Survivors’ Guilt, Moral Injury and COVID-19
When we reflect on the past couple of months, it is understandable that we might feel like the rules that have governed our lives have been completely upended.
My generation is somewhat cynical and — some might say — over-informed about the world and our responses to current events — but that said, there are some things that are happening within ourselves and our relationships that might seem like completely uncharted waters: Children berating their boomer parents for continuing to attend their salsa dancing classes, panic buying of flour (why flour and not, for example, its more evolved cousin, the cookie?!), and, perhaps most significantly, the emotional upheaval that many of us have experienced over the past weeks — despair, followed by some hope, followed by face-numbing anxiety, followed by snacking.
I know for myself, having an understanding of the tricks and switches our minds make to protect us has helped me to understand some of my feelings and behaviors over the past few weeks. With this in mind, consider the following useful, and universal terms:
Survivors Guilt
You might have heard of this term before — of the psychological toll that a survivor or a ‘lucky one’ can carry with them after they have been witness to, or had a close encounter with, tragedy or loss. Probably one of the reasons that it is so difficult to process is that there is a feeling of guilt at having survived while others perished, relief (thank goodness it’s not me), and then guilt on top of the previous guilt for feeling this way.
As much as we’d like our emotions to be straightforward, the reality is that they’re not, and a lot of the time we can grapple with what we call ‘complicated’ grief — when we lose someone with whom the relationship was not straightforward, and so we don’t really know how to feel about their loss. Survivors guilt is a bit like this — our brains are not good at processing strong emotions that are somewhat contradictory, and often the result of this is often a sense of anxiety and confusion.
Many of us have likely experienced survivor’s guilt to some degree when watching footage of hospitals in Italy or, closer to home, of the hospitals in Queens with bodies piled in the corridors. A sense of horror, of trying to understand what that would be like, followed by our minds kicking into gear with the comforting thought that since this is not happening to us, in this very moment, we are technically safe.
Survivor’s guilt is further complicated by the fact that while the disease itself infects people at random, it is more likely to be fatal for those already in poor health, low income earners who cannot afford to take time off, and those who live in poor areas which are under-serviced with hospitals, and who cannot afford to pay for suitable health care.
There is a sense of this somehow being a problem that could be solved, and so we are faced with the reality that perhaps there was something we could have done to help — or that we are in some way complicit with what is happening. How does your mind process all of this? Short answer — it doesn’t, at least not straight away — and that is probably a good thing, lest we become complacent about the suffering of those in vulnerable positions.
The only good thing about survivor’s guilt is that it is a normal response to a tragic situation, and is a testament to our humanity that we struggle with this paradox. A useful way of dealing with it is to try and make meaning from the situation — consider what we might do with our position and how we can best make use of our lives, if we’ve been spared what other people have gone through.
Maybe we’ll try and be more present with those around us, or we’ll make a decision to go back to school to study something that will help us to make a difference in the world. Often turning outwards is one of the most psychologically healthy ways of dealing with this emotion — looking at the bigger picture and away from our own, individual, experiences.
Anticipatory Grief
This term refers to the process many people go through if they learn a loved one is sick, or that something they value is going to come to an end. It is different from normal grief, since that object is still there (a person, job or situation), but there is an awareness that it is soon going to be gone. Just like with survivor’s guilt, this is a psychologically complex process for our poor minds to go through — how can we grieve something that isn’t yet gone?
When you think about it, anticipatory grief is likely to present as anxiety — a sense of unease, loss, uncertainty and instability. We know that things will change, that we’ll lose people and valued things — jobs, money, rituals — but we don’t quite know what these are yet. Our mind is trying to prepare us for the pain of loss and the period of adjustment that follows, but it is hard to achieve this when we don’t yet know specifically what we have lost.
Anxious people might be well prepared for this scenario — being used to spinning out to the worst case scenario — but it is still challenging to sit with the reality and likelihood of loss.
Again, the solution to this is probably more of a focus on values and what really matters to us. Just like we might talk about ‘post-traumatic growth’ as something that comes out of trauma and clarifies what really matters to us, going through the process of anticipatory grief is likely to clarify for us what is actually important. Perhaps you’ll be motivated to contact your relatives more during this time, hold your loved ones closer, make changes to the things that aren’t working in your life — whatever it is, it is likely that you’ll currently be far more aware of what is really meaningful for you right now.
Moral Injury
This is a term that is often used to describe the fatigue and depression seen in members of the emergency services or armed forces who have been exposed to things that are beyond their capacity to tolerate. This might look like many years of attending domestic violence incidents, war zones, suicides or serious illness. For most of these individuals, they have functioned normally for years in these roles, but then something else happened (eg. an illness, lack of support at work, flawed systems and processes) and things came crashing down — bringing to the forefront feelings of anger, grief, irritation, cynicism and a pervasive sense of loss and injustice.
The term ‘moral injury’ is apt — for many people going through this process, they feel like their very core has somehow been injured in the process of doing their jobs (core in terms of soul, rather than pilates) — whether they feel they’ve been complicit in a broken system, or that they were unable to prevent the suffering of those they were trained to protect. The human mind can tolerate only so much, and sometimes that weight becomes too much to bear — especially in the absence of support or the ‘good stuff’ like time off or life-affirming experiences.
My sense is that moral injury is a normal outcome of what we are experiencing now — in particular for those on the front lines — but also for society as a whole. Witnessing death and suffering on an immense scale does not fit into our frame of reference — and for many people this disaster will be the final straw in a litany of misfortune and pain, and they might sink under its weight.
The answer to this — well, there isn’t one, really, except to focus on the one factor that we know protects us from developing moral injury — human connection and kindness.
How do we equate kindness like that with how cruel the world can be sometimes? This is probably the antidote to moral injury — to offer, and ask for help from those around you, and try and fit both the good and bad into your understanding of the world in all its complexity.
At some point things will return to normal, and we will be tasked with integrating what we’ve experienced into our frame of reference. It is unknown how this will end, but my sense is that at the end, we will be ever more keenly aware of what truly matters to us and what others are capable of — both good and bad.
