*** Compassion Fatigue (Part 1)

Overview
The recent tsunami in Asia and major earthquake in Pakistan have highlighted problems long recognized in the helping professions. Caregivers have known well the potentially draining experiences of compassion fatigue – from experiences of policemen, firefighters, paramedics and other emergency and rescue personnel, through doctors, nurses, psychotherapists and counselors, and not to overlook the family members and volunteers who come forward to help in individual challenges and collective disasters.

The same is true of staff working with soldiers who have post-traumatic stress disorder (PTSD). Hearing the horrendous stories of wartime traumas can be traumatizing to the therapist, particularly when this form of secondary PTSD trauma is not even recognized, much less treated.

When we hear the stories of victims of illness, misfortune, trauma and disasters it is natural to feel compassion for their hurt, loss and distress. We help by being there in times of need and grief; our presence is a reassurance that aid is available; our caring through attention, emotional support, advice and material assistance are at the very least injections of hope that repair and order will be restored, and often are much, much more.

It is a help and a healing to those who are suffering to know that their stories of pain, loss and grief are heard and acknowledged; to have the steadying presence of caring people who can help to prioritize and address the immediate needs, to identify and locate the necessary remedies, and to provide support in whatever ways are beyond the victims’ capabilities.

Compassion fatigue is a risk in these situations – from the emotional impact upon caregivers who feel overwhelmed by the enormity of individual and collective pain and suffering following disasters. Technically, this problem is designated Secondary Traumatic Stress Disorder, which is essentially identical with Post Traumatic Stress Disorder except for the cause of the stress.

Signs of this overload include: weariness that goes beyond appropriate physical fatigue; difficulty concentrating; forgetfulness; depression; labile emotions and emotional outbursts – such as unreasonable irritability, crying or anger; feeling distant from others; difficulty falling asleep; disturbed sleep, waking during the night – with or without nightmares; physical symptoms of stress – such as headaches, backaches, stomach and bowel upsets; feeling it is difficult to get out of bed or to go to work; having a strong startle reaction with minor stimuli; obsessing over traumas or having flashbacks to these.

While the recent focus of the media has been on professional caregivers who experience compassion fatigue in crises, this may also be found in relatives who are dealing with acute and chronic problems of family members, in doctors and nurses, in hospice workers and in clergy ministering to people who are ill and dying.

Compassion fatigue may be compounded by caregivers’ feelings: guilt that they are not strong enough to continue under stress; guilt that they have not suffered the losses of the people they are helping (Nader); self-doubts and inadequacies in the face of overwhelming problems of the people they are helping; shame at admitting they cannot cope with the stresses of their jobs; frustration at circumstances beyond their control that impede provision of help; and anger at bureaucratic or governmental authorities who are less than cooperative or supportive.

Compassion fatigue may also be a symptom of buried and forgotten psychological trauma that the caregiver experienced in the past. When we repress painful emotions under acute stress (which may be a very helpful and adaptive reaction at the time, allowing us to cope with a situation without feeling overwhelmed) we end up carrying the buried feelings inside us. Compassion for the victim of a similar situation, or for their responses to the situation, may reawaken memories of these buried feelings.

Essentially, compassion fatigue is a form of post traumatic stress disorder (PTSD). Caregivers can be traumatized through hearing the distressing stories of clients or may have their own PTSD activated from the past. If you are wondering whether you might be suffering from compassion fatigue, an on-line test is available to help you clarify this (Florida State University).

Historical notes
Carl Jung (1907) was the first to identify countertransference as a potential problem for psychoanalysts. This is the emotional response of the therapist to the person being treated. Jung noted that in treating severe emotional problems it was possible for the therapist to become emotionally disturbed, particularly when the therapist was inexperienced or had unresolved emotional conflicts that resonated with those of the patient.

Burnout in the helping professions has been recognized for several decades. This is a broader problem than compassion fatigue, including also overwork, loss of interest out of boredom with routines and job dissatisfaction.

Secondary post traumatic stress was discussed in relatives of Viet Nam veterans, of rape victims and of incest victims.

Compassion fatigue was first named as such in 1992 by Carl Joinson, who pointed out that nurses and ministers were subject to exhaustion of their capacities to provide empathetic care, due to being repeatedly traumatized secondarily by having to deal with the stresses of patients they cared for. Various authors have followed up on this subject.