“The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.” ~ Naomi Rachel Remen

Most people are asked to be a caregiver at some point in their personal lives. We take care of our children, elderly parents, spouse, friends and so on. But also many of us take the role of a caregiver as a profession, becoming doctors, nurses, social workers, psychologists, teachers, lawyers, police officers, veterinarians and so on. We usually begin our career with high ideals of serving our community, to improve people’s lives, to make a difference, but along the road, over time, we become overwhelmed, and we begin to lose our enthusiasm and motivation to care.

The cost of caring
Compassion fatigue has been described as the “cost of caring” for others in emotional pain (Figley, 1982).  “We have the gift of empathy and we suffer with our clients. We feel their feelings. We experience their fears. We dream their dreams. We have not been directly exposed to the trauma scene, but we hear the story told with such intensity, or we hear similar stories so often. Eventually, we lose a certain spark of optimism, humor and hope. We tire. We aren’t sick, but we aren’t ourselves.”– C. Figley, 1995

There are many rewards to being a caregiver and helping professional. However, there can also be a cost of caring.  These costs can be emotional, psychological, physical or spiritual in nature.  The work of helping requires us to open our hearts and minds to our students, clients or patients. But being empathic also makes us more vulnerable. Taking on a career in the caring sectors involve also the psychological impact of caring for others who are struggling. Many caregivers at home can suffer from the constant demands and frustrations of providing care for a loved one, also risking burnout.

Compassion fatigue is complicated!
Compassion fatigue has been called by so many other names such as caregiver burnout, empathy fatigue, secondary victimization, secondary traumatic stress, vicarious traumatization, secondary survivor and others. More recently, it has been pointed out that compassion fatigue is actually a misnomer and that it should be renamed “empathy distress fatigue”.

Empathy fatigue versus compassion fatigue
Empathy is related to our mirror neurons enabling us to feel a similar emotion, as another person which is also called emotion contagion.  This is the capacity to feel  “with” another person their joy as we notice their good moments or feel their distress as we observe their pain and struggles.

Perceiving someone else’s suffering can activate both “empathic distress” or “empathic care”. We suffer from empathic distress when the “self-other” distinction becomes blurred, and we take on the emotional pain of the other person as our own pain. Empathy can also evolve into a mental construct of mentalizing and perspective-taking, that allows us to resonate with the feeling that another person is having, yet remaining aware that we are different. Here, we are feeling “for” the other person’s struggles.  Empathic care is similar to compassion, where we respond to the distress of others with warmth and care, as well as being motivated to alleviate their suffering.

Many have argued that it is “empathic distress” that causes burnout among caregivers, whereas “empathic care” leads to sustained engagement and satisfaction (Klimecki and Singer, 2011; Caroe, 2012).  Neuroscientific evidence suggests that empathic distress versus empathic care or compassion are very different reactions, supported by distinct brain systems. The biological basis of compassion is a powerful motivation which has an evolutionary purpose.  The research indicates that when we experience empathic distress, we activate the brain areas related to negative affects, pain and aversion.  On the other hand, when we feel compassion, our heart rate slows down, “feel-good bonding hormone” are being activated such as oxytocin and the regions in the brain linked to empathy, caregiving, reward and pleasure light up (Dacher Keltner 2012, Klimecki et al 2013).  Therefore, Olga Klimecki & Tania Singer(2012) have proposed that the term “compassion fatigue” should be replaced by “empathic distress fatigue” to more accurately account for symptoms of withdrawal and burnout in caregivers.

Compassion or empathy fatigue is not your fault
Compassion or empathy fatigue is not a weakness or failure.  It is a normal human reaction to the ongoing stress of caring for others. It can affect anyone and some would argue that it affects most of us in the helping sector at one time or another. The more we understand about compassion and empathy fatigue, the more we can be proactive.  As we let go our feelings of guilt or shame for experiencing symptoms of compassion fatigue and burnout,  we can begin to reach out for the help that we need.  

There are remedies for compassion or empathy fatigue
Exposure to the ongoing stress of caring for others takes its toll on our human capacity. Compassion or empathy fatigue lead many good carers to leave the field prematurely and to change job. Their leaving the field is a loss for our community.  It’s important to know that there are many remedies to alleviate and prevent compassion/empathy fatigue. We need to pause to personally identify our challenges, concerns and possible causes, so we can begin to explore remedies. Mindfulness, Self-Compassion as well as good self-care practices, can protect us, especially in times of crisis.

We know that compassion strengthens our consumers (students, clients and patients), so we need to turn our compassion to ourselves. We can regain some of our early enthusiasm and vitality.  We can keep the flame alive.  We seek ways to take good care of ourselves, so we can better take care of others.