Survivor guilt is the guilt that people feel when they are the one left behind after a death. It could be for surviving the accident that killed them. It could be what you felt you should or shouldn't have done before their death. Or it could simply be that they were ill and you were not. Around 90% of people who survive a traumatic event experience survivor guilt.
 
The kinds of symptoms of survivor guilt overlap with those seen with post-traumatic stress disorder (PTSD), and survivor's guilt has been defined as a symptom of PTSD.

• Guilt for surviving
• Flashbacks, nightmares and intrusive thoughts
• Constantly thinking and analysing what happened
• Wondering what might have happened had things been different – the What Ifs
• Anger, mood swings and irritability
• Anxiety
• Appetite changes
• Problems sleeping
• Feeling confused, helpless or disconnected, or having trouble concentrating
• Physical symptoms, like nausea, stomach-aches and headaches
• Lack of motivation, depression, despair or suicidal thoughts
• Desire for isolation
• Feeling like you can't trust anyone
• Feeling that you are a bad person and that you are responsible for what happened (even if you weren’t)
• Feeling that you didn't deserve to be alive
• Seeing the world as unjust, unfair, cruel or dangerous

 
People who have been through trauma before, who live with mental health, addiction or psychiatric issues, or who lack self-esteem, are introverted or are submissive by nature may be more likely to experience survivor guilt.
 
Survivor guilt generally starts to fade over time. There are a few hints and tips that might help you cope with the feelings:

• Understand that while the feelings aren't logical, and often aren't true, they are normal, and you are allowed to feel like this
• Try to process your feelings of grief or guilt
• Think about the outside factors that may have caused the situation, which might help you to put things in perspective
• Try to forgive yourself for any role that you played in the situation
• Talk through how you feel with friends, family or people in your grief support groups
• Write about how you feel or create some art
• Be kind to yourself – go for a walk, read a book you love, watch a film you enjoy, listen to music, have a warm bath
• Try not to resort to self-medication through drugs or alcohol
• Do something that helps other people – volunteer, give blood, work to improve your local community

 
If your survivor guilt symptoms become overwhelming and mean that you can't function properly, consider talking to a psychotherapist or counsellor.

There are so many 'what ifs' after we lose someone

• What if I'd given them a lift?
• What if I'd noticed their cough?
• What if I'd gone instead of them?
• What if I'd looked after them better?
• What if I'd seen the signs?
• What if I'd sent them to the doctor's?
• What if they'd seen a different doctor or had a different surgeon?
• What if they'd left earlier, left later, hadn't gone at all?
• What if I had, or what if I hadn't?
• What if they'd worn a helmet?
• What if I'd loved them more?
• What if I had told them to stop drinking, or eat more healthily?

 
I've looked back over some old posts of mine on the Widowed and Young Facebook forums (WOC is short for the Widowed and Young Without Children group).

My mental and health physical health weren't good in the few months before Tim died. What if that was the reason he didn't tell me he felt ill, or the reason I missed it? Or what if being ill meant that I made his last few months unhappy?
 
Coping with the what ifs
I believe that we get these feelings because our brain is trying to explain things, and attempting to deal with our feelings of helplessness. A fellow WOC said to me "what ifs are like demons on the shoulders of our grief, whispering in our ears at times when we are most vulnerable". What comforts me is that Tim and I loved each other, and that he died at my side.
 
When we get what ifs, it's important to remember that hindsight is 20/20, and what-ifs are generally completely unrealistic. It's like looking at a puzzle – when you first glance at it, it seems unfathomable, but once you have the answers it seems so obvious.
 
When you get caught in what ifs and if onlys:

• Be kind to yourself
• Learn to recognise what ifs for what they are - nasty weaselly thoughts that invade your head
• Say to yourself:
  • That was then and this is now
  • I did the best I could based on what I knew at the time; if I could have done differently I would have
  • I was not the person controlling the situation
  • It was not my fault
  • It was not something I did intentionally
  • I was not a mind reader
  • I am not a doctor​
  • They could have made the decision to go to the doctor or change their diet
• Deal with them as you would other intrusive thoughts, for example using grounding techniques
• Do something you enjoy or that brings you comfort
• Do something physical – go for a walk, a run or a swim, dig the garden, clean the bathroom
• Drown out the thoughts with music, audiobooks or podcasts
• Visualise slamming the door on the thoughts, or stamping on them
• Write the thoughts down and tear them up or scribble them out

Tim died suddenly in the early hours of the morning. His heart just stopped. He had type 2 diabetes that he perhaps didn't manage as well as he should, and he had been feeling tired. But he was a bookseller, and we were in the process of moving his enormous stock of books from one storage unit to another.

​I asked him if he was having chest pain, and he said no. So, I brushed it off as simple weariness. A banana box of books weighs a lot, after all.

After he died, and the post-mortem revealed heart failure related to type 2 diabetes, I was wracked with guilt. What could I have done? Monitored his diet more closely? Watched him take his tablets three times a day? Insisted he went onto insulin? Got the truth out of him about how he was actually feeling? If he'd died in an accident, I suspect I would have felt guilty for not giving him a lift that day, or persuading him to get the bus, or agreeing that he should cycle.

That's one kind of guilt after someone dies. There's also the guilt of feeling that you didn't say what you should have, or said what you shouldn't have. Did I tell him I loved him the night before? Did we work too much and not spend enough time together? What if our last night out had been a terrible one (rather than the wonderful evening it was), or if I'd persuaded him that we shouldn't go? How would I feel if we'd had an argument? This kind of guilt may become more complicated if you had a difficult relationship with the person who died.

As survivors, we can often feel guilty that we are alive, and our partner is dead. This is particularly intense for people surviving an incident where their partner died. Survivor guilt can also be a symptom of post-traumatic stress disorder (PTSD) – talk to your doctor or a psychotherapist if you think you might have PTSD.

In grief, I became full of 'I should have…' 'I could have…' 'I would have…' But feeling guilty doesn't mean that we are guilty – it's us trying to put order into the chaos that grief is. If we can blame someone, especially ourselves, we can think we get back control.
 
What can we do?

• Accept that feeling guilty is totally normal
• Unpack your guilt – is it rational or irrational?
  • If it's irrational, tell yourself this – we can only act based on the information and experience that we have at the time. Consider – could you really have done anything more?
  • If it's rational, is there some way that you feel you could make symbolic amends? Perhaps learning new skills or volunteering. And then actively work to forgive yourself
• Talk to people about it – family, friends, fellow widows, a counsellor, or a psychotherapist
• Use grounding techniques if you feel yourself getting into a guilt spiral
• Think about the positive things you did with your partner, and remember the things that you did do right, not the things that you felt went wrong