What is Survivor's paradox?

This is the Survivor's Guilt Paradox: Veterans are happy to be alive and uninjured, yet feel guilty that teammates have been catastrophically injured or killed.

veteranmentalhealth.com - The Survivor's Guilt Paradox — Head Space and Timing

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This post is part of a year-long series, The Paradox Problem. You can go here to see the introduction to the series, and see all the articles in the series here. We who have come back, by the aid of many lucky chances or miracles – whatever one may choose to call them – we know: the best of us did not return. – Viktor Frankl This quote by Viktor Frankl illustrates the feelings that concentration camp survivors had about their fellow prisoners. In his book, Man’s Search for Meaning, Frankl shares how survival through suffering can provide meaning to one’s life. For Frankl, and for many veterans, this suffering comes in the form of ultimate loss: the loss or injury of those who were closest to us. The guilt and shame that many service members experience related to the loss or injury of someone they served with is contrasted with the appreciation they have for life. This is certainly true in combat veterans, but not necessarily always. I have seen this level of guilt happen in someone who was sent to a new duty station or on military school or training; they “should have been” on a deployment when a friend lost their life. At the same time, however, there is relief that they survived and happiness at being alive.

This is the Survivor’s Guilt Paradox:

Veterans are happy to be alive and uninjured, yet feel guilty that teammates have been catastrophically injured or killed

Happy to Be Alive…

Even in difficult times, joy for life can be found. Many veterans I work with find satisfaction in their daily lives; in their families, in their work, in community activities and civic engagement. We fly aircraft, climb mountains, surf waves, travel, run for office, take care of those we love. When someone returns from a combat deployment, or even just leaves the military, they often have a greater appreciation for things that they used to take for granted. Not just the common things like a good home-cooked meal or something from their favorite burger joint, but things like safety. Solitude. quiet. After working with someone in therapy and they look back on what they thought and how they felt, they are often surprised at the progress they have made. They realize that there is hope for the future and satisfaction in their daily lives. This came at a cost…we have to go through hell to truly appreciate heaven…but it came all the same. Life can be very, very good, even in the midst of chaos and pain.

…But Feel Guilt Related to Survival

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While a veteran can, and arguably should, feel happy at their survival and enjoy life, there is also a measure of shame and guilt related to that survival. Survivor Guilt is a significant component of Moral Injury, the act of witnessing, failing to prevent, or perpetrating acts that transgress deeply held moral beliefs and expectations (see Litz et al., 2009). Moral injury has a sense of betrayal as it’s core aspect. The deeply held belief related to this guilt is something like, “I should have done something to stop it” or “I should have been there.” Quite often the belief after the loss is, “it should have been me.” The problem is often compounded by the fact that the veteran can acknowledge that they had a measure of responsibility related to the loss. They ordered a soldier to be in a certain place at a certain time, or allowed themselves to be convinced that a certain thing should happen. A decision was made to leave a location at a certain time, or go to the right of an obstacle instead of left, and someone else was hurt or killed. The “act of witnessing, failing to prevent, or perpetrating acts” described above relates to doing something or not doing something that resulted in serious injury or death.

Struggle Between Happiness and Guilt

The tension between these two sides of the paradox can cause significant distress for many veterans. How is it possible to be happy and enjoy life when my friend is gone? Why should I get to feel satisfied with my work, spend time with my family, when their family paid the ultimate sacrifice? These painful negative thoughts can cause veterans to isolate or avoid others. This can be done to protect the veteran, “I’m not safe around others” or protect those around them, “others are not safe around me.” Overburdening themselves with guilt and shame can complicate the grieving process and ultimately result in long-standing and complex grief. This can also cause feelings of inadequacy and shame. Some veterans will minimize the impact of their experiences because “at least I made it back” or “I have all my fingers and toes.” This will keep a veteran from reaching out for help if they need it, feeling that there is a limited amount of resources and what resources there are should go to “those who deserve it.” In the meantime, the veteran is experiencing unnecessary hardship. The impact of “I don’t deserve” is related to the feeling of inadequacy and shame related to their perceived role in the loss or injury of those they served with.

Resolution

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Resolving the Survivor’s Guilt Paradox can be challenging. Both are true…life can be enjoyed while at the same time experiencing guilt about the loss of a fellow service member. Acknowledging that both are true and accepting the reality of it can help the veteran resolve the conflicting emotions. It is also often helpful to assign appropriate responsibility to the injury or loss. Often times, the veteran blames themselves for what happened…”they did what I told them to do” or “I wasn’t there to stop it.” The entire amount of the blame falls squarely on the shoulders of the veteran…but are there others who share a measure of the responsibility? Others in the unit? Persons in the chain of command? What about the person who bears ultimate responsibility…the enemy combatant who planted the IED or pulled the trigger?

One of the reasons that the military works so well is the bond that is developed between those who serve together. Like many other instances of traumatic loss in our lives, the loss or injury of someone we served with can be devastating. At the same time, it does not mean that we should not enjoy life. This post is part of a year-long series, The Paradox Problem. You can go here to see the introduction to the series, and see all the articles in the series here. This paradox, and many others, were identified in a 2015 article in the Journal of Traumatology, authored by Carl Castro, Sara Kintzle, and Anthony Hassan. Castro, C. A., Kintzle, S., & Hassan, A. M. (2015). The combat veteran paradox: Paradoxes and dilemmas encountered with reintegrating combat veterans and the agencies that support them. Traumatology, 21(4), 299. Do you want to help offset some of the costs of the Head Space and Timing Blog and Podcast? Want to show your appreciation and support? You can put some paper in the tip jar by going here or clicking the button below

veteranmentalhealth.com - The Survivor's Guilt Paradox — Head Space and Timing

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