Moving beyond the passing of a loved one is always difficult, but grief can be compounded when the survivor is tormented by guilt. What’s at the root of this emotion and how does one work through it?

Though it's been over 30 years, Lisa’s voice still cracks with emotion when she shares her story. Shortly after she married, her parents made aliyah. “My father begged me and my husband to move to Israel at least for the first few years of our marriage. I wanted to,” she relates, “but my husband had been accepted to medical school and he wanted to get started already.”

Two years later, Lisa’s father was diagnosed with a rare aggressive cancer.

“I visited many times that year but in my last conversation with him — and this is engraved in my mind forever — he said to me, ‘Don’t you wish now that you moved here?’ Well,” Lisa shares, “I don’t blame myself for not moving to Israel. I knew my husband’s wishes superseded my dad’s, but I still feel torn apart because instead of just saying ‘Yes, Daddy, I love you so much and wish I’d spent these last few years with you,’ I started defending my position, explaining why I had to do what I did. I’ve been replaying that scene for the last 30 years, each time wishing I would have spoken differently.”

When an individual passes away, grief is the normal reaction. But almost as common — though not nearly as well acknowledged — is a sense of guilt.

“Guilt is one of the most powerful negative reactions to the loss of a loved one, equaled only by anger as a common grief experience,” according to Carol Staudacher, grief consultant lecturer and author of Beyond Grief: A Guide for Recovering from the Death of a Loved One (New Harbinger Publications).

“After someone close dies, people may blame themselves for things they did or didn’t do that they feel contributed to the death of their loved one.” Ms. Staudacher continues, “Regardless of how or why our loved one died, we sift through the evidence of past behavior, giving ourselves reasons to be miserable. We become tormented by our own perceived failures, omissions, insults, poor judgment, or unwise choices.”

Why the Guilt?

When Sora’s dear friend died of cancer five years ago, Sora couldn’t shake her intense feelings of guilt.

I should have visited more. I should have asked her how she felt. I saw she wanted to talk about serious things — like dying — but I pushed her off. I rationalized that she didn’t really want to talk about it, but really I was scared to talk about it. I should have encouraged her to talk, but I thought, who do I think I am to bring up such topics? Maybe she’ll be hurt and angry if I talk about it. So it became the elephant in the room. She must have felt so alone those last months — I don’t think anybody talked about it with her. Why wasn’t I there for her in her ultimate time of need?

“There is always a modicum of guilt [when a loved one passes away] because we are human and we could always do better,” says Dodi Lamm, a clinical social worker in West Hempstead, New York, specializing in treating people undergoing life cycle changes. “We could have called more often, made the person happier, run to the store more frequently, it’s endless.”

Dr. Yetta Krinsky, a psychiatrist in Melbourne, Australia, works with women primarily to facilitate the healing process from severe childhood and adult trauma. She describes different kinds of guilty feelings which may emerge in the healing process from loss of a loved one. She describes a patient of hers — a young widow with small children whose husband died of brain cancer.

“In her case, the feelings of guilt she experienced were not surprising. The young wife and mother was torn between her need to mother and shield her young children from what was happening to their beloved father, and her husband’s need for love, care, and support. When she was with one, she would feel guilty about the needs of the other, and when she ended up feeling resentful, she would feel guilty about that too.”

Another instance Dr. Krinsky cites is of a young teenager who had a fight with her mother; soon afterward the mother died in a car accident. The girl’s strong feelings of guilt persisted until she was able to understand that their argument did not diminish her love for her mother or her mother’s love for her. “These are both normal responses any person would feel in that situation,” stresses Dr. Krinsky.

Dr. Krinsky shares a third example of a patient who was angry at her mother for dying young and abandoning her — and then felt guilty about her irrational anger. Once she was able to express these feelings and have them validated as a natural reaction to such a loss, she was able to heal.

When someone passes away from an illness, the disease itself might affect his mood and behavior, comments Dr. Krinsky, whether it’s due to severe pain or side effects of medication. This can make him difficult to care for, engendering feelings of resentment in the caretaker — for which he might feel guilty later.