Home » Posts tagged 'compassion fatigue'
Tag Archives: compassion fatigue
Review: Brené Brown, (2021). Atlas of the Heart: Mapping Meaningful Connection and the Language of Human Experience. New York: Random House, pp. 304.
This is three books in one. It is a psychology “how to” book filled with tips and techniques about how to identify and name emotions, feelings, affects, and their triggers and consequences. This inquiry is engaged in order to build connections and community. It works. People who are able to name their emotions and feeling experience expanded power in getting what they want and need from other people. They also get expanded power in contributing to building meaningful connections and community.
Second, the Atlas is a research report on what might be described as “crowd sourcing” (my term, not Brown’s) what emotions were important to some 66,625 persons in Brené Brown’s massive online classes in 2013/14.
Comments and narratives were solicited from the participants. This input was anonymized, color coded, aggregated, filtered, subjected to expert selection as to which emotions and emotion-related experiences were significant in promoting “healing.” The terms were then defined using 1500 academic publications. What falls out of this complex and interesting, though not entirely transparent process, are emotions, emotional triggers, emotional consequences, experiences, lots of experiences, and, well – an atlas of the heart. Readers are all the richer for it.
Finally, Atlas is an art book. The text on high quality paper is interspersed with color photos, cartoons, and enlarged quotations of key phrases such as one would find on social media. Take a tip or technique and using large and colorful type, put it on a page by itself: “I’m here to get it right, not to be right [p. 247. Note: there is no close quote. Is that a typo or poetic license?]
I especially liked the photos of Brown’s hand written journal (or college essay?), saying “throughout our lives we must experience emotions and feelings that are inevitably painful and devastating” (October 9, 1984). Early on, Brené showed promise, and she movingly shares her struggles and what she had to survive in her family of origin. The photo of the dog with the guilty, “hang dog” expression, next to the torn up upholstered chair was genuinely funny. Never let it be said that dogs don’t experience emotions! The artistic aspects will be deemphasized in this review, but the book definitely has possibilities for placement on the “coffee table” to invite browsing and conversation prompts.
The book succeeds in all three of its aspirations, though to different degrees.
At this point, an analogy may be useful. People are not born knowing the names of colors. Children applying to start kindergarten are quizzed on such basics as the names of the letters (ABCs), their address and phone number, and the names of the colors. The spectrum from red through orange, yellow, green, blue, to violet is indeed a marvelous thing. But no one assumes anyone knows what these distinctions are called without guidance. Why then is it that children (and of all ages) are assumed to know the difference between basic emotions fear, anger, sadness, high spirits, much less more subtle nuanced feelings such as envy, jealousy, resentment, shame, guilt, and so on?
This is the first challenge that Brené Brown addresses with her book. She provides a guide, an atlas of the heart, to people struggling to identify the emotions and emotion-ladened experiences they are feeling, sensing, or trying to express. Even though Sesame Street, Mister Rogers, and Mary Gordon’s Roots of Empathy, have taken decisive steps to put this aspect of emotional intelligence – x identifying and naming the emotions – on the school curriculum map, large numbers of people of all ages struggle with the basics. What is this feeling that I am feeling? What is this emotion, if it is an emotion, that I am experiencing?
Brown begins with a nod to the innovative body of work on the emotions by Paul Ekman (e.g., Emotions Revealed. New York: Owl (Henry Holt), 2003). Ekman put facial micro-expression on the map as the key to emotions with a seven year plus study resulting in his Facial Action Coding Scheme. According to Ekman, a relatively small set of some seven basic emotions are universal, evolutionarily based, and part of a biological affective program that is “hardwired” into our mammalian biology. These basic emotions (sadness, anger, agony, surprise, fear, disgust, contempt, and maybe enjoyment) get elaborated and transformed in a thousand ways by social conventions, community standards and cultural pretenses.
The human face is an emotional “hot spot,” according to Ekman. The micro-expressions are the “tells” that disclose a person’s underlying feeling or attitude, regardless of the facial expression the person may be adopting for social display purposes. Thus, a person may smile to express agreement with his friends, but his eyes do not participate in the smile (also called a “Duchenne smile”) and something looks not quite sincere. More concerning, the would-be suicide bomber puts on a calm, happy face, but a micro-expression of contempt momentarily steals across his face, expressing his hatred for the system he is about to try to destroy. Notwithstanding Ruth Ley’s penetrating and trenchant critique of loose ends in Ekman’s approach (see Ley, The Ascent of Affect. Chicago: University of Chicago press, 2017), his approach remains today the dominate design in emotion research. Enter Brené Brown’s contribution.
For example, Brown’s first constellation of emotions engaged include “stress, overwhelm, anxiety, worry, avoidance, excitement, dread, fear, vulnerability” (p. 2). She quotes the American Psychological Association Definition of anxiety (so we know where that definition came from!): “an emotion characterized by feelings of tension, worried thoughts and physical changes like increase blood pressure” (p. 9).
Worry and avoidance, not exactly emotions as such, are ways of dealing with the painful aspects of anxiety. Excitement seems to be the physiological aspects of anxiety given a positive spin, valence, or trajectory. Add “negative event approaching” and “present danger” and you’ve got dread and fear. Stress and overwhelm are the again physiological aspects of anxiety, elaborated, for example, by having to be a waitress in a restaurant at its busiest (as was Brown while working her way through college). “Stressed is being in the weeds; overwhelm is being blown.”
For Brown, vulnerability is a key emotion, since it initially shows up as a weakness to hide, but has the potential, when approached with a willingness to embrace risk, to be transformed into courage, accomplishment, and what people really want from inspirational speakers – inspiration. Never was it truer, our weaknesses are our strengths. Dialectically speaking.
At this point, I am inspired by Brown’s contribution, and will not split hairs over what is an emotion and what an emotional fellow traveler. Vulnerability is the perception and related belief, thought, or cognition, whether accurate or not, that the person is able to be hurt whether physically or in social status. Keep your friends close but your enemies, including your near enemies such as flatterers and people who ask you to lend them money, closer?
This is a good place to point out that if you really want to “get” the emotions, you may usefully engage with Brown. Definitely. But do not overlook Paul Griffiths, What Emotions Really Are (Chicago: University of Chicago Press, 1997). Emotions may not even be a natural kind. A mammal (for example) is a natural kind, emotions arguably are not. Emotions are a “kludge” cobbled together by the scientific community from an evolutionary affective program, moral sentiments such as righteous indignation in the face of social injustice (a strategic, energetic, passionate reaction to enforce the social convention of promising among distrustful neighbor), and social pretence such as romantic love.
In a famous one line statement in Martin Heidegger’s magnum opus, Being and Time (1927: H139), he says that the study of the moods, affects, and emotions has not made a single advance since Book II of Aristotle’s Rhetoric (347? BCE). He then proposes that anxiety is the way the world is globally disclosed as a limited finite whole. It is tempting for purposes of being collegial to write, “Finally an advance on Aristotle, Brené!” but she would surely be the first to acknowledge that would indeed be a high bar. Suffice to say, Brown’s contribution is significant and in many ways, impressive. Aristotle is still Aristotle. (See Agosta 2010 in the References.)
Since this is not a softball review, and in spite of saying a lot of interesting things about love, it is not defined in Brown’s book. I applaud Brown’s decision to leave the definition of love to the poets and artists, whether intentionally or by omission. Anyone who tries to define love is likely to end up with more arrows in the back than Cupid has in his quiver.
A definition would be something like Freud’s statement: Love is aim-inhibited sexuality. Or Aristophanes narrative that love is the search for one’s other half and the joining with that half if/when one finds it. Or Bob Dylan’s “love is just a four letter word.” No inhibition here; just hormones all the way down.
The research challenge present here is how to finesse the canonical interpretation of the data by her team of experts, assembled from her extensive network of colleagues, which data after all is highly survey-like yet without controls, randomization, or rigorous sampling dynamics. The outer boundary of the demographic respondents seems to be the 66K plus followers who signed up for her massive online courses.
Other features of the book that became wearing for this reviewer were the seemingly endless rhetoric of stipulation, how inspiring to her has been everyone else’s research from which she liberally borrows, always with a slew of well-crafted footnotes, and an epidemic of near enemies to authenticity and courage. This is perhaps inevitable when one has to give 87 definitions.
Still, the question invites inquiry: Where after all did the definitions of these 87 emotions and experiences really come from? I cannot figure it out. My best guess is “the team” made it up based on reading 1500 research articles and extensive input from the “lead investigator,” Brené Brown. To be sure, Brown is generous with her recognition and acknowledgements of a long list of thinkers, mentors, scholars, spiritual guides, and researchers. She really lays it on thick with how much she has learned from her friends and colleagues; and it indeed must be thrilling to have one’s name called out by a celebrity academic. I am green with envy – not one of the positive emotions – that I am unlikely to make the short list with my seven books on empathy, especially given this review.
Still, Brown’s contribution is a strikingly original synthesis of existing ideas. I have been known to say, “Research also includes talking to people.” Yet the risk is scientism. The air of scientific authority without the fallibility of human subjectivity and idiosyncrasy. It may not matter. The value lies in the tips and techniques that can be used to build community and connection. If it is scientism, then it is scientism at its best.
Once again, since this is not a softball review, I join the debate about one of the most troubling of emotions, anger. Brown properly raises the issue of whether anger is fundamental or derivative. Anger often seems to be a front for something else = x, such as shame, guilt, jealousy, humiliation (this list is long). In spite of the dramatic display of being angry, there is something inauthentic about anger. Anger is a burden to those who experience it, and this burden often gets discharged in maladaptive and self-defeating ways by acting out aggression and violence. Brown’s position is a masterpiece of studied ambiguity. I agree.
My take on this? If you want to see or make people angry, then hurt their feelings. If you see an angry person, ask: Who hurt the person’s feelings and/or did not give the person the respect, dignity, or empathy that the person deserves or to which the person feels entitled. You see here the problem? Entitlement, legitimate or otherwise.
This was Heinz Kohut’s point: When people don’t get the empathy they need and deserve, they fragment emotionally – and one of the fragments is narcissistic rage (extreme anger). From this perspective, empathy is not a mere psychological mechanism but the foundation of community, connection and intersubjectivity. Donna Hicks makes the same point in Dignity (New Haven and London: Yale University press, 2011). If you see anger in the form of conflict, substitute the word “dignity” for “empathy” – someone has experienced a dignity violation, a breakdown, a loss of dignity, which loss must be restored to have any hope of resolving the conflict (whether in Northern Ireland or the bedroom).
As regards empathy, Brown engages it along with compassion, pity, sympathy, boundaries, and comparative suffering. Like many psychologists, Brown regards empathy as a psychological mechanism not empathy as a way of being and the foundation of community. For the latter, the foundation of community, like a good Buddhist, she privileges compassion. Nothing wrong with that as such. Heavens knows, it is not an either-or choice – the world needs both expanded empathy and compassion.
Another point of debate. When Brown says that taking a walk in the other person’s shoes is a myth that must be given up, she is rather overthinking what is a folk saying. Key term: overthinking (occupational hazard of all thinkers and academics).
“Talking a walk in the other person’s shoes” is the folk definition of empathy. Consider the situation from the perspective of the other person, especially if that individual is your critic, opponent, or sworn enemy. Especially if the latter is the case.
This is folk wisdom and appreciating the point requires a folkish charity. Key term: charity. It is uncharitable to take a saying and read it in a way that willfully distorts or makes it sound implausible or stupid. Ordinary common sense is required. This is what Brown properly calls a “near enemy” – for example, the way “pity” is the “near enemy” of empathy – a way of dismissing it.
Therefore, when one says take a walk in the other’s shoes, this is not a conversation about shopping therapy or shopping for shoes. It is a conversation about taking the other person’s perspective with the other’s life circumstances in view in so far as one can grasp those circumstances. If one wants to unpack the metaphor, the idea is to get an idea where the other person’s shoe pinches or chafes. One might argue that the metaphor breaks down if one uses one’s own shoe size. It does. It breaks down into projection, which would be a misfiring or breakdown of empathy. In being empathic, I do not want to know where the shoe pinches me, but rather where it pinches the other individual.
And that is a useful misunderstanding – as noted, what Brown elsewhere calls a “near enemy.” Empathic interpretation breaks down, fails, goes astray as projection. If I do not take into account differences in character and circumstances, then one is at risk of attributing one’s own issue or problem or emotion to the other person. It may be that we have to dispense with the word itself. “Empathy” has become freighted with too much semantics and misunderstanding. That is okay – as long as we double down and preserve the distinction empathy as a way of being in community and authentic relatedness, what Brown elsewhere calls meaningful connectivity. Still, the word “empathy” has its uses, and if the reader substitutes “empathy” for “meaningful connection” the sense is well preserved in both directions. Okay, keep the word.
If you have seen Brené Brown’s Netflix presentation (The Call to Courage”), then you know this woman is funny. Not standup comedy funny, she is after all an academic who broke out of the ivory tower into organizational transformation and motivational speaking. She knows how to tell a good story, often in a funny self-depreciating way, that makes one laugh at one’s own idiosyncrasies. Like packing three books for a vacation with the kids at Disney World. Who is one kidding, once again, except perhaps oneself? This approiach does not translate as well into print as one might wish. No one is criticizing Brown for not being Dave Barry, but, unless you are familiar with her “in person” routine, much of the humor is lost in translation. The author is sooo compassionate, that by halfway through the work, I was actually starting to experience compassion fatigue.
However, notwithstanding Brown’s aspiration to rigorous science, and she does have a claim to “big data.” For me, this is not the most valuable part of her contribution. I have been known to say, “We don’t need more data, we need expanded empathy.” The good news is that Brown displays both in abundance. As noted, one could substitute the word “empathy” for her uses of “connection” and “meaningful connection,” the topics of her dissertation and research program, and not lose any of the impact, meaning, or value. Empathy is no rumor in Brené Brown. Empathy lives in Brené Brown’s contribution.
Lou Agosta. (2010). “Heidegger’s 1924 Clearing of the Affects Using Aristotle’s Rhetoric, Book II.” Philosophy Today, Vol. 54, No. 4 (Winter 2010): 333–345. [Download paper: https://philpapers.org/rec/AGOHC-2 ]
© Lou Agosta, PhD and the Chicago Empathy Project
A person can regulate his or her empathy up or down by crossing the street. The empathy lesson is that if you can cross the street to avoid the beggar, regulating your empathy down, then you can cross the street (as well as use other methods) to expand your empathy, regulating it upward. So don’t tell me that empathy cannot be dialed up or dialed down with practice. That’s the point: practice.
Crossing the street is what happened in another story with which many readers are already familiar. The story of the Good Samaritan, one of the parables of Jesus of Nazareth, tells of two people who crossed the street, and one who did not. In the story, a traveler was waylaid by robbers. He is left for dead by the side of the road. The first two persons—the Levite and the priest experienced empathic distress, and, crossed the street, passing by the victim.
The Samaritan, however, was not overwhelmed by the victim’s suffering. The Samaritan perceived the suffering; he had a vicarious experience of the suffering that did not over-stimulate him with suffering and cause empathic distress. The Samaritan saw a fellow human being; recognized the suffering humanity; and he decided to get involved.
Multiple empathy lessons are available here. First, to regulate one’s empathy, cross the street. This is an edgy and confrontational way of putting it, but it is literally accurate. Cross the street away from the neighbor to “down regulate” your empathy, and experience less empathic distress; and cross the street towards your neighbor to expand your empathy in the direction of creating an inclusive community of persons, who recognize the value of cooperation.
The empathy lesson is that the vicarious experience does not have to be overwhelming. Rather, with practice, one is able to shift one’s focus from suffering to neighborliness; one is able to shift one’s attention from suffering to making a difference and enhanced self-esteem, expanding community and shared humanity.
Crossing the street is not the only way to reduce one’s chance of empathic distress or responding empathically. One may imaginatively changes places with the survivor and reflect that one would want the other’s help if one were in a similar predicament. One may spontaneously and without thinking act impulsively to be helpful, because one’s upbringing has made such responsiveness a habitual practice. (I believe this was the case with the Samaritan.) One may reflect, “I am safe and the survivor is no danger to me and it is my turn to help out.”
Or, on the contrary, one may make a devaluing judgment such as “The guy deserved what he got.” Such a judgment would be inaccurate—and in this case it would literally add insult to injury—but such thoughts do occur among by-standers. The passers-by may have just been hard-hearted. One person’s empathy is another’s antipathy. The language speaks volumes.
The empathy lesson consists in distinguishing such a devaluing thought; acknowledging that thinking is profoundly different than acting and should not be confused with it. The empathy lessons is to take action coming from one’s authentic commitments to building community through empathy, not devaluing thoughts.
This story is an empathy lesson that also instructs us in the difference between empathy and compassion. The Samaritan’s empathy told him what the other person was experiencing; his compassion (and ethics) told him what to do about it.
This bears repeating: empathy tells one what the other person is experiencing; compassion (and ethics) tell one what to do about it.
We are usually taught to devalue the behavior of the Levite and the priest; and surely they do not win a prize. Yet in an alternative point of view, they were all-too-human. Seeing all that suffering embodied in the survivor, they just couldn’t take it. They succumbed to empathic distress.
They experienced a breakdown of their empathic receptivity, and were overwhelmed in a kind of instant empathy fatigue (not compassion fatigue).
In an alternative reading of the parable, the would-be rescuers dial down the granularity of their empathic receptivity, so as not to be too sensitive to the suffering, even as they get a sample of the suffering, which is needed to inform their humanity.
The Good Samaritan, who is a seemingly infinite source of insight, is called to his empathic neighborliness by the distress of the injured traveller. The traveller who had fallen among thieves and was beaten near to death creates the possibility of empathic community by his loss of human well-being. He has been reduced to a lump of suffering, broken, physical pain.
The Samaritan rescues the traveller; the traveller humanizes the Samaritan, calling him not just to the role of an altruist doing a good deed (though that occurs too), but to his possibility as a human being in relation to another fragile, suffering, dependent human being.
The stricken traveller, by his very being, gives the Samaritan his own humanness. This occurs precisely in making the Samaritan a neighbor in answering the question, “Who is one’s neighbor?” Such was the trick question that the Pharisees posed to Jesus, to which this parable is the response.
The Samaritan gives humanness to the distressed traveller in an intervention that defines them as part of the same community of fellow travellers—neighbors—on the road of life.
In an alternative retelling of the story suppose that the Levite and the priest were “natural empaths,” biologically predisposed to be sensitive to the pain and suffering of other people. They were endowed with a certain “delicacy of empathy,” and they feel the suffering of the world deeply. Perhaps too deeply. Some people report: “I am a natural empath—and I suffer because I feel the pain of others too acutely. I started out being empathic—but people took advantage of me—and even when they didn’t, I was just too empathic; I got overwhelmed with sensation and sucked dry—the result was burnout, compassion fatigue. Nice guys finish last—so do empathic ones.”
Thus, the lament of the natural empath.
Empathy becomes a burden, because the world is filled with so much suffering. Yet if the person uses avoidance to “down regulate” their empathy, the person feels guilty because the individual believes that what she is doing is unkind, thoughtless, lacking in fellow feeling, and—unempathic.
So the natural empath falls into a double bind, and her suffering seems inevitable. She is over-whelmed by too much openness to the suffering of the other person or over-whelmed by guilt at not living up to her own standards of fellow-feeling and ethics.
These statements imply that empathy cannot be regulated through training, albeit a training that goes in the opposite direction (from too much empathy in the moment to less empathy) than that required by the majority of people, who are out of touch with their feelings and need to “up regulate” their empathy. The empathy lesson for the natural empath is to be more flexible about her ethical standards, while attempting to tune down her empathic distress.
Some people are skeptical that “natural empaths” are all that they say they are. Natural empaths in their natural state assert that they feel overwhelmed and distressed by other people’s thoughts and feelings. I see no reason to doubt such statements. However, to some critics, a redescription of the natural empath asserts that the latter are “irritable” and “hypersensitive.”
Empathy is recognizing and understanding the other’s perspective and then communicating that understanding to the other person. Someone who is unwittingly, even helplessly, swept along by the other’s feelings is not really being empathic. Over-identification, not empathy?[i]
The way out of this apparent impasse is to consider that the natural empath does indeed get empathic receptivity right in empathic openness to the other’s distress, but then the person’s empathy misfires.
Whether the misfiring is over-identification, resulting in empathic distress, depends on the description and redescription. Standing on the sidelines and saying “Try harder!” is easy to do. Where is the training the person needs when they need it?
The recommendation regarding training? Most people need to expand their empathy; some people—natural empaths—need to contract (or inhibit) their empathy. Empathy regulation—learning to expand and contract empathy—is the imperative in either case.
Instead of complaining about being an overly sensitive natural empath (however accurate that may be) do the work of practicing empathy by “down regulating” one’s empathy in a given situation, transforming empathic distress into a vicarious experience. Instead of complaining about not being pre-disposed to empathy, get up and do the work of practicing empathy, which for most persons means “up regulating,” expanding their empathy.
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
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