Survivor guilt is thriving in colleges and hospitals.


  • Survivor guilt has resurfaced in the face of the pandemic and the war in Ukraine.
  • First-generation, urban college students are especially prone to survivor guilt that interferes with academic success.
  • Survivors of disasters need to find a sustaining rationale for their continued pursuit of a meaningful life.

Source: AntonioGuillem/iStock

The concept of survivor guilt has been around for decades but has taken on particular relevance with the pandemic and, even more recently, the war in Ukraine.

R.J. Lifton, in discussing the reactions of the survivors of the nuclear bombing of Hiroshima during the Second World War, defined a survivor as “one who has come into contact with death in some bodily or psychic fashion and has himself remained alive.”

For Lifton, survivors’ reactions could be categorized under several general themes. Among the most relevant currently are psychic numbing (diminished capacity to feel), heightened imagery about death, including fear of contagion, struggles to formulate the meaning of life, and survivor guilt.

While not currently recognized as an official psychiatric diagnosis, survivor guilt is associated with post-traumatic stress and depressive disorders and has been investigated in survivors of AIDS and workplace layoffs.

Survivor guilt essentially refers to guilt at having survived physically and/or psychologically when others who seem equally deserving did not.

When family members die or are severely injured by disasters, especially when it’s through no fault of their own, relatives and friends often can’t understand by what logic they came to be spared.

Many survivors of the Holocaust who watched their fellow prisoners succumb to Nazi atrocities became guilt-ridden by their survival and lived out their remaining years depressed and unfulfilled.

Healthcare Workers

With the pandemic, survivor guilt has not been limited to relatives and friends of the deceased but caretakers. In addition to being exhausted and burned-out, many medical personnel tending the severely ill in crowded hospitals with limited resources felt guilty at being spared themselves.

They also felt morally distressed at losing so many people to COVID-19. As one doctor said, “I probably signed more death certificates in the past two years than I have in my entire career. It takes a toll on people.”

High-stress levels, comprised of exhaustion, generalized anxiety, moral distress, and survivor guilt, led many medical personnel to leave their professions for less taxing occupations. Nearly one in five health care workers have left their jobs during the pandemic, with another 8 percent considering doing so.

First-Generation College Students

Another area where survivor guilt has gained a destructive foothold is among first-generation college students, especially those coming from urban environments plagued by drug use, gangs, poverty, and unemployment. For them, the question, “Why did I survive when they died?” has been expanded to include a related quandary, “Why should I succeed when they failed?”

Only 26 percent of first-generation college students graduate with a bachelor’s degree compared to 70 percent of the students who had at least one parent holding a bachelor’s degree or higher.

Some urban college students have encountered serious forms of psychosocial pathology among their families, such as alcoholism/ drug use, criminal behavior, and/or violence, which makes concentrating on academic work difficult.

Most of these students are the only members of their families attempting to improve their level of functioning by taking college courses. Often these students wonder why they should escape poverty with all its attendant ills when their brothers and sisters have failed.

Low-income, urban, first-generation students who try to become more successful than their families often grapple with frustration, isolation, and criticism from family members. Some students trying to improve their grammar find that their newly polished manner of speaking is ridiculed.

“So, you think you’re too good for us!” is a taunt frequently directed at the person trying to move beyond their family’s socioeconomic level, especially by others who feel threatened and left behind by the student’s upwardly mobile behavior. Unless a student is comfortable with academic success, trying to elevate one’s social and economic status can create conflict—both internally and with others.

The severity of family conflicts experienced by urban, first-generation students is illustrated in the following examples:

A 28-year-old African American man came to his college counseling center for help with study skills. He was barely making Cs when he sought help, even though he had been an honors student in high school.

He verbalized difficulty concentrating and said he spent a lot of time thinking about family members. His oldest brother had been shot and killed six years before in a drug-related incident, and his youngest brother’s baby had died recently. In addition, all his siblings and his parents were experiencing psychosocial difficulties, including psychiatric impairment, unemployment, and criminal involvement.

Fortunately, the concept of survivor guilt helped reduce his isolation from college peers, clarified his discomfort at trying to “make it” in life, and improved his academic performance.

Following a workshop on survivor guilt, another minority student said: “If you come from a family that didn’t make it, you feel you shouldn’t. My sister lost her job, and I feel guilty—like why should I have a job? It’s typical of my family—always somebody losing their job or something.

“We just don’t have the same kind of problems. When I’m around my family, I feel I don’t have any right to talk about anything positive. It’s got to be something negative. They don’t have anything positive to say.”

The only member of her family attending college, she sought help for chronic depression and marital problems. In her counseling, she found the concept of survivor guilt especially meaningful.

A Message to Survivors

There is no perfect answer to “Why did I survive (or succeed) when others didn’t?” While we are all endowed with certain inalienable rights, including rights to “life, liberty, and the pursuit of happiness,” the reasons for continuing to build a meaningful life after devastating loss are quite personal.

Perhaps we are religious/spiritual and believe that it’s not our time to die. Perhaps we value the life we’ve been given and find meaning in bettering ourselves. Perhaps we appreciate our unique talents and believe that we have more contributions yet to make. Perhaps our family and friends need us for support, inspiration, or as role models.

In general, healthy survival provides hope for all of us, just as the single surviving tree fragment found in the rubble of the World Trade Center bombings did and continues to do so. Over 20 years later, the pear tree stands in full bloom during warm weather as a testament to life’s resiliency, even after tragedy.

About the Author

Dr. Geraldine K. Piorkowski is a retired clinical psychologist who received her Ph.D. in Clinical Psychology from the University of Illinois, Urbana-Champaign. Since then, she has worked in a variety of academic and clinical settings for over fifty years. Besides holding the position of Chair of the Psychology Department at Roosevelt University, Chicago, she was also on the faculty at the University of Illinois at Chicago, the College of Medicine and Dentistry of New Jersey at Newark, and the Northwestern Medical School in Chicago. In addition, she was the director of two university counseling centers in Chicago. She is the author of many psychological articles and three books: Too Close for Comfort: Exploring the Risks of Intimacy (1994), Adult Children of Divorce: Confused Love Seekers (2008), and most recently, Beyond Pipe Dreams and Platitudes: Insights on Love, Luck, and Narcissism from a Longtime Psychologist (2021). Currently, she is on the local Board of the Phi Beta Kappa Honor Society and lives in Chicago with her husband of 61 years. They have two adult children (Paul and Julie) and also had a son, Michael, who died in 1995.


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