How to cope with COVID survivor's guilt

Many of us experienced death up close, survived or lived through painful events after three years of pandemic. This scenario makes us prone to certain mental conditions such as survivor's syndrome, a phenomenon that occurs when we feel guilty for having survived a situation where the lives of others and ourselves were at risk.

"Guilt is a common response to life disasters, because the person thinks they could have done more or done it differently," says Carlota De Sousa, a clinical psychologist, with a Master's degree in cognitive-behavioural therapy and certifications in Gestalt therapy, EMDR and experiential techniques.

The term “survivor guilt” was first used after the Holocaust. Since then, it has been related to life-threatening traumatic events such as wars, car accidents, terrorist attacks, natural disasters and recently to the pandemic.  

Grieving during the pandemic brings its own unique characteristics. For many it has been difficult to cope with the consequences of the virus, not to accompany their loved ones during illness or even not being able to arrange a funeral. This context is a threat to mental health according to recent research that qualifies COVID-19 as a traumatic stressor.

Complicated grief during the pandemic

Because of the isolation, no one in my family was able to visit my dad when he was hospitalised from COVID in 2021. After three weeks, I had to identify his body while I was wrapped in a biosafety suit. At that time, the health authorities told us about the ban on funerals. I understood it and took it as a responsibility. I knew that my dad, as a doctor, would not want anyone else in the family to go through a similar process.

Grief is experienced in different ways. For many people, it is complicated to cope with these circumstances and additionally to obey the new rules that change the cultural processes related to death. According to psychologists, in potentially traumatic times, anyone can develop mental health conditions. Specifically, survivor guilt in the current scenario is being associated with post-traumatic stress disorder. We have all been through collective trauma, however, there are populations that are more susceptible.

In a study conducted by Hannah L Murray, a clinical psychologist and researcher at Oxford University, it was revealed that 90 per cent of survivors of a traumatic event reported feelings of guilt. The data were collected over an 18-month period at a traumatic stress clinic in the United Kingdom.

For my 94-year-old grandmother it was particularly difficult. Over the first few months she felt guilty. She contracted COVID in 2020 and kept asking herself one question: why did she survive the virus and her son did not? A thought with which she punished herself. My maternal grandmother (86) also berated herself, after almost 50 years of knowing my dad, to her, he was another of her children.

In the last few months they both faced health problems. Although they are of advanced age, they have always been healthy, lucid and active, but the pandemic and the deaths have affected them. The fact that so many young people have died does not sit well with them.

Mental and physical processes

"The body speaks. The body needs to express the process that the mind is going through. Survivor guilt is going to lead to a lot of emotional difficulties that can be related to physical illness," De Sousa points out.

Some symptoms of the syndrome can include depression, anxiety, fatigue, headache, irritability, heart palpitations, recurrent thoughts and fear. However, according to De Sousa, survivor guilt is complex, as each person reacts differently, so the intensity, duration and symptoms can vary. "Some people share the feeling to alleviate guilt. But many people keep it quiet, they hold it inside because of guilt or shame."

A study by a group of researchers in England, reports an increased likelihood of the onset of guilt when the survivor has the same chances as those who died, "for example, COVID-19 patients admitted to ICU who knew that many other patients on the ward died, but not them." Similarly, they admit that it could be part of a complicated grief reaction, where negative beliefs about the loss can prevent acceptance of reality.

"People who have been in the ICU or with preexisting conditions are more prone to guilt, because they don't get to understand why they haven't died and another younger person, without diseases or respiratory difficulties, has died," De Sousa says. "It also depends on the bond with the deceased person, it is more accentuated with a close person or even people who have shared a hospital room."

How to help us heal?

While undergoing this process it is important to access beneficial resources such as meditation, exercise, connecting with nature, establishing a routine, going to therapy and fostering communication. Therapists advise sharing emotions with people close to us or with others who have experienced similar events.

Talking helps to change perspective, realise we have support and abandon states of personal recrimination. "Thoughts are an important part of this process and of all vital processes. Certainly, we have to work on them," De Sousa stresses the need to take care of ourselves, "with punishment we are not going to solve anything. We have to be kinder to ourselves and remember that we have not harmed our loved one by having survived."

During bereavement and mental health processes, we should avoid following social expectations that create more anxiety. Everyone has their own pace and process. However, we must be aware of practices that can be harmful such as skipping meals. Feeling guilt is not the same as being guilty. It is essential to validate our emotions and accept our lack of control over everything that happens in our lives.

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