With the ongoing crisis happening around the globe, most people may find it overwhelming to the point of losing their compassion. This can lead to what’s known as Compassion Fatigue (CF). This week You! talks to Karachi-based psychologist Yumna Zafar Usmani in this regard…
In a little over six months, we have seen a fair share of historic events take place and all of them seem to be worse than the other. It started with US-Iran clash that could have instigated World War III, natural calamities happening across the globe – Australian bushfires, Indonesian floods, volcano eruption in Philippines, earthquakes in Turkey and the Caribbean, Locust attacks in East Africa – including the Muslim atrocities in India, Chernobyl fire, a plant explosion in Lagos and the coronavirus pandemic are amongst the few that have happened so far. Only halfway through the year, and we have possibly seen a decade’s worth of misfortunes. At the start of 2020, no one could’ve predicted the dire circumstances that we would be faced with. And, seeing the frequency of such events, most of us don’t know how to react.
“I felt like something inside of me finally broke and I just let go. I let myself cry, curled up in a corner of my darkened room. I couldn’t think, I couldn’t pray…I couldn’t do anything. I just sobbed and sobbed until I couldn’t do that anymore as well,” narrates Zahra*, a 28-year-old social worker who felt heartbroken after she had watched a video of the plane crash in Karachi last month. “It’s not like this was the first time I had seen such a tragedy. There was the earthquake in 2005, and then the plane crash in 2016. Not only this, I have experienced great loss personally and hear and observe many tragic tales while doing volunteer work. On top of that, I am caring for COVID-19 family member at home. But, never have I ever felt so vulnerable and helpless. Never have I felt so done with everything…The coronavirus pandemic has claimed so many lives which includes many young doctors. Every day, I read something about someone dying from COVID-19, or how doctors are struggling to stay safe and keep their families safe… it’s all come to a point where it’s all a bit too much and I just want to stop,” bemoans Zahra.
Zahra isn’t the only one who feels this way nowadays. Given our current circumstances, most of us might have found themselves slipping into a dark place and feeling overwhelmed. Normally, this feeling was often associated with people from particular professions, like healthcare workers who tend to exude a lot of compassion when they’re on the job. They have to assist those who are sick or injured, comfort their family members, and deal with all kinds of difficult, emotionally complex situations. This can lead to what’s known as Compassion Fatigue (CF), a state of being in which their emotions and physical health can deteriorate because of their repeated exposure to death and other emotionally overwhelming situations. However, compassion fatigue is no more an ‘occupation hazard’. These days, many empathetic people from all walks of life may find themselves being swept in this wave.
To make sense of the feeling of exhaustion and hopelessness being felt around, Karachi-based psychologist Yumna Zafar Usmani explains, “Compassion fatigue is basically when one tends to feel depleted and empty, like there is nothing left to give anymore. You can call compassion fatigue as the ‘cost of caring too much’, the cost of perhaps taking care of someone else, especially if they are unwell or distressed. It is a syndrome where you feel emotionally and physically exhausted – you feel that you ran out of empathy. This syndrome is also comparable to Secondary Vicarious Stress disorder or Posttraumatic Stress Disorder (PTSD) because they share some of the symptoms. Some of these symptoms include that you are feeling anxious, irritable, depleted, a lack of empathy, you have constant anger, you feel extremely sad, you’re impatient, isolated and disconnected from everyone, even from yourself. What’s happening is that you may be generally very compassionate and too giving to others but right now in this state you’re feeling like you have had enough and you just don’t have it in you to listen to anybody else or deal with anybody else’s problems. You do recognise that this is not how you usually react but you can’t help but feel it this way.”
When a person feels validated and their feelings actualised, the chances of experiencing such disorders are minimal. However, if you feel like your feelings are unwarranted or something is amiss, that is where it contributes to compassion fatigue. “Usually a key factor in compassion fatigue is an imbalance, which is when someone else’s needs surpass your own. Apart from caring for someone who is ill, this condition can also occur if you are in an abusive or emotionally manipulative relationship. That’s because you are giving your all but not getting anything in return,” informs Yumna.
However, CF can often be confused with other disorders, like depression, but most likely with Vicarious Trauma (VT) and Burnout. “VT is when one is significantly impacted by the exposure to indirect trauma. What happens is that you tend to get flashes intrusive images, you have difficulty in thinking about anything else, you have difficulty in moving away from someone – be it a person or their story. Now, what happens is that after some time, the person suffering from VT starts viewing the world to the length of that trauma which makes difficult to distinguish whether it is their own experience or someone else’s. This makes you anxious, stressed, fearful, more agitated. For instance, if there was a kidnapping in your neighbourhood, every time you or anyone leaves the house you may get paranoid that someone would kidnap you or your loved one. It affects you to a level that your daily effective hindered,” explains Yumna.
“Burnout is the extreme end. Burnout can be at the end of compassion fatigue or vicarious trauma or can happen separately. You can be burnout because you are simply in an unhealthy environment, be it a professional or personal capacity. Moreover, you can develop all the three conditions, compassion fatigue due to perhaps an exposure to extreme number of such events or patients or being in the same environment. Moreover, if you are in an abusive relationship, you would feel like every day you are giving year by year, you are giving your all to your partner with the hope that your feelings will be returned. However, the person doesn’t change and instead causes fatigue and a burnout,” adds Yumna.
To be in a mentally sound environment means that you should feel validated, actualised, acknowledged, respected and connected.While CF, VT and Burnout may be similar, what really matters is the context and that you acknowledge its presence within you or with your loved one. Knowing how such conditions can occur will also help you avoid getting them in the first place. “The difference in all these conditions is a little difficult to identify because they can coexist as the symptoms can coexist. However, what matters is the context. In Vicarious Trauma, there is a shift in how you see the world and that may not necessarily be the case in compassion fatigue. The main difference is that in VT there isn’t a decrease in compassion but in compassion fatigue there is. In CF, you lack empathy as you’ve had enough and you literally lack of emotions and inability to give more of yourself. Burnout and compassion fatigue happen over time and it is cumulative of a lot of events. The same may not be always applicable for VT. Sometimes the impact of a single event is so grave that you may experience VT after hearing or experiencing that one event. Other times you keep hearing about that event or events similar to it constantly which eventually leads you to VT,” elucidates Yumna.
When a person feels validated and their feelings actualised, the chances of experiencing such disorders are minimal. However, if you feel like your feelings are unwarranted or something is amiss, that is where it contributes to compassion fatigue.
One may not realise they are ignoring their needs until they reach their lowest point, which is why selfcare is vital. One has to be emotionally intelligent to identify their needs. You need to realise that you are reaching that state when you’re not being respected, validated or acknowledged – be it in a professional or personal capacity. It comes in different forms and shapes but it is a necessity.
When you feel that you are going through any of the three conditions, Yumna advises to be accountable. “Accountability is very, very important. When you sense an imbalance, that is a sign when you need to take an action. On a personal level, you must understand what gives you a sense of happiness, relaxation or a sense of virtue. This can be quite subjective but generally one identifies their support network. Connect with your friends, family and be okay with letting people know that you need space, help, comfort or support, especially nowadays. If it is an abusive relationship, you need to hold the other person accountable and remind yourself to take care of your needs too.”
The same can be applied to a professional capacity to stop you from reaching to a point of fatigue from being traumatised to being burnout. Here, companies should provide development, supportive supervision, supportive management, mental health counselling support – these can be enacted personally and professionally. The cost of ignoring any of the three conditions is highly expensive because your quality of work, quality of relationships, daily functioning they all have a significant impact and go through a significant decline unless necessary interventions are taken place. But, while there is a lot of conversation taking place regarding mental health, it is still not enough to make a significant difference. “I personally haven’t seen any company where they offer a leave if you are not feeling mentally well, unless you have had a breakdown in front of them and you have cost them or something else is the case. Perhaps, compassion fatigue, vicarious trauma or burnout more considered occupational hazard in more developed countries and more for those professions that are directly in-line with patients and trauma controls. So, mental health is usually side-lined. While there are certain professions that are more prone to such conditions, but it is not just limited to them but can affect anyone. Any vigilant employment would want to avoid the cost associated with such mental health conditions, as they lead to a drastic decline in your quality of exchange, work and daily functioning. So, to avoid suffering an impact, many employments should give mental health its due importance,” concludes Yumna.
