327 - Compassion Fatigue
What is compassion fatigue?
Compassion itself is characterized as a sense of shared suffering or a desire to alleviate someone’s suffering, and essentially arises through empathy, often manifesting as someone acting with compassion seeking to aid someone who is suffering. This is not necessarily a bad thing, of course, but when it bleeds over into compassion fatigue, it can become detrimental.
“Compassion fatigue is a state experienced by those helping people or animals in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper.”
Dr. Charles Figley
Compassion fatigue is also known as secondary traumatic stress, vicarious traumatization, empathic distress, toxic empathy, or burnout (though burnout is usually more characterized by working long hours or being in high-pressure environments as opposed to the negative effects that can come from caring for others).
Where can it show up?
Helping professions such as therapists, social workers, or counselors.
Crisis workers, i.e. EMTs, nurses, hospice workers, doctors, police officers.
Aid work, humanitarian work, and volunteer work.
Activism and social justice work.
Helping a partner or partners, family members, or friends through difficult times.
Watching the news.
Caring for an ill loved one.
Parents raising children.
What does it look like?
Exhaustion.
Irritability.
Lack of empathy or compassion, numbness or cynicism.
Resentment towards the person or people you are caring for.
PTSD symptoms such as physiological arousal, intrusive thoughts, or dissociation.
Bottled up emotions.
Self-medicating.
Dread of work or of a particular person.
Isolation.
Poor boundaries, or incredibly rigid boundaries, or a toxic cycle of both.
Denial of all of the above.
How to handle it
Self care
Food, movement, sleep.
Communicating what is going on to people around you.
Actual rest, such as sensory deprivation, meditation and mindfulness, and naps.
Professional help or support groups.
Reading inspirational material.
Creation and expression.
Connection, avoiding isolation.
Asking for the support and help you need from a partner.
Pet an animal.
Foster a separate self, with rituals for on/off modes.
Cultivating compassion skills
Listen to episode 326 on Stoicism.
Zooming out to get perspective on interdependence.
Zooming in to see the individual who is benefitting from your care or your work.
Buddhist or other mindfulness practices that have been studied and shown to be effective.
Paid time off and helping organizations being able to turn inward and care for their own.
Transcript
This document may contain small transcription errors. If you find one please let us know at info@multiamory.com and we will fix it ASAP.
Jase: On this episode of the Multiamory podcast, we're talking about compassion fatigue. Having a sense of compassion for our partners and our loved ones is crucial to having happy relationships. However, sometimes there are moments when we can't be as compassionate as we would like, because we're experiencing compassion fatigue. Today, we're going to talk about compassion fatigue, the science behind it, what it is, and some practical ways to renew yourself when you're caring for others.
Dedeker: First, let's define compassion. We covered compassion as a topic back in Episode 274. This is the definition that we used in that episode. Compassion is an emotion that is a sense of shared suffering, most often combined with a desire to alleviate or reduce the suffering of another, to show special kindness to those who suffer. Compassion essentially arises through empathy and is often characterized through actions where a person acting with compassion will seek to aid those they feel compassionate for. It sounds pretty great. Let's talk about compassion fatigue.
Jase: You can't talk about compassion fatigue without talking about Dr. Charles Figley, actually, is the first time I have seen his name I think for this episode. Anyway, he's the psychologist who popularized the term and he defines it this way. Compassion fatigue is a state experienced by those helping people or animals in distress. It is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper.
Dedeker: First, I want to check in with the two of you. Have you heard of this term before because in my field of work where I'm working with clients, it gets thrown around all the time with counselors, therapists, nurses, especially compassion fatigue is this really well-known topic. I realize that to some people this may be totally new. Are the two of you familiar with this? Have you come across this before?
Emily: I didn't know about it beforehand but upon reading about it, I definitely know that I've felt it before. That's interesting.
Jase: I just know about this, because Dedeker, you introduced me to the term maybe a year ago or something and I was just like, "Oh, gosh, yes." I definitely see when that shows up sometimes. It's also known by other names. I think as Emily was saying, a lot of people are familiar with the concept or the feeling or the experience of it. Some other names for it are things like secondary traumatic stress or vicarious traumatization, empathic distress, toxic empathy or burnout is another term used for it some time.
Emily: Yes, but for the purposes of this episode, we're going to distinguish compassion fatigue from burnout. Burnout, this is something that a lot of us talk about these days and burnout can occur from working long hours or being in super high pressure or demanding environments at home or at work. Whereas compassion fatigue specifically refers to the negative effects that can come from helping or caring for others. There's a bit of a distinction there.
Jase: It's not just like fatigue, fatigue. It's specifically compassion fatigue.
Emily: Compassion fatigue. Just that part of yourself or giving I guess, that specific part can be fatigued as well. Compassion fatigue presents on a spectrum not as a binary so it's not just like you're either fatigued or you're not or you have no compassion or you do, it is on a spectrum as well.
Dedeker: There's a lot of theories out there about not only what comp fatigue actually is but also what causes it. We're going to get deeper into the more interesting parts of the science behind this a little bit later. Just to scratch the surface of this a little bit, the predominant theory out there is that it is overuse of compassion in your work or in your environment that leads to compassion fatigue. Almost the same way that we think about decision fatigue, how we have a certain amount of decision-making energy in a day, and then when we have to make a lot of decisions over and over and over, that gets depleted to the point where it becomes a lot harder to make even small decisions.
The prevailing theory is the same with compassion is that when we're in a position of having to call in our compassion over and over and over and over and over again, that eventually the well runs dry, and there's some negative effects on us. It becomes harder to draw on that compassion. There are also some theories actually on the opposite side that it might be under use of compassion or really not being able to complete your empathic response. That's actually what leads to the fatigue. For example--
Emily: If you're not used to being compassionate, but then a little bit comes up, you're like, "I'm fatigued now."
Dedeker: For example, any situation where you as the helper or you as the person feeling compassion are needing to hold back and not act on that compassion or if you're needing to hide your own emotions or vulnerabilities while helping others. This could be a wide range of things.
Emily: Like doctors.
Dedeker: Yes, it could be like a doctor where you really can only go so far to feel compassion or really give a compassionate response to someone who's going through a really terrible time, even if it may be very distressing to you but you have to keep your emotions in check. Really any professional. I think this mostly shows up as a workplace thing where you have to be professional even if you're in a helping profession, like a therapist or a counselor where there's really only so far you feel like you can go. There's only so far that you can emote, there's only so much of your own emotions you can let come to the forefront.
There are some theories that say that's the fatiguing part is like having to keep your compassion in check even though you feel it. There's this Diana Fosha who's written a lot of really fascinating stuff, and specifically about therapists and counselors. She says, we are wired to care, but trained to be neutral and that that's a hard place to be in, that as human beings, we naturally do have an empathic response to other people's pain. Yet, we're often in situations where we just can't necessarily act on it.
Jase: I had never heard that side of compassion fatigue before that it could be that of having to hold back your reaction. That's really interesting, because I can definitely think of some situations in my life where I've had that struggle, but I guess it felt different from other times when I've identified it as compassion fatigue. I don't know. That's interesting, that maybe they're even two different things that are both related to compassion in a way.
Dedeker: Again, this is a little bit of a spectrum. There's not a black and white sense of, Oh, this person is 100% in compassion fatigue, and this one not. Sometimes it's hard to measure. Sometimes we start to get into semantics of like is it compassion, is it empathy, is it vicarious trauma, is it all these things, where these things are measured slightly differently and felt slightly differently. It's sometimes a little bit amorphous. That may explain why people's experiences and also the causes of compassion fatigue can be a little bit different. We're going to get into this a little bit more later on in the episode when we talk about current studies on compassion fatigue.
Jase: We've mentioned this a little bit before, but places where compassion fatigue can show up helps a lot in helping professions, so things like therapists, social workers, counselors, also crisis workers like EMTs, nurses, hospice workers, doctors, police officers, and then aid work like humanitarian work, volunteer work, things like that. Then also with activism and social justice work.
There's a quote here from Jacqueline Detwiler- I hope that's how you say her last name. Jacqueline Detwiler who says, "We are shouldering a burden of protecting each other that should be shouldered by companies, institutions and the state, and it is crushing us." Just talking about that if you're out there trying to fight for social justice and activism, it is a lot of weight to carry and can have negative health effects for those people doing it.
Emily: Also helping a partner or multiple partners, friends, family members, if they're going through really difficult times. A non-monogamous example could be that you have a partner who's going through jealousy or through extended relationship drama with a metamour. I'm also curious I thought about if you have a partner or a friend who is upset with something that you did or that they perceived having a triggering response to something that you've said or whatever, and how challenging it can be to be compassionate towards that like you can and you want to help them, but only to a point, perhaps, and eventually it does become fatiguing, especially when it's like, the trigger is about you.
Dedeker: Yes, 100%. It makes me think of often couples that I work with who are recovering from some major breach of trust, which could traditionally be something like infidelity, but doesn't necessarily have to be that, it could be any number of things. Yes, I think any time we're in a position where our partner is hurt because of something that we did or something that we said, already, it takes effort to meet that with compassion.
Already it takes a lot of emotional effort to not slip into defensiveness, to not throw it back at them, to not escalate the situation to be able to listen and be compassionate and meet your partner or your friend's emotions and accept those and then if it keeps going as these things do, like if someone's really, really hurt, it's not always a one and done where it gets processed and then complete or sometimes they need to revisit it and need to come back to it and that can get fatiguing very, very, very quickly.
It's really common, I've seen with couples who are working through some breach of trust where the partner who, maybe made the breach of trust, gets to the point of just like, "Oh, my god, how many times can we go over this? How many times can I apologize?" That it does just become fatiguing.
Jase: I would imagine that that situation also then is hitting that thing of needing to hold back like we talked about before, where it's like you're trying to be compassionate about something you did but also like because it's about you, you're having to, I don't know, I guess be a little more neutral than maybe you would if they were talking about something someone else did, where you could more fully express your compassion for their feelings and instead, there's a bit of that.
Like the effort that comes from maintaining neutrality, I could see that also or like you said, Dedeker, like the effort to not get defensive or to make excuses or something, like even that effort can add to that fatigue.
Emily: Yes. Also things like just watching the news, especially news about the pandemic, that fatigue also, it can make us just go numb at this constant barrage of terrible things that are happening in the world. That makes a lot of sense to get fatigued with your compassion.
Dedeker: Yes, and just, so much World News, because often, it's not very good news, and there was this really interesting quote from, I found so many PowerPoints that people have done on compassion fatigue, because it strikes me that this is a really common, "workplace wellness presentation", that shows up in a lot of industries. I found a lot of people's slides, but this particular quote I really liked but it can be the realization of many painful realities that we may be powerless to change or effect.
Yes, I've spent a lot of time thinking about the fact that this is such an interesting time period in human history with access to global news, where on the one hand, it's a really good thing, and it's really good to be informed but also just to think about how, my armchair evolutionary psychologist theory is that it's like others haven't quite caught up to that level of being able to absorb and understand just the full extent of global human suffering, like having such a hard time connecting to suffering on that scale.
Yes, like you said, either, it's totally numbing, and we just can't connect to it or it's completely overwhelming but like, either way, either it activates so much of our compassion that it gets depleted or I think like you're talking about, Jase, we're not really able to complete the empathic response on that scale, and so that becomes really tiring as well.
Jase: Yes, I think also, with the news is just that it's the whole thing of, yes, we have access to learn about all of the suffering in the world, and we're not being given an equal measure all the neutrality in the world or positive things like we're doing this filtered thing, because it's the one that gets this reaction from us. I know I go on this rant all the time so I'm not going to do it now, but it's a real shitty thing that in the commercialization of news has done to all of us, I think.
Dedeker: Definitely. Compassion fatigue can also show up if, for instance, you're caring for a loved one, like a loved one who is aging or a loved one who is chronically ill or who has a disability, that needs care, that that's another thing that can draw on your compassion reserves and become really depleting over time. Same thing with parents raising children, whether you're raising a child that has more needs than average or even just a regular child, depending on your situation parenting calls on that compassion a lot, especially if you're trying to really be a good, gentle, loving parent.
I was curious to hear of the two of you, because it seems like the two of you really have connected to the fact that like you felt this before you, felt this sense of compassion fatigue, and like, where and when is it showed up for the two of you?
Emily: Like I said, a friend or with a partner who, yes, was upset about something that I did, and eventually just being over it, over having to hear about how awful I was in that moment or whatever but also, I see it, I have a lot of doctors in my life, and I see it with a particular friend of mine who is a radiation oncologist and sees trauma and death and people dying every single day. I think how challenging it is to also go home and be with a husband and a kid and be compassionate towards them, and there are trials and tribulations that might have happened during the day.
I think that, yes, for a lot of people in that industry, it's got to be really difficult to have compassion, not only for the moment that you're in, and the people that you're seeing in your profession, but then stepping outside of that as well and having to give even more of yourself to the people that you love it's tough, I'm sure.
Jase: Yes, no, absolutely. I feel like we've covered all of the main ways it shows up, I feel like with news, it's like each year there's like some other thing that really gets you and we talk about it a lot and can lead to fatigue. I think also when people first, I guess, awaken to some injustice in the world that they were not aware of, such as becoming aware of some part of their privilege and how other people don't get that that they weren't before or becoming aware of the real-life effects or something like sexism or racism that they knew about, but didn't really get beforehand.
Once that sinks in, I feel like that can lead to that situation of just feeling helpless and like I need to fix it all right now because I need to make this feeling go away and then that leads to frustration and anger that needs to get directed somewhere or maybe going numb or, there's just all sorts of things that can happen in those situations, some of which are compassion fatigue.
Emily: Yes. How can this look when you are fatigued? When you don't feel like that compassion is really at your fingertips in the way that it always generally is, it can look like exhaustion, things like irritability, lack of empathy or compassion, numbness, cynicism.
Dedeker: Yes, for me, with the work that I do, like working with clients, there are some days where, sometimes I show up to dinner, and I know to both Alex and Jase, I've said this sometimes half-jokingly and half-seriously, that'll get to the end of the day and I'll just be like, "Okay, I'm out of empathy, so I'm sorry if you need any empathizing I don't got it, I can't empathize with anything, you're on your own for the rest of the evening."
Again, mostly, it's joking but then there is a part of me that feels that way, where I'm just like, I can't listen to any more problems, I can't offer any more grace or kindness or care, because I just feel like I've used it all up at the end of the day sometimes.
Jase: Have you ever had someone in your life who just really gravitates toward upsetting stories and wants to share them with you? Because I've encountered this a few different times in my life with people who've been in my life quite a bit, who just it's like their small talk, it's like, oh I heard about this thing with someone whose daughter was hit by a car in their neighborhood.
Just going into retelling and reliving the suffering of some stranger, stranger to me, often a stranger to them too or like, oh, I heard about this random thing that happened to this person in Israel, that was just so awful, they were killed by a cement mixer, I don't know I just made that one up. Some terrible traumatic story, that they just love those things. I found that, at least for myself, I feel like I'm a pretty compassionate, empathetic person, that I just find too much of that, my whole day I'm upset the rest of my day, because of this one random story that I think to them felt like small talk or maybe they were trying to process it or something, but I know certain people who just always gravitate to these stories and love to talk about those.
I find I have to distance myself or even just be like, oh, oh gosh, look at the time I really got to go. Because I'm like, I don't want to use up my compassion on this. I've got a lot of better things to use it on today.
Dedeker: Interesting. It's like you need a little meter attached to your shirt or something.
Jase: Yes.
Dedeker: That's going to Dole it out.
Emily: It can also manifest as resentment toward the person or the people that you're caring for. Even if you are in a profession like that, perhaps you might be resentful towards those people that you are caring for or if it's a loved one as well.
Jase: Yes, definitely.
Emily: Also. PTSD symptoms. Physiological arousal intrusive thoughts disassociation and also bottled-up emotions.
Dedeker: The PTSD symptoms, this is why compassion fatigue is sometimes called vicarious traumatization or secondary like stress disorder or things like that is that they find with people who are exposed to other people's trauma constantly especially in the line of their work without having anything there to help them balance it out or process it or things like that, that they can take on like similar PTSD symptoms even if they themselves didn't go through the particular trauma.
Sometimes it's to a lesser degree, it's not exactly a carbon copy PTSD response as though they were the primary receiver of that trauma, but people do report having weird dreams or these intrusive thoughts or having their heart race even when they're thinking about a particular client or things like that that can show up just by being exposed in that way.
Jase: Other ways this can look is maybe secondary to this, but it's things like self-medicating, and by that generally meaning drugs and alcohol, could be actual pharmacy type drugs. I feel like usually when we say self-medicating we're talking more about things you can buy over the counter. Could also be just like a dread of work or dread of a particular person. I guess I mentioned that with like the dread of this person telling me these .
Shoot. Could also look like isolation, right? Just retreating into your shell and not having any time for anybody, any energy for anyone. Also could show up as really poor boundaries or incredibly rigid boundaries or a cycle of both between like really standing up for yourself and being like, no, I can't. Then other times just like giving in to every beck and call from everyone and every demand and every request for help, regardless of whether you can provide it or not.
Dedeker: I think I've seen this. Usually, it does become this cycle where it's like because someone has poor boundaries on the front end, that then they will realize like, oh my god, this is depleting me. This is too much, and then they'll pendulum swing the complete opposite way to these very, very rigid boundaries of just like, no, get the hell away from me no, I can't help. No, no, no, no, no, no, no. And then it's just this constant swinging back and forth.
Jase: This is another quote from Jacqueline Detwiler, who we've quoted before, who was talking about in activism and social justice work is, "It feels perverse to recoil from those who need our help, so we don't." Like even if you don't have any left to give and this is harming yourself, it's like, well, but I can't say no to these people because these are the people I'm trying to help. Then lastly, this could look like a denial of all of the above and just pretending it doesn't. Just, No, No. This isn't me. I'm totally fine. Totally fine.
Dedeker: I think especially for people who have picked professions that are helping professions, there could also be the sense of like guilt. Like if you're feeling fatigued by this, maybe this isn't the right position for you or maybe you're not cut out for this or maybe this isn't really the job that you want to have. That can really foster a culture of also wanting to deny that there even is such a thing as compassion fatigue or that having to hold compassion for people day in and day out has any impact on you.
Jase: We're going to go on and talk about some of the research and some of the studies that are done about compassion fatigue. Before we do that, we're going to take a quick break to talk about our sponsors for this episode. It really helps us out a lot if you go and check them out, they directly support this show to help keep it coming to all y'all out there for free.
Dedeker: We're back, and we're going to be talking about the interesting science behind compassion fatigue. There are many, many, many, many studies about compassion fatigue, mostly studies with the purpose of trying to figure out how to alleviate it. That makes sense as we run into with other topics, our culture or work a day capitalist culture popularizes anything that helps us to understand, oh, how do we get our workers to be even more efficient and work even longer without all their pesky emotions or human needs getting in the way?
It makes a lot of sense where we're like, interesting, our nurses, they're getting really fatigued by doing this. Can we understand what it is that they're going through and how to fix it so that they don't have to take as much time off so that we don't have to invest in actually giving them a good quality of life at work? I think it makes a lot of sense that there's a lot of studies about this and most of them are about that, about fixing compassion fatigue, specifically.
If you're interested in that, you can just Google compassion fatigue study, and you'll find a billion hits and a lot of really interesting information. Today we're going to look at two papers in particular, that out to me that are connected to each other as well.
Emily: The first is findings from a 2011 study led by Dr. Tania Singer of the social neuroscience lab at the Max Planck Institute for human cognitive and brain sciences in Germany.
Dedeker: Sounds like the nerdiest place on earth and I love it.
Emily: Try saying that twelve times fast. Wow.
Jase: This in Germany so it'd be like the Max Planck Institute.
Emily: Max Planck Institute, ja. In the study, they used married couples as subjects and hooked them up to FMRI scanners. One partner-- This sounds awful by the way. One partner would have a painful stimulus applied to their hand and the other partner would be able to see and hear the reaction to the pain. How can .
Dedeker: I think in the study it was probably just like a little electric shock. I don't think it was anything really like intense. It could have been like a rubber band. I think the intention was just a tiny pain response, but something that would provoke a response.
Emily: I wonder who like volunteered for that.
Dedeker: He had to also study how the partners negotiated who was going to be in pain.
Emily: Exactly.
Dedeker: They probably didn't get to choose.
Jase: I don't think so.
Emily: Hopefully not. Areas of the anterior insula and the anterior middle cingulate cortex were activated when subjects received pain, but also when they observed that their partner experienced pain. Basically like the same brain waves were happening when you see--
Dedeker: Like the same brain areas.
Emily: Yes. That's like empathy like literally, it's occurring in your brain like it's happening to you. That's really interesting. The researchers concluded that the part of the pain network associated with its emotional qualities but not its sensory qualities, mediates empathy for suffering. The firsthand experience of pain as well as the knowledge that somebody we love is in pain, activates the same brain circuits. That makes a lot of sense. It makes it understandable why we feel empathy at all.
Jase: Well, and this is making me think about mirror neurons, which is also an interesting thing in neuroscience, but they're basically neurons that go alongside all of our regular neurons that specifically react to other people going through things. It's like what leads us to, if we see someone smiling, it's sometimes hard not to also smile or I guess to see someone in pain, not to also feel some amount of that.
I think it's why things like movies are effective because we're not going through these things but we almost feel like we are because we're watching people and our mirror neurons are looking at that, seeing that recreating that feeling inside ourselves, even sometimes physically like if we cry along with someone in a movie or something that. That's really interesting and makes a lot of sense that that would show up that way.
The second paper to talk about builds on the findings of the first one. The second paper is titled, Compassion Does Not Fatigue! This was published in 2018 in the Canadian Veterinary Journal written by Dr. Tricia Dowling, who is, guess? A veterinary officer. It turns out that compassion fatigue shows up when you work with animals as well.
Emily: Of course it does.
Jase: Of course, right?
Dedeker: I don't know if anyone's done a study of like where they take you and your dog and-
Jase: Oh no.
Dedeker: -See if your brain lights up when your dog gets spotted on the snoot.
Emily: I'd rather I get slotted on the snoot than the dog.
Dedeker: What about the opposite, does your dog care when you are in pain?
Jase: That's what I was going to say. I want to know if my dog actually cares when I'm in pain.
Is this a one way transaction or what?
Dedeker: Right, or does your dog just like food? Food? No food?
Jase: Yes. I get food at the end of this, right? We're cool.
In this paper, Compassion does not fatigue!, Dr. Dowling makes the argument that empathy is necessary to establish a social connection with another human being but from there, it can either turn into empathic concern and compassion or it can turn into empathic distress.
Dedeker: Yes. Dr. Dowling is making this distinction that it's the empathic distress that is the fatiguing thing, not the empathic concern or compassion. Basically, she makes the argument that we feel empathy first. We can't really avoid that, right? Especially if our brains are literally wired to have that empathy response. Feel that pain almost as though we are feeling the pain that we're observing but then, what the empathy turns into, whether it turns into compassion or into distress, is highly dependent on our capacity for what's known as self-other differentiation. There's been plenty of studies on this as well.
Basically, when self-other distinction becomes blurred, we really do take on the emotional pain of the other person as our own pain and that just puts us into empathic distress, where it is just really fatiguing for our systems because basically, what they find is that when subjects are in a state of empathic distress, it depletes the dopamine levels in our brain. That means that our ability to experience pleasure is decreased, our motivation towards natural rewards, especially the natural rewards that would be the results of our actions or compassion action, our motivation for that decreases.
If we have a chronic depletion of dopamine, that leads to feelings of emotional exhaustion, depression, lack of motivation, irritability, all those things that we listed that are the hallmarks of compassion fatigue. However, compassion goes beyond feeling with the other to feeling for the other. That's the way that Dr. Dowling distinguished it, which I think is really interesting.
Specifically, when there's compassion that's directed toward the other, when there's more of a sense of the self-other differentiation, those feelings of compassion actually increase dopamine activity as well as oxytocin-related processes which enhance our positive feelings in the face of adverse conditions.
Jase: Whoa.
Dedeker: Right?
Emily: Yes, and this is really interesting. In the same study, they actually did a brain scan of a Buddhist monk while doing a compassion meditation. Brain scans showed that his experience of empathy had registered in the neural networks associated with pain, whereas the compassion phase of his experience had registered in different neural networks; those associated with positive emotion, maternal love and feelings of affiliation.
The monk described his experience during the compassion meditation as a warm, positive state coupled with a strong desire to be of service. This was in distinct contrast to his earlier experience with empathy, actually, empathic distress, which was completely draining and debilitating so like the title of this study says, compassion does not fatigue. It is neurologically rejuvenating. Wow.
Dedeker: Yes. I thought this is really interesting. Again, like I talked about earlier, some of this, unfortunately, starts to get a little bit murky because of semantics, because we have to distinguish compassion from empathy in this case. Dr. Dowling is making the argument that at least from a brain chemistry level, there is a distinction between empathy and compassion as far as how our brains experience it.
Out in the real world, we don't always necessarily make that distinction, and I think sometimes it's hard to even feel or tell when is it just empathy? When is it compassion? How do those things feel differently to my brain and to my body?
Jase: I think this one's interesting too because-- I'm not exactly sure where this comes from, but I know that I definitely experienced this idea that if someone else is suffering and I'm then suffering with them, that's somehow good, that I'm somehow helping them. I'm somehow taking that on for them so they don't have to suffer as much, or something, some idea there that I think we can sometimes glorify in a way. That kind of suffering on someone else's behalf.
The irony of it and the thing that was a big wake up call for me because I was someone who very much did this was, I forget how this happened but when it was pointed out to me that that's not actually helping anyone and in fact, often it's making it worse because then you end up in a situation where they're almost feeling like they need to help you, then or now, other people are needing to help you, and you're spreading this around rather than focusing your compassion on, I guess, maybe more of this kind of self-other differentiation of having compassion and how can I help this person who's suffering rather than how can I-- You get all kind of riled up and really feel how awful that is.
I find that actually makes me less able to help or to do anything about it than letting them be the one who's doing the suffering, but trying to offer how to help. Does that make sense?
Emily: Yes.
Dedeker Yes. It reminds me, I think, in the therapeutic community, basically, if we look to the birth of therapy, which is psychological analysis from Freud and things like that, where it starts out in a very unempathetic place, an analyst is purely supposed to be this mirror, this blank sheet, just reflecting things back. It's not about being caring, it's not about empathizing, it's purely just about unpacking and helping someone try to understand their past trauma or their childhood baggage or things like that.
Then, I think, in the last few decades, there was a swing more towards 'no empathy is the big thing'. Empathy is the skill that someone who's going to be a therapist or a counselor or social worker needs to have. Now I am seeing that start to shift back a little bit, not to a kind of cold, unfeeling analyst side of the spectrum, but more of the-- I think what you're speaking to, Jase, is feeling with the pain of others is only so helpful, not that it has zero place or zero function but ultimately, for the health of the client and also the health of the helper or the practitioner, it needs to be something a little bit different than just the ability to empathize with somebody.
Emily: Middle path is always the way.
Dedeker: Middle path, man.
Jase: Keep coming back to that, yes.
Emily: Yes.
Jase: What can we do? What can we do about this? Maybe you're listening to this, and you're like, "Yep. Got it. Check."
Jase: "Got it. Toxic empathy."
Emily: I know what that is.
Jase: "Empathic distress. Whatever you call it, I got it."
Dedeker: That is the funny thing, of course. Because this has been so extensively studied, there's a lot of assessment tools out there for trying to figure out if you are in a state of compassion fatigue or not. However, my favorite was that I found in some resource that just said, "If you think you have compassion fatigue, you probably do."
Jase: Yes.
Emily: Yes, there it is.
Jase: Yes.
Dedeker: It may not need a super rigid measuring tool.
Jase: The question then is, what do we do about this? How do we transform the draining qualities of empathy into those more energizing and sustaining qualities? The answer is a one-two punch of self-care and cultivating compassion skills.
Dedeker: Yes. First thing to talk about here is self-care. I always think about this as filling yourself up. It's if we talked about it as being drained or being depleted like you need to put things back in, you need to recharge in some way. This is pretty common advice around compassion fatigue, specifically. Of course, the basics like food that's appropriate for your body, movement that's appropriate for your body, the amount of sleep that you need to be functioning and have as good of health as you can possibly give yourself.
Things like just being able to communicate what's going on with the people around you, just being honest with your partners or family members or friends or therapists that, hey, I'm experiencing this, just to let people in so that they know.
Things like actual rest. What I mean by that is, I think we can get so depleted that at the end of the day, the only thing we have energy for is just being on the couch and Netflix or just being on the couch and phone scrolling. Those things have a time and a place. They're not necessarily bad in and of themselves, but I think I have found that sometimes those activities can actually be a little bit of a net-zero. They're not exactly filling you back up or not exactly energizing activity.
Sometimes, I think of it almost as a breaking-even activity, especially if you're sitting and scrolling social media and maybe subjecting yourself to more feelings of depression or anxiety or jealousy.
Jase: Gosh, yes. Yes.
Dedeker: Whatever it is.
Emily: Negative.
Emily: Yes, probably not helping to rejuvenate you. As far as actual rest, that could be things like naps, it could be meditation and mindfulness, it could be sensory deprivation, whether that's you want to drop a bunch of money going to a fancy float tank or do the much more affordable sensory deprivation of just redoing yourself up in a blanket and just sitting in a dark room for a few minutes or sitting in a closet, I'm telling you it works.
Emily: Yes, Dedeker, has done that before.
Dedeker: Yes. I think it feels weird to be like, "I'm going to go lay on the bed and not look at my phone and not watch TV. I'm just going to lay there, it's not even going to be enough I'm just going to be in the dark." It sounds and feels weird but I'm telling you, I swear about it, it really does some amazing things for your brain.
Jase: Just just earlier today, I found myself in this situation where I was just like I feel awful and terrible and anxious and stressed and I was like, I want to just go sit in a dark room and just sit on the ground or lie on the ground in a dark room for a little while. Unfortunately, I was not able to do that at that time in the day but--
Emily: Then you had confession fatigues for the two of us.
Jase: Exactly.
Dedeker: Yes. Then you showed up in it, oh my goodness, Jase.
Jase: I don’t know because I didn't get that sensory deprivation that I needed so--
Emily: You got to do it, got to do it.
Dedeker: Of course, it can be really helpful to get professional help, to see a therapist, see a counselor, find a support group, you can find groups and communities that are tailored specifically to if it's your profession, if you're a nurse, if you're a therapist yourself or if you're caring for a loved one or caring for a chronically-ill loved one, there are support groups for that as well.
Emily: Also you could do things like reading inspirational material whatever that looks like to you. We talked about stoicism last week so maybe something like that or the Bible or whatever you like. Creation and expression, maybe go paint. I don't know how to do that. Maybe go cook, I do know how to do that. Connection, avoiding isolation, get on the phone with a loved one, go outside, asking for the support and help that you need from a partner, let others care for you instead of you just constantly caring for others.
Jase: I think that's easier said than done.
Emily: It is. Yes, I agree, we should do an episode on that. How to ask for help. Really though.
Jase: Not only how to ask what how to actually receive it. I think especially if you're someone who’s-
Emily: Good point.
Jase: -really like your identity is about fixing things for other people, like I really fall into this, it’s so hard to let other people do stuff for you sometimes. It’s a good idea. I’ll have I put that in the backlog there.
Emily: Cool, yes. I pet in the animal, love this. My cats are huge huge love buckets for me and I get a lot of care from them and then also fostering a separate self. Things like rituals for work on and work off modes or care on and care off modes so that you can turn off that side of you that is constantly giving and instead turn on the side that is giving back to yourself.
Jase: Yes. Then that was the one punch of the one-two punch, was the self-care and the two punch is cultivating compassion skills. One thing you could do is just rewind your podcast machine back to last week to our episode on stoicism where we talked about some exercises for this. You could also look up things like metta meditation in Buddhism as you know all about this developing compassion on a global scale.
Just in general finding ways of zooming out and getting some perspective on the way that you're connected to other people and all the ways that people that you don't even know are all doing things that support you being able to exist in the way you are right now making sure that you are able to have food and electricity and shelter and so many people and animals often had to be involved, and your plants and everything had to be involved and do so much work before you ever touched these things for you to be able to have those.
Just really understanding and trying to get some perspective on how truly interconnected you are to so many people and things.
Dedeker: The opposite of doing the zoom out is you can also do the zoom in. I read some really interesting stories of people where in their line of work, depending on how big of a company they worked for or what position they were in, it became hard to see how is this actually benefiting the world, who is this actually benefiting, and finding ways to either literally see or conceptually see the individual who is benefiting from your care or from your work so it doesn't feel like it's just going out into the ether, out into nowhere but being able to connect to that sense of like I know specifically that this is having an impact on this specific person.
It could be real or imaginary or perhaps an example of the person that you want to help that that can be a really good way to generate compassion that is more rejuvenating for your work. Of course, Buddhist-based practice, other mindfulness-based practices those are the ones that have been the most effectively studied as far as studies about generating compassion, those are the ones that have been shown to be effective. There are plenty of practices outside of that tradition but just these are the ones that I guess have more backing of research.
Things like particular mantras can help, visualizations. If you just do a Google search for Buddhist-based compassion practices, you'll probably find plenty. There is a Buddhist practice known as tonglen. Tonglen meditation that comes out of Tibetan Buddhism and this practice, my goodness, I haven't done very much of it because it always scares me because I'm scared of getting compassion fatigued but I think thinking about it in this different way of separating self may be actually helpful.
Basically, tonglen meditation is you're sitting in meditation and visualizing all the suffering of the world and you're breathing in other people's suffering and breathing out like relief and gentleness and peace and contentedness to the rest of the world. It’s the opposite that I think usually when we do breath meditation, it's a little bit of like, breath in spirit and breathe out bullshit is the way that our pop culture meditation goes and this was throwing that on its head of actually breathing in pain and transforming that into peace or relief or things like that. This one feels challenging to me I think because I'm just like, "Oh god, how do you not just get more fatigued in doing that?"
Emily: Breakdown and cry.
Dedeker: Yes. How do you not just breakdown down and cry from doing that? I do think that it would probably require already having that healthy sense of self separate from others ironically for being a Buddhist space practice in order to be able to just hold that sense of compassed giving to the rest of the world. We have some other ideas that you can also find if you go back to episode 274 where we covered compassion more extensively.
Then my last note on this, I also just want to acknowledge that there's a fair amount of the factors that cause compassion fatigue that are systemic, like helping organizations that don't offer paid time off to their helping professionals or organizations that are not willing to put the resources into turning inward to care for their own workers or care for their own therapists or nurses or whatever it is.
Just bearing in mind that if you're in a state of compassion fatigue, that doesn't mean it's just your personal failing and you're not doing a good enough job to take care of yourself. Some of this is also bigger systems and bigger work systems that are not necessarily within our direct control. You can also offer yourself a little bit of compassion as well if that's just part of the system that you're in.
I thought it was really funny when I was doing all this research that I found a lot of these workplace PowerPoint presentations about compassion fatigue that did come to the same conclusion of actually ironically we need to generate maybe more compassion and less of a sense of just taking on other people's pain.
There was this really funny PowerPoint presentation from a hospice provider in North Carolina where they were talking about Buddhist-based compassion practices and they're like, "We can practice compassion whenever, you can generate compassion when you're in line for the grocery store, we can practice compassion with northerners, we can practice compassion with Democrats," and it's nice for me to think about that radical idea.
Jase: Yes.
Emily: Well, how radical, goodness.
Dedeker: I know.
Jase: I think that sentiment there is absolutely true.
Dedeker: Hey, you know what y’all? The sentiment is true. We can practice compassion with people that we don’t politically agree with.
Emily: Correct.
Dedeker: We can practice compassion with conservative people with Republicans or people who are not as progressive as we are, the sentiment still stands for sure.
Jase: Yes.
Dedeker: Lastly, for more resources, you can also take a look at episode 216 that was all about emotional support and also we highly recommend googling something called the Caregiver's Bill of Rights that can give you some more thoughts around this whole topic.
For our bonus episode today we're going to be talking about the concept of compassion stamina which is a little bit different from anything that we've covered here and specifically I'm going to talk a little bit about a conversation that I had with professor Mark Steedman specifically about this topic of compassion seminar.
Emily: Oh you had the conversation?
Dedeker: I did.
Emily: It’s now just like, "Well, how exciting? I can't wait."
Dedeker: We want to hear from you. Have you experienced compassion fatigue? We want to hear your answers to that you find that question on our Instagram stories for this week. Also, the best place to share your thoughts about this episode with other listeners is on this episode's discussion thread in our private Facebook group or Discord chat. You can get access to these groups and join our exclusive community by going to patreon.com/multiamory.
In addition, you can share with us publicly on Twitter, Facebook, or Instagram. Multiamory is created and produced by Jase Lindgren, Emily Matlack and me, Dedeker Winston. Our episodes are edited by Mauricio Balvanera, our social media wizard is Will McMillan, our production assistants are Rachel Schenewerk and Carson Collins, our theme song is Forms I Know I Did by Josh and Anand from the Fractal Cave EP. The full transcript is available on this episode’s page on multiamory.com.