Surviving Survivor's Guilt

Recently, I lost another friend to breast cancer. Although I knew her death was imminent, I was unprepared for the news when it arrived. My first response was disbelief. Doing my best to process her daughter’s words, I tried to accept them, but it was difficult. My friend had just started a new treatment regimen. We were hopeful it was going to work. She’d been feeling better. Although I was thankful her suffering was finally over, it just didn’t make sense. And if felt so unfair.

When we’d first met, this friend and I discovered we had a lot in common. We shared the same diagnosis, the same stage of cancer and the same grade of tumor. Our cancers were also fed by the same hormones. We shared other commonalities that were unrelated to health, too. We were the same age, had the same number of children and enjoyed the same types of hobbies.

After initial treatment for breast cancer, both my friend and I opted against chemotherapy, so we chose to explore natural treatment options, instead. By choosing alternative therapies, we’d hoped for long lives devoid of the problematic side effects we'd experienced during our rounds of radiation and as we'd tried antihormonal therapy.

As we researched options, we shared them with each other in hopes of finding something that would work. At times, it felt like a game. I’d call her saying, "Have you tried this?" And she’d call me asking the same question about a different alternative treatment. Occasionally, we’d find that, through trial and error, we were helping each other. In those moments, we developed a comaraderie like no other. We were sisters, even though we share no familial ties. That closeness is one of the reasons the news of her death was so difficult.

After her passing, I experienced a range of emotions. Of course, I was sad at losing my friend. I was also angry. I was upset that cancer had won the fight, especially since my dear friend had given her all to live. And then, something unexpected happened. I began to feel guilty — guilty that I was alive and she was not.

My guilt felt like a double-edged sword. On one hand, I was extremely sad that my friend had died, but on the other hand, I was so thankful I was still alive. As I tried to process these feelings, I felt confused. Why was I feeling guilty about something over which I had no control? I didn’t realize it at the time, but learned later that the feelings I was experiencing were known as survivor’s guilt.

I’d heard about survivor’s guilt at the cancer treatment center, but I’d never experienced it myself. According to the counselors at the center, this phenomenon happens when a person feels guilty about surviving a life-threatening situation when others did not. It’s a common reaction to a traumatic event and is often associated with symptoms of post-traumatic stress disorder.

In a publication posted by Memorial Sloan Kettering, Kimarie Knowles, a clinical social worker who works with cancer survivors, says: “Often, when people are diagnosed with cancer, they contemplate their own mortality and vulnerability for the first time, (and) the feelings of powerlessness or helplessness that can be triggered in the face of illness are overwhelming. Guilt can be a way to protect us from those feelings, because it’s something we feel we can control.” Ms. Knowles goes on to say that “One sign of survivor’s guilt is when patients try to minimize or dismiss their own cancer experience because they believe other people are worse off than they are. They may say, ‘I only had surgery, while he had surgery, chemotherapy and radiation. Survivors coping with these emotions often feel that they need to justify their existence or that they don’t deserve to be here. This often speaks to the feelings of powerlessness and grief related to their own cancer experience.”

Survivor’s guilt is not experienced by every cancer survivor, but for those who face it, the feelings of remorse and grief are very real. These feelings are different for each individual and are not limited to survivors of cancer. For instance, some military veterans experience it during times of war, as do people affected by tragic events such as those that occurred on Sept. 11, 2001.

Surviving survivor’s guilt is challenging. There is nothing that can completely remove feelings of guilt or sorrow after the loss of someone to cancer, but there are things one can do to cope and ease some of the burden.

In my situation, a grief counselor’s advice helped me understand the importance of acknowledging my feelings. She said that, as I gave myself permission to feel what I was feeling, I’d begin to understand that my thoughts and feelings were valid. When I came to that point, I was able to give those feelings a voice.

It took time to learn to speak freely about what I was feeling. At first, I was embarrassed to admit feeling guilty over my friend’s death. But as I began to share my thoughts with others who’d been through some type of cancer experience, I began to feel better. And the interesting thing was, I found that others felt the same way, and took comfort in knowing I was not alone.

Another way I coped was by focusing on my friend’s life. As I remembered her, I couldn’t help but think about what she might wish for me in the future. I knew she wouldn’t want me to be sad and depressed. She’d want me to go on living my life and she’d want me to be happy. I knew if the shoe had been on the other foot, so to speak, I’d have wanted the same for her.

What all this has taught me is that those of us who experience survivor’s guilt can rest assured that the feelings are normal. This guilt is a clear indicator of the depth of compassion one person feels for another. None of us may ever understand why one person lives and another doesn’t, but we must choose to live our best lives as long as we are able. In doing so, we honor those who’ve lost the fight.