When you come close to death, when you survive while others lose their lives, or when you get a chance to escape into safety and relative stability while others stay trapped in fear and poverty, the joy of life is likely to get suppressed by an overwhelming pressure on both your body and mind. In the chaos of feelings, bodily sensations and thoughts, you may recognize anger about the injustice, a deep grief after the loss, fear and confusion about what may come next, and also feeling that escapes simple logic – the guilt of surviving. It feels like you almost have no right anymore to smile or enjoy your meals, walks, relationships – like simply living your life is a betrayal of those who keep suffering or died, like your joy adds to the injustice of the world, like you’ve lost your right to desire things or complain about them. You are alive and you are expected to feel grateful, but instead you experience it as a burden to carry. This state, called survivor’s guilt, may isolate you from yourself and from the people around you. You may stop listening to your needs, depriving yourself of sleep, rest, medical care, and fun. You may think ”I survived, so I have to pay back for it and work myself to the absolute limit”, or ”I am here in safety, so I have duties towards those in danger”.   If the tragedy you safely escaped is an ongoing war, often the only thing you can do is to stay informed and connected, sometimes offering little financial support and calming words from afar. You may find yourself glued to your phone, constantly checking for updates and news, staying on alert, ready to respond and act. Like your phone sends you constant notifications, so does your mind and body, chaotically reminding you about responsibilities, traumatic memories, unsolved problems, or the faces of people you’ve left behind. This uses up a lot of battery, both of your phone and of your mind and body. As days pass you miss the moment when you are becoming your own oppressor, almost like a manic dictator that neglects your basic human rights: to rest, to plan the future, enjoy friendships, love and learning new things. Almost like what didn’t kill you in the war zone slowly kills you in safety, eating up your relationships with loved ones, your individuality, energy, joy and spontaneity. You may not realise it but you punish yourself for surviving by pushing the limits of how much you can work, how little you can sleep or eat, how much pain you can experience. You seek punishment or forgiveness. Survivor’s guilt isolates you from yourself, but also from others. They feel your lack of presence. They recognise that your thoughts aren’t with them when you drink coffee at one table. Your friends or loved ones may feel that whatever they do will never be enough to make you happy so they slowly start withdrawing and giving up. You also isolate yourself from people who don’t share your story of survival. They may annoy or bore you with their simple life struggles of broken hearts, peanuts allergies or weight gain.  Hardly anything can beat the death, torture or terror. People may shame you, calling you ”a hero” or expecting you to be grateful for being alive. How can you respond to that with the dark truth of your heart? Isolation from yourself and others naturally causes anxiety, and when unattended may lead to sudden panic attacks. Why? Imagine a body that you detached from by sabotaging its longings and basic needs, a body that is under constant pressure, a body living among other people who seem foreign and unsupportive. The body will go on strike or start a desperate rebellion, calling for attention and for change. And what better way to catch your attention than to disable your rational thinking, make your heart pump so loud that you can’t escape its noise, force you to focus on breath as it becomes unpleasant, tiresome and fast, make you realize that you actually have a physical body as it starts trembling and you lose control? You come in contact with the fear of death your body is carrying and after the panic, you feel that something has to change. But what and how? The first step may be to increase self-awareness. Step by step. You have been running for long enough. Now is the time to slow down and maybe find new ways of dealing with the traumatic past. I agree that the picture painted above may feel extreme and gloomy. At the same time, many trauma survivors may find in it at least elements of their own story. Understanding, recognizing the process may be the first step to heal. So how do we precisely define survivor’s guilt? It may manifest itself as a feeling of guilt for surviving life-threatening events (like for example war, murder, terrorist attacks, natural disasters or disease epidemics), the result of which other people died or were harmed.

People who suffer from survivor’s guilt feel that they don’t deserve to be safe – they imagine that they should have been harmed as well, despite the fact that they often didn’t have control over the situation and had limited opportunities to help others.

They not only think about things they could have done differently, but also feel guilty over things they really did or for the words they said – be it pushing other people too hard during an escape from a shooting, leaving home for the last time in anger and without a kiss, or screaming at a family member in anger just before he or she was taken or killed. In case of traumatic happenings that are spread over time, like for example the 8 years of the conflict in Syria or the years of varied crises in Iraq, survivor’s guilt becomes a constant dialogue of the past, present, and future. ‘What could I have done better or differently’ melts with the inner noise of ‘what can I be doing better now?’ and ‘what I can do better in the future?’. How do I save the lives of people I care about? Many Syrians in Berlin I have talked to anticipate feeling paralyzing guilt in the future when they finally will have arrived, found a prosperous job, settled down and adapted to the local environment – perhaps not forgetting the traditions and recipes for the perfect tabouleh, but instead forgetting the pain. The trauma of many newcomers is not only in the past – it is an ongoing process whose ending is impossible to predict. Hence, it is so important and challenging to not only heal past wounds, but also integrate pain and deep sadness into daily life, finding acceptance, peace, and dignity in the darkest of moments and allowing beams of light to shine through. And above all, live. Unattended survival guilt may lead to its suppression from the conscious mind. Guilt that is stored in the unconscious lives its own life-seeking resolution. Resolution can mean forgiveness – a person, for example, will be driven towards helping others in the quest of forgetting themselves, sometimes to the unhealthy extreme of self-sabotage or even humiliation. Suppressed survivor’s guilt can also lead to auto-aggression through drug or alcohol addiction, physically harming oneself, or simply riding a bicycle without much care. Auto-aggression can manifest itself also in autoimmune diseases, where your own immune system attacks your body organs (like in Hashimoto’s disease). Other forms of reactions to suppressed guilt may include looking for punishment in hallucinations. People’s minds may produce paranoid thoughts and images of someone after them, waiting to hurt them. They may hear voices of threats or see shadows following them, which may be parts of their own psyche running after them. From my experience, healing is possible once a person allows it, giving themselves permission to live. No medication prescribed by psychiatrists, no papers from the job center, no international powers and United Nations resolutions – simple self-compassion and self-love may allow the healing process to happen. But here comes the difficulty. Guilt often does not allow acknowledgment of our own wounds. Survivor’s guilt makes people rationalize and belittle the scale of their own trauma: ”I am safe now, I shouldn’t focus on myself. Others need more help. What I experienced is nothing in comparison to others. Focusing on my feelings would be unfair, it would be a weakness. I have no right to feel pain”. The paradox here is that by neglecting their own trauma, feelings, and needs, a person is slowly using up their resources. The mind and body is becoming exhausted and unable to function. The end-result of this self-neglect is physical and mental illness. So how does one help others when there is no spirit and strength left in themselves? I am aware that being overwhelmed by survival’s guilt makes it very difficult to recognize one’s own needs, making it feel almost impossible to press the green light for their fulfillment. But if you can’t do it for yourself, start doing it for others. An old saying states “you can’t pour water from an empty jar”, so if you want to keep helping and supporting, you have to stay healthy, present, grounded, resilient, flexible and physically and mentally strong. It is a lot to ask for, and one way to maintain it – not just for a month, but for a lifetime – is to bring more balance into your life. In the following articles, I share a few ideas on how to make it happen without belittling what you are going through. Part 2 and part 3 of this series can be found by clicking the highlighted links. Hania Hakiel is a psychologist and psychotherapist who runs the GSBTB Open Art Shelter. This article was first published in a special mental health edition of the Arabic-German newspaper Eed Be Eed, in partnership with Give Something Back to Berlin.