realized that it did not mean she had to stay in her current circumstances but meant that she could create something good from every circumstance in which she found herself. Discovering new resources, new strengths, and new methods of dealing with difficult problems and reaffirming relationships or making new ones has benefitted many survivors. Some survivors have benefitted from attending support groups. Others have built meaningful memorials or found ways of sharing the process of honoring the dead.

In fact, survival is an achievement. It is a tragedy that so many have been killed in violent events or as result of terminal diseases. It is a blessing to all of us that no more are killed. Although choices may be limited during a traumatic event, the survivor does have choices after the event. They can remain locked in numbness or distress or can use survival as a source of insight and growth. Guilt can be adaptive when it leads to improvements in character and behavior. Unprocessed guilt can make recovery difficult. Therapeutic assistance is important for persistent and/or intense guilt as well as other trauma symptoms that disrupt life.

A Method for Processing Survivor’s Guilt

  • Thank goodness, you survived!
    • More people than you know are happy that you survived
    • We are saddened by so many deaths
    • Even if the rest of your life seems insignificant to you, we are relieved that you are alive
  • Know that there is no offense in surviving
    • It is good to survive
    • It is okay to delight in being alive
  • Feel free to reassess your life
    • Reassess what is valuable to you
    • Make the best of your life
      • Making the best of your life can be a tribute to your survival and to those who died
      • Take the opportunity to reevaluate the meaning of your life
      • Is your life all it can be?
      • What is or can be your purpose?
      • Your talent?
      • Your benefit to life?
      •  Bloom where you’re planted
        • Process the traumatic experience and its associated symptoms with appropriate assistance
        • Put guilt to good use
      • Maintain a healthy realization of you can and can’t do
        • Do not overextend yourself by overcompensating trying to do too much beyond your capabilities or resources
        • We can do just enough and still bloom where our seeds are planted
  • If it is in your nature to do so, CHERISH LIFE
    • Treasure being alive
      • Whether you survived due to fate, a purpose, luck, chance, or “just did”, long life and kindness are not guaranteed to any of us
      • Each day and each act of kindness can be treasured as gifts
      • Treasure the best of each day
      • Treasure the lesson that the departed have given you
        • An opportunity to enlighten your own life
      • Be aware of your physical mortality in good and positive ways
      • Allow that cherishing life may be easier after recovery from trauma
  • Recognize the reawakening of old issues
    • Survival may have triggered old feelings of worthlessness or unworthiness
    • Surviving may have amplified old messages that you received about not being worthy, about being a nuisance, about not measuring up, and/or about not counting
  • If guilt persists or disrupts life, seek appropriate therapeutic assistance

 The Positive Side

Whether for acts committed or omitted or for a sense of culpability, guilt can have a significant effect on the spiritual, mental, emotional and physical well-being of the guilty and others affected by the guilty party’s behaviors and attitudes. It can influence demeanor, actions and circumstances. Failure to resolve guilt can result in a multitude of problems including mental health difficulties (e.g., depression), negative responses from others, disrupted relationships, a more pronounced traumatic reaction, and/or immobilization. Staying focused on guilt rather than acting positively and toward resolution can be a way of avoiding facing other issues and emotions. Without resolution, it can hinder and/or complicate traumatic response and recovery as well as the nature of relationships. Guilt can punish more than the guilty.

With the help of a skilled intervener, the level of culpability and the appropriate actions to take can be thoroughly assessed. Guilt can serve as a mobilizer – a call for action. It can move us to reexamine ourselves and our actions and to act in a carefully considered positive manner that benefits the survivor and others who are affected by the event and/or the survivor’s actions.

Acknowledgements references and more information at:

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Is Survivor’s Guilt Similar to Post-Traumatic Stress Disorder (PTSD)?

The National Cancer Institute at the National Institutes of Health have found that some survivors of cancer experience trauma-related symptoms similar to symptoms experienced by people who have survived highly stressful situations, such as military combat, natural disasters, violent personal attack (such as rape), or other life-threatening events. This group of symptoms is called post-traumatic stress disorder (PTSD) and includes avoiding situations related to the trauma, continuously thinking of the trauma, and being overexcited.

People with histories of cancer (survivors, family members, and caregivers) are considered to be at risk for PTSD. The physical and mental shock of having a life-threatening disease, of receiving treatment for cancer, and living with repeated threats to one’s body and life are traumatic experiences for many cancer patients. Likewise, close family members of cancer patients (parents, siblings, close friends, and others) and caregivers may identify with the illness and suffer from related traumatic symptoms.

Diagnosis and Symptoms

Post-traumatic stress disorder (PTSD) is defined as the development of certain symptoms following a mentally stressful event that involved actual death or the threat of death, serious injury, or a threat to oneself or others.

For the person who has experienced a diagnosis of cancer, the specific trauma that triggers PTSD is unclear. It may be the actual diagnosis of a life-threatening illness, aspects of the treatment process, test results, information given about recurrence, or some other aspect of the cancer experience. Learning that one’s child has cancer is traumatic for many parents. Because the cancer experience involves so many upsetting events, it is much more difficult to single out one event as a cause of stress than it is for other traumas, such as natural disasters or rape. The traumatic event may cause responses of extreme fear, helplessness, or horror and may trigger PTSD symptoms.


PTSD in cancer survivors may be expressed in these specific behaviors:

– Reliving the cancer experience in nightmares or flashbacks and by continuously thinking about it.

– Avoiding places, events, and people connected to the cancer experience.

– Being continuously overexcited, fearful, irritable, and unable to sleep.

To be diagnosed as PTSD, these symptoms must last for at least one month and cause significant problems in the patient’s personal relationships, employment, or other important areas of daily life. Patients who have these symptoms for less than one month often develop PTSD later.

Risk Factors, Protective Factors, and the Development of PTSD

 As many as one third of people who experience an extremely upsetting event, including cancer, develop post-traumatic stress disorder (PTSD). The event alone does not explain why some people get PTSD and others don’t. Although there is no clear answer as to which cancer survivors are at increased risk of developing PTSD, certain mental, physical, or social factors may make some people more likely to experience it.

Individual and social factors

Individual and social factors that have been associated with a higher incidence of PTSD include younger age, fewer years of formal education, and lower income.

Disease-related factors

Certain disease-related factors are associated with PTSD:

– In patients who received a bone marrow transplant, PTSD occurs more often when there is advanced disease and a longer hospital stay.

– In adult survivors of bone cancer and Hodgkin lymphoma, people for whom more time has passed since diagnosis and treatment tended to show fewer symptoms.

– In survivors of childhood cancer, symptoms of PTSD occur more often when there was a longer treatment time.

– Interfering thoughts occur more often in patients who experienced pain and other physical symptoms.

– Cancer that has returned has been shown to increase stress symptoms in patients.

Mental factors

Mental factors may affect the development of PTSD in some patients:

– Previous trauma.

– Previous psychological problems.

– High level of general stress.

– Genetic factors and biological factors (such as a hormone disorder) that affect memory and learning.

– The amount of social support available.

– Threat to life and body.

– Having PTSD before being diagnosed with cancer.

– The use of avoidance to cope with stress.

Protective factors

Certain factors may decrease a person’s chance of developing PTSD. These include increased social support, accurate information about the stage of the cancer, and a satisfactory relationship with the medical staff.

How PTSD may develop

PTSD symptoms develop by both conditioning and learning. Conditioning explains the fear responses caused by certain triggers that were first associated with the upsetting event. Neutral triggers (such as smells, sounds, and sights) that occurred at the same time as upsetting triggers (such as chemotherapy or painful treatments) later cause anxiety, stress, and fear even when they occur alone, after the trauma has ended. Once established, PTSD symptoms are continued through learning. The patient learns that avoiding the triggers prevents unpleasant feelings and thoughts, so coping by avoidance continues.

Although conditioning and learning are part of the process, many factors may explain why one person develops PTSD and another does not.

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It is important that cancer survivors and caregivers undergo a careful assessment for post-traumatic stress disorder (PTSD) so that early symptoms may be identified and treated. The timing of this assessment will vary with the individual patient. Cancer is an experience of repeated traumas and undetermined length. The patient may experience stress symptoms anytime from diagnosis through completion of treatment and cancer recurrence. In patients who have a history of victimization (such as Holocaust survivors) and who have PTSD or its symptoms from these experiences, symptoms can be started again by certain triggers experienced during their cancer treatment (for example, clinical procedures such as being inside MRI or CT scanners). While these patients may have problems adjusting to cancer and cancer treatment, their PTSD symptoms may vary, depending on other factors. The symptoms may become more or less prevalent during and after the cancer treatment.

Symptoms of PTSD usually begin within the first 3 months after the trauma, but sometimes they do not appear for months or even years afterwards. Therefore, cancer survivors and their families should be involved in long-term monitoring.

Some people who have experienced an upsetting event may show early symptoms without meeting the full diagnosis of PTSD. However, these early symptoms predict that PTSD may develop later. Early symptoms also indicate the need for repeated and long-term follow-up of cancer survivors and their families.

Diagnosing PTSD can be difficult since many of the symptoms are similar to other psychiatric problems.

For example, irritability, poor concentration, increased defensiveness, excessive fear, and disturbed sleep are symptoms of both PTSD and anxiety disorder. Other symptoms are common to PTSD, phobias, and panic disorder. Some symptoms, such as loss of interest, a sense of having no future, avoidance of other people, and sleep problems may indicate the patient has PTSD or depression. Even without PTSD or other problems, normal reactions to the cancer diagnosis and treatment of a life-threatening disease can include interfering thoughts, separating from people and the world, sleep problems, and over-excitability.

Questionnaires and interviews are used by health care providers to assess if the patient has symptoms of stress and to determine the diagnosis.

Other problems may also exist in addition to PTSD. These problems can include substance abuse, emotional problems, and other anxiety disorders, including major depression, alcohol dependence, drug dependence, social fears, and/or obsessive-compulsive disorder.


 Effects of post-traumatic stress disorder (PTSD) are long-lasting and serious. It may affect the patient’s ability to have a normal lifestyle and may interfere with personal relationships, education, and employment. Because avoiding places and persons associated with cancer is part of PTSD, the syndrome may prevent the patient from seeking medical treatment. It is important that cancer survivors receive information about the possible psychological effects of their cancer experience and early treatment of symptoms of PTSD. Therapies used to treat PTSD are those used for other trauma victims. Treatment may involve more than one type of therapy.

The crisis intervention method tries to lessen the symptoms and return the patient to a normal level of functioning. The therapist focuses on solving problems, teaching coping skills, and providing a supportive setting for the patient.

Some patients are helped by methods that teach them to change their behaviors by changing their thinking patterns. Some of these methods include helping the patient understand symptoms, teaching coping and stress management skills (such as relaxation training), teaching the patient to reword upsetting thoughts, and helping the patient become less sensitive to upsetting triggers. Behavior therapy is used when the symptoms are avoidance of sexual activity and intimate situations.

Support groups may also help people who experience post-traumatic stress symptoms. In the group setting, patients can receive emotional support, meet others with similar experiences and symptoms, and learn coping and management skills.

For patients with severe symptoms, medications may be used. These include antidepressants, antianxiety medications, and when necessary, antipsychotic medications.

In my next post I plan to look at the “positive” side of having feelings of “Survivor Guilt”.

Here is a recent study on this topic: Survivor Guilt


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Interviews with Cancer Survivors Experiencing “Guilt”



The following link will direct you to interviews with cancer survivors who have experienced or are experiencing “survivor guilt”. These testimonies can bring into perspective the different ways that this syndrome surfaces and what others have done about it.

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Welcome to “Alive and Not Guilty”


I started this blog to share my interest on the topic of “survivor guilt”, and provide information and resources to those who might be interested in the topic and how to deal with it. Please share your thoughts, experiences, and resources. I am just starting to wrap my hands around the topic and hope this information is of some help.

This is an area of personal interest that I have developed during my PhD studies in psychology that may be on interest to some of you. Many terminal illness survivors and caregivers may experience this in many different ways and it could be of benefit to be aware of its occurrence. I also survived the Sept 11, 2001 attack in the Pentagon, and most recently, the shootings at the Washington Navy Yard.  These prompted me to ask “why not me?” “why am I still here?” and ever since I have been living every day to make it count, to make a difference, and help others.

I have also seen how some great friends have been affected by this after losing loved ones or surviving a period of struggling with an uncertain future. They feel like they did not do enough and now are trying to compensate for it, or feel not worthy of making it though the challenge. That can be good and bad, as they may end up overextending themselves and their effort may backfire on them. I intend to conduct post-doctoral research on this and would like to include a competency at LIVESTRONG on how to help people that experience Survivor Guilt cope with it in a positive way.

Here are some thoughts on the topic I shared in the LIVESTRONG website last year:

Survivor Guilt: What Long-term Survivors Don’t Talk About

While survivor guilt is not experienced by everyone, and may vary a great deal in intensity, it appears to be a common experience. The following article answers some questions survivors may have after experiencing a tragedy.

What is survivor guilt?
Survivor guilt has been described in Holocaust survivors, war veterans, rescue workers, transplant recipients and relatives spared from hereditary illness. Relatively little discussion of survivor guilt has taken place among long-term survivors of acute and chronic illnesses.

Survivor guilt, when it occurs, derives from situations where persons have been involved in a life- threatening event and lived to tell about it. It is often experienced after traumatic incidents causing multiple deaths. In the special case of chronic illness, survivor guilt can occur after the deaths of peers who faced the same diagnosis. By definition, there is an implied comparison with people who have endured similar ordeals.

Who experiences survivor guilt?
Anyone who survives can experience these feelings including patients, families and healthcare providers. Survivor guilt explores the other side of the coin of why me? Namely, why not me? Why did I survive when others did not? Those who struggle with it may express the feeling of being an impostor: somehow the “wrong” person survived; it “just doesn’t seem right.” Many feel that beating the odds makes little sense unless the survivor earned or deserved it in some way. But some survivors emphasize they don’t feel especially deserving. To complicate feelings of unworthiness, in the early stages of grief there is a tendency to idealize the deceased, so the survivor may feel even less deserving by comparison.

Why does survivor guilt occur?
Survivor guilt may be reinforced by the frequent use of statistical profiles to predict as well as to describe illnesses. However, people given the very same odds for survival do not necessarily have similar outcomes. When only one survives, it is not unusual to conclude that two persons facing the same threat somehow changed places; that one person’s healing occurred at the expense of another; or that there is a debt owed to those who are gone. Some survivors may keep a low profile to avoid spotlighting this contrast of outcomes.

Does survivor guilt have a function or purpose?
Survivor guilt may exist for a reason. It can help people find meaning and make sense out of their experiences. It may help survivors cope with the helplessness and powerlessness of being in a life- threatening situation without the ability to protect or save others. It can also be one way to express a connection to those who have died, a way, for a time, of keeping them alive. Importantly, survivor guilt can co-exist with other responses, such as relief and gratitude, and may occasionally be prompted by them.

What can I do if I experience survivor guilt?
Acknowledge and accept that guilt exists. Feelings of guilt are quite common and represent part of the healing process for persons coping with loss.

When people feel guilty, they tend to isolate themselves. While tempted to keep silent, try to discuss the experience with persons who will not express judgment.

Logic may have little or no impact on guilt, but it is important to do some reality testing with your beliefs. Remind yourself that you are human.

When you find you are comparing yourself with others, try instead to evaluate your situation on its own merits.

Some people try to “work off” their guilt by setting high standards of achievement. This is a very compelling strategy, but it rarely eases feelings of unworthiness.

It may help to find additional ways to keep the memory alive for those who have died by creating a special memory book or holding a service.

Remind yourself that you are struggling to make sense of one of the greatest mysteries of the human race. Rather than explaining it away, try to embrace the mystery.

Source: The Brain Tumor Society
By Roberta D. Calhoun, ACSW, LICSW – The Brain Tumor Society

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