# Motivation and emotion/Book/2021/Survivor guilt

* Multimedia presentation (3 min)

## Overview

This chapter introduces the origin of guilt and its connections with the unconscious mind, followed by the historic and relatable definition of survivor guilt, as well as the process of treatment in cognitive therapy. Modifications to certain brain regions are expressed during a traumatic event and when one feels a sense of guilt. A brief introduction to equity and evolutionary theory and their association with survivor guilt, and the sharing of the emotional stories of three survivors and their experience with survivor guilt will finalise this chapter.

## The origin of guilt

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## Sigmund Freud (1856-1939)

Sigmund Freud (1856-1939) was an Austrian neurologist and the father of psychoanalysis, a theory explaining the effects of unconscious motives on human behaviour (McLeod, 2018). Freud believed the unconscious mind controls behaviour to a greater degree than people suspect, proposing that awareness existed in layers with thoughts occurring ‘below the surface’ (McLeod, 2018). Fascinated by the ‘ Anna O' case study, Freud proposed that physical symptoms as such are often the surface manifestations of deeply repressed conflicts and therefore developed the topographical model in 1900, identifying three levels of the mind as conscious, preconscious, and unconscious (McLeod, 2018). Unfortunately conflict is inevitable amongst each element of the psychic apparatus, and as such the superego can torment the sinful ego and make a person feel guilty (McLeod, 2018). The term guilt was first introduced in Freud's work during a short discussion of a case in The Neuro-Psychoses of Defence, this encouraged Freud to begin psychoanalysing himself, from dreams (Irma) and early experiences such as his hostile relationship with his father and the unhealthy wishes towards his younger brother (Westerink, 2013). The passing of Freud's father deeply affected him, and it was from this experience Freud connect the feelings of guilt as an unconscious effect stating 'that tendency toward self-reproach which death invariably leaves among the survivors, because unconsciousness is where our most painful and frightening events and desires lay, and they lay there through repression, and the process of repression is a non-conscious act (Westerink, 2013).

## What is survivor guilt?

Survivor guilt has been part of our cultural lexicon since the middle of the twentieth century, relating it to the survivorship of war, natural disasters, and disease (Cherry, n.d.). Survivor guilt was first documented and described in psychoanalytic writings about the Holocaust and Hiroshima survivors, describing the guilt people feel when literally surviving the death of another, and this term was initially influenced at the time of research by the Vietnam war veterans, reporting high levels of survivor guilt (Cherry, n.d.).
Diagnostic and statistical manual of mental disorders (DSM)
Survivor guilt is defined as ‘guilt about surviving when so many others did not or about things one had to do to survive’, and has been listed as a symptom for post-traumatic stress disorder (PTSD) in DSM-5 that can be viewed as one of the cognitive and mood related symptoms, including distorted feelings of guilt and negative thoughts about oneself. Survivor guilt varies between individuals with and the symptoms of survivor guilt can be both psychological and physical and often mimic those of PTSD (Cherry, n.d.).
More recently, the use of the term has been expanded to include guilt about any advantage a person believes they have when compared with others or believe they are harming others by surpassing them, such as when someone close suffers misfortune, illness or the loss of a job[factual?]. Survivor guilt can also occur on witnessing the suffering of strangers, such as reading about victims of violence, or seeing homeless beggars (Cherry, n.d.).

## Treatment

Unfortunately there is no pharmaceutical treatment to remove the emotional pain one feels during survivor guilt, however, cognitive therapy interventions such as grief therapy and debriefing, assist survivors in reclaiming a purposeful life. The first principle of treatment is recognition, followed by fact investigation, revealing objective irrationality of the situation and the explanation of its evolutionary and psychological sense. Cognitive views are explored, to encourage the thawing of defenses, and lastly the release of the emotional pain is processed and assimilated into context of an emphatic, moral therapeutic relationship. The anticipated outcome is for the survivor’s own morality is retrieved with the realisation that past circumstances, not themselves, were irrational and damaging, and therefore allowing the survivor to see oneself as a victim and not a perpetrator, allowing them to grieve losses, and achieve new hopeful meanings for oneself. The anticipated outcome is for survivors to see oneself as a victim and not a perpetrator, to gain back their morality with the realisation that their past circumstances, not themselves, were irrational and damaging, to grieve their losses and to achieve new hopeful meanings for oneself (Valent, 1998).

## The Mind

| Trauma | Trauma can be defined as a deeply distressing response to a real or perceived threat to one’s life impacting a person’s psychological, emotional, and physical behaviour through severe alterations to the amygdala, hippocampus, and prefrontal cortex; the three main structures of the brain responsible for processing trauma (Himelstein, 2016; “Trauma, Its Effects on the Brain, and Coping Skills,” 2019). | Trauma can be defined as a deeply distressing response to a real or perceived threat to one’s life impacting a person’s psychological, emotional, and physical behaviour through severe alterations to the amygdala, hippocampus, and prefrontal cortex; the three main structures of the brain responsible for processing trauma (Himelstein, 2016; “Trauma, Its Effects on the Brain, and Coping Skills,” 2019). | Trauma can be defined as a deeply distressing response to a real or perceived threat to one’s life impacting a person’s psychological, emotional, and physical behaviour through severe alterations to the amygdala, hippocampus, and prefrontal cortex; the three main structures of the brain responsible for processing trauma (Himelstein, 2016; “Trauma, Its Effects on the Brain, and Coping Skills,” 2019). |
| Amygdala | Almond shaped and located within the limbic system. Stress hormones release by the thalamus stimulate the amygdala, when the amygdala is stimulated the brain goes into survival mode and a split-second decision is made regulating either the fight, flight, or freeze response as well as increasing the bodies physiological symptoms (Himelstein, 2016; “Trauma, Its Effects on the Brain, and Coping Skills,” 2019). | Almond shaped and located within the limbic system. Stress hormones release by the thalamus stimulate the amygdala, when the amygdala is stimulated the brain goes into survival mode and a split-second decision is made regulating either the fight, flight, or freeze response as well as increasing the bodies physiological symptoms (Himelstein, 2016; “Trauma, Its Effects on the Brain, and Coping Skills,” 2019). | Almond shaped and located within the limbic system. Stress hormones release by the thalamus stimulate the amygdala, when the amygdala is stimulated the brain goes into survival mode and a split-second decision is made regulating either the fight, flight, or freeze response as well as increasing the bodies physiological symptoms (Himelstein, 2016; “Trauma, Its Effects on the Brain, and Coping Skills,” 2019). |
| Hippocampus | Part of the limbic system and located next to the amygdala, primary role is to convert short term memories to long term memories. The stress hormones that stimulate the amygdala impair the hippocampus, which means the focus is on how we feel not on the details of the event, making it difficult to remember the exact details of the traumatic event (Himelstein, 2016; “Trauma, Its Effects on the Brain, and Coping Skills,” 2019). | Part of the limbic system and located next to the amygdala, primary role is to convert short term memories to long term memories. The stress hormones that stimulate the amygdala impair the hippocampus, which means the focus is on how we feel not on the details of the event, making it difficult to remember the exact details of the traumatic event (Himelstein, 2016; “Trauma, Its Effects on the Brain, and Coping Skills,” 2019). | Part of the limbic system and located next to the amygdala, primary role is to convert short term memories to long term memories. The stress hormones that stimulate the amygdala impair the hippocampus, which means the focus is on how we feel not on the details of the event, making it difficult to remember the exact details of the traumatic event (Himelstein, 2016; “Trauma, Its Effects on the Brain, and Coping Skills,” 2019). |
| Prefrontal cortex | Assists with critical thinking, problem solving, empathy, and awareness, located within the frontal lobe. The release of the stress hormones causes the prefrontal cortex to shut down, because the brain is now in survival mode. When this happens it can be more difficult to understand what is happening during the event resulting in explaining the situation as a series of sequential events. As a protective mechanism the brain responds to familiar traumatic measures similar to how the brain responded to the actual traumatic event. Overtime this leads to issues such as decreased self-regulatory abilities and a constant state of hyper or hypo-vigilance with a decreased ability to manage such states (Himelstein, 2016; “Trauma, Its Effects on the Brain, and Coping Skills,” 2019). | Assists with critical thinking, problem solving, empathy, and awareness, located within the frontal lobe. The release of the stress hormones causes the prefrontal cortex to shut down, because the brain is now in survival mode. When this happens it can be more difficult to understand what is happening during the event resulting in explaining the situation as a series of sequential events. As a protective mechanism the brain responds to familiar traumatic measures similar to how the brain responded to the actual traumatic event. Overtime this leads to issues such as decreased self-regulatory abilities and a constant state of hyper or hypo-vigilance with a decreased ability to manage such states (Himelstein, 2016; “Trauma, Its Effects on the Brain, and Coping Skills,” 2019). | Assists with critical thinking, problem solving, empathy, and awareness, located within the frontal lobe. The release of the stress hormones causes the prefrontal cortex to shut down, because the brain is now in survival mode. When this happens it can be more difficult to understand what is happening during the event resulting in explaining the situation as a series of sequential events. As a protective mechanism the brain responds to familiar traumatic measures similar to how the brain responded to the actual traumatic event. Overtime this leads to issues such as decreased self-regulatory abilities and a constant state of hyper or hypo-vigilance with a decreased ability to manage such states (Himelstein, 2016; “Trauma, Its Effects on the Brain, and Coping Skills,” 2019). |
| Guilt | Guilt is closely related to shame and is one of the most difficult emotions to manage (Learn about the Guilt Area of the Brain, 2019). | Guilt is closely related to shame and is one of the most difficult emotions to manage (Learn about the Guilt Area of the Brain, 2019). | Guilt is closely related to shame and is one of the most difficult emotions to manage (Learn about the Guilt Area of the Brain, 2019). |
| Lateral orbitofrontal cortex | Involved in the regulation of emotion and memory, located within the prefrontal cortex above the orbits (eye sockets) (Know Your Brain, 2015). The lateral orbitofrontal cortex is responsible in regulating behaviour by inhibiting the influence of sensations, feelings, thoughts, and actions, however not everyone experiences a sense of guilt, and stimulation in this area is non-existent amongst criminals, narcissists, compulsive liars, and murderers (Hooker & Knight, 2006). | Involved in the regulation of emotion and memory, located within the prefrontal cortex above the orbits (eye sockets) (Know Your Brain, 2015). The lateral orbitofrontal cortex is responsible in regulating behaviour by inhibiting the influence of sensations, feelings, thoughts, and actions, however not everyone experiences a sense of guilt, and stimulation in this area is non-existent amongst criminals, narcissists, compulsive liars, and murderers (Hooker & Knight, 2006). | Involved in the regulation of emotion and memory, located within the prefrontal cortex above the orbits (eye sockets) (Know Your Brain, 2015). The lateral orbitofrontal cortex is responsible in regulating behaviour by inhibiting the influence of sensations, feelings, thoughts, and actions, however not everyone experiences a sense of guilt, and stimulation in this area is non-existent amongst criminals, narcissists, compulsive liars, and murderers (Hooker & Knight, 2006). |

## Theories
### Equity theory

Also known as the equity theory of motivation, it was first developed by John Stacey Adams, a workplace and behavioural psychologist, in 1963 (Adam’s Equity Theory, n.d.). Equity theory acknowledges that subtle and variable factors effect an employee’s relationship with their work and for a working relationship to be considered equitable, it needs to pass two tests (Adams’ Equity Theory, 2021; “Adams’ Equity Theory of Motivation,” 2021).
1. Individuals need to feel that the reward they receive for their contribution is intrinsically fair
2. They need to feel that the levels of rewards they receive are similar to those received by their peers in the organisation
With both tests at present a fair and equitable working arrangement may exist, resulting in a sense of fairness, equity, content, and increased motivation, also reinforcing the workforce to be perceived as observant and appreciative (“Adams’ Equity Theory of Motivation,” 2021). If both or either test is non-existent, the employee will be dissatisfied and demotivated (Adam’s Equity Theory, n.d.). Dissatisfaction affects the employee in feeling under-appreciated and perhaps worthless, resulting in reduced effort, becoming disgruntled or, in more extreme cases disruptive (Adam’s Equity Theory, n.d.). Employees can also feel a sense of shame or guilt when being overcompensated as well as feeling a sense of humiliation, anger, and injustice when being undercompensated, therefore, the importance of a fair workplace is vital for performance and work ethic (“Adams’ Equity Theory of Motivation,” 2021).

#### Equity theory and survivor guilt

One study discusses the effects of positive inequity on employees and the consequences in behaviour and attitude from layoffs, where the connection of layoffs may increase the anxiety levels produced by job insecurity (Brockner et al., 1986). Positive inequity refers to workers' perceiving the ratio between input and output (Brockner et al., 1986). The two basic means of equity theory in response to positive inequity is the arousal of guilt, and the motivation from individuals to redress this guilt through behavioural or psychological means (Brockner et al., 1986). There were three distinguished condition types within this article addressed as random, control, and merit layoff groups, and within the merit group participants were formerly told that a dismissal is due to lack of performance, therefore the participants who are not dismissed will believe they have outperformed another (Brockner et al., 1986).
This findings within this article are consistent with the equity theory, with participants from the control layoff group reporting being treated much more fairly than other participants and feeling a sense of guilty which increased the quantity but not the quality of their performance to a greater extent (Brockner et al., 1986). A similar result within the random layoff group where the quantity of output was increased (Brockner et al., 1986). Participants within the merit layoff group redressed inequity by focusing on the fact they had performed better than their co-worker, restoring equity through psychological rather than behavioural means (Brockner et al., 1986).

### Evolutionary theory

Charles Darwin (1809-1882) an Englishman naturalist of the 19th century is known as the father of evolution due to his contribution to the Darwinism theory in biological evolution (Darwin’s Contribution-The Theory of Evolution, 2021). The theory of evolution was proposed by Charles Darwin and Alfred Russel Wallace (Charles Darwin Theory, n.d.). Charles Darwin stated that through the natural selection of small, inherited variations, increase the individual's ability to compete, survive, and reproduce (Theory of Evolution, 1996).

#### Evolutionary theory and survivor guilt

One study hypothesised survivor guilt, as the type of guilt associated with feeling better off than others, is also linked to submissive behaviour. Submissive behaviour is usually regarded as a form of defensive behaviour when an individual is under some kind of social threat from a more powerful other. Evolutionary theory describes submissive behaviour as a fear-based, self-protective strategy when in a subordinate position. Survivor guilt has been selected by evolution as a psychological mechanism supporting group living. The complexity of social motivations includes both the need to belong and be accepted, as well as the need to achieve status and success in competition and social comparison, however people may sometimes feel badly when they believe that they are better off than others (O’Connor et al., 2000).
Survivor guilt is also found in egalitarian cultures (O’Connor et al., 2000). A reverse dominance hierarchy in which aggressive leaders who attempt to demonstrate superiority are controlled and punished; ‘intentional leveling’(O’Connor et al., 2000). Establishing the hierarchies in group cohesion (dominance and submission) are fundamental to the organisation of most social groups (O’Connor et al., 2000). Traditionally, submissive behaviours have been viewed as social defensive behaviours from more powerful others. This may be due to the fear and anxiety one feels under certain circumstances (O’Connor et al., 2000). Other reasons may include desires to ingratiate toward the leader, achieving a good impression, or a sense of care for others (O’Connor et al., 2000). Survivor guilt promotes group cohesion, inhibits anti-social competition, and leads people to engage in altruistic behaviour, therefore affirming that survivor guilt is a psychological mechanism that promotes sharing and concern for others (O’Connor et al., 2000).

## Case studies

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### Hiroshima

On August 6th, 1945, during World War 2 (1939-1945) the U.S American B-29 bomber assigned ‘operation downfall’, dropped the world’s first deployed atomic bomb over the Japanese city of Hiroshima (Bombing of Hiroshima and Nagasaki, 2021). Named 'Little Boy' exploded 2,000 feet above Hiroshima in a blast equal to 12-15,000 tons of TNT, destroying five square miles of the city. The energy from the a-bomb consisted of heat rays, blast, radiation, and a force that caused buildings to collapse (Bombing of Hiroshima and Nagasaki, 2021). The explosion killed an estimate of 80,000 people instantly, and roughly 70,00 to 135,000 people died from acute exposure from the blast and long-term side effects of radiation causing serious disease in survivors, such as leukemia and other cancers. The Hiroshima bombing failed to elicit immediate Japanese surrender, and in response the U.S dropped a second bomb targeting Nagasaki (Bombing of Hiroshima and Nagasaki, 2021). Named ‘fat man’ created for a 22-kiloton blast, however, Nagasaki was located in a narrow valley, which reduced the force of the blast limiting the destruction area to 2.6 square miles (Bombing of Hiroshima and Nagasaki, 2021). Mrs Yamada was a young schoolgirl during the a-bomb attack and witnessed the deaths of many, especially when one would drink the water that was now contaminated from radiation, promising herself to not drink the water. During the post-bomb attack Mrs Yamada separated from her mother to receive medical treatment. On the way back Mrs Yamada was with her friend Michiko, and Michiko suggested to jump into the river to relieve their burns. When Mrs Yamada turned around, Michiko had already jumped into the river and drowned. This moment caused Mrs Yamada to feel a sense of guilt which lays heavy on her heart as she felt somewhat responsible for Michiko's death, using the phrase ‘migoroshi ni shimashita’ which means ‘to allow someone to die’ therefore ‘to abandon someone,’ describing her Michiko's death as the saddest thing (Cantrell, 2017). |}

### Holocaust

World war 2 (1939-1945) provided the Nazi officials with the opportunity to assign ‘final solution’ and murder all the Jews in Europe, murdering six million Jews from a population of nine million. The Nazi’s believed that the Germans belonged to a superior race and claimed that the Jews belonged to an inferior race and was therefore a threat to the so-called German racial community. While the Jews were the priority target of Nazi racism, other groups within Germany were persecuted because of their perceived racial and biological inferiority, including the gypsies (Roma), Afro-Germans (people of colour), people with mental or physical disabilities, some of the Slavic people (poles, Russians, and others) and Soviet prisoners. Many of these individuals died from maltreatment and murder, and most were incarcerated in prisons and concentration camps. The concentration camps, also known as the ‘euthanasia’ programs, consisted of stationary chambers with poison gas, this was the primary means of murder at these camps (Introduction to the Holocaust, 2021).
* Helene
* Helene is a child survivor from Germany and was captured with her parents by the Nazis and sent to Gurs concentration camp for six months. Helene shares her suffering from constant hunger and feeling really cold, Helene describes a haunting memory from when she walked into one of the barracks that was filled with corpses, and an unforgettable moment she witnessed from a mother suffering from grief, frantically digging in the mud in hopes to find her deceased baby. During her time of internment, the camp commander allowed some Jewish children to be released to French Jewish authorities, and in the attempt to save Helene’s life her parents insisted for Helene to be one of the released children. Helene remembers the traumatic separation when her father said ‘always pray, and everything will be okay,’ but fails to recall her mother saying anything, but now understands maybe it was because she was incapable of speaking as it was so hard for her to say goodbye. Helene recalls her father waving a handkerchief as far as he could see her. At the time Helene did not cry, she did not know that she would never see her parents again. Helene's parents died at Auschwitz. Helene shares, ‘I never mourned my parents’ the pain was unbearable…I had friends, but I always felt lonely, I always smiled, but the smile was a mask that hid my pain’ When I think of my parents dying in Auschwitz I cannot come to terms with their suffering or their pain. What happened to them is much more unbearable than what happened to me. I had people who rescued me and loved me, but they had no one… they had to die and go through this terrible thing (Farber et al., 2021).

### Bee Gees

A group of three, were known for their infectious harmonies, memorable records, and their production and song writing skills, becoming the prime artists of the disco era. The Gibb brothers made their mark in the 1970’s and even wrote songs for other artists to perform, such as Barry co-writing and producing Barbra Streisand's entire 'Guilty' album. Despite their immense fame and success, none of the Bee Gees had an easy life and were troubled by drug abuse, alcoholism, disease, divorce, FBI investigation, and even death. All three members of the Bee Gees encountered drugs in their lives, with Maurice as an alcoholic, Robin's addiction to amphetamines, and Barry with marijuana (Kelly, 2021).
* Barry Gibb
* Barry is the eldest sibling of five, born on the Isle of Man with his twin fraternal brothers Maurice (Mo) and Robin, and younger sister Lesley, then relocating to Manchester, England, where his youngest brother Andy was later born. Barry came from a musically gifted family with father Hugh as a drummer and mother Barbara as a talented singer. Maurice was known as the most outgoing of the three brothers, the one that held the band together, unfortunately in January 12, 2003, Maurice went into surgery for a blocked intestine due to his long history of alcoholism, but suffered a heart attack during the operation passing away at the age of 53. Robin passed away at the age of 62, in May 20, 2012 after battling liver and colon cancer. Andy, was not a member of the Bee Gees yet a very talented singer, occasionally performing with his brothers but found more success as a solo artist. On March 10, 1988, Andy passed away at the age of 30 from myocarditis, a heart condition which was most likely caused by prolonged drug abuse. Being the last Gibb brother standing, Barry expresses his views as "My greatest regret is that every brother I've lost was in a moment when we weren't getting on, so I have to live with that and I'll spend the rest of my life reflecting on that, I'm the last man standing. I'll never be able to understand that as I'm the eldest" (Kelly, 2021).

## Conclusion

This chapter reviewed the means of survivor guilt one experiences when conflicted with a traumatising event. With the initial definition concerning disaster related veterans, survivor guilt has now developed into a much broader context concerning the sense of guilt someone experiences when comparing one’s level of wellbeing with another individuals’ level of wellbeing. All three case studies relate to the equity and evolutionary theories, through displaying submissive behaviour in the care for others as well as comparing one’s life to another, with equity theory emphasising on the importance of equality within the workplace and evolutionary theory emphasising on the association with submissive behaviour and survivor guilt, through social organisations.