Vol. I., No. 1 April 2019 Building Resilience from Survivor Guilt After a Traumatic Event Veronica Powell, PhD Measures4Success, LLC Monique Swift, PsyD Swift Solutions Consulting Services, LLC Please address correspondence to: Veronica Powell, PhD, LPC, Measures4Success, LLC, 1629 K St NW Suite 300 Washington, DC 20006 ([email protected]) Monique Swift, PsyD, LPC, Swift Solutions Consultant Services, LLC, 362 Albermarle St., Rahway, NJ 07065 ([email protected]) The authors have no conflicts of interest to declare as it pertains to this article. Abstract: Not a year goes by without media coverage of causalities involving mass violence or natural disasters. Those affected directly or indirectly are left to pick up the pieces and establish a “new norm” for navigating the life that was lost pre-tragedy. Those who physically survived the trauma of mass casualties are challenged to reconcile various emotional reactions such as guilt from the tragedy. The emotions of guilt take on a transformative quality, moving from healthy guilt to unhealthy guilt, such as survivor guilt. With guilt itself being a powerful emotion, those plagued by the grips of survivor guilt may be limited in their ability to recognize the role of resiliency to assist in their recovery and healing from the trauma. Additionally, practitioners may be challenged to assist trauma survivors with complex guilt reactions. This paper examines the etiology, symptoms, and intervention strategies for survivor guilt and its impact on trauma survivors and provides strategies to assist trauma survivors in harnessing the power of resilience to move through the barriers of survivor guilt post-tragedy. Keywords: guilt, survivor guilt, PTSD, prosocial behavior, protective factors, resilience The experience of guilt after a traumatic depression), decreased self-esteem, or limited event is not a new phenomenon. In general, social support (Good Therapy, 2018). These guilt represents a form of judgment that may be factors are noted to increase the trauma based on one’s belief system, such as remorse survivor’s susceptibility to developing survivor from something that is believed to be bad, guilt. wrong, or a biblical sin (Fink, 2016). The destructive impact of a traumatic Unfortunately, the unprecedented rise of experience on a trauma survivor depends on natural disasters and mass violence has created factors such as characteristics of the individual, a paradigm shift in how survivors of a traumatic the type of event(s), developmental processes, event process the emotion of guilt. Although a the significance of the trauma, and traumatic event may affect people differently, sociocultural factors (SAMSHA, 2014). For some trauma survivors may display increased example, a CNN interview of a trauma survivor vulnerability to the impact of guilt, whereas from the 2017 Las Vegas massacre described others may exhibit more resilient responses to the guilt of surviving the massacre “unscathed” the trauma. An individual’s vulnerability to and not knowing if they “Did enough?” or if guilt may be related to factors such as a history they “Helped enough people?” (Ellefson, of trauma, mood related disorders, (i.e., 2017). The survivor presented a classic case of This is an Open Access journal. It adheres to the CC BY-NC-ND 4.0 Creative Commons licensing guidelines for copyrighted material. For terms and conditions of permitted uses, please see https://creativecommons.org/licenses/by-nc-nd/4.0/legalcode. _____________________________________________________________________________________________________ CSHR Vol. I, No. 1 April 2019 14 Building Resilience from Survivor Guilt After a Traumatic Event what is known as survivor guilt. I too [VP] can instinctual survival drives and pleasures in a attest to the experience of survivor guilt. When prosocial direction. Valent further noted that I was 14 years old (1984 Easter weekend), a guilt is one of three moral judgments, with the tornado in my rural Mississippi community other two being shame (e.g., judgment of an killed a family who lived approximately one individual’s worth) and justice (e.g., judgment mile from my home. I reflect on my own of fairness). experience of survivor guilt after surviving the Fundamentally, guilt has prosocial storm. I was left with many questions such as attributes in that it judges an individual’s “How come my family didn’t die from the actions as good or bad and can strengthen storm?” “How did the tornado sideswipe my interpersonal relationships (Valent, 1998; house (without destroying it) and then Baumeister, 1997). However, for those who miraculously go back in the air, only to touch have experienced a traumatic event there is a down and destroy the house and the family potential for the individual to feel excessive or down the road from us?” “Why them and not irrational guilt over surviving the trauma. us?” “How did we escape and not them?” Kubany and Manke (1995) identified four “What could we have done to warn the family cognitive factors of guilt related to survivors of down the road?” “What was my purpose for traumatic events as identified in traumatized living?” (Powell, 2019). individuals: (1) a violation personal standard This article expands the general related to right or wrong; (2) perceived understanding of survivor guilt and its ownership/responsibility or preventability of differentiating factors from what represents a the event; (3) perceived lack of justification for healthy response to guilt versus unhealthy guilt. acting; and (4) false beliefs regarding pre- Further examination of survivor guilt includes outcome knowledge or hindsight bias. Guilt a review of the literature on (a) its etiology, that is associated with an individual surviving symptoms, and intervention strategies; (b) the or being uninjured in circumstances whereby impact on trauma survivors; (c) postvention another person died or was physically or treatment strategies; and how the power of psychologically injured is known as survivor resilience is leveraged to move through the guilt (Hutson, Hall & Pack, 2015). barriers of survivor guilt post tragedy. A contextualization of guilt is presented as a Etiology, Symptoms, and Intervention baseline to understanding survivor guilt. for Survivor Guilt Survivor guilt as an unintended Contextualizing Guilt consequence of a traumatic experience has A review of the literature identifies several been recognized as a shared phenomenon by definitions associated with the concept of guilt. trauma survivors. For example, Neiderland Guilt is generally defined as a fact or state of (1961) introduced the concept of survivor guilt having committed an offense, crime, violation based on his work with Holocaust patients. or wrong that goes against a moral standard or Through his observations, Neiderland penal law (as cited in Elliot, 2018). It is further described a psychological state that was defined as a cognitive or emotional experience common among survivors from World War II occurring when an individual believes or concentration camps. He noted that survivors realizes that they have compromised their own displayed feelings of intense guilt for surviving standard of conduct or violated a universal loved ones who were killed in the concentration moral standard and feel significantly camps and would behave as if they were dead responsible for the violation. Tilghman- themselves (O’Connor, Berry, Weiss, Bush, & Osborne, Cole, and Felton (2010) expand the Sampson, 1997). The concept of survivor guilt definition of guilt as representing “moral was further expanded to include all trauma- transgressions (real or imagined) in which related events, be they natural or manmade. people believe that their action (or inaction) According to Modell (1971), survivor guilt contributed to negative outcomes” (p. 546). can include more subtle forms such as Valent (1998, 2000), described guilt as an inhibiting oneself from success, engaging in internal moral judgment that aims to modify self-destructive behavior, or over-identifying _____________________________________________________________________________________________________ CSHR Vol. I, No. 1 April 2019 15 Building Resilience from Survivor Guilt After a Traumatic Event with one’s suffering. Valent (2000) identified trauma-related symptoms. Furthermore, the following eight survival behaviors that are symptoms of survivor guilt are often related to associated with survivor guilt: those of anxiety and depression. 1. Rescue/caretaking mode involves agonizing over Symptoms experienced may range from guilt due to neglectfulness and self-concerning mild to severe, and may impact physical being, behavior that caused harm, suffering, or death to thoughts, feelings, and behaviors. A few others, particularly those for whom they bore examples of symptoms are presented in Table responsibility. Individuals operating in 1 (adapted from Weaver, 2011, p. 15; rescue/caretaking mode will blame themselves for E4Health, 2012). not saving those for whom they felt a sense of The noted symptoms experienced by a responsibility. trauma survivor indicate that intervention is 2. Attachment consist of guilt that is experienced as warranted to mitigate the long-term negative bad, sinful, or disobedient. The individual believes consequences of psychological trauma. When that they are the cause of the catastrophe and by working with trauma survivors, it is important abandoning the situation, must be punished for to validate their experience of the trauma by their badness.