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For every problem, there exists a solution which is simple, elegant, and wrong.
"I'd like to think the world could survive another sexy night, But every time that I do, an innocent loses their life- All of the time that it takes could be better spent fighting crime, Somebody dies every time that I ignore the signal chime... Why do I have to be the one who has got to save the world? All that I ask is some special time with my important girl."
— TV's Kyle, "Another Sexy Night"
How unfair is it that those people won the Superpower Lottery? All of that power and not a care in the world! They can get rich off those abilities or play "superman"! That is, except ... every time they take a coffee break, it means a Bus Full of Innocents somewhere fell off a cliff. When they took that Intrepid Reporter out on a date, a Giant Space Flea from Nowhere leveled Manhattan. And while they renegotiate their rent, Atlanteans invade Madagascar. And you can forget about sleeping.
You guessed it: with great power Comes Great Responsibility. While Muggles can "pass the buck" in terms of the responsibility for recycling, civic duty, or taking the government to task, Superheroes can't. Being the only ones capable of dealing with super villains and natural disasters, it means the price of their inaction is the burden of a death they could have prevented on their conscience. Or not.
This is so very seldom lampshaded that it's more of an implication than anything... because no sane superhero is ever going to mention the school bus to anyone. One also wonders what's happening on Earth while the superheroes are in space fighting an Eldritch Abomination.
When it is addressed, it's why super heroes, especially the idealistic types, tend to be workaholics who feel great guilt over any and every death that happens on their watch. You see, the problem with having the power of a god is you also get the responsibility of one... which is a burden no sane human is built to take. Being (mostly) human, heroes will have to balance the responsibilities implicit in having their abilities with basic needs like food, sleep, friendship, fun, romance, and perhaps even un-heroic hobbies and work.
Needless to say, this can go to either extreme. Some go overboard as they attribute any and every un-prevented accident to themselves, running themselves ragged, while others deny all responsibility in favor of living a normal life.
The former type tends to shun their civilian identity, friends, and loved ones. Often becoming exhausted, unbalanced, and much more at risk of snapping and going into a Heroic BSOD over a real or perceived failure. Some Super Heroes may even become a Martyr Without a Cause out of a subconscious desire to die just to get a chance to rest. This is especially true when the setting has Ungrateful Bastards who see fit to blame the hero for things they can't control. The latter will usually be somewhat like a Zen Survivor, while they might not go into supervillainy and actively cause death and destruction, one has to wonder at the good they could have done, and how many deaths they could have prevented... if they hadn't been, oh, mowing their lawn.
This can turn into a self perpetuating cycle if the Hero Harasses Helpers that might take some of the load off.
The "happy mean" between the two is one where they use their abilities as much and as effectively as they can while taking time for themselves. The balancing itself is itself a great source of drama for a "kitchen sink" style of superhero story. Samaritan Syndrome also lends itself well as a Drama-Preserving Handicap, preventing heroes from dangerously cutting loose.
Because of this trope, one key question about any superhero-containing universe is whether there is a surplus or deficit of superpowered awesomeness relative to crime and other dangers. If there is a surplus, heroes can kick back with no guilty pangs. If not, this trope may come into play in one form or another. If the hero isn't able to take time off, this can easily lead to Heroic Fatigue. To help with that and with this trope, many series will have other similarly powerful characters or True Companions take up some of the load, say "we got this one" and give the hero some rest/free time, remind them You Are Not Alone
A sort of variation of this trope is when someone feels guilt because they didn't do enough.
Prone to Think Nothing of It — they think the heroics are part of the job, not something requiring special gratitude. See also Chronic Hero Syndrome, where the hero is constantly compelled to help everyone who needs it, regardless of circumstances.
Named in part for the parable of the Good Samaritan.
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Anime and Manga
Light Yagami has to make the world a better place. Nobody else can put a stop to crime, nobody else has the intelligence, the moral courage, or the magic notebook to do it. Or at least, that's what he believes. Needless to say, this is one of the darkest uses of the trope in history.
Sailor Moon shows this in spades, particularly during the first half of Sailor Moon R: deep inside, Usagi's tired of being Sailor Moon, especially after the events of last season and it starts futzing with her powers to the point where her Moon Tiara Action attack powers down in mid toss and her original brooch is destroyed. The second half had Ami preparing to leave for Germany to study medicine abroad, but when her friends don't show up to say goodbye, she realizes she CAN'T leave and runs back to save the day.
Nanoha has aspects of this. Early on, her negligence enabled a disaster that she probably could have prevented. Unlike most people in her situation, she doesn't angst about it- she just resolves never to let it happen again. Nanoha does have a tendency to overwork herself, although she toned it down somewhat after it almost got her killed.
In one story his fellow superheroes made arrangements to protect the world without him for one night so that he could go on a date with a superheroine. Both of them had a hard time relaxing on the date, but it's not implied that their being out of action for a little while cost the world anything. There's also one moment towards the very end of the issue where they enjoy a very short moment of dead silence, with no emergencies.
It's really brought home by the fact that he dreams of being able to fly free (as in, "just fly around for the fun of it" rather than "fly toward the latest emergency").
In his director's commentary for Groundhog Day Harold Ramis refers to what he calls the "Superman problem," e.g. the notion that Supes can and should be busy 24/7 doing heroic stuff, so why is he wasting time with Lois, Perry White, and Jimmy Olsen?
Especially in the Silver Age, when being Clark Kent was entirely a hobby. More recent stories seem to (attempt to) suggest that he'd go nuts having to be Superman every single moment.
Superman said this outright in the DCAU ("The Late Mr. Kent").
Superman: I am Clark. I need to be Clark! I'd go crazy if I had to be Superman all the time!
The classic Bronze Age story "Who Took The Super Out Of Superman?" involves him being forced to choose only one of his identities to maintain. He soon realizes that both are equally important to him, because he can't stand the guilt of ignoring his calling if he stays as Clark for too long, but even Superman can't stand being Superman 24 hours a day. This theme crops up repeatedly in Bronze Age Superman stories (and even a Supergirl story), but "Who Took..." is the most well-known example.
Surprisingly, the Big Blue offered one of the better deconstructions of this trope. An elderly woman living in Suicide Slums (Metropolis' ghettos) gets the idea that she is able to call down Superman on bad guys after praying twice for divine intervention (only once was it for personal reasons, and that was for her own life to be saved). She eventually goes looking for trouble so that Superman will come in and stop it. Then she tries it when (unknown to her) Superman was away preventing an Eldritch Abomination from devouring Earth (which would be bad), and goes into a gang's hang out hoping that they will be broken up. She is shot (not fatally) and the people of Metropolis realize that they can solve their problems without Superman. The woman bears no ill will towards him, nor do the people of Metropolis and the story concludes that Superman is a nice thing to have around, but doesn't need to be there all the time (well, except when there's a hostile Eldritch Abomination or its equivalent in the vicinity, but for human-scale problems, he can take a break).
This problem and one solution is used heavily in the Elseworld story Superman: Red Son.
One storyline had Superman early in his Post-Crisis career realising that even with all his speed he can't be everywhere and save everyone even in one city, and having to learn to tune out 99% of the cries for help his super-hearing picks up every minute of every day.
Superman: You said that the world doesn't need a savior. But every day I hear people crying out for one.
Despite all this, Superman was hit with this twice in the mid to late 90s. First was when he was resurrected: he and Lois go to Europe for a nice dinner out. While he was gone, the Toyman kidnaps a bunch of children, including the son of a former co-worker of theirs, and kills them. He's so guilt-ridden by this, he vows never to take another vacation.
The second time had Superman mind-controlled by a powerful super villain, ditching his Clark Kent identity to be Superman 24/7 and watch over the entire world. How bad did it get? He shows up in nearly every DC Comic during one particular month (twice being tossed out ofNo Man's Land-ravaged Gotham by Batman), creating an entire army of Superman Robots and finally having the JLA on his ass!
In Marvel Comics, The Sentry (another Superman Captain Ersatz) gets so upset about being unable to save everyone that he offloaded the responsibility of deciding who gets his attention into a purpose-built robot.
The Sentry actually is a basket case if he has to make any decisions. Fittingly, that's a real-life symptom of certain personality disorders, such as the monstrous case of harming himself he at least believes he suffers.
Genis-Vell had a form of omniscience and omnipotence that were unfortunately limited in time and place (could only be in one place doing one thing, however tremendous), and drove himself crazy trying to pick which help to give and then seeing how wrong his choices were.
Notably, he went from heroic to Heroic BSOD (literally a coma) after about a day of dealing with this. Then he woke up with a bad case of A God Am I. The universe didn't last long after that.
It was heavily implied that an Eldritch Abomination had amped his powers up deliberately to provoke his insanity. Genis's father and sister had the same awareness and never demonstrated the insanity.
In one of the City of Heroes comic books, the local Superman Captain Ersatz Statesman is seen to have this problem deep down- although he's had over 100 years to reach a good balance, his inner fear is revealed to be that he doesn't have the time to help everyone. Manticore is also revealed to have a similar problem, though more related to his own doubts about Crimefighting with Cash.
In the actual game, some heroes roleplay the "always be working" mentality... while in the Everyone's Welcome interdimensional nightclub. The commonly accepted belief is that, with thousands of heroes in the city, everyone can take a break on occasion. Villains, on the other hand, need no excuse.
Thanks to respawning, it is literally impossible to stop every crime or arrest every villain. High-level heroes routinely pass, and ignore, dozens of low-level spawns as they move around the city.
Driven to its brutal conclusion in Powers with the Superman Captain Ersatz who finds himself run ragged mentally and emotionally by the task of living to save the world every second of every day. He's been around for decades and, despite his best efforts and those of all the other superheroes in the world, he keeps seeing the same problems playing out... so he starts getting contemptuous and develops a God complex. And then he accidentally kills a friend, snaps, and destroys the Vatican, large chunks of the Middle East, and anything else he's come to see as inherently corrupt and contributing to The Problem instead of The Solution, before he's stopped.
Spider-Man, ironically, is usually good at avoiding this, since he knows that there are only so many hours in the day and that he can't always be there. Besides, there are plenty of other superheroes hanging around New York (nearly all of them, in fact), so chances are that if he's not there, one of them is. However, when he knows that something might go down that he was even remotely connected with, he can't pass the buck, not even to another superhero who might be more capable. After all, he blames his uncle's death on his refusal to stop a crook.
He got a full-blown case when he briefly got cosmic powers, however.
There's a prose short story where he's about to get out of bed and begin a day of crime-fighting and people saving. His wife convinces him to stay in bed for just five more minutes of snuggling. Later, it turns out that during those five minutes, someone committed suicide, in a manner he easily could have stopped. Heroic BSOD ensues.
Rorschach of Watchmen is what happens when this trope is taken off the far end. Walter Kovacs has no real friends, families, job, or anything of substance in his life as a civilian. His whole purpose of being is so Rorschach can gather information and continue to be a justice enforcing masked-hero, even though it eats away at his humanity. Given the book's deconstruction status, this is to be expected, as Rorschach is meant to establish what would happen to people who felt responsible to bring punishment to others at their own expense.
In fact, every hero in Watchmen shows what happens when so-called superheroes exist. Dr. Manhattan increasingly feels disconnected from humanity by his god-like abilities; the Comedian snapped and became a sociopath in order to reconcile the horrors that he saw, Night-Owl held on to his idealism and punished himself for it later in life, and Rorschach lost his mind to his delusions, becoming the very thing he once hunted. And of course, Ozymandias eventually felt that his heroing was too limited in scale and decided he needed to protect the world, even at the expense of a small part of it, basically taking the First Law of Robotics (protect humans) and evolving it into the Zeroth Law of Robotics (protect humanity).
The one time he did after his back had been broken, the stand-in ended up with a huge case of this, essentially going crazy trying to build a better suit to fight with, ultimately fighting Batman himself, claiming to be the true Batman.
Consider what drove him into this business in the first place. If he called someone else, he wouldn't get to punish the bad guy himself.
On the other hand, Bruce has trained a lot of skilled heroes who are, for the most part, more mentally well-adjusted than him- and, to some extent, his career as the Batman has made this trope necessary, as Bruce's presumed-death-actually-timeshifted absence culminated in Gotham pretty much going to hell because Gotham needs a Batman to strike fear into the cowardly and superstitious criminals.
This has actually been somewhat addressed in the new Batman Inc. series, where Batman has been recruiting like-minded and able heroes all over the world to serve as the Batman of that area. This means that essentially, that most regions of the world are being taken care of by their own Batman.
This is a serious problem for Empowered, made worse by the unreliability of her powers. At one point, her boyfriend had to put her super-suit down the garbage disposal (it regenerates, so that's not as bad as it sounds) to prevent her from going after a supervillain when she was too sick to fight.
To make matters worse, almost all of her great accomplishments revolve around What You Are in the Dark — it's not like she's going to get any credit for her self-sacrificing nature, as about 99% of the world just thinks of her as that superheroine who gets kidnapped a lot/ that superheroine who might be a supervillain in disguise
Played for laughs in issue #0 of Dr. Blink: Superhero Shrink. A therapy session with SupermanExpy Captain Omnipotent ends with the realization that the Captain is a perfectionist overachiever because of his Survivor Guilt, striving for the approval of his dead parents. A jubilant Captain Omnipotent frees himself from his heroic obsession... causing him to ignore a half-dozen crimes and disasters occurring around him.
Early in the career of Wally West, the third Flash, he's having problems with his powers due to this syndrome, and visits a shrink. The shrink asks him to count how many people's lives he's personally saved (leaving out foiled alien invasions and such). Wally comes up with a number around 112. The shrink says, "I once stopped a guy from taking a bottle of pills to kill himself. That thought still keeps me warm at night. Those 112 people forgive you for not being perfect. You need to forgive yourself."
Somewhat later, Wally doesn't check every room in a burning building, and a woman is crippled as a result. After the ensuing lawsuit, she asks him, "What about the next time? What'll you do when you're not fast enough?" He replies, "We'll never know," and proceeds to learn everything he can about the speed force, overcoming his psychological limits, and truly becoming the Fastest Man Alive.
In the first issue of Dell Comics' Dracula (which is about a descendant of the original Dracula who suddenly gets vampire-like powers), upon discovering he has powers Dracula baldly states "Now I'll go to the United States and become a superhero."
Mr. Incredible's very first line in is "Every superhero has a secret identity; I don't know a single one who doesn't. Who wants the pressure of being Super all the time?" Though he laments his lack of free time at the beginning of the film, once public opinion forces him underground Mr. Incredible finds himself driven to leap back into action.
Mr. Incredible: No matter how often you save the world, it always manages to get back in jeopardy again. Sometimes I feel like the maid: "I just cleaned this up! Can you keep it clean for...for ten minutes?!
There is a scene later on in which Frozone has to cancel a dinner with his wife that they had gotten reservations for and planned for two months.
Films — Live-Action
In the Fantastic Four sequel, the protagonists couldn't even get a few hours off to enjoy their own wedding (or have a wedding at all) before some new catastrophe intruded.
Poor Peter Parker, in the Spider-Man Trilogy, suffers from this. He suffers on an even larger scale than most heroes, as he's exhausted, dirt poor and failing college because he has to stay awake all night and take random breaks in the middle of the day to stop the crimes around him, costing him studying and job advancement. When he temporarily decides to quit being Spider-Man, he becomes much, much happier for a little while, until this trope eventually catches up to him again.
Schindler: I could have got more out. I could have got more. I don't know. If I'd just... I could have got more. [...] This pin. Two people. This is gold. Two more people. He would have given me two for it, at least one. One more person. A person, Stern. For this. I could have gotten one more person... and I didn't! And I... I didn't!
Parodied, BTW, in that one episode of Seinfeld with Judge Reinhold.
Kevin Costner in The Guardian is shown to be the product of this kind of life as a living legend in the Coast Guard Rescue Swimmers, he spent his life always leaving movies and parties to go out and save people stuck at sea. Notable especially for a scene when Ashton Kutcher asks him "what his number is" to which:
Kutcher: 22? I expected it to be a bit more, haven't you been a swimmer for years?
Costner: It's the number of people I couldn't save.
It doesn't end well
In the Soviet Sherlock Holmes series, Holmes says that any decent man should feel guilt whenever a criminal manages to commit a crime.
Mercedes Lackey's Diana Tregarde has a minor, slightly selfish version of the trope in Children of the Night. She's a Guardian, endowed with incredible mystic powers, and she has to help anyone in her area who really needs those powers. If she doesn't, there are other Guardians who will try and stop a developing crisis, but they're a little ways away and one of them is old, one of them has a broken leg, and one has extreme acrophobia. They'll do it, but she doesn't want them to have to, not when her only problem is that the threat in question gives her panic attacks. Briefly after becoming a Guardian she tried to ignore it and live a normal life, but found out that it just meant that monsters would go after her on their terms.
In her Heralds of Valdemar series, this is a common feature of the Heralds that tends to go hand in hand with their Incorruptible Pure Pureness. Few have felt it more keenly than Vanyel Ashkevron, the Last Herald-Mage, who had to be practically tied up and forced to take a vacation. It's also justified to an extent in that a great enemy of Valdemar was deliberately picking off the Herald-Mages in order to drive Vanyel into exhaustion and thus make him vulnerable.
Odd Thomas goes through this problem when he finds out that, even though a possible thousand were saved from a mall shooting and bombing thanks to the use of his gift, he was still not fast enough in his rescue to save nineteen people.
In Aaron Allston's Sidhe-Devil, Zeb Watson is upset because a mistake he made may have kept him from reducing the death toll in a terrorist attack (even further than he did). And Doc Sidhe tells him:
"That's why I am still in this business, Zeb. The newspapers talk about the good we do. But when I dream, only the ones I failed to save come to visit me. And I think, 'Maybe next time. Maybe then I'll get everyone out. Maybe then I'll take the killer down in time.' I owe it to the ones I've failed."
The Beachwalker is a civilian example. Even after she gets shot, she can’t take a break because she’s the only one in a position to help her patient, and her aging employer has no one else he can depend on.
Harry Potter will all too often go out of his way to help others. Hermione even notes this in the fifth book ("Don't you have sort of a saving-people thing?"). Voldemort knows it, too ("The boy has a great weakness for heroics.").
In the Wearing the Cape setting there seems to be enough super powered heroes to go around; there are even "reservist" superheroes who live normal lives unless called upon for help in cases of extreme disasters. That said, some superhumans (like Hope Corrigan)feel the need to Use Their Powers For Good deeply enough to force them to put on a costume and fight crime when they would really rather be doing something else.
Brought up in a few episodes of My Hero; when George for whatever reason is unable to get away quickly, he agonizes over people he is unable to save.
In Star Trek: The Original Series, Jim Kirk is like this regarding his crew. He often (as a young man, not so much in the movies) seems terribly close to curling up into a little ball of guilt every time someone under him dies, especially if it's a result of his orders.
The deaths of 200 people on the starship Farragut (including the ship's captain) because Kirk believed his moment's hesitation in firing phasers allowed the alien monster to attack continued to haunt him years after the event. This is despite the fact that the ship's First Officer noted that then-Lieutenant Kirk "performed with uncommon bravery".
In a Star Trek Expanded Universe novel, Kirk tests out one of the first holodecks (which still requires him to wear a full-body suit), which allows him to replay the destruction of the Farragut. This time, he doesn't hesitate and has the ship fire phasers. Nothing changes. The ship still gets destroyed and the crewmembers still die.
Generally happens to every captain in every series. Picard had a particularly painful moment when he had the choice between ordering his recent true love on a dangerous mission or forcing her to stay on the Enterprise, even though she was the most qualified for the mission. Eventually, he came to the realization that there was no choice at all, and ordered her to go. When she survives, she requests a transfer off the ship, knowing that their feelings were clouding their judgment, and he approves it, again having to make the hard choice. Picard's love life sucks, man.
Don't forget the holographic Doctor on the Voyager having the AI equivalent of a mental breakdown not once but twice over the same issue: a crewmember dying because she and another patient had the exact same chances of survival, and he chose to operate on Harry Kim because of their friendship. The first time, Janeway had his memory of the events wiped. The second time, Seven convinced her to let the events play out at the risk of losing their only doctor. Somehow, the Doctor manages to pull through and keep his program from experiencing a "cascade failure".
This was a common theme on Buffy the Vampire Slayer; everything normal Buffy wanted to (or had to) do seemed to conflict with some new supernatural threat to Sunnydale. In the series finale, Willow made every potential Slayer into a full-fledged Slayer, and the series ended with Buffy realizing that because she's no longer The Chosen One but just one of The Chosen Many she had more freedom to live a normal life.
This is why all of Buffy's attempts to keep Xander Harris "fray adjacent" failed. He even lampshaded it once, saying that now that he knew the truth about the things that go bump in the night, there's no way he could just sit on the sidelines.
Cordelia got hit with this bad after the events of the first season finale of Angel. She repeatedly refused to give up her visions despite the fact that they were horrifically painful; she eventually lost any trace of a social life due to her drive for helping others. This is, of course, some amazing character development for her that still feels perfectly natural.
A variant (part inversion, part lampshading) shows up in the form of a particularly chilling Hannibal Lecture in Doctor Who, in the First Doctor's final serial "The Tenth Planet":
Polly: Don't you care?!
Cyberman: Care? No. Why should I care?
Polly: Because they're people and they are going to die!
Cyberman: I do not understand you; there are people dying all over your world, and you do not care about them.
Examined in Criminal Minds: Hotch has a bit of this, but Rossi points out that if one of the BAU quits, there will be someone else to pick up the slack.
Rossi: It's not about us. It's about the job.
When Lois gained Superman's powers thanks to red kryptonite in Lois and Clark, she became overwhelmed by all the calls for help and even broke down into tears when she couldn't help with two disasters at the same time. Clark had to tell her that no one can be anywhere at once and it was very hard for her since as a reporter, she is supposed to do everything in her power to help others and get the story.
In House episode "TB or not TB", House confronts a man who is refusing to take TB medication as a publicity stunt. House believes that he has TB and something else, and wants to take the symptoms caused by the TB off of his board.
Dr. Sebastian Charles: There’s people dying in Africa of a disease that we cured over...
House: Yeah, I know. I saw the concert. Seriously, let’s say you sleep six hours, that means every night you kill 1,440 people. I guess you gotta get some sleep, but come on, if you’d stayed up another 10 minutes you could have saved 40 lives. Do you send notes to the families in the morning? That’s gonna take at least 10 minutes so that’s another 40 dead, another 40 notes why don’t you go wrack yourself with guilt in your own room?
In "Sneeze", after Zod and Brainiac wrecked havoc across the globe, Clark ran himself ragged trying to rebuild everything.
Seriously lampshaded as 'The Blur' became more and more well known, there was a period where citizens were upset that he could not save everyone. Every tragedy started being blamed on 'Where was The Blur?' and 'Who gives The Blur the right to decide who lives and who dies?'.
Like the Lois and Clark example, "Prophecy" has Lois gain Clark's powers and become overwhelmed by the cries for help. Part of the significant character growth Clark has done by this point is that he admits he can't save everyone and while he does feel guilt over this, he must prioritise who is in the most immediate danger before moving on to the next, comparing his role to a Doctor in triage.
Shorty Rossi, the eponymous Pit Boss, has a serious case of this when it comes to all things involving pit bulls. This attitude is taken to the point of Deconstruction at times, as his single-minded determination to help every dog they come across has put his crew in harms' way and pushed them beyond their limits — at which point he expects them to give even more. His own health concerns don't help much, as he has literally put his back on the line several times.
Michael suffered from this in Prison Break. First he sacrificed his life to get sent to prison and save Linc. Then he wanted to save Sara. Then he found out about the Company and the General and wanted to take the General down, despite the fact he had a brain tumour and a ton of enemies.
"The Ballad Of Barry Allen" by Jim's Big Ego has The Flash lamenting that by the time the people he rescues even know what happened, there's someone else who needs him.
That, and because of his super-speed, people around him as basically statues. A normal, idle conversation takes him subjective weeks at least.
But it's not so bad if you're a One Hundred Percent Completionist (or really soft-hearted). You can hit the Reset Button as many times as you like, and once you've successfully finished a quest, it stays "completed" even if you start the cycle over.
Sapphire lampshaded this in a Champions Online blog post on how to keep yourself from starving when crime won't let you stop for lunch.
Kingdom Hearts: Actually, Sora is not supposed to act like this and Donald even tried to remind him not to "meddle" a few times, but he eventually gives in, because Sora just doesn't stop. All There in the Manual explains that Sora's benevolence and sense for justice (and naiveté, to some degree) have always been too strong for his own good.
Poor Gordon Freeman went into work one day, was inadvertently part of an experiment that ripped the universe a new one, and for every waking moment since has been killing everything in his path to protect the planet from one Alien Invasion after another without a single break. Painfully subverted though, in that this isn't his choice at all.
The GMan: Rather than offer you the illusion of free choice, I will take the liberty of choosing for you, if and when your time comes round again.
This is easily explainable by a key word: He doesn't THINK he's the type of guy who'd leave a dead woman lying around. As it turns out, his Samaritan Syndrome is merely caused by who he perceived himself to be when he was told.
Litchi Faye-Ling in BlazBlue. After a negligence in her research caused her colleague Lotte to turn into Arakune, she has resolved to restore him to normal, and along the way, help other people so they don't have to suffer like him, putting her life below others. While it does make her a Good Samaritan, she ends up into the dark side because of it.
By Mass Effect 3, the stress of the Reaper invasion seems to have driven Shepard into a severe case of this, regardless of alignment. Implied PTSD and Survivors Guilt over those they couldn't save manifest themselves in numerous haunting dream sequences that occur throughout the game, and past a certain point the support of their squad seems to be the only thing holding them together. It's particularly driven home in the ending if you choose Destroy, the only ending where they survive, they still walk towards the exploding conduit.
Misho's original Samaritan Syndrome was worsened when he made his Sacrifice to gain mastery of sorcery; going to the Loom of Fate and seeing the destiny of all mortals which, thanks to his perfect memory, resulted in: "So Misho sacrificed his ignorance."
Touched on in Love and Capes. Abby wants to know what being a Superhero is like, so the local expy of Doctor Strange helps get her some superpowers. Mark and Darkblade discuss that "it hasn't happened yet", and "it" turns out to being in a situation where you can't save everyone (she can only save 14 of 15 people falling off a bridge), and Mark tells her that every hero has to come to terms with the fact that no matter how good you are, you can't save all the people who need saving. Abby understands this, but knows she would have trouble handling it, and her powers fade.
Parodied in Oglaf in the adventures of Sir Coffee, who cannot sleep because there's always someone needing urgent help. (Page safe, but the rest of the comic is mostly NSFW)
Interestingly, while she's used to it (although very tired of it), she knows her friends volunteered to become Sailors and help her fight but were not entirely clear on what it would cost. Specifically, she despairs that they too will become like her, numb and nearly dead from the constant pressure. So she decides that, effective immediately, it isn't enough to contain the Yamiko — she's going to wage all-out war against them, in hopes of finally ending the conflict once and for all.
Achilles has absolutely no life outside of superheroics, specifically because of this reason.
Panacea from Worm has this, as she is among the only healers in the world, she spends all of her free time visiting hospitals and helping people because she couldn't live with herself if she didn't. Unfortunately, the lack of oversight of her visits and her broken home life mean that nobody really notices when she begins to suffer Heroic Fatigue....
Johnny Test played with this trope, when Johnny decided to be a super hero, and found that they wouldn't let him take a nap, play video games, or even go to the bathroom.
The Powerpuff Girls episode "Too Pooped to Puff" featured this. They're so good at (repeatedly) saving Townsville that the people simply stop doing anything for themselves, rationalizing it with "Eh, the Powerpuff Girls will get to it." Eventually, the entire town becomes a group of incredibly lazy slobs. Even Professor Utonium himself (the Girls' creator/father), tries to ask them to bring him the remote control...which is lying 2 feet away on the coffee table in front of the couch Utonium is lying on. The Girls get sick of this and pretty much leave the town on its own. This all well and good until the inevitable monster comes rampaging into town. And of course, the townspeople ask for the Girls' help. After forcing them to promise to get off their butts and do some things for themselves, the girls instruct them on how to save the day.
Another episode had the girls racing to get home after school because they were excited to go on vacation. This resulted in time travel, causing the girls to go absent for 30 years and The Big Bad taking over. After witnessing this, the girls manage to undo the time travel and invoke a variation of this trope, telling the Professor that they can't leave Townsville. Ever.
An episode of Batman: The Animated Series featured the hero making his annual visit to the site of his parents' murder, which makes him late for a sting operation that he helped set up. He arrives in time to help subdue the crooks, but finds that Jim Gordon has been severely wounded. Batman's guilt (which is not helped at all by Detective Harvey Bullock) over not being there in time to save Jim sends him into a Heroic BSOD.
In other episodes, he's refused to let minor inconveniences like a cold and, oh, blindness stop him from bringing down the bad guy because he knows what kind of mayhem is being unleashed while he sits it out.
In the former episode, Batman is saved from Heroic BSOD because he stops another attempt on Jim Gordon when he wakes up and finds out Jim has the same doubts.
Special Agent Oso, a preschool-targeted series about a stuffed bear who helps young kids do basic tasks has a mild example in that Oso is sometimes invited by the parents of the kids to stay for a meal, or other such invitations, but can't accept because he has to get back to his training mission.
In an incredibly sad real-life case of this, a Pulitzer Prize winning photographer who took pictures of starving Sudanese children committed suicide because he was haunted by the feeling of being helpless to save any of them.
During the 1937-1938 Rape of Nanjing, at the Ginling Girls' College, the lead American professor, Minnie Vautrin, an American missionary and a professor of education, worked tirelessly in a parallel effort to preserve the young women of her school from rape. In cooperation with the German (member of the nazi party) businessman John Rabe, her efforts to protect her young women from degradation were ceaseless. Hundreds, perhaps thousands, of girls were spared gang rape as a result of her efforts. Upon her return home, in 1941, she too committed suicide.
Watching interviews with Lt. General Roméo Dallaire, military commander of the UN Assistance Mission in Rwanda during the Rwandan Genocide, is rather soulcrushing. He basically blames himself personally for the uselessness of the UN's response, despite having had fewer than 500 people and next to no support from the UN or anyone else.
Major Charles Whittlesey, who was the commander of the famous "Lost Battalion" in World War One, managed to keep his men alive under impossible odds and was awarded the Congressional Medal of Honor for his achievements. However, the combination of guilt over his inability to save all of his men and the fact that people were always constantly reminding him of the event were likely factors in his subsequent suicide.
Triage. The easy part is sorting out the ones who are dead and the ones that don't need any emergency care. The hard part is passing those people who need emergency care, but it would be too time and resource intensive versus their chances of survival. The only thing you can do is quick pain management and maybe find a volunteer to stay with them while they die and you move on to the next.
Becomes even worse when painkillers can't be spared.
Both Oskar Schindler and Karl Plagge, two Nazi Party members (well, Plagge was kicked out for not being sufficiently racist) who between them saved hundreds of Jews by claiming they were "essential workers," apparently felt enormous guilt for the rest of their lives that they couldn't save more. Plagge even refused to be officially exonerated at his de-Nazification trial, requesting to be reclassified as a "follower" of Nazism instead. Both were awarded the title of "Righteous Among Nations" by the State of Israel for their efforts, however.
In a way, this trope applies to anyone with a decent first-world income. These twoarticles point out that a really small amount of money can improve or save a life through an efficient charity. So every time you buy a computer, or go on vacation, or donate to an inefficient charity, a life that could have been saved wasn't. Hardly anyone thinks like that (because it's a slippery slope from there to "every bite of food you take could have gone to someone hungrier"), but there's an element of truth to it.