Lying Down in the Ever-Falling Snow

Canadian Health Professionals’ Experience of Compassion Fatigue

by Wendy Austin; E. Sharon Brintnell; Erika Goble; Leon Kagan; Linda Kreitzer; Denise Larsen & Brendan Leier

tagged: human services, social work, issues

Description

Compassion fatigue from the perspective of insiders in caregiving roles

First used to describe the weariness the public felt toward media portrayals of societal crises, the term compassion fatigue has been taken up by health professionals to name—along with burnout, vicarious traumatization, compassion stress, and secondary traumatic stress—the condition of caregivers who become “too tired to care.” Compassion, long seen as the foundation of ethical caring, is increasingly understood as a threat to the well-being of those who offer it.

Through the lens of hermeneutic phenomenology, the authors present an insider’s perspective on compassion fatigue, its effects on the body, on the experience of time and space, and on personal and professional relationships. Accounts of health professionals, alongside examinations of poetry, images, movies, and literature, are used to explore the notions of compassion, hope, and hopelessness as they inform the meaning of caring work. The authors frame their exposé of compassion fatigue with the very Canadian metaphor of “lying down in the snow.” If suffering is imagined as ever-falling snow, then the need for training and resources for safe journeying in “winter country” becomes apparent. Recognizing the phenomenon of compassion fatigue reveals the role that health services education and the moral habitability of our healthcare environments play in supporting professionals’ ability to act compassionately and to endure.

About the Authors

Wendy Austin

The authors are Wendy Austin, Canada Research Chair (Relational Ethics), E. Sharon Brintnell, Erika Goble, Leon Kagan, Linda Kreitzer, Denise Larsen, and Brendan Leier. Scholars and/or clinicians situated primarily at the University of Alberta (Kreitzer, University of Calgary), they form an interdisciplinary group (anthropology, medicine, nursing, occupational therapy, philosophy, psychology, and social work) with a deep interest in ethical, compassionate health care and the well-being of those who provide it.

E. Sharon Brintnell

The authors are Wendy Austin, Canada Research Chair (Relational Ethics), E. Sharon Brintnell, Erika Goble, Leon Kagan, Linda Kreitzer, and Brendan Leier. Scholars and/or clinicians situated primarily at the University of Alberta (Kreitzer, University of Calgary), they form an interdisciplinary group (anthropology, medicine, nursing, occupational therapy, philosophy, psychology, and social work) with a deep interest in ethical, compassionate health care and the well-being of those who provide it.

Erika Goble

Leon Kagan

Linda Kreitzer

Denise Larsen

Brendan Leier

Excerpt

Excerpt from Lying Down in the Ever-Falling Snow: Canadian Health Professionals' Experience of Compassion Fatigue by Wendy Austin, E. Sharon Brintnell, Erika Goble, Leon Kagan, Linda Kreitzer, Denise J. Larsen, and Brendan Leier

The Icy Wall of Compassion Fatigue

Compassion fatigue deeply affects the relationship between the health professional and the patient. Rather than having a relational connection and attunement to the patient, the professional feels unable to reach out and connect with those in his or her care. Perceived failure in repeated efforts to make a difference in the suffering of others seems to create a form of indifference in the health professional. Veronica says compassion fatigue feels like indifference to her: It doesn't matter what is going on. It doesnrt affect you in any way, and it should. People's pain . .. misery . .. suffering should affect you. It's not normal that it doesn’t affect you. It’s not normal that you can see someone in severe agony and then go have your lunch as if nothing has happened. “Indifference” originates in the Latin word indifferentia, meaning “not differing, making no difference . .. of no consequence, not particular, careless. ”30 Bill, a psychologist, describes his experience of this: You have a hard time getting up in the morning; you really don't want to go to work. You might start showing up late for appointments; you don't prepare a lot for your appointments. You don't have a lot of hope; you wish sessions would go faster. When the patient before you is in dire straits, the compassion fatigue is particularly evident. Bill gives an example from his own experience: If you see someone who has killed their own child, the clock really stops. There is not much you can say to someone who has killed their own child. .. . What can one say or do? The horror of such a situation can entirely overwhelm the compassion- fatigued therapist.

Veronica believes she could definitely recognize compassion fatigue in a colleague. She thinks of someone with whom she works who to me is very pent up. She will curse, and she doesn't make chit-chat or small talk. She doesn't take interest in other things. She is always straight to work. She comes to work looking a bit disheveled or she looks tired sometimes. When I first met her, she was very warm and friendly, and now she is cold.

As we explored in this study what compassion fatigue is like, we examined images that seemed to capture it. Images—sculptures, photographs, paintings—of a person who is overcome, collapsed, and whose arms appear to have lost all strength seemed to catch the pervasiveness of the fatigue. 31 When the health professional can no longer reach out and enact a compassionate response toward his or her patients or clients, it is as if there is a coldness, an icy wall in the way. It is a progressively thickening wall that blocks one's presence to the other.

An icy barrier to family relationships can also form. For those who work in intense and demanding environments, it may often be difficult to leave work and relate to the less profound concerns of a family member. It can be difficult to act as if the choice of new wallpaper matters very much when one has just left a patient who has been told he cannot be cured. One health professional noted that she would try to listen to her husband's concerns about technical problems at work but that it took effort. Though she kept to herself thoughts of I'm thinking of someone who is dying of cancer, while your statistical analysis doesn't work out, such thoughts colour the empathy that otherwise would be there for him.

Justine, a social worker, was offered insight into the personal impact of compassion fatigue by her husband. He told her: Before [you had counselling for compassion fatigue] I would say something and you would just jump all over it or you wouldn't answer me or you'd be so preoccupied with something. You were so sad. And so, I just kind of stopped talking about anything that was important.

Lucille, an occupational therapist, says that compassion fatigue changed the way she interacted at home with her children. When it starts carrying over to your children who don’t know any better . .. I realized there was something going on. She knew she needed to be able to focus on their everyday concerns and to have patience helping them deal with them. Lucille eventually left her position.

Editorial Reviews

“The seven authors form ... an impressive interdisciplinary team.... To the extent that this book brings the reality of compassion fatigue to our collective awareness, there is reason to hope that increased understanding can promote avoidance of compassion fatigue for many as well as the amelioration of the suffering of those who become afflicted.... The discussion of hope does much to enlarge our comprehension of the processes that underlie the ‘fatigue’ condition. Hope is seen as necessary for compassion, but hope repeatedly denied without adequate conditions for restoration is a damaging experience.... The authors present a thoughtfully detailed discussion of what can be done to lessen and prevent the suffering and loss caused by compassion fatigue.... The depictions of the emotional life of caregivers afford invaluable experience for the reader, perhaps even an enlargement of one’s emotional compass. From a more functional view, the accounts can serve as a stimulus for analysis of the process of caregiving itself, which could foster a more sensitive institutional management, both self and organizational.... The authors have collaboratively created a comfortably readable text, effectively smoothing any disjunctions, so that the reader is given an eminently readable, finely woven work.”

— Canadian Journal of Counselling and Psychotherapy

“This book should be required reading in the education of all health and human service professionals. Although technical and therapeutic expertise is a core foundation of competent, ethical, and safe practice, education often neglects compassion fatigue as a central aspect of human relationship. Also neglected is the meaning of human suffering—much to the consistent detriment of service providers and those for whom they care, particularly in the context of increased market-driven healthcare. This book can create the foundation for much-needed open conversations about these pressing issues.”

— Elizabeth McGibbon, Ph.D., RN, editor of <i>Oppression: A Social Determinant of Health</i> (2012)

“This book offers a refreshingly honest viewpoint, exploring the phenomenon of compassion fatigue from the perspectives of a variety of Canadian health professionals, discussing their feelings and how work can affect them.... Given the potential for risk reduction by educating future practitioners on how to recognize and address compassion fatigue, either in themselves or their colleagues, this book should be a core text for all universities that teach occupational therapy.”

— British Journal of Occupational Therapy

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