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Compassion fatigue: A radical proposal for overcoming it

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?

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.

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

The Evidence: Empathy is good for your health and well-being

Empathy is good for your health and well-being: Empathy is on a short list of stress reduction practices including meditation (mindfulness), Tai Chi, and Yoga. Receiving empathy in the form of a gracious and generous listening is like getting a spa treatment for the soul. But do not settle for metaphors.

For evidence-based research on empathy, empathy and stress reduction, and empathy training you may start by googling: Antoni et al. 2011; Ciaramicoli 2016; Del Canale et al 2012; Farrow et al. 2007; Irwin et al. 2012; Maes 1995, 1999; Pollack et al. 2002; Rakel et al. 2009; Segerstrom and Miller 2004; Slavich et al. 2013 [this list is not complete].

You do not have to buy the book, Empathy Lessons, to get the research, but if you would like more detail see especially Chapters Four and Six in Empathy Lessons (click here to get book from Amazon).

[Also included are chapters on the Top 30 Tips and Techniques for Expanding Empathy, Overcoming Resistance to Empathy, Empathy Breakdowns, Empathy as the New Love, Empathy versus Bullying, and more.] 

The healing powers of stress reduction are formidable. Expanding empathy reduces stress; and reducing stress expands empathy. A positive feedback loop is enacted. Expanding empathy expands well-being.  Here empathy is both the end and the means.

A substantial body of evidence-based science indicates that empathy is good for a person’s health. This is not “breaking news” and was not just published yesterday. We don’t need more data, we need to start applying it: we need expanded empathy.

Evidence-based research demonstrates the correlation between health care providers who deliver empathy to their patients and favorable healthcare

Well-being rides the wave of empathy: sketch by Alex Zonis (AlexZonisArt.com)

Well-being rides the wave of empathy: sketch by Alex Zonis (AlexZonisArt.com)

outcomes. What is especially interesting is that some of these evidence-based studies specifically excludepsychiatric disorders and includemainline medical outcomes such as reduced cholesterol, improved type 2 diabetes, and improvement in related “life style” disorders.

Generalizing on this research, a small set of practices such as receiving empathy, meditation (mindfulness), yogic meditation, and Tai Chi, promote well-being by reducing inflammation. These practices are not reducible to empathy (or vice versa), but they all share a common factor: reduced inflammation. These anti-inflammatory interventions have been shown to make a difference in controlled experiments, evidence-based research, and peer-reviewed publications.

Using empathy in relating to people is a lot like using a parachute if you jump out of an airplane or getting a shot of penicillin if one has a bacterial infection. The evidence is overwhelming that such a practice is appropriate and useful in the vast majority of cases. The accumulated mass of decades of experience also counts as evidence in a strict sense. Any so-called hidden or confounding variables will be “washed out” by the massive amount of evidence that parachutes and penicillin produce the desired main effect.

Indeed it would be unethical to perform a double blind test of penicillin at this time, since if a person needed the drug and it were available it would be unethical not to give it to him. Yes, there are a few exceptions – some people are allergic to penicillin. But by far and in large, if you do not begin with empathy in relating to other people, you are headed for trouble.

Empathy is at the top of my list of stress reduction methods, but is not the only item on it. Empathy alongwith mindfulness (a form of meditation), Yoga, Tai Chi, spending time in a sensory deprivation tank (not otherwise discussed here), and certain naturally occurring steroids, need to be better known as interventions that reduce inflammation and restore homeostatic equilibrium to the body according to evidence based research.

The biology has got us humans in a bind, since it did not evolve at the same rate as our human social structures. When bacteria attack the human body, the body’s immune system mounts an inflammatory defense that sends macrophages to the site of the attack and causes “sickness behavior” in the person. The infected person takes to bed, sleeps either too much or too little, has no appetite (or too much appetite), experiences low energy, possibly has a fever, including the “blahs,” body aches, and flu-like symptoms. This response has evolved over millions of years, and is basically healthy as the body conserves its energy and fights off the infection using its natural immune response.

Now fast forward to modern times. This natural response did not envision the stresses of modern life back when we were short stature, proto-humanoids inhabiting the Serengeti Plain and defending ourselves against large predators. Basically, the body responds in the same way to the chronic stressors of modern life—the boss at work is a bully, the mortgage is over-due, the children are acting out, the spouse is having a midlife crisis—and the result is “sickness behavior”—many of the symptoms of which resemble clinical depression—but there is no infection, just inflammation.

The inflammation becomes chronic and the body loses its sensitivity to naturally occurring anti-inflammatory hormones, which would ordinarily kick in to “down regulate” the inflammation after a few days. Peer reviewed papers demonstrate that interventions such as empathy reduce biological markers of inflammation and restore equilibrium. This is also a metaphor. When an angry—“inflamed”—person is listened to empathically—is given a “good listening” as I like to say—the person frequently calms down and regains his equilibrium.

Empathy migrates onto the short list of inflammation reducing interventions. The compelling conclusion is that empathy is good for your well-being.

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