22 Feb Compassion Fatigue
One of the greatest gifts I receive in my work as an addictions therapist is to witness individuals and families surmount incredibly difficult challenges and embrace a life of recovery. Often the breakthrough occurs at the bitter end, when I’m scratching my head in disbelief that they can endure such intense levels of frustration and pain.
Witnessing the thrashing that occurs at addiction’s hands is grueling. I’ve spent countless sleepless nights wondering if a patient will “make it” or “get” the breakthrough they need to begin the healing process. Fortunately, as a professional I’ve been trained to deal with the frustrations that come with this work.
As a young clinician, I had wonderful mentors who taught me to never to give up on the human spirit. “You never know when the seed you planted will take hold,” was the steady advice of Dr. Stanly Evans, a man of enormous integrity and a pioneer in the field of addiction treatment. Another, Sid Goodman, creator of the highly effective Florida Model and Family Restructuring programs, constantly reminds me to be fearless and tenacious in challenging a family’s resistance to change. “You must think systemically,” he constantly instructs me when I’m baffled with what to do in a particular case. “The patient is the family and the family is the patient.” But even with this exceptional support, there are times when I get exhausted, crushed by the weight of a disease that diminishes the dignity and souls of my patients and their families.
What is Compassion Fatigue?
Compassion fatigue is a well-established concept in the realm of health care providers. First observed in nurses who worked in emergency rooms, it describes the sense of helplessness and hopelessness that can overtake a person providing care for someone whose suffering seems never-ending and insurmountable. It’s also a condition that I observe frequently in the families and loved ones of the patients I treat.
Marsha* is an example of a wife and mother whose emotional spirit and physical health were beaten down by the seemingly hopeless addictions that plagued her husband and daughter.
A once beautiful and vibrant woman, Marsha presented for treatment disheveled and profoundly depressed. Coffee stained her blouse, mud caked her shoes and silver roots defined the brittle locks of her auburn hair. Although she had a master’s degree in English and for years taught American literature at a local college, she could barely put together a coherent thought. “I’m just exhausted…tired…no energy.” It didn’t take long for me to realize why. Her 17-year-old, heroin-addicted daughter was expelled from school for selling OxyContin and had been in and out of five $30,000-per-month rehabs in the last three years. As if that wasn’t enough, Marsha’s husband of 27 years was on the verge of losing his middle management job at an insurance company for excessive absences due to his late stage alcoholism. “It seems he loves cheap vodka more than he loves me and our kids” Marsha sighed as she finished telling her story.
Exhaustion, frustration and an overwhelming sense of hopelessness: these are just a few of the symptoms described by people who suffer from compassion fatigue. The following is a more thorough list compiled by the American Academy of Family Physicians.
Common Symptoms of Compassion Fatigue
Abusing drugs, alcohol or food
Diminished sense of personal accomplishment
Exhaustion (physical or emotional)
Inability to maintain balance of empathy and objectivity
Less ability to feel joy
You can determine if you are suffering from compassion fatigue by taking a self-assessment test. If you respond with a 1 (very true) to more than 15 questions, it’s critical that self-care is your first priority.
For Marsha, self-care meant finding something to anchor herself to when the gales of her daughter and husband’s addictions thrashed against her. Since she was a child, Marsha had internalized the belief that if she fixed those upon whose love she depended, then all would be well. It was a message she learned as an infant, completely reliant on the conditional love of a narcissistic and anorexic mother. But while her selflessness enabled her to survive her childhood, it trapped her in relationships that crushed her spirit and enabled those she loved to march uninterrupted down paths of self-destruction.
Fortunately, for Marsha and millions of other people like her, there is a way out of these devastating relational patterns. The key of liberation is to acknowledge that your unhealthy response to other peoples’ behavior is a habit – and most importantly – that it’s a habit you can break.
In his best selling book, The Power of Habit, Charles Duhigg, an investigative reporter for The New York Times, distilled habits into three key components. The first of these components consists of a cue. This is the cause of your reaction. The second is a routine. This is the effect. It’s the behavior you engage in or the reaction you have in response to the cause. The third is the reward. This is the benefit you derive or the instantaneous relief you feel once you’ve had your reaction.
In Marsha’s case, the cue for her reaction to save and protect others was the unmanageability of her life, caused by the insanity and chaos of her family’s addictions. The routine she fell into was to become a caretaker extraordinaire. When a crisis struck (and there always was a crisis), Marsha became super mom and super wife. Like a caped crusader she swooped in and solved their problems. The reward she got from her behavior was having a moment, if only fleeting, of mastery and control – and perhaps most importantly – of being validated as a person who mattered.
Unfortunately her habit, while enabling her to survive as child, had outgrown its usefulness. Now instead of adding value, it became deeply rooted in her family’s disease.
How Can We Overcome Compassion Fatigue?
Fortunately, Marsha possessed within her the tools to change. To recover, she needed to become hyper conscious of when her cue arose and implement different routines to address it. So instead of looking to control the externals of her life, she needed to enhance the mastery of her internal, emotional state.
Central to accomplishing this skill was her coming into therapy and talking about what was going on in her life with a person who was completely present for her. Second, she needed to find and cultivate a life outside the stagnate confines of her family. In Marsha’s case, this expansion occurred slowly. Initially and reluctantly she started attending Sunday mass at her community church. A month later she was back at work, teaching English as a second language to families in need. Finally, she was able to get her daughter into a treatment program that had a robust family therapy component as a central part of its curriculum. The work that she and her family were able to do in this program broke the strangle hold of their addictions and liberated them in a spirit of mutual respect, love of self and each other. They were finally able to hear each other out and set boundaries that were clear, consistent and enforceable.
Six months have passed, and is Marsha’s life perfect? No. But, it’s infinitely better than the life she found herself in upon entering treatment. Although her husband did lose his job, he was attending AA meetings and was cobbling together periods of sobriety. Her daughter was clean and living in a half way house in Florida and had just started a part time job in a coffee shop in Delray – a wonderfully robust recovery community. The greatest transformation, however, was that which occurred in Marsha. No longer were her eyes flat orbs surrounded by craters of darkness. In them shown a light of recovery and hope –evidence that her compassion fatigue had been replaced by compassionate strength for her self and others.
*The name and identifying details have been changed for patient confidentiality.