I caused the crash that hurt my passenger and I can't forgive myself

I was on the other side of this — I was the at-fault driver in a crash that hurt my brother. Different circumstances but the guilt spiral you're describing? I lived in that for a long time. What helped me was finally having the honest conversation with him, not just the 'it's okay' surface version. It was uncomfortable and we both cried but after that something actually lifted. The unspoken thing between you two is probably making it worse for both of you.

Please take your doctor's suggestion about talking to someone seriously — not as a 'nice to have' but as actual treatment. Trauma responses and guilt after causing an accident are real and they can absolutely interfere with physical recovery too. Stress and anxiety slow healing, affect sleep, tighten muscles. The flinching while driving is your nervous system still in threat mode. A therapist who does EMDR or trauma-focused CBT can make a huge difference. You don't have to white-knuckle through this.

I just want to say — the fact that you feel this much remorse says something real about who you are. People who don't care don't agonize like this. Be a little gentle with yourself, okay?

You're both alive. You're both healing. And you clearly still have each other — she's not gone from your life, she's still choosing to be there. That's not nothing. Guilt has a way of making us feel like we owe a debt that can never be repaid, but sometimes people really do just... forgive. Let that be real.

Have the real conversation with your cousin. Not the 'I'm so sorry' version you've already had — the one where you actually say out loud what you did and why and what you wish you'd done differently. It's going to be awkward. Do it anyway. The thing you're both tiptoeing around is taking up way more space in your head than the actual conversation ever would.

Not trying to pile on, but I'm curious — is there any insurance or legal stuff still open from this? Like is your cousin dealing with medical bills from her injuries? Sometimes the practical stuff being unresolved keeps the emotional stuff from closing. If there's a claim still hanging over both of you that's its own stressor on top of everything else.

Jumping off what the person above said — if your cousin had injuries from this and there's any liability insurance involved, it's worth making sure she's had the chance to actually get her medical costs covered. I've seen situations where the injured passenger didn't pursue anything because they felt awkward about it, and then ended up with out-of-pocket bills that quietly became a source of resentment later. That's not good for either of you. It's worth a low-key conversation to make sure she's taken care of on that front, separate from all the emotional stuff.

One thing I'd flag — if there's any open insurance claim, be careful about what you're posting publicly, even anonymously. I'm not saying don't process your feelings, just be aware that things can resurface in ways you don't expect.