Moving Beyond Survivor Guilt

By Laurie Wertich

“Tell me, what is it you plan to do with your one wild and precious life?” — Mary Oliver

Cancer survivorship can be accompanied by a unique set of emotions—joy, grief, fear, relief, deep gratitude, a heightened sense of purpose, and an overwhelming sense of responsibility to live life to the fullest.

But there is another nagging feeling that can sneak into the mix: guilt. Survivorship is such a blessing, yet in spite of that blessing, we often find ourselves reflecting on those who have not been as fortunate.

Why me?

The first question that many people ask in the face of a cancer diagnosis is Why me? This is a normal response to such an overwhelming diagnosis. Why did I get this disease? Why am I sick when others are not? Why do I have to endure this treatment? Though generally unanswerable, it is a completely reasonable question.

In the shift from diagnosis to treatment and on to recovery, the primary question changes. More often than not, most cancer patients move pretty quickly from Why me? to What’s next? What do I need to do to survive? How can I best care for myself during treatment? What will I do with my precious life after treatment?

Here’s where it gets interesting: in the face of survivorship, many patients find themselves also circling back around to that first question as they move beyond diagnosis to treatment and recovery, only this time Why me? carries with it a twinge of guilt and sadness. Why did I survive when others did not? Why was I so lucky?

What is survivor guilt?

Survivor guilt is common among survivors of traumatic events—such as war, natural disasters, accidents, and even acute or longterm illnesses such as cancer. Survivor guilt refers to the sense of guilt or responsibility that can occur when one person survives a traumatic event that others did not. And, yes, cancer can be a traumatic event.

“Not all of our patients experience cancer as a traumatic event,” explains Rhonda Colley, MS, LPT, LMFT, a mind-body therapist at Cancer Treatment Centers of America® (CTCA) in Tulsa, Oklahoma. “But even if they aren’t traumatized, they can still experience survivor guilt, which means basically feeling guilty that they got through this treatment journey relatively unscathed.”

Colley works with a lot of survivors who are experiencing some level of guilt. “We call it ‘imagined guilt’ or ‘survivor guilt,’” she says. “Sometimes patients feel responsible in part for the passing of fellow patients.”

This may not make sense to someone who has not walked the cancer path, sat with fellow patients in the waiting room, compared diagnoses and treatment plans, and given and received encouragement throughout the journey. But to a cancer survivor, it makes perfect sense, and it is another part of the cancer journey that must be processed.

Who experiences survivor guilt?

There is a sense of implied comparison that occurs among people who have endured similar ordeals. It’s only natural to compare type and stage of cancer, treatment plans, nutrition plans, and more. It’s what we do—we find common ground, especially in the face of cancer—because we need one another.

“We have an amazing support community at CTCA®,” Colley says. “Our patients seek each other out in the cafeteria and the waiting rooms. They gravitate toward one another. But because of that tight bond, they might be more inclined to feel a sense of survivor guilt.”

Colley explains that CTCA patients form deep connections. “They may have the same type and stage of cancer, and then they go through treatment and one has a different outcome.”

Sometimes in these cases, but not always, survivor guilt ensues. Some patients develop a sense of guilt or responsibility— believing that they should have helped the other patient survive or, worse, that they should have been the one to pass away. Some survivors will get stuck in a vicious cycle of “if only”: If only I had told her about the special vitamins I was taking. If only I had encouraged him to try acupuncture. If only I had worked harder to build hope in that person.

“Some people experience no survivor guilt, and others are overwhelmed by it,” Colley explains. “Many times it’s something that may be operating at a deeper level, and the person is not even aware that they have it.”

Coping With survivor guilt

Though some refer to survivor guilt as imagined guilt, that’s not to say it isn’t real. “We do not invalidate anyone’s feelings. Feelings are very real,” explains Colley. “The feeling of guilt is real, but the foundation of it is imagined.”

With that in mind, often the first step in coping with survivor guilt is to examine the foundation of the guilt. A mind-body therapist can be instrumental in this process. “I really encourage patients to talk to us about their feelings regarding other patients,” Colley says. “Sometimes it is a big help just to verbalize the feelings.”

Colley says that she asks patients to be willing to hear feedback: “We mirror back to them what we are hearing them say— which is that they are experiencing something that is understandable but unfounded.” She says that it is important to examine the feelings and understand that they are real—but unrealistic. “We ask them to really think about how they arrived at this conclusion that they should have been able to help this other person survive.”

Colley encourages patients to examine their feelings of guilt by journaling, talking to a therapist, or participating in a support group. “I like to get patients connected to groups because that can help give them a constant sense of balance,” she explains.

What’s more, Colley says that one of the most effective ways to move beyond survivor guilt is to look ahead and try to bring something good out of the experience. “What could a survivor do that would be productive and fruitful going forward?” she asks.

Survivorship presents an opportunity to leave regrets behind and reprioritize life in a new way. Sometimes this means making drastic changes, but sometimes it can be as simple as planting a tree in honor of a fellow patient who did not survive.

This too shall pass

The good news is that survivor guilt typically fades with time. It is important to acknowledge and accept the feelings of guilt—and allow yourself to move beyond them. You deserve to survive and thrive and enjoy your one wild and precious life.



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