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/ Source: TODAY
By A. Pawlowski

Three suicides in recent days show that when horror strikes, the trauma lingers deeply for those who survive.

Sydney Aiello — a student who lived through the Marjory Stoneman Douglas High School shooting that left 17 people dead in Parkland, Florida, in 2018, and graduated last year — took her life earlier this month. The 19-year-old had been close friends with Meadow Pollack, who was killed in the attack.

Another Parkland shooting survivor who was a sophomore at Marjory Stoneman Douglas High School also passed away this month in an apparent suicide. The student’s name has not been released.

And Jeremy Richman, whose daughter Avielle was among the 20 first-graders and six adults killed in the Sandy Hook Elementary School massacre in Newtown, Connecticut, in 2012, was found dead Monday in a suspected suicide.

Aiello’s mother told CBS Miami that Sydney struggled with survivor’s guilt — a term used to describe the experience of people who live through harm or a life-threatening event while others do not. Many of those who made it out alive after the Holocaust, 9/11, a war, a natural disaster, a violent attack or a plane crash have felt this anguish, which can be powerful enough to lead to suicide, mental health experts say.

“The guilt of being grateful to be alive is heavy,” said Patience Carter, who survived the 2016 Pulse nightclub shooting in Orlando, Florida, describing her feelings in a poem she wrote after the attack.

Haunted by thoughts

Survivor’s guilt usually develops in a setting where it’s easy for a person to think, “It could have happened to me and didn’t,” said Dr. Edward Silberman, a psychiatrist at Tufts Medical Center in Boston. It strikes because one of the hardest concepts for humans to accept is the notion they can’t control an event, so they try to create a false sense of control by blaming themselves, he explained.

“People have an easier time blaming themselves and therefore maintaining an illusion of controllability than accepting that there was absolutely nothing that they could do,” Silberman told TODAY.

“Because if there’s nothing you can do, then what’s to prevent another tragedy, another bad outcome from happening again? Then people feel as though life is essentially walking through a minefield and something terrible could happen at any time… (they feel) pessimism about how the world works and what the future will be like.”

Patients who feel survivor’s guilt brood and ruminate about what they could have done to prevent the terrible outcome, said Silberman, who counseled people after the Boston marathon bombing in 2013. Symptoms also include low mood, loss of interest in usual activities and a preoccupation by the tragedy.

Patients experience excessive guilt and are haunted by thoughts such as, “How come I survived the event? The persons who died instead of me were nicer than me, better than me. It’s not fair that I got to live and they didn’t,” said Dr. Laurel Williams, chief of child and adolescent psychiatry at Texas Children’s Hospital and an associate professor of psychiatry and behavioral sciences at Baylor College of Medicine.

“It can be extremely disruptive. If you’re not getting the treatment you might need for PTSD and/or depression, it could certainly take up a good percentage of your day thinking about it,” Williams noted.

“It may color your actions, what you might do moving forward for yourself because you’re sitting there thinking, ‘I don’t deserve to be alive.’”

It’s very much not a rational guilt, but it’s a symptom within post-traumatic stress disorder (PTSD) and depression, which are risk factors for suicide, she said.

There are effective treatments for both illnesses, so people can get through survivor’s guilt and recover. Therapy can help people accept that something terrible happened and there was nothing they could do about it, but they are not helpless in the face of everything in life, Silberman noted.

Asking about suicidal thoughts

If you have a loved one who is suffering from survivor’s guilt, PTSD or depression and you are worried they are thinking about suicide, both mental health experts advised talking about it very directly.

“Ask, ‘How bad is it? Are you having thoughts about dying? About killing yourself?’” Silberman advised.

“It’s always OK to say, ‘I’m concerned for you. I’m wondering if… maybe you think your life is not worth living,’” Williams added. “You’re never going to make somebody become suicidal just because you’re asking them… You want to acknowledge the pain they’re experiencing and help them deal with the pain.”

The first step could be connecting them with therapist or counselor. Suicide is the third leading cause of death for young people and those who endured the horror at Parkland or survived other trauma are at risk, Williams said.

If you or someone you know is at risk of suicide please call the U.S. National Suicide Prevention Lifeline at 800-273-8255, text TALK to 741741 or go to SpeakingOfSuicide.com/resources for more additional resources.