One of the criticisms of empathy is that is leaves you vulnerable to compassion fatigue. The helping professions are notoriously exposed to burn out and empathic distress. Well-intentioned helpers end up as emotional basket cases. There is truth to it, but there is also an effective antidote: expanded empathy.

For example, evidence-based research shows that empathy peaks in the third year of medical school and, thereafter, goes into steady decline (Hojat, Vergate et al. 2009; Del Canale, Maio, Hojat et al. 2012). While correlation is not causation, the suspicion is that dedicated, committed, hard-working people, who are called to a

Compassion Fatigue: Less compassion, expanded empathy?

life of contribution, experience empathic distress. Absent specific interventions such as empathy training to promote emotional regulation, self-soothing, and distress tolerance, the well-intentioned professional ends up as an emotionally burned out, cynical hulk. Not pretty.

Therefore, we offer a radical proposal. If you are experiencing compassion fatigue, stop being so compassionate! I hasten to add that does not mean become hard-hearted, mean, apathetic, indifferent. That does not mean become aggressive or a bully. That means take a step back, dial it down, give it a break.

The good news is that empathy serves as an antidote to burnout or “compassion fatigue.” Note the language here. Unregulated empathy results in “compassion fatigue.” However, empathy lessons repeatedly distinguish empathy from compassion.

Could it be that when one tries to be empathic and experiences compassion fatigue, then one is actually being compassionate instead of empathic? Consider the possibility. The language is a clue. Strictly speaking, one’s empathy is in breakdown. Instead of being empathic, you are being compassionate, and, in this case, the result is compassion fatigue without the quotation marks. It is no accident that the word “compassion” occurs in “compassion fatigue,” which is a nuance rarely noted by the advocates of “rational compassion.”

Once again, no one is saying, be hard hearted or mean. No one is saying, do not be compassionate. The world needs both more compassion and expanded empathy. Compassion has its time and place—as does empathy. We may usefully work to expand both; but we are saying do not confuse the two.

Empathy is a method of data gathering about the experiences of the other person; compassion tells one what to do about it, based on one’s ethics and values.

Most providers of empathy find that with a modest amount of training, they can adjust their empathic receptivity up or down to maintain their own emotional equilibrium. In the face of a series of sequential samples of suffering, the empathic person is able to maintain his emotional equilibrium thanks to a properly adjusted empathic receptivity. No one is saying that the other’s suffering or pain should be minimized in any way or invalidated. One is saying that, with practice, regulating empathy becomes a best practice.

Interested in more best practices in empathy? Order your copy of Empathy Lessons, the book. Click here.

References / Bibliography
M. Hojat, M. J. Vergate, K. Maxwell, G. Brainard, S. K. Herrine, G.A. Isenberg. (2009). The devil is in the third year: A Longitudinal study of erosion of empathy in medical school, Academic Medicine, Vol. 84 (9): 1182–1191. 

Mohammadreza Hojat, Daniel Z. Louis, Fred W. Markham, Richard Wender, Carol Rabinowitz, and Joseph S. Gonnella. (2011). Physicians empathy and clinical outcomes for diabetic patients, Acad Med. MAR; 86(3): 359–64. DOI: 10.1097ACM.0b013e3182086fe1.

Louis Del Canale, V. Maio, X Wang, G Rossi, M. Hojat, and J.S. Gonnella. (2012). The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy, Academic Medicine, 2012; 87(9):1243–1249.

(c) Lou Agosta, PhD and the Chicago Empathy Project