Survivor guilt is a psychological condition that occurs when an individual believes they have done something wrong by surviving a traumatic event when others did not. The medical community now considers survivor guilt to be a powerful symptom of PTSD. With the ever growing incidence of natural disasters, mass shootings, epidemics, and combat death, survivor guilt must be understood as a potentially crippling mental health crisis.

At its most basic level, survivor guilt is a persistent negative feeling state that may vary in intensity and duration from one person to another- but the underlying thoughts and feelings are similar. The primary feeling is guilt that you survived, even if hurt, when someone else died and you do not deserve to have done so. In some cases this includes feeling that you could have done more to save someone else, or that it is wrong that someone else died saving you.

The question that plagues someone experiencing survivor guilt is “ Why me?” as they struggle with both the randomness of this outcome as well as the powerful feeling that they are not worthy of their fate.

Clinical psychologists suggest that what underlies this guilt is a strong innate sense of personal responsibility for another, and that it is our way of fending off a potent sense of powerlessness in the face of tragedy. It may also be that such guilt represents a final sense of connection which serves to keep the loved one alive, at least for a time.

Social psychologists argue that survivor guilt should best be understood as a phenomenon that happens between people as much as it happens inside them. Rather than viewing it as an individual cognitive crisis, it is seen to occur as a consequence of our being an innately social species, and it is adaptive in communities that share expectations of mutual concern. Not only does it help ensure that the strong tend to protect the weak, but it motivates human beings to strive harder—in accord with their appreciation of their good fortune at having been spared.

Not everyone who witnesses or experiences a traumatic event will develop intense feelings of survivor guilt. However, certain factors such as prior history of trauma, low self-esteem, depression and lack of social support can enhance the likelihood of survivor guilt intensifying and failing to abate over time. For some, it can have a life-long impact and can even be passed from one generation to another.

Of course, many who survive tragedy will be able to transform their feelings of guilt into a sense of increased meaning, purpose and productivity in life. However, friends, family and co-workers need to recognize that survivor guilt is a true emotional crisis that holds the potential to become all consuming, impede functioning and is potentially a precipitant for suicide.

While literature has long focused on tales of survivor guilt, especially in works of historical fiction, there are some novels that do an exceptionally keen job of bearing witness to the power it has to either propel an individual forward into a meaningful future, or compel them to be mired in their past.

"The Lost Family," by Jenna Blum, is a deeply moving, genuinely compelling, and unforgettable portrait of the devastating consequences of traumatic loss. Told with great compassion, Blum creates vivid characters that will not be easily forgotten.

Set in 1965, "Lost Family" is the story of Peter Rashkin, a handsome, charismatic owner and head chef of a fashionable New York restaurant. While considered a highly eligible bachelor by any standards, he is also a survivor of Auschwitz who bears unspeakable pain and terrible guilt about having survived, while his beloved young wife Masha and twin daughters did not.

While it is difficult for Peter to let anyone get close, he meets June Bouquet an exquisite, highly intelligent, fashion model 20 years his junior. During their passionate courtship, an unexpected pregnancy propels him to attempt to move forward with marriage and let go of the horrors of his past. Yet, as Peter and his new family move into the 1970s and '80s, will he ever be able to quiet the grief and guilt that plague him? Will he ever forgive himself and become the husband and father this family so desperately needs him to be?

"The Mistake," by K.L. Slater, is a tension filled, gripping thriller that will keep you guessing until the very end. Recommended for anyone who enjoys a psychological thriller with a poignant twist.

Sixteen years ago, 8-year-old Billy disappears while flying kites with his beloved older sister Rose. Rose and her family are horribly grief stricken when two days later Billy is found dead.

Now, Rose is like a shadow of her former self, still tethered by guilt to that awful day when the police found Billy. She can’t stop blaming herself for failing to protect Billy. And maybe never will.

One of the few people she shares this pain is her older neighbor Ronnie, who has been like part of her family for as long as she can remember. But when Ronnie falls ill and Rose offers to care for him, she makes a heart pounding discovery. Rose thought she knew who was responsible for taking Billy, could she have been terribly wrong? How far will she go and what will she risk to try and expunge her guilt?

"We Were the Lucky Ones," by Georgia Hunter, is an extraordinary, chilling, and emotionally sensitive look at the lengths one family must go in order to survive the Nazi brutality that threatens their very existence during World War II. Inspired by a true story, "Lucky Ones" is a compelling read.

It is 1939 in Radom, Poland, and three generations of the Kurc family are continuing to thrive and grow. They are looking to the year ahead with the birth of new babies, upcoming marriages, and beginning romances. Yet, with increasing threats of violence against Jews in their town, the Kurcs soon must confront the Nazi threat at their door.

One family member goes into exile, another tries to flee to safety, and the others left behind try to survive by hiding their true identities pretending they are gentile. Each member must navigate a dangerous path. Will their drive to survive the horrors of the holocaust allow them to live and reunite once more as a family? And should they possibly manage to live through the horror, will the choices they made leave them to suffer irreparable grief and guilt?

Book Smart is a monthly column by Nancy Harris of Scituate, a practicing psychologist and a former instructor of psychology at Harvard Medical School.

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