Compassion fatigue

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Recently I had the joy of attending an interesting seminar on Compassionate Care for Health Care Workers: The Way Forward in Medicine and Health Care. This seminar was organized by the Faculty of Health Sciences of the University of Malta as well as by the Pastoral Commission for Health Care Workers of the Archdiocese of Malta.

First of all I want to say a big thank you for both the organizers and also to the speakers who were invited to talk at this seminar. Besides their accademic preparation I really liked the way they delivered the subject material that was asked of them to be covered. A theme that has struck a cord at the seminar was compassion fatigue. Normally, those who show compassion can fall into the trap of avoiding to receive it themselves. Obviously, such a mistake can happen not just to health care workers but to every person who cares from his and her heart for the needy ones.

Jesus wisely opened our eyes in order not to commit this serious mistake when he boldly told us: For to every one who has will more be given, and he will have abundance; but from him who has not, even what he has will be taken away (Matt 25:29). Obviously this does not only apply to those who remain idle, closed in their fantasies of what spirituality can be to the detriment of avoiding being of service to others. It can also be applied to those who work without resting at the cost of ruining the gift God the Father, in Jesus Christ, through His Spirit, has given them to serve compassionately. Hence, the summons of Jesus to his busy disciples: Come away by yourselves to a lonely place, and rest a while (Mark 6: 31), is evermore actual and makes perfect sense.

This come away by yourselves to a lonely place and rest a while is, according to Jesus, the pefect remedy for the reality we all face in life, which the second evangelist aptly describes in the following comment he made in his gospel, and which, incidentally, is also to be found within the same line: For many were coming and going, and they had no leisure even to eat (Mark 6:31). Yes! Caring needs are enermous! They simply does not end! In view of this harsh reality we can sympathize with St. Paul when he confided in his Second Letter to the Corinthians: And, apart from other things, there is the daily pressure upon me of my anxiety for all the churches (2 Cor 11:28). The honest Paul couldn’t explain the situation better than he did! In actual fact it is all about anxiety!

According to a patient-centred medicine research published in BMJ online journal dedicated to publishing medical research from all disciplines and therapeutic areas, compassion is defined as “a virtuous response that seeks to address the suffering and needs of a person through relational understanding and action”. It is a clear fact that to put yourself in a person’s shoes you need to be healthy psychologically, spiritually and physicially. Otherwise a discrepancy in one of these aspects of being can gravely impair the compassionate relationship.

Mandip Kaur and Kings Fund say that: “If we want patients to experience kindness and compassionate care in their treatment, then the staff who deliver that care must experience the same kindness and compassion in the way they are managed and led”. Apart from the organizational aspect for the care workers each person who works with people who are suffering needs to care for himself and herself. If not burnout creeps in and the results would be catastrophic and devastating not just for the persons who give care and the people they serve but also for the people with whom they live with.

According to the Compassion Fatigue Awareness Project (CFAP) and the American Institute of Stress, although the symptoms of compassion fatigue can alter yet they normally involve any of the following aspects: (1) excessive sadness or bottling up of emotions; (2) isolating oneself; (3) losing your sense of humor; (4) neglecting your appearance; (5) abusing substances to cope; (6) feeling mentally and physically tired; (7) having difficulty concentrating; and (8) reduced sense of meaning or purpose in one’s work.

It needs to be said that chronic exhaustion, reduced sympathy/empathy, feelings of anger, dreading work, poor work satisfaction, difficulty in sleeping, headaches, weightloss and so on reveal that organizational factors, the belief that taking care of others is more important than taking care of ourselves, guilt in taking care of oneself, lack of self-care routine, blurry personal boundaries and unresolved pain and trauma might trigger compassion fatigue. Hence, all this blatantly shows that self-care is a priority and necessity and not, as some erroneously assume, self-care is a luxury. In simple words, self-care can be defined by this popular dictum: You gotta nourish to flourish!

In order to have a proper compassionate regeneration balance and self-care are direly needed. Helpful tips like: (1) planning time out; (2) learning when to say no; (3) self-care routine; (4) asking for help; (5) practice balance; (6) find your own spirituality; (7) mindfulness; (8) meaningful friendships and (9) being grateful can surely help so as a person can be regenerated to serve with the greatest vigour and compassion possible. Having a holiday every now and then, during the year, is also important. So please those who does not understand this fact can they please shut up their mouths and let people who dedicate their lives working with those who suffer enjoy their holidays peacefully without creating them more stress by their ridiculous and cruel judgments?

Self-care clearly shows that the five pathways to self-compassion are being in touch with the physical, mental, emotional, relational and spiritual aspects of being human. It is important that those who care for people who are suffering genuinely ask these two pertinent questions personally and on a daily basis: What are my warning signs? How do I find balance? Let us not forget what L.R. Knost says: “Taking care of myself doesn’t mean ‘me first’. It means ‘me too’”.

Being in touch and compassionate with ourselves is so important. It is a question not of surviving but of thriving. It means engaging ourselves in a process of resilience with the clear intent of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress. Hence, by being resilient, we manage to ‘bounce’ back from difficult experiences, adapting successfully, manage adversity or hardship, and gain strenght from such a difficult experience.

It needs to be said that a resilient person still experiences difficulty. That is why it is so important to have caring and supportive relationships within and outside the family. Such relationships create love and trust, provide role models as well as offer encouragment and reassurance.

We who work with people who are suffering let us learn to take care of ourselves. Let us pay attention to our needs and feelings, engaging ourselves in activities that we enjoy and find relaxing moments, exercising regularly, developing a healthy lifestyle, being organized and managing our time well, learning from our past and staying flexible and adaptable. After all, as Vivian Komori says: Life is not about how fast you run or how high you climb, but how well you bounce.

Fr Mario Attard OFM Cap

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