Brad Zebrack, Ph.D., M.S.W., M.P.H., says survivors' guilt may jump-start a more productive process.
Reframing the Picture:
Once cancer treatment ends, many patients report a lingering sense
of guilt -- for the demands the disease placed on their families, for behaviors that they believe (mistakenly or not) may have caused the
cancer, or even just simply for having survived when others didn't.
U-M expert discusses ways to reconsider survivors' guilt
We talked about this with Brad Zebrack, Ph.D., M.S.W., M.P.H., a University of Michigan associate professor of social work whose
research focuses on the psychological and social impact of cancer on long-term survivors. Here's what he had to say.
Can you tell us what you've learned about this notion of survivors'
guilt -- that some people feel guilty for living when other people die of cancer?
Cancer survivors use the word "guilt," but the scientist in me is skeptical. When people say they feel guilty about surviving, I think
that the comment is really more about an existential crisis. It's about seeking a purpose in life: What is my life about, given
that I've survived and others haven't?
You don't think survivors' guilt really exists?
It exists because cancer survivors say it exists, but I think "guilt" may be the wrong word to describe what's going on. Guilt is a detrimental
emotion that can lead to depression or the possibility that patients may decide to go off their treatment regimens. There isn't any evidence
to show that something called "survivors' guilt" leads to that sort of behavior. In my interviews with patients, many say they
feel guilty, but ultimately they often talk about a more positive -- and potentially transformative -- existential experience of
determining what reasons they have to go on living.
So survivors' guilt may be beneficial?
I think survivors' guilt has been assigned a very negative connotation. But if you consider it as a factor that pushes people to
have a greater appreciation for life and to take one day at a time, it could be beneficial. A lot of times people talk about living on and
doing work in honor of others. That, to me, sounds like a potentially positive experience.
In a more practical sense, though, cancer imposes burdens on patients and families. What abut the
guilt that surrounds those issues?
Guilt sometimes comes into play if patients feel they've become a burden on their families or caregivers. If that's the case,
I would encourage patients to bring up these issues and discuss them with family members. The financial implications
of cancer can also play a role in this respect. If you find you can't shake these feelings, it may be helpful to involve a social worker in
the conversation. It may also be helpful to consider family counseling to help adjust to life after cancer. A lot of times patients and
family members expect life to return to the way it was before the diagnosis; for many patients, that's not possible. Trying to live
up to that expectation can provoke negative feelings of guilt.
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