The Washington Post
Compassion fatigue can leave caregivers with health problems of their own.
My lifelong friend Vicki had finally hit the wall. For a long time, she’d tried to lighten the load of a friend who was facing a terminal illness. “As she got sicker, I tried to relieve every burden I could imagine,” Vicki, 61, who asked that her last name not be used for privacy reasons, told me recently. “I figured that compared to what this family was going through, no service I could offer would be too much for me.”
She did this while also caring for her parents throughout their illnesses and deaths. After her friend died, Vicki says she continued to “jump to action” every time someone close to her needed help. That’s when she confessed to “compassion fatigue.” She just felt “weighed down, tired and sad,” she said, after taking care of so many loved ones.
To make things worse, her contemporaries continue to face dreaded diagnoses, with many needing assistance. Finally, she rightfully asked herself, “How much more could I do without getting even more tired and sad?”
Vicki’s no outlier among people in their 50s and 60s dealing with parents and friends — and sometimes even children — who need support. Numerous studies have documented compassion fatigue among professional caregivers — with critical care, neurology and emergency medicine practitioners among the most
affected. But not only professionals are at risk, says Patricia Smith, founder of the Compassion Fatigue Awareness Project and author of “To Weep for a Stranger.”
“It can take hold in any person who cares for others who are in pain or suffering,” says Smith. “Family/friend/relative caregivers are highly susceptible to compassion fatigue due to the intense, intimate and emotional care they provide.”
Compassion fatigue is not psychobabble; it’s a real diagnosis, also known as “secondary trauma stress,” Smith said. Its symptoms include isolation, physical ailments, bottled-up emotions, substance abuse, and recurring nightmares and flashbacks. It’s challenging to get an understanding of its prevalence, especially where personal caregivers are involved, Smith said. Too often, symptoms aren’t even recognized, with family members suffering in silence, she added.
But it is preventable and treatable.
Heidi Hanna, author of “Stressaholic” and director of education for the nonprofit group American Institute of Stress, adds that the emotional damage from compassion fatigue may be the most severe when caregivers feel either hopeless or depressed, “or, on the flip side, agitated, irritable or aggressive.”
Another friend, Staci Girsch, 61, also has acknowledged to suffering from compassion fatigue. “Everyone is different when they ‘hit their wall,’ ” she says. “It can even be just from taking a shower. It happens when you least expect it.”
Indeed. Even though Vicki and I had first spoken about compassion fatigue more than a year ago, I was blind to seeing it in myself. This spring, during a heated business meeting, I responded to a colleague’s offensive language with a sharp retort. My behavior was not at all typical, and another person at the meeting tactfully said, “You’re not your usual self.”
It took a few weeks, but eventually I could see that I was unusually prickly in part because of my own emotional and physical exhaustion at helping to care for two close family members with cancer. That, along with assisting with my parents’ care for years (before they died within months of each other in 2017), had left me running on empty. I’d hit my own wall.
Smith and Hanna point to the importance of “self-care”: to take care of others, you must first take care of yourself. Vicki came to understand that. “Ultimately, I figured that I wasn’t going to be helpful to anyone if I burned out,” she told me.
Smith encourages caregivers to create a “Self-Care Plan” that includes identifying personal needs and finding ways to release stress. She suggests walking, bike riding, hugging a pet, reading and journaling.
I admit that I walk early in the morning with my Jack Russell terrier while singing “Do-Re-Mi” from “The Sound of Music” in my loudest — and truly awful — voice. I’ve also been vigilant about my diet, exercise and meditation — but still I often find myself like a ping-pong ball bouncing between depression and irritability.
So what can be done about compassion fatigue?
“Go for a walk [with a friend], see a funny movie with your friend, do something creative or just distracting — together,” Hanna advises.
One of my neighbors, who worries about my stress, frequently asks me to walk with her at the end of a long day. Sometimes we talk. Sometimes we just walk. It’s always helpful (although I do not sing “Do-Re-Mi” in her presence). Others I know try to stay grounded through spiritual practices, which include meditation, walks in nature, phone chats with friends, focusing on what is good in life and in the world, or making an appointment to see a therapist.
Vicki’s solution is trying to better define situations, in which she says her “assistance is actually needed as opposed to just making me feel momentarily good” for offering. She’s become more judicious about the type of help she’ll offer up.
“Sometimes it’s important enough to get on a plane to be the driver to daily chemo so that a spouse can have a break or get some work done,” she says, but at other times — to preserve her own resources — she now chooses to make a phone call or send a cheerful card.
All of which reminds me that “compassion fatigue” starts with compassion, which is a virtue, not a disorder.
“There’s a real honor in helping people — being there at those terrible times,” Vicki says. “I have many wonderful memories of my parents, but one of the most profound moments I remember is being there when they died. But there are very real limits on being able to give that much to everyone. It’s exhausting and becomes devalued. I’m still learning how to set my own boundaries.”
To see whether you might be suffering from compassion fatigue, take the Professional Quality of Life Scale, which despite its name is considered the gold standard in helping diagnose compassion fatigue: bit.ly/fatigue_scale.