Compassion Fatigue -- How to Protect Yourself

STORY HIGHLIGHTS
Caretakers can struggle with demands on time, energy and patience
But they can also become overwhelmed if they're too empathetic
That can flood them with other person's pain, leaving them exhausted, angry
Meditate, keep a journal, keep in touch with outside and be unafraid to ask for help

By Tim Jarvis
For OPRAH Magazine
August 28, 2009

(OPRAH.com) -- The next time someone dreams up a new superhero, she should be wielding a bedpan. And Kleenex. And playing cards and travel Scrabble.

Caregivers try to be empathetic but they run the risk of taking on the other's stress and depression.

As any of the more than 50 million Americans caring for an elderly, disabled, or chronically ill loved one knows, the task requires superhuman strength and patience -- and loads of compassion.

Given the constant demands on your time and energy -- for months or years on end -- as well as the stress and frustration involved, having large reserves of empathy is crucial.

Yet as strange as it sounds, all that empathy can backfire, flooding you with the other person's pain, and leaving you exhausted, angry, even unable to care anymore. No one likes to talk about these feelings; they seem selfish, shameful, indecent. They take a toll, however -- on both you and the patient. And they're a growing concern among physicians, who have a name for what's happening: compassion fatigue.

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"About 6 to 8 percent of physicians and nurses suffer compassion fatigue," says Michael Kearney, M.D., the lead author of a report on the subject published this year in the Journal of the American Medical Association.

Unlike burnout, which is caused by everyday work stresses (dealing with insurance companies, making treatment choices), compassion fatigue results from taking on the emotional burden of a patient's agony.

In a way, it's similar to post-traumatic stress disorder, except that the stress is a reaction to the trauma of another. As with PTSD, symptoms include irritability, disturbed sleep, outbursts of anger, intrusive thoughts, and a desire to avoid anything having to do with the patient's struggle.

Deborah Garner, a social worker at Hospice and Palliative Care of Greensboro in North Carolina, has suffered from the condition.

"There was one patient I particularly bonded with," she says. "After somehow managing to fulfill this woman's last request -- getting her three very large dogs to the hospice -- I was drained. I felt like if someone asked me to do one more task that day, make one more phone call or see one more dying patient, I would scream. I had no energy left."

Garner drove home in a daze and sat on the couch with her 8-year-old daughter -- no TV, just talking. "It took three or four weeks to feel the joy -- the calling -- of my job again," she says. The biggest help: sharing her feelings with her coworkers.

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Philip Muskin, M.D., a professor of clinical psychiatry at Columbia University Medical Center, has also gone through compassion fatigue. In the course of treating a young man who became more and more depressed, Muskin says, "Nothing I did worked. Here was a really talented person with tremendous potential. His suffering became my suffering."

After trying every medication and therapy he knew of, Muskin felt angry and demoralized, and went to see a therapist himself. "He told me, 'People send you these patients all the time. It isn't that you don't know enough; maybe no one does. Maybe the only way to help this person is to just try to be with him and understand his pain."

For the millions of ordinary people who become caregivers, Muskin says the most important way to prevent compassion fatigue is simply to recognize that it can occur. "It means saying to others, 'This is really getting to me, not because I'm weak or inept, but because it's a terrible situation.'"

Caring for yourself may seem like a low priority while trying to care for another -- but it's essential for the patient. "Knowing that someone is crying for you and feeling your pain," says Muskin, "really is therapeutic."

Five ways to help yourself

When you're caring for someone, practicing self-awareness and self-care can help you maintain your boundaries; this, in turn, allows you to be fully compassionate without being consumed by the other person's pain. Consider:
• Mindfulness meditation: It's been shown to decrease depression and anxiety while boosting empathy. Oprah.com: Try these meditation exercises
• Keeping a journal: Research suggests that reflective writing helps prevent compassion fatigue.
• A daily act of self-centering: Set an alarm for noon and take four deep breaths; or when you wash your hands, sink into the experience, feeling the sensation of the water on your skin while noting, "I am worthy of my own time."
• Staying connected to the outside world with at least a phone call every day. Better yet, get outside, even just to take a walk.
• And don't be afraid to ask for help.

By Tim Jarvis from O, The Oprah Magazine © 2009

http://www.cnn.com/2009/LIVING/personal/08/28/o.have.compassion.fatigue/index.html