Compassion fatigue

Compassion fatigue, also known as a Secondary Traumatic Stress Disorder, is a term that refers to a gradual lessening of compassion over time. It is common among victims of trauma and individuals that work directly with victims of trauma. It was first diagnosed in nurses in the 1950s. Sufferers can exhibit several symptoms including hopelessness, a decrease in experiences of pleasure, constant stress and anxiety, and a pervasive negative attitude. This can have detrimental effects on individuals, both professionally and personally, including a decrease in productivity, the inability to focus, and the development of new feelings of incompetency and self doubt.

Journalism analysts argue that the media has caused widespread compassion fatigue in society by saturating newspapers and news shows with often decontextualized images and stories of suffering. This has caused the public to become cynical, or become resistant to helping people who are suffering. Journalism analysts cite research which shows that visual images affect brain activity in demonstrable and measurable ways.

History

An early use of the term was in a 1981 US document on immigration policy. In the early 1990s the news media in the United States used the term to describe the public's lack of patience, or perhaps simply the editors' lack of patience, with "the homeless problem," which had previously been presented as an anomaly or even a "crisis" which had only existed for a short time and could presumably be solved somehow. The term was also used in 1992 when Joinson used the term in a nursing magazine to describe nurses who deal with hospital emergencies. Compassion Fatigue has been studied by the field of traumatology, where it has been called the "cost of caring" for people facing emotional pain.

Compassion fatigue has also been called "secondary victimization" (Figley, 1982), "secondary traumatic stress" (Figley, 1983, 1985, 1989; Stamm, 1995; 1997), "vicarious traumatization"[1] (McCann and Pearlman, 1989; Pearlman & Saakvitne, 1995), and "secondary survivor" (Remer and Elliott, 1988a; 1988b). Other related conditions are "rape-related family crisis" (Erickson, 1989; White & Rollins, 1981), and "proximity" effects on female partners of war veterans (Verbosky and Ryan, 1988). Some of these terms relate to family members being affected by those in their midst living with trauma (Figley, 1982, 1983, 1985, Remer and Elliott, 1988a, 1988b; Erickson, 1989; White & Rollins, 1981). Most of these describe the affects people who are providing care to those who have experienced suffering. Stamm (2002) added the term Compassion Satisfaction which describes the opposite, or positive side, of compassion fatigue.

Historically Compassion Fatigue has also been called a form of burnout. The term was also used after the 2004 Indian Ocean earthquake, where commentators noted the apparent decrease in donations for other natural disasters. This also occurred during the 2005 hurricane season. Another contrasting example involves the 2003 earthquake in Bam, Iran.

In academic literature, the more technical term secondary traumatic stress disorder may be used. The term "compassion fatigue" is considered somewhat euphemistic. However, the terms are not interchangeable in most literature. Compassion fatigue also carries sociological connotations, especially when used to analyse the behaviour of mass donations in response to the media response to disasters.

The most commonly used measure of compassion fatigue is in the ProQOL, or Professional Quality of Life Scale (Stamm, 2009).

Current Theory

Advances in the understanding of the relationship between Compassion Fatigue, Burnout and Secondary Trauma have emerged based on research using the ProQOL. The ProQOL maintains an international data bank [2] that is used to improve measurement and understand theory related to the negative and positive aspects of providing care.

Based on research, Stamm and Figley (Stamm & Figley, 2009; Stamm, 2009) have revised the theory, clarifying the relationship between burnout, compassion fatigue and secondary traumatic stress. This theory advancement addresses, among other concerns, the addressing concerns that, among other things, the euphemistic aspect of compassion fatigue.

Compassion Satisfaction and Compassion Fatigue are two aspects of Professional Quality of Life. They encompass the positive (Compassion Satisfaction) and the negative (Compassion Fatigue) parts of helping others who have experienced suffering. Compassion fatigue breaks into two parts. The first part concerns things such as such as exhaustion, frustration, anger and depression typical of burnout. Secondary Traumatic Stress is a negative feeling driven by fear and work-related trauma. It is important to remember that some trauma at work can be direct (primary) trauma. In other cases, work-related trauma be a combination of both primary and secondary trauma (Stamm, 2009; Stamm & Figley, 2009).

Programs Based on Prevention of Compassion Fatigue

Many organizations that provide care to people who have experienced suffering and extremely stressful events have programs to reduce the negative costs of caring (Compassion Fatigue) and increase the positive costs of caring (Compassion Satisfaction). It is not uncommon for health and human service organizations, schools, and public safety agencies to have programs to prevent compassion fatigue. Research has indicated that people working in areas of war and civil conflict are at particular risk (see for example, (Ali Musa & Hamid, 2008). Many nongovernmental organizations (NGOs)who provide care to refugees and internally displaced persons and those living in areas of conflict and civil violence to have prevention programs. Organizations like The Headington Institute [3] and The Helpers Fire [4]are examples of resource organizations. Some organizations such as the Green Cross [5] provide training with certification.

A very large implementation of compassion fatigue prevention is the U.S. Army Medical Division which launched in 2005 a prevention program to build provider resiliency for all AMEDD personnel. At the direction of the Army Office of the Surgeon General, the program was developed by the Soldier and Family Support Branch (SFSB). In 2007, the program was redeveloped into the Provider Resiliency Training (PRT) Program. Participants learn about compassion satisfaction, burnout, compassion fatigue, secondary traumatic stress and resiliency. They also take the ProQOL [6]. The program includes four modules beginning with a 20 minute video Introduction to PRT. PRT Level 1 includes two hour didactic training for both military and civilian providers. The AMEDD describes it in this manner: "PRT Level 2 includes four to eight hours didactic training, expanding on PRT 1 and includes practical application of self assessment and self care plans. PRT Level 3 includes 2-3 day training for Clinicians who treat fatigued Providers." [7] The AMEDD created specific Training Instructor (Provider Resiliency) positions at many facilities. Over 50,000 Service men and women as well as civilian AMEDD personnel have participated in the program and taken the ProQOL.[8]. Research by the program indicates that providers plan to use the information they learn in PRT (Adams, Camarillo, Lewis & McNish, 2010).

In health care

Caregivers for dependent people can also experience compassion fatigue; this can become a cause of abusive behavior in caring professions. It results from the taxing nature of showing compassion for someone whose suffering is continuous and unresolvable. One may still care for the person as required by policy, however, the natural human desire to help them is significantly diminished. This phenomenon also occurs for professionals involved with long term health care. It can also occur for loved ones who have institutionalized family members. These people may develop symptoms of depression, stress, and trauma. Those who are primary care providers for patients with terminal illnesses are at a higher risk of developing these symptoms. In the medical profession, this is often described as "burnout": the more specific terms secondary traumatic stress and vicarious trauma are also used. Some professionals may be predisposed to compassion fatigue due to personal trauma.

In lawyers

Recent research shows that a growing number of attorneys who work with victims of trauma are exhibiting a high rate of Compassion Fatigue symptoms. In fact, lawyers are four times more likely to suffer from depression than the general public. They also have a higher rate of suicide and substance abuse. Most attorneys, when asked, stated that their formal education lacked adequate training in dealing with trauma. Besides working directly with trauma victims, one of the main reasons attorneys can develop compassion fatigue is because of the demanding case loads, and long hours that are typical to this profession.

In charitable giving

Compassion fatigue can be seen in the resistance of the general public to give money to charity or other good causes due to overexposure. This is exacerbated by the increasing practice of charitable organizations requesting a potential patron's bank details for ongoing monthly donations rather than one-time donations. "Overexposure" in this context refers to the repeated solicitation of donations or voluntary efforts from civilians by charitable agencies, often triggered by natural disasters, or disasters of a large scale. Some people become frustrated by constantly being solicited for donations or they become skeptical that most of the money will ever reach the needy. In the aftermath of the September 11 attacks, many givers were frustrated with the Red Cross's handling of donations; they believed that their donations would go to the families of the victims, when the Liberty Fund only paid out approximately 1/3 of its receipts to families and dedicated the rest to long-term planning.

See also

• Cynicism
• Bystander effect
• Diffusion of responsibility
• Post-traumatic stress disorder

References

• Stamm, B.H. (2009), The Concise ProQOL Manual: Professional Quality of Life: Compassion Satisfaction, Burnout and Compassion Fatigue, Pocatello, ID: ProQOL.org1

• Hamid, A.A.R.M. (2008), Psychological Problems Among Aig Workers Operating in Darfur., Social Behavior & Personality: An International Journal

• McNish, N. (2010), Resiliency training for medical professionals., U.S. Army Medical Department Journal, 2010 Apr-Jun:48-55.

Further reading

• Barnes, M. F (1997). "Understanding the secondary traumatic stress of parents". In C. R. Figley (Ed). Burnout in Families: The Systemic Costs of Caring, pp., 75-90. Boca Raton: CRC Press.
• Beaton, R. D. and Murphy, S. A. (1995). "Working with people in crisis: Research implications". In C. R. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized, 51-81. NY: Brunner/Mazel.
• Figley, C. R. (Ed.) (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. NY: Brunner/Mazel.
• Figley, C. R. (Ed.). (2002). Treating Compassion Fatigue. New York: Brunner-Routledge.
• Joinson, C. (1992). "Coping with compassion fatigue". In Nursing, 22:4, 116-122.
• Kinnick, Katherine N.; Krugman, Dean M.; and Cameron, Glen T. (1996). "Compassion fatigue: Communication and burnout toward social problems." Journalism & Mass Communication Quarterly 73:3, 687-707.
• Kottler, J. A. (1992). Compassionate Therapy: Working with Difficult Clients. San Francisco: Jossey-Bass.
• Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. New York: New York: Norton.
• Saakvitne, K., & Pearlman, L. (1996). "Transforming the pain: A workbook on vicarious traumatization." W W Norton & Co.
• Stamm, B. H. (1995/1999). Secondary Traumatic Stress: Self-Care Issues for Clinicians, Researchers and Educators (2nd ed.). Baltimore: Sidran Press.

External links

• Compassion Fatigue Awareness Project
• ProQOL.org, Professional Quality of Life Organization
• Compassion Fatigue - Because You Care
• A set of links to articles about compassion fatigue
• Mirrored emotion by Jean Decety from the University of Chicago.