Compassion Fatigue

Ever since my mother’s cancer diagnosis and her treatment, I feel like I have been on low fuel. For her and for myself. I know I am being irritable with my family but I just feel like I have lost the capacity to empathise.”

“I routinely lose my pet patients on the operating table and sometimes, i just feel numb and really need to push myself to go to work again.”

“Listening to the stories of daily wage earners who don’t have that income anymore- its just heartbreaking and i don’t know how many i can listen to, anymore.”

Different clients have expressed these feelings at different points in life and in varying situations and roles (a caregiver, a vet and a field journalist) with the underlying common thread of Compassion fatigue.

So what is compassion fatigue?

Compassion fatigue has been used to describe the “emotional, cognitive, and behavioural changes in professionals working with trauma sufferers” (Figley, 1995) or secondary traumatic stress, as it is officially termed. Professionals such as medical doctors, emergency workers and mental health therapists are the most vulnerable to experiencing this. It could include withdrawal, anxiety, sleep disturbances, feelings of helplessness, guilt, an elevated startle response and lowered concentration (Figley, 1995, 2002), as in the case of the above mentioned clients who all experienced a pervasive sense of helplessness.

The term was first identified in an article written by historian, Carla Joinson, who, at the time, was observing nurses in emergency departments and noticed the above mentioned states of distress in various nurses, some of whom seriously considered even leaving the profession. Figley then later explored how professionals who provided empathetic support were prone to exhibiting some of the distress embodied by their patients as well.

The impact of compassion fatigue is real. If left unchecked and not taken seriously, it can lead to reduced quality of care, increased stress and anxiety. Thus, leading to an increase in errors in the professional and personal setting - which can lead to clinical and mental health concerns.

The previously mentioned clients are no outliers for those in professions or life situations which require a large amount of empathy and emotional investment. Numerous studies have documented the prevalence of compassion fatigue in caregiving, healthcare and even in journalism where individuals are exposed to varying levels of trauma and distress. It was also found that compassion fatigue can result from feeling empathy towards someone suffering from trauma even if the contact is brief (Hansen et al, 2018)- so it is not just restricted to healthcare professionals.

With the current pandemic bringing with it an onslaught of helplessness and fear, it has taken a huge toll on us all. The constant barrage of distressing instances of death, sickness, inequality and injustice and the constant exposure to mortality, grief and fresh emotional concerns that have cropped up has made us all feel like we are running on empty. It is especially important in times like these to be aware of our internal processing and be attuned to our needs.

Coping with it

Once we have recognised that we have indeed hit a wall and that something has to give, there are some personal steps that can and should be taken, pre-emptively as well:

Taking time off: While this may be an obvious one, the notion of having time off has drastically changed. Constantly being connected to work, stimulated to thinking about work and even working during so-called ‘time off’ has made it impossible to really switch off. Having real time off would mean truly refraining from work related activities and using the time to reconnect with friends, family and more importantly, oneself, in different ways. These could include reconnecting with nature, outdoor activities, journalling, creative expression through art, music or dance, reading that book that you’ve been putting off and even catching up on much needed rest.

Knowing when to say ‘No’ and sticking to boundaries: More often than not, being firm and sticking to boundaries set around time off is easier said than done. Setting automatic replies on and turning off email app notifications can be helpful in this respect where there is a sense of finality and the mental association made with actually putting the automatic replies on and notifications off. Declining certain work related opportunities to maintain a balance, as one sees fit, is essential. Knowing when to say no in non-work related aspects is also equally important- as much as you would like to support everyone, you can’t do everything and be everywhere all the time and have a fountain of compassion and energy.

Reaching out for support: Be it to colleagues to delegate work or one’s social support system to take over some home related responsibilities, it is vital to ask for the help when you need it.

Seeking professional help: Working with a mental health therapist to explore your distress and recoup can provide a holding space for your emotions and be cathartic in nature whilst adding fresh perspectives and ways to cope, healthily.

These are very trying times and there are very real limits on our own capacity to give which warrant active attempts, on our part, to replenish our capacity.