Survivor’s Guilt

Recently, a friend shared an article from the New York Times by Matthew Futterman that discusses the prominence of Brain Injury in the sport of Bobsledding, a sport that is often overlooked by the popular press, and this got me thinking about survivor's guilt. The article shares the story of Joe Sisson, a bobsled athlete with an Olympic future who experienced a crash resulting in TBI for both he and his partner, Travis Bell — Sisson has survived while Bell has not.

It was not in the moment of the injury that Bell passed, but suicide nearly fifteen years post injury, but regardless of the time post injury it was clearly directly related to the accident. As Bell's father reports, “In reality, he died the day that crash happened. He never recovered from it.” The article doesn’t directly state how much Sisson, the surviving bobsledder, knew of his teammates’s struggles, but one must assume there was at least some contact and that he had a sad awareness as his friend descended into the medically prescribed hell of numbing drugs and treatments that eventually led to suicide. In contrast to Bell, Sisson has decided to use his experiences and passion to begin his path toward becoming a collegiate level strength and conditioning coach. Bell was not able find such an alternative path.

When BI occurs, professionals cannot say with certainty what causes particular outcomes, but several have suggested that Sisson’s relatively young age, 21 at the time of his injury, may have helped to temper the effects of the injury. Bell was 27, and while there was only a six years difference in their ages, it was likely enough to change how the athletes were able to adapt to the effects of the trauma, and that difference will hang over Sisson’s professional and personal success as he moves into the future — it’s understandable that he has survivor’s guilt.

Now, guilt was not the focus of this article – in fact it was only briefly mentioned – but that mention made me think about what is meant by the term “survivor’s guilt”. Prior to my accident, I had thought of survivor’s guilt as as condition that occurs when there is a trauma with two or more persons and one survives the initial collision (or other event) while others do not. It seem reasonable in this situation that the surviving person might ask, “Why did I survive while they didn’t?” As there is no satisfying answer to such pain, guilt forms as a substitute. Over the years, however, I’ve come to recognize that a trauma does not end in that moment, and effects will resonate for a lifetime. Bell survived for 15 years after his injury before he was subsumed by the difficulties of recovery and decided to end his life, and Sisson understands that Bell’s choice to commit suicide was directly connected to the trauma. Sisson survived by finding a way to move on with his life and his teammate was not able to do the same. There are medical explanations that can suggest some reasons happened, but these are cold comfort to the question — “Why? When we both worked so damn hard, how did I find a way to adapt and you did not? Why did you have to die?”

I will not delve any further into this particular story as I have only the information presented in the short article cited above, but as I said, this mention of guilt made me curious, and when I web-searched for more information about “survivor’s guilt after TBI” I found the article, “TBI Survivor Guilt — Life After Brain Injury”, written by David A. Grant, author and publisher of the TBI Hope magazine. In this article Grant shares about his guilt that comes from the challenges his recovery has caused in the lives of those who love him — the guilt he feels about requiring that his loved ones cope with his personality changes, find ways to deal with his inconsistent emotions, manage the financial strain of medical appointments, and deal with countless other tasks that require both assistance and acceptance. Grant recognizes that his BI burdens those around him, and this creates guilt.

Let’s be clear that Grant’s guilt this can be considered a variation from the definition of “survivor’s guilt”, and some might suggest that because it does not stem from surviving when another died, and it might be considered something else all together. I will point out, however, that in Grant’s situation he is dealing with a negative, painful emotion that originates from feelings attached to the burden of living after a trauma — call it what you will, and I don’t want to get tangled in the specifics of definition, but he does have guilt that is related to his survival after a trauma.

I also reflected on my experiences working with The Crumley House Brain Injury Rehabilitation and Living Center. If you’ve read my previous work, the name of this institution should be familiar to you, but if you are new to this blog, know that I became familiar with the residents when doing graduate work about brain injury. Prior to work with The Crumley House, my exposure to other survivors of TBI was relatively limited, and my interactions with the institution introduced me to the range of recoveries that occur after TBI, causing me to face the reality of how fortunate my recovery had been. At the time, I was grateful to receive this knowledge, but I also felt distress at the realization of how hard recovery is for many survivors — I felt guilt that my healing been so comparatively smooth, yet I moaned about the trials of recovery. This made me mad — I felt anger toward myself for bitching about comparatively trivial difficulties when there are so many other people who have not been able to move on after injury in the same way. To be clear, it didn’t stop me from feeling personal sorrow about difficulties that came from BI, but with each moan there was a simultaneous self-spiteful questioning, “How dare I complain when I had such a comparatively easy recovery process.” I hesitate to term this “survivor’s guilt” as I don’t want to abuse the term with over generalization, but I did discover feelings that required significant energy to process. Again, I don’t think the specific term matters, as what I felt was guilt that came from having survived and recovered in the manner I did.

So, in this writing, I have presented three examples of what may be variations on “survivor’s guilt” after TBI — feeling guilt about a suicide that occurred a significant time after the initial injury, guilt at how the BI burdens the life of caregivers, and guilt at reaching a high level of recovery while many are not so fortunate. Some may disagree with lumping these situations under an umbrella of “survivor’s guilt,” and I understand that, but will not take space to parse out exactly what is or isn’t this condition. I do, however, invite and encourage anyone to share experience or insights about this in the comments as I am eager to learn more.

But moving away from the definition, I point out the similarity in all these situations — a person who has survived BI will almost certainly struggle with the foul fortune of questions that can come as part of surviving. From my experience, the questions can be — Why am I the one that survives? Is there a reason for any of this? Is my life forever a burden to everyone around me? Did I do anything to deserve my injury or my recovery? Would it have been better if I had died instead? Be clear, these are simplified versions of questions, but I believe they allude to a cauldron of painful quandaries that many survivors reading this will understand.

But more importantly, and this is what I want to emphasize I also see a similarity in the actions of the survivors in dealing with their situation -- we have found a method to reach out to assist fellow survivors. I suggest that this is something that can help to manage the guilt — finding a way to use the experience of recovery as a tool to help others. In the first story, Sisson has made the decision to study and lead courses on sports safety at a collegiate level — while the article doesn’t specifically state his motivation for this decision, it seems likely that this may come from his desire to encourage fellow athletes in finding ways to avoid similar injuries. In the next example, Grant has taken it upon himself to regularly publish a magazine of hope and inspiration for fellow TBI survivors, using his experience and skill as both a writer and editor to inspire and connect the BI community. Similarly, in the third example, I am using my experience to share an inspirational stories and advocate for BI rehabilitation. In all three examples we deal with our confusing and possibly dangerous emotions by using our experience — our story — to help other people. We have learned how to use BI as a tool and have devised a way in which it can add a new dimension to our life.

Brain injury is not a good thing, but that doesn’t mean it needs to be all bad. It is an experience, and by surviving, one can turn this experience into a tool for helping others. The examples cited above demonstrate how embracing such an opportunity can help to alleviate guilt that might come from surviving — by surviving, you have been given a tool and it can be your choice to use that tool to aid others. Personally, I hope that you do use your experience to enrich lives, for knowing that your thoughts, insights, and words have helped someone is one of the greatest rewards a person can find, and this can help to create personal gratitude for survival.

Those are my thoughts, thank you for reading. Please leave any comments or thoughts on survivors guilt in the comments below. Also, please share with friends and anyone who might be helped by these thoughts. Keep in touch.