|September 4, 1998
You're drained, tapped out, have little energy to give others. We’ve
all been there. Usually, after a little break we revive and step back up
to the plate. What happens, however, when these feelings don’t pass —
going beyond fatigue and turning into something much worse, like apathy?
This could spell trouble for those caring for an elderly parent or sick
child, or for health care professionals rendering care to others. In this
InteliHealth interview, one of the nation's leading medical experts talks
about compassion fatigue, a condition that plagues many individuals
working in and out of the home. What actions can you take to prevent this
serious occupational health hazard and risk to caregivers in general?
Q: What is compassion fatigue?
A: This term has replaced the
more familiar term "burn-out." It refers to a physical, emotional and
spiritual fatigue or exhaustion that takes over a person and causes a
decline in his or her ability to experience joy or to feel and care for
others. Compassion fatigue is a one-way street, in which individuals are
giving out a great deal of energy and compassion to others over a period
of time, yet aren’t able to get enough back to reassure themselves that
the world is a hopeful place. It’s this constant outputting of compassion
and caring over time that can lead to these feelings.
Q: What causes it?
A: Compassion fatigue comes from a variety
of sources. Although it often affects those working in care-giving
professions — nurses, physicians, mental health workers and clergymen — it
can affect people in any kind of situation or setting where they’re doing
a great deal of caregiving and expending emotional and physical energy day
in and day out.
Q: Who is most at risk of developing compassion fatigue?
Although those in the health care and mental health professions are most
at risk of developing these feelings, it is not limited to these arenas.
It affects those who don’t work outside the home as severely as those who
do. Take someone who is actively engaged in taking care of a family
member, especially during a crisis period when there is a higher need to
give out feelings of compassion and sensitivity. If the crisis doesn’t
pass quickly and the individual continues functioning at this level, he is
just as susceptible to compassion fatigue over time as those in high-risk
Q: What are some telltale signs of compassion fatigue?
First, you should understand that it’s a process. It’s not a matter of one
day, you’re living your life with a great deal of energy and enjoyment,
and the next, you wake up exhausted and devoid of any energy — both
physical and emotional. Compassion fatigue develops over time — taking
weeks, sometimes years to surface. Basically, it’s a low level, chronic
clouding of caring and concern for others in your life — whether you work
in or outside the home. Over time, your ability to feel and care for
others becomes eroded through overuse of your skills of compassion. You
also might experience an emotional blunting — whereby you react to
situations differently than one would normally expect.
Q: If you have this condition, what can you do?
A: The most
critical need is to acknowledge that you may be experiencing it. All of us
have multiple demands and energy drains in our lives — some positive, some
negative — which all require a great deal of emotional and physical
attention. There are, however, many hands-on things you can do to mitigate
the feelings of compassion fatigue. For one, start refocusing on yourself.
Before you can tend to and be sensitive to the needs of others, you have
to take care of your own well-being. This can be as simple as getting
plenty of rest, becoming more aware of your dietary and recreational
habits, and cutting out negative addictions in your life like nicotine,
alcohol and caffeine. Remember, the healing process takes time, as does
the development of the problem.
Q: What if you’re in a high-risk profession and the feelings don’t
pass? Should you quit your job, request a transfer or take an extended
A: All of these are options depending on your situation.
Sometimes people who witness a lot of trauma as part of their jobs — like
law enforcement agents, paramedics and fireman — will opt to choose
different lines of work. Even if they recuperate and successfully combat
these feelings, they sometimes feel they don’t want to begin again the
process of exposing their heart and feelings day in and day out. For
others, a vacation may do the trick. Vacations are healthy, restorative
interventions that can head off negative feelings so that they don’t
progress beyond the point of no return. Transferring to another unit
either temporarily or permanently is another alternative. A job that’s
more mechanical and less human service-oriented can sometimes give people
just the respite they need to regain their balance and their empathy
Q: Is there anyway to prevent compassion fatigue?
Preventing compassion fatigue is really the key. It’s much easier to stop
it from occurring in the first place than it is to repair things once it
sets in. You have to continually practice good emotional health
maintenance along the way and maintain some sort of balance in your life.
There has to be a portion of your life inn which you need to take, rather
than give. Beyond practicing fundamental self-care skills, you need to put
yourself in situations in which you see the positives in life, for
example, attending a field trip with your child where you’re truly
enjoying the experience, or volunteering where you’re able to give and
receive. Sometimes, you can’t prevent compassion fatigue from occurring.
We see this a lot with individuals working in professions with a high
degree of human interaction and human service. However, practicing some of
these techniques can restore your ability to feel compassion for and
sensitivity to the troubles and difficulties of others.
Q: If you’re in a health care profession, could you be a danger to
your patients if you have compassion fatigue?
A: Maybe yes, if you
took the scenario to its extreme; however, this isn’t what usually
happens. What typically occurs is a numbing of feelings or a distancing
and detachment from a patient and his family. It rarely results in a
serious medical mistake, but rather prevents the individual from bonding
and connecting with those under his care. It’s akin to being on auto-pilot
in which those affected put up an interior wall to separate their feelings
from the tasks they need to do.
Q: What if you’re caring for an elderly parent and develop these
A: You need to seek assistance from others — siblings,
relatives, friends and neighbors — to give yourself a breather. You also
might rotate duties with a sibling, for example. If you’re the one
responsible for accompanying your parent to chemotherapy sessions — a
highly charged and draining event — you might let your brother or sister
do that task for a while while you pick up another.
Q: We’re all bombarded with bad news everyday just by listening to
the news or reading the paper. Can this desensitize us as well and what
can we do about it?
A: We live in a world in which the media
constantly bombards us with images of poverty and violence, bringing us to
a point where we almost shut down because it becomes too emotionally
taxing to feel for others. One way to prevent this from happening is to
refrain from watching the news or reading the paper for a while. This mild
escapism can help prevent your heart strings from being constantly tugged
by all the sad things taking place in the world.
This interview is not intended to provide advice on personal medical
matters, nor is it intended to be a substitute for consultation with a