Survivor guilt and chronic illness

Objective: To examine the grief reactions that may result in patients after a death occurs within a treatment setting for chronic illness, and in particular to look at the applicability of the concept of survivor guilt in these situations. Clinical picture: Two patients with endstage renal disease are described. Both presented states of pathological grief for fellow patients. Vulnerability existed in both patients in terms of previous unresolved mourning and in terms of strong feelings of comradeship with the dead patients. Both demonstrated features reminiscent of what has been termed the 'survivor syndrome'. Treatment: The treatment involved supportive psychotherapy allowing exploration of grief and its relationship to current psychosomatic crises. Outcome: Supportive psychotherapy successfully aided the resolution in one patient and made some difference in the other. Conclusion: The impact of death within a treatment unit is emphasised. Surviving patients may have significant distress relating to such bereavement and may need appropriate intervention.