“it isn’t fair”: postoperative depression and other manifestations of survivor guilt

The objective of this paper is to demonstrate and explain an array of phenomena, clinical and social, that share a common dynamic although they seem to be quite disparate. These experiences range from combat neuroses to postoperative depressions. Situations and case histories demonstrating this dynamic are presented, namely, the guilt of getting more than one’s share of life, material possessions, or physical gifts than the people one loves. The relationship of this getting more and the concept of the “zero-sum game” is discussed. Suggestions are presented for the treatment of depressions resulting from this conflict. Survivor guilt is a common theme, running through our society in both dramatic and subtle ways. An awareness of this can help us explain certain phenomena and deal with some types of depression in our psychiatric work.