PTSD and Survivor Guilt

What is "survivor guilt?"  In the case of soldiers who have been in combat, it is the guilt they feel when they survive when some of their comrades or 'battle buddies' did not.  In the case of other types of trauma or abuse, survivor guilt is similar, but may sometimes have other components.  Basically, in my case, it meant the guilt I felt for not fighting back more, for not leaving sooner, for not doing a better job of protecting my children from an abusive atmosphere, for not knowing that something bad was going to happen for no reason that I could explain ...

In a workbook I used entitled The PTSD Workbook (by Mary-Beth Williams and Soili Poijula), I had been working on filling out an exercise entitled: "My Survivor Guilt."  Even though it was a supposedly simple "fill-in-the-blank" type of exercise, I had a lot of trouble completing it.  My own guilt and shame that were attached to the abuse really threw me for a loop.  However, I'm determined to conquer my own response to the abuse and feel less guilt and shame about it.  So, here's what I wrote in 2012  . . .

My statements about my own survivor guilt:

• I made it out alive from an abusive marriage when some women do not. 
• I made it out less physically damaged or less seriously injured than some women.
• I escaped some of the emotional pain and distress by dissociating when trauma happened.
• I escaped some social disgrace and humiliation by not telling anybody what was happening to me.  Some women were braver than I was and sought out medical help, but I did not always have that option.
• I should have died several times, but I did not.
• If I had left the abusive relationship sooner, my children could have had a better life.
• Some survivors are 'luckier' than I am because they don't have any more physical pain & suffering, while I am stuck here with this emotional anguish.
• I have nightmares about the trauma.  In my dreams, sometimes I actually die.  And when I wake up, sometimes I wish I had really died back way back then because sometimes it seems that coping with surviving is worse than death.
• I daydream sometimes about various traumas and wish that I could change the outcome.
• I never talk about certain specific traumas because I feel like I could have done more to prevent those horrible things from happening.
• I feel so guilty and ashamed because after awhile I quit fighting back or resisting.
• At times, I questioned the very existence of God because I felt like there was no rescue for me or my family when we truly needed help.
• I used to wish that I could kill myself to end the pain,  and even tried committing suicide multiple times. I nearly succeeded several times, but they resuscitated me. Right now, suicide is *NOT* an option because my children need me.  Therefore, harming myself intentionally is no longer an option for me. 
• When I have periods of intense grieving about traumas and losses, I sometimes dissociate and use other things to help numb the pain.
• I have used substances to try to make the pain go away.  I used to smoke cigarettes when I was stressed or sad.  Sometimes I took my 'sleeping pill' early just so that I could go to sleep and escape the pain. 
• If I watch movies or documentaries about domestic violence or sexual abuse or similar events, I become very depressed and emotional and I have a hard time not thinking about what happened to me.
• I felt I had no reason to live for myself.  The only reason I was living was to take care of my family.
• In hindsight, I might have been able to prevent some of what happened by telling someone or calling the cops either during or immediately after an attack. (although I did try once and a corrupt officer just laughed at the situation and went on his merry way)
• I feel very ashamed that I essentially participated in prostitution.  This is against my moral beliefs and causes me a great deal of guilt and shame.
• I should have done a better job of protecting my children and myself.

Then, the workbook asks what I learned from making those statements.  My response was: "not much, except that I hate myself for not being stronger."

In the book, Post-Traumatic Stress Disorder: A Clinician's Guide, A. Matsakis says there are seven steps to overcoming survivor guilt:

1. Remembering what happened.  That's a difficult thing for me.  I do remember way more than I want to, even though I try to forget.  I don't like remembering what happened.  I'd rather avoid thinking about it.  But apparently I NEED to remember in order to get past these awful emotions. Over time, a lot of details have faded. What sucks is that it seems like i've now put myself in potentially problem circumstances again from my ownstupidity.
2. Separating survivor guilt from other emotions.  That's another toughie -- I often have trouble identifying emotions in general, much less separating them appropriately.  This one will take me some time. Still working on that.
3. Examining your role in what happened before, during, and after the trauma; looking at your errors in thinking and your irrational emotions.  Boy, have I done enough of this.  I've gone over and over in my head what I could have or should have done differently.  I've come to the conclusion that in many cases, it wouldn't have mattered what I did, the outcome would have been the same (or perhaps worse).  I suppose my errors in thinking would include things such as, "If I had done x, y, or z, this wouldn't have happened."  My irrational emotions? I guess feeling so guilty over not having left sooner would fall into that category.
4. Countering self-blame and irrational guilt through newly constructed statements about the self that are based on true responsibility.  Perhaps in another post I'll attempt to make some new positive statements about myself, but that will truly be challenging.
5. Accepting guilt for what you did or didn't do.  I've already done that (over and over), and that's part of the problem.  I think what's needed in my case isn't so much accepting the guilt as being willing to forgive myself.
6. Examining the personal consequences of your guilt to your own self-esteem, self-care, physical health, emotional health, job performance, and life contributions. 
7. Making a commitment to being honest about the guilt and to taking action toward putting that guilt to positive use.  I'm not yet sure how I can put these feelings and emotions to "good use."  I'm still working on identifying them, sorting them out, and releasing myself from the hold the guilt has had on me.   But I do make a commitment to trying to understand why I feel so guilty and to trying to change the way I look at my own actions and feelings/emotions.