Survivor guilt

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Survivor guilt or survivor's guilt (but also survivor syndrome, survivor's syndrome, survivor disorder and survivor's disorder) happens when individuals feel guilty after they survive a near death or traumatic event when their loved ones perished. [1] It can cause similar depressive symptoms associated with PTSD. Niederlande first introduced the term to describe the feeling of punishment many of the Holocaust survivors felt for surviving their loved ones. [1] The experience and manifestation of survivor's guilt will depend on an individual's psychological profile. When the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) was published, survivor guilt was removed as a recognized specific diagnosis, and redefined as a significant symptom of post-traumatic stress disorder (PTSD). History of survivor guilt outlines similar symptoms among many groups and individuals that experience tragic situations. Other patterns of guilt are found in medical aid groups who lose patients and place blame on themselves. Examples of traumatic events involve situations where an individual feels intense feeling of guilt after a loved one has past. War and the losing of a loved one due to traumatic events are closely related to feelings of depression and anxiety, that can later lead to PTSD. Suicidal thoughts are related to intense feelings of anxiety and depression from guilt related to traumatic events.

Contents

Post-Traumatic Stress Disorder (PTSD)

People that have a lasting fear or other mental health issues after traumatizing events may be experiencing Post-Traumatic Stress Disorder. Almost all people experience some type of traumatic event throughout their lifetime, and a percentage (5.6%) will be diagnosed with PTSD. [2] Symptoms include: unwillingly reliving a traumatic event, avoiding situations that are a reminder of the event, feelings of intense distress that affects everyday activities, feeling of fear and horror when there is no threat, etc.,. [2] An individual whose everyday activities are hindered due to recalling a traumatic event may be experiencing PTSD.

History

A mass grave in a concentration camp from the Holocaust. Survivors of such traumatic events may experience feelings of guilt or wonder whether they deserved to survive. Mass Grave at Bergen-Belsen concentration camp - Fritz Klein - IWM BU4260.jpg
A mass grave in a concentration camp from the Holocaust. Survivors of such traumatic events may experience feelings of guilt or wonder whether they deserved to survive.

Survivor syndrome was first identified during the 1960s. Several therapists recognized similar if not identical conditions among Holocaust survivors. Similar signs and symptoms have been recognized in survivors of traumatic situations including combat, natural disasters, terrorist attacks, air-crashes and wide-ranging job layoffs. [3] A variant form has been found among rescue and emergency services personnel who blame themselves for doing too little to help those in danger, and among therapists, who may feel a form of guilt in the face of their patients' suffering.

Stephen Joseph, a psychologist at the University of Warwick, has studied the survivors of the capsizing of the MS Herald of Free Enterprise which killed 193 of the 459 passengers. His studies showed that 60 percent of the survivors suffered from survivor guilt. Joseph went on to say: [4]

There were three types:

Sufferers sometimes blame themselves for the deaths of others, including those who died while rescuing the survivor or whom the survivor tried unsuccessfully to save. [5]

Survivor syndrome

Trousers from a concentration camp uniform owned by Shimson Kleuger, interned in three KZ camps. Kleuger increasingly isolated himself in the family mansion, likely as a result of trauma left by the experiences of the Holocaust. Spodnie z kombinezonu obozowego, MZ-328-O 01.jpg
Trousers from a concentration camp uniform owned by Shimson Kleuger, interned in three KZ camps. Kleuger increasingly isolated himself in the family mansion, likely as a result of trauma left by the experiences of the Holocaust.

Survivor syndrome, also known as concentration camp syndrome (or KZ syndrome on account of the German term Konzentrationslager), [6] are terms which have been used to describe the reactions and behaviors of people who have survived massive and adverse events, such as the Holocaust, or the Rape of Nanjing. [7]

In 1949, Eddy de Wind, a Dutch psychiatrist and survivor of Auschwitz concentration camp, introduced the term "concentration camp syndrome" regarding the psychological consequences of persecution, describing the "pathological after-effects" unique to former prisoners of Nazi concentration and extermination camps. The subsequently well-documented syndrome among Holocaust survivors includes anxiety and depression, intellectual impairment, social withdrawal, sleep disturbance and nightmares, physical complaints and mood swings with loss of drive. Several studies have examined the "chronic and progressive" nature of the condition, with symptoms increasing in intensity as survivors age. [8] [9]

Commonly such survivors feel guilty that they have survived the trauma and others – such as their family, friends, and colleagues – did not.

Both conditions, along with other descriptive syndromes covering a range of traumatic events are now subsumed under post-traumatic stress disorder. [10]

AIDS survivor syndrome

AIDS survivor syndrome refers to the psychological effects of living with the long-term trajectory of the AIDS epidemic and includes survivor's guilt, depression, and feelings of being forgotten in contemporary discussions concerning HIV. [11] While AIDS survivor syndrome has not been recognized as a pathologizable illness by the NIH (as of December 2017), scientific research and publications are available that address this issue. [12]

Examples

Waylon Jennings

American musician Waylon Jennings was a guitarist for Buddy Holly's band and initially had a seat on the ill-fated aircraft on February 3, 1959, which would later come to be known as "the day the music died". Jennings, however, gave up his seat to the sick J.P. "Big Bopper" Richardson, only to later learn of the plane's crash. When Holly learned that Jennings was not going to fly, he said, "Well, I hope your ol' bus freezes up." Jennings responded, "Well, I hope your ol' plane crashes." This exchange of words, though made in jest at the time, haunted Jennings for the rest of his life. [13] [14]

Stoneman Douglas High School shooting

On February 14, 2018, Nikolas Cruz went into Marjory Stoneman Douglas High School in Parkland, Florida, and shot randomly at students and staff, killing 17 people and injuring 17 others. Sydney Aiello, whose close friend was killed, struggled with survivor's guilt, and was later diagnosed with post-traumatic stress disorder. On March 17, 2019, Aiello died by suicide at the age of 19. [15] Less than a week later, on March 23, Coral Springs police announced that Calvin Desir, a juvenile male student from Stoneman Douglas, had been found dead as a result of an apparent suicide. [16]

Stephen Whittle

Stephen Whittle was a Liverpool F.C. fan who had bought a ticket for the FA Cup semi-final between Liverpool and Nottingham Forest F.C. on 15 April 1989, but sold his ticket to a friend due to work reasons. The friend (whom he and his family have chosen to leave unidentified) was one of the 97 victims of the human crush at that game. Whittle became unable to go to football matches due to his guilt and related feeling of responsibility for his friend's death, and died by suicide on 26 February 2011, almost 22 years after the ill-fated match. [17]

The British poet, broadcaster and teacher Charles Causley (1917-2003) served at sea and on land in the Royal Navy for most of the Second World War. Afterwards, he trained and worked as a teacher in Launceston, Cornwall, and (in his spare time and after retiring) wrote hundreds of poems for adults and children, between 1951 and 2000. One strong theme running through his work is his own sense of survivor's guilt -- a feeling in part triggered by the death of a friend who left Launceston for the war on the same train in 1940, but was later lost in action in the North Sea. For instance, Causley tells of how, when walking through the town centre years later, he would cross the road in order to avoid coming face-to-face with that friend's mother.

See also

Related Research Articles

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

<span class="mw-page-title-main">Stockholm syndrome</span> Contested psychological condition

Stockholm syndrome is a proposed condition or theory that tries to explain why hostages sometimes develop a psychological bond with their captors. It is supposed to result from a rather specific set of circumstances, namely the power imbalances contained in hostage-taking, kidnapping, and abusive relationships. Therefore, it is difficult to find a large number of people who experience Stockholm syndrome to conduct studies with any sort of validity or useful sample size. This makes it hard to determine trends in the development and effects of the condition, and in fact it is a "contested illness" due to doubts about the legitimacy of the condition.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples include violence, rape, or a terrorist attack.

Acute stress reaction and acute stress disorder (ASD) is a psychological response to a terrifying, traumatic or surprising experience. Combat stress reaction (CSR) is a similar response to the trauma of war. The reactions may include but are not limited to intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. It may be exhibited for days or weeks after the traumatic event. If the condition is not correctly addressed, it may develop into post-traumatic stress disorder (PTSD).

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Gender is correlated with the prevalence of certain mental disorders, including depression, anxiety and somatic complaints. For example, women are more likely to be diagnosed with major depression, while men are more likely to be diagnosed with substance abuse and antisocial personality disorder. There are no marked gender differences in the diagnosis rates of disorders like schizophrenia and bipolar disorder. Men are at risk to suffer from post-traumatic stress disorder (PTSD) due to past violent experiences such as accidents, wars and witnessing death, and women are diagnosed with PTSD at higher rates due to experiences with sexual assault, rape and child sexual abuse. Nonbinary or genderqueer identification describes people who do not identify as either male or female. People who identify as nonbinary or gender queer show increased risk for depression, anxiety and post-traumatic stress disorder. People who identify as transgender demonstrate increased risk for depression, anxiety, and post-traumatic stress disorder.

Rape trauma syndrome (RTS) is the psychological trauma experienced by a rape survivor that includes disruptions to normal physical, emotional, cognitive, and interpersonal behavior. The theory was first described by nurse Ann Wolbert Burgess and sociologist Lynda Lytle Holmstrom in 1974.

Stress-related disorders constitute a category of mental disorders. They are maladaptive, biological and psychological responses to short- or long-term exposures to physical or emotional stressors. The National Institute of Environmental Health Sciences categorizes Obsessive-Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD) as stress-related disorders. However, the World Health Organization's ICD-11 excludes OCD but categorizes PTSD, Complex Post-Traumatic Stress Disorder (CPTSD), adjustment disorder as stress-related disorders.

Traumatic stress is a common term for reactive anxiety and depression, although it is not a medical term and is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The experience of traumatic stress include subtypes of anxiety, depression and disturbance of conduct along with combinations of these symptoms. This may result from events that are less threatening and distressing than those that lead to post-traumatic stress disorder. The fifth edition of the DSM describes in a section titled "Trauma and Stress-Related Disorders" disinhibited social engagement disorder, reactive attachment disorder, acute stress disorder, adjustment disorder, and post-traumatic stress disorder.

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous. Additional procedures include processing of the trauma memory and breathing retraining.

Incident stress is a condition caused by acute stress which overwhelms a staff person trained to deal with critical incidents such as within the line of duty for first responders, EMTs, and other similar personnel. If not recognized and treated at onset, incident stress can lead to more serious effects of posttraumatic stress disorder.

Derealization is an alteration in the perception of the external world, causing those with the condition to perceive it as unreal, distant, distorted or in other words falsified. Other symptoms include feeling as if one's environment is lacking in spontaneity, emotional coloring, and depth. It is a dissociative symptom that may appear in moments of severe stress.

Victimization refers to a person being made into a victim by someone else and can take on psychological as well as physical forms, both of which are damaging to victims. Forms of victimization include bullying or peer victimization, physical abuse, sexual abuse, verbal abuse, robbery, and assault. Some of these forms of victimization are commonly associated with certain populations, but they can happen to others as well. For example, bullying or peer victimization is most commonly studied in children and adolescents but also takes place between adults. Although anyone may be victimized, particular groups may be more susceptible to certain types of victimization and as a result to the symptoms and consequences that follow. Individuals respond to victimization in a wide variety of ways, so noticeable symptoms of victimization will vary from person to person. These symptoms may take on several different forms, be associated with specific forms of victimization, and be moderated by individual characteristics of the victim and/or experiences after victimization.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

<span class="mw-page-title-main">Transgenerational trauma</span> Psychological trauma

Transgenerational trauma is the psychological and physiological effects that the trauma experienced by people has on subsequent generations in that group. The primary mode of transmission is the shared family environment of the infant causing psychological, behavioral and social changes in the individual.

Emotional abandonment is a subjective emotional state in which people feel undesired, left behind, insecure, or discarded. People experiencing emotional abandonment may feel at a loss. They may feel like they have been cut off from a crucial source of sustenance or feel withdrawn, either suddenly or through a process of erosion. Emotional abandonment can manifest through loss or separation from a loved one.

The genetic influences of post-traumatic stress disorder (PTSD) are not understood well due to the limitations of any genetic study of mental illness; in that, it cannot be ethically induced in selected groups. Because of this, all studies must use naturally occurring groups with genetic similarities and differences, thus the amount of data is limited. Still, genetics play some role in the development of PTSD.

<span class="mw-page-title-main">Effects of genocide on youth</span>

The effects of genocide on youth include psychological and demographic effects that affect the transition into adulthood. These effects are also seen in future generations of youth.

Trauma-sensitive yoga is yoga as exercise, adapted from 2002 onwards for work with individuals affected by psychological trauma. Its goal is to help trauma survivors to develop a greater sense of mind-body connection, to ease their physiological experiences of trauma, to gain a greater sense of ownership over their bodies, and to augment their overall well-being. However, a 2019 systematic review found that the studies to date were not sufficiently robustly designed to provide strong evidence of yoga's effectiveness as a therapy; it called for further research.

<span class="mw-page-title-main">Post-traumatic stress disorder after World War II</span>

WWII lasted from September 1st, 1939 until September 2nd, 1945. The death toll during WWII has been estimated to be between 35,000,000 and 60,000,000. However, the exact number is unknown. With all those fatalities, it should not be surprising that it left so many lasting effects on the survivors. There have been many terms for these lasting effects over the decades. These terms include, but are not limited to, shell shock and combat fatigue. In 1980, the diagnosis of PTSD was added to the newly published DSM 3.

References

  1. 1 2 Fimiani, Ramona; Gazzillo, Francesco; Dazzi, Nino; Bush, Marshall (2022-07-03). "Survivor guilt: Theoretical, empirical, and clinical features". International Forum of Psychoanalysis. 31 (3): 176–190. doi:10.1080/0803706X.2021.1941246. ISSN   0803-706X.
  2. 1 2 "Post-traumatic stress disorder". www.who.int. Retrieved 2024-07-27.
  3. ↑ JoNel Aleccia, "Guilty and stressed, layoff survivors suffer, too", NBC News, December 15, 2008
  4. ↑ Joseph, S., Yule, W., & Williams, R. (1994). The Herald of Free Enterprise disaster: The relationship of intrusion and avoidance to subsequent depression and anxiety. Behaviour research and therapy, 32(1), 115-117.
  5. ↑ Bonnie S. Fisher, Steven P. Lab. Encyclopedia of Victimology and Crime Prevention, SAGE, 2010, p. 33, ISBN   978-1-4129-6047-2
  6. ↑ Ryn, Z (February 1990). "The evolution of mental disturbances in the concentration camp syndrome (KZ-syndrom)". Genet Soc Gen Psychol Monogr. 116 (1): 21–36. PMID   2184095.
  7. ↑ Walt Odets, "In the Shadow of the Epidemic: Being HIV-Negative in the Age of AIDS Archived 2018-02-21 at the Wayback Machine ", 1995.
  8. ↑ Lebovic, Matt; Gross, Judah Ari (18 January 2020). "The only novel written at Auschwitz is finally to be published in English". The Times of Israel. Retrieved 2020-01-21.
  9. ↑ Raphael, Beverley, (1986). When disaster strikes. pp. 90-91. Century Hutchinson, London.
  10. ↑ Wilson JP, & Raphael B Editors. Theoretical and Conceptual Foundations of Traumatic Stress Syndromes. The International Handbook of Traumatic Stress Syndromes, p. 1. Plenum Press, New York. 1993.
  11. ↑ "What is AIDS Survivor Syndrome – Lets Kick ASS". Lets Kick ASS. 2016-08-08. Retrieved 2017-11-30.
  12. ↑ Broun, Stacy N. (1998-06-01). "Understanding "Post-AIDS Survivor Syndrome": A Record of Personal Experiences". AIDS Patient Care and STDs. 12 (6): 481–488. doi:10.1089/apc.1998.12.481. ISSN   1087-2914. PMID   11361996.
  13. ↑ VH1's Behind the Music "The Day the Music Died" interview with Waylon Jennings.
  14. ↑ "Waylon's Buddy: Jennings Never Forgot His Mentor". CMT. Archived from the original on March 23, 2004.
  15. ↑ "Parkland survivor takes her own life just more than one year after deadly mass shooting". Aol. News. March 22, 2019.
  16. ↑ Madan, Monique (24 March 2019). "Second Parkland shooting survivor kills himself, police confirm". Miami Herald. Retrieved 24 March 2019.
  17. ↑ "The 97th Hillsborough victim: Fan sold ticket to friend who died in disaster". The Independent. 2012-09-16. Retrieved 2022-11-02.

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