Compassion fatigue

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Because of their exposure to long work hours and workloads, health practitioners are at an increased risk of being personally influenced by their work. Few enter the veterinary profession thinking they might pay dearly for their care of animals. They usually come with strong beliefs in such ideals as the decency of people, the conviction that justice will prevail, and their own ability to make a difference. As beliefs become eroded, they may be overwhelmed with a sense of disappointment, failure, hopelessness and responsibility[1].

Compassion fatigue is a well-recognised syndrome seen in all health care professions[2]. Burnout and compassion fatigue are concepts that describe the responses experienced by those dealing with the demands of a stressful job. It may be useful to distinguish between burnout and compassion fatigue, as early recognition of compassion fatigue may prevent burnout[3].

Compassion fatigue correlates with a deep physical, emotional and spiritual exhaustion accompanied by acute emotional pain. Whereas physicians (doctors, vets, dentists, chiropractors and nurses, etc) with burnout adapt to their exhaustion by becoming less empathetic and more withdrawn, compassion-fatigued physicians continue to give themselves fully to their patients, finding it difficult to maintain a healthy balance of empathy and objectivity[4].

Cause

Contributing factors include professional isolation, working with a difficult client population, long hours with limited resources, ambiguous success, unreciprocated giving, and failure to live up to one’s own expectations.

Clinical signs

Those who have experienced compassion fatigue describe it as being sucked into a vortex that pulls them slowly downward. They have no idea how to stop the downward spiral, so they do what they've done since medical school: They work harder and continue to give to others until they're completely tapped out.

Symptoms include helplessness, confusion, isolation, exhaustion and dysfunction. There is usually a feeling of being overwhelmed by work and of being incapable of effecting successful patient outcomes. If addressed in the early stages there can be complete and rapid recovery. The ability to deal effectively with the risk of burnout is partly dependent on an emotional and intellectual understanding of why GPs entered the helping profession, as well as an increased awareness of their own adaptive resources and coping mechanisms.

A significant issue is the tension between empathy and detachment. Empathy has been described as a ‘way of being where the helper, without judgment, enters the private world of the client to understand the feelings and personal meanings that the client is experiencing’. There can be a still ‘deeper level of empathy, where the helper gains an insight beyond that of the client, into the client’s own story’[5].

Diagnosis

Answering "yes" or "no" to the following statements will help you assess your risk for compassion fatigue[6]:

Personal concerns commonly intrude on my professional role Yes No
My colleagues seem to lack understanding Yes No
I find even small changes enormously draining Yes No
I can't seem to recover quickly after association with trauma Yes No
Association with trauma affects me very deeply Yes No
My patients' stress affects me deeply Yes No
I have lost my sense of hopefulness Yes No
I feel vulnerable all the time Yes No
I feel overwhelmed by unfinished personal business Yes No
My moods are constantly wavering Yes No
Thoughts of terminating my employment are frequent Yes No
Life seems pointless and futile Yes No
I have frequent thoughts of suicide or self-endangering activities Yes No

Treatment

Compassion fatigue can be all-pervasive and psychological recovery from this form of grief can be difficult[7]. Interestingly, most breakthroughs in recovering from compassion fatigue require the development of a new psychological outlook, often involving a heightened sense of inner purpose and less of a reliance on social or financial achievements. The irony of grief recovery is a lessening of a desire to attach to those who define themselves through grief (the "kitchen-sink hearts"[8]).

Treatments for compassion fatigue requires a multi-modality approach as there is no one universal therapy that works for any one individual. Various regimens can be found, but include:

  1. Encourage a liberal dose of wet, dry or morgue humour
  2. Avoid long hours (>50 hrs) and night-shifts
  3. Attend to sanity and health, two priceless items that cannot be bought
  4. Moderate use of alcohol, nicotine, caffeine and other prescription drugs
  5. Engender a rock garden at home; a strong interpersonal support network of family, friends, pets.
  6. Maintain a good hobby, or social activity
  7. Sustain a deep sense of life purpose, not necessarily religious and commit to daily reflections on this[9]
  8. Learn to say "No", to clarify emotional boundaries.
  9. Learn to say "I have enough", to avoid the "scarcity syndrome" of spiritual and physical materialism.
  10. Learn to always be patient with yourself and sometimes, others.
  11. Lower your expectations - failure may be problematic but mistakes are the touchstone of "reality".
  12. Avoid self-diagnosis - seek professional psychological assessment; rarely are people objective about themselves.

Balance in all things, personal and professional is de rigeur for a permanent avoidance into this psychological trap.

References

  1. National Organisation for Victim Assistance. Stress reactions of caregivers. In: Community Crisis Response Team training manual. 2nd ed. Ch 18: Washington DC: National Organisation for Victim Assistance, 1998
  2. AAFP.org
  3. Figley C. (2002) Compassion fatigue: psychotherapists’ chronic lack of self care. J Clin Psychol 58:1433–41
  4. Figley, CR (1995) Compassion Fatigue: Coping With Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. New York: Brunner/Mazel
  5. Stebnicki M. (2000) Stress and grief reactions among rehabilitation professionals: dealing effectively with empathy fatigue. J Rehabil 66
  6. Answering "yes" to four or more questions may indicate that you're suffering from compassion fatigue.
  7. National Center for PTSD. Working with trauma survivors, 2003. Available at: www.ncptsd.org/facts/disasters/fs_working_disaster.html
  8. Dr Jim Euclid, pers comm
  9. Mother Theresa insisted that her trainee nuns have compulsory early morning prayers for a minimum of 5-10 minutes, without which they would rarely endure the rigors of missionary work