by Laura McDonald, LCSW, Overdose and Substance Use-Related Loss Bereavement Services Manager
A sudden traumatic loss can be overwhelming to the human mind and spirit, no matter the cause of death. Everyday we lose loved ones through tragic accidents, sudden cardiac events, war and catastrophe, leaving survivors ill equipped to reconcile with the profound loss and grief that ensues. Yet the heartbreak of death by overdose brings its own special albatross, as the survivors often experience crushing feelings of guilt and counterfactual thinking. For many families, the road to an overdose had been a long and complicated journey, with many attempts to find help and health for their loved one, only to lose the battle in a sudden and irreversible way.
Many survivors feel paralyzed by a profound sense of guilt for not being able to save the one they loved. They ruminate on every decision and discussion ever had regarding substance use and addiction, every action taken and not taken. If only they had managed to make the right decisions, be more patient, more strict, more giving, less giving, perhaps their loved one would still be here. After a death caused by overdose, the end can be seen as an inevitable train wreck that somehow they could and should have been able to control. So what can we do to possibly address this crippling cycle of pain?
A good place to start is to take a good look at our feelings and thoughts through a different and more rational lens. The definition of guilt is a feeling of worry or unhappiness because you have done something wrong and you have harmed another person. Guilt is when we do something that we knew was wrong while we were doing it, and we did it anyway. Guilt is carried by all of us at some time or other, and it can be an appropriate human response. Guilt is warranted when in the moment we are aware that we are making a harmful mistake but we proceed with our actions anyway.
Regret, however, is called for when we look back at an action and wish we had done something differently. In re-examining the past, we can evaluate which feeling should be applied to our efforts in helping the one we loved so dearly. By allowing ourselves to recognize this difference, and to really re-examine what actions of ours belong in the guilt bucket and which ones are regrets, we give ourselves the opportunity to unburden some of the heartbreak we carry.
Magical thinking, or counterfactual thinking, can also unfairly strain the grieving heart. In grief, we often believe that if we had only done something differently, everything would have been okay. Added to this thinking is a psychological phenomenon called “hindsight bias”. Hindsight bias causes people to believe that outcomes were predictable, so when an outcome is known, the information that is consistent with what they now know to be true. After losing a loved one to an overdose, the human mind goes to multiple “what if’s” and causes (ie: if only he hadn’t gone out that night, if only we had allowed her to move back home, if only we had tried one more residential program). But in truth, we really have no idea what the outcomes would have been if any of the actions, decisions or conversations with our loved one had been different. It may have been better, it may have been worse, or it may have stayed the same, we simply will never know.
The human spirit needs to mourn authentically, without the constraints of guilt and shame. Those mourning a loss from overdose are already disenfranchised in social grieving due to stigma and disregard for the one who struggled with addiction. We must not allow ourselves to suffer further harm by carrying destructive feelings about ourselves as well. We may have great regret as well as great grief, but if we can remember that we also carry great love within us then healing and self-compassion are within reach.
Full Circle Grief Center 