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Dr. Robert,

On June 8 of this year my son (22) attempted to take the keys from his best friend (22) in the parking lot of a local bar. His friend had a fight with his girlfriend and had been drinking much too much. After 45 minutes his friend agreed to be driven home. My son ran back into the bar to get another driver and when he came out his friend was driving away. He decided the best thing to do was to follow him and make sure he got home okay. He was only minutes behind when he saw his friend hit a pole. My son stopped and ran to his friends car, reached in to shut it off, and opened the passenger side door and his friend fell out into his arms. He had sever head and neck trauma so my son took off his shirt and wrapped it around his friends head, called 911 and tried to keep his friend alive until the paramedics arrived. But, it was too late, his friend was dead.

After the accident his friends kept calling him, I don't think his phone stopped ringing until after the funeral. I told him to just turn off his phone, but he wouldn't. He talked to everyone. If they wanted to talk about it he would spend however long it took, sometimes at his own expense. He wasn't eating or sleeping well.

I can't seem to get through to my son. His pain is enormous. He visits the cemetery every night, wants to tattoo a huge monument on his chest (an angel and headstone with name and dates). I've asked him to wait at least 6 months before he gets the tattoo, perhaps by then he would rather remember the better times. He will have to see it every day for the rest of his life. He says that's what his friend would do! I've asked him to seek professional help with his loss, but can't get through. I only make him angry. I'm afraid he is feeling he didn't do enough to stop his friend from getting into the car.

What should I do now?

Thank you for any help you can be,

Victoria



Dear Victoria--

I am so sorry about all this suffering.

Your son finds himself in an extremely difficult and vulnerable situation. If you factor in the loss of his friend, plus the horror of watching his friend die right in his arms, it is easy to understand that your son has been severely emotionally traumatized. But beyond the initial loss and the traumatic experience of violent death, your son also seems to be suffering from survivor guilt, which is not at all uncommon--in fact expected--in such circumstances.

Survivor guilt, along with the accompanying self-reproach, is a formidable problem. Even if the survivor knows that his or her feelings are not completely rational, the guilt can feel overwhelming, and sometimes the survivor tries to deal with it by self-punishment of some kind. I could be wrong, but I imagine that the tattoo idea might constitute for your son a kind of self-mutilation which he believes (perhaps unconsciously) might help to alleviate his guilty feelings.

I believe your son should receive expert treatment with a psychologist experienced in survivor guilt as soon as possible, This treatment might include both individual sessions, and also membership in a group therapy circle with others who have similar experiences--returned soldiers, for example, who now reproach themselves for having escaped death while their buddies fell on the battlefield. Unfortunately, if your son refuses to consider this kind of treatment, I have no special advice for you on how to convince him. After all, he is not a child (although I imagine that to you he still seems to be one, especially now). And refusal of therapy may be part of the self-reproach and self-punishment to which survivors often seem attracted.

If he continues to refuse professional help I think the best thing you can do for him right now is this: stop trying to save him from the tattoo, and concentrate instead on trying to help him with his guilt. If he gets the tattoo, so be it. As for helping him with the guilt, I would probably approach it like this:

I would understand that the eventual goal is for the survivor to learn that it is reasonable to feel sad about someone's having died in a traumatic situation, but not rational or appropriate to feel totally responsible for that person's death. The method for helping the survivor to reach this goal is to accept without question all of the survivor's feelings (sadness, anger, self-reproach, depression, whatever), encouraging the survivor to express them freely, while you continue to stress that he did all he could and that it was not his fault. Even if this must be repeated hundreds of times over weeks or months, eventually it will help.

Secondly, you should begin to stress other factors besides your son's not having done enough (as he sees it). In other words, it would be helpful to keep on mentioning the drinking, the argument, the excessive speed, how upset his friend must have been, etc.

Although you might not state this explicitly to your son, the aim of all of this is to help him to arrive at feeling that he or she did the best job in the situation that could have been done considering the circumstances and the resources available in the situation. One way to help your son to get to this point is to ask him how long he will need to continue to make himself suffer (but don't rush this particular intervention--you will have to use your judgment about when it is possible and appropriate to voice that question). If you get an answer of any kind, then you might say that you know that no amount of restitution or personal self-punishment can ever make up for the loss of a friend, and that perhaps the best he can do for that lost person is pull himself together and make his own life positive, meaningful, and fulfilling.

Sorry not to have more to offer, but the truth is that your son needs expert care right now, not simply my words.

Be well.











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page last modified July 8, 2006



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