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    By Tom Moon, MFT

    The concept of survivor guilt has been around since the 1960s, when it was identified in survivors of the Holocaust and the bombing of Hiroshima. Originally, it was assumed to be a relatively rare syndrome that only occurred in horrific disasters, maybe because the idea of feeling guilty for surviving seems so strange that most people assumed that it had to be rare. Only recently has it become clear how widespread the issue really is.

    I first noticed this form of guilt in gay men who were survivors of the AIDS epidemic. Many men who lost friends and partners to the epidemic, but who themselves survived long enough to access effective treatments, or who remained HIV-negative through the epidemic, didn’t just feel fortunate about their own survival, but also experienced deep conflict about it. Had they in some way abandoned those who died? Had they stolen a “survival slot” from someone else? If they allowed themselves to go on to find success or happiness or love, were they being insensitive or indifferent to those who could never have those things again?

    If ideas like these sound bonkers, well, yes. They are. Part of the treatment for survivor guilt is to make the ideas that drive it conscious, so that their inherent irrationality can be recognized. But irrational or not, survivor guilt is normal, even common, and the human mind is far more susceptible to it than we used to think.

    I remember, for instance, a crystal meth addict who hit bottom and recognized that his addiction was killing him. He knew that he was only going to survive if he left behind his whole circle of friends, who were also meth users. Today he’s free from the grip of his addiction, and virtually all of his friends are dead. He mourns them, but he also suspects that his own survival meant selfishly turning his back on them, and he is tormented by the question, “What right do I have to be alive when they’re all gone?”

    Survivors of family dysfunction often feel deep conflict about their survival. I think of a woman who grew up in a household with chronically depressed parents. She escaped the family misery and now struggles to allow herself to thrive, but has to fight the judgment that she has no right to be happy when that was impossible for her parents. Survivor guilt also shows up among people who come from backgrounds of crushing poverty, but who rose out of it in their own lives; in people who are healthy but have relatives with severe hereditary illness; in veterans of war; in first responders to tragedies; in recipients of organ transplants, and so on.

    Survivor guilt can be tricky to spot, because often the ideas behind it aren’t fully conscious. Typical symptoms are anxiety and depression, insomnia, inability to grieve, emotional numbness, and preoccupations with questions about the meaning of life and about why one survived. A very common pattern is self-sabotaging behavior. People with survivor guilt often are accident prone, or in other ways unconsciously take away their success or happiness in order to atone for their guilt.

    To get a feel for the acute emotional suffering that survivor guilt can create, I highly recommend the 1980 film Ordinary People. In that film, Conrad (Timothy Hutton) suffers agitation, depression, and isolation following a boating accident that he survived, but in which his brother drowned. In his talks with a therapist, he comes to understand that his symptoms aren’t just the result of the trauma of the accident, but are due to his guilt over surviving when his brother did not.

    When we look at the bigger picture, sooner or later almost all of us face the dilemmas of the survivor. Most of us at some point leave behind people or situations that are destructive or dangerous to us; or we experience health, success, or good fortune that is denied to people we care about.

    In such situations, it can take considerable effort and determination to remember that self-care isn’t selfish, and to maintain a focused commitment to our own well-being. If you recognize this struggle in yourself, you might be inspired by reading Mary Oliver’s poem The Journey, which beautifully depicts the intensity of courage and steadfastness that is required to remain loyal to our highest good.

    Tom Moon is a psychotherapist in San Francisco. For more information, please visit his website