One afternoon eight years ago, Juliette Watt received a very important email in her inbox. It read: “Dear Mrs. Watt, this is Mr. Earnest Cooke from the Camden Council Mortuary in London. We have your mother in the fridge. What would you like us to do?” Her first instinct was to laugh.
Watt grew up under difficult circumstances. Her father passed away when she was only ten years old, and for the following fifty years, despite being in good health, Watt’s mother placed the burden of familial duties onto her daughter. After they ran into issues with money, 15-year-old Watt was forced to drop out of school, find a new living situation for her and her mother, and forge a birth certificate to begin working before the legal age. Even after Watt moved from London to the United States to create distance between her and her mother, she had to order her mother’s groceries online every week, to a store two blocks from her apartment. In return, her mother gave her no love, once telling her that “everything and everyone [she] had ever loved is dead.”
In 2014, when Watt learned her mother’s numb corpse was rotting in a fridge via a three-sentence email, she “felt nothing.” She didn’t care. She soon realized that her own emotional numbness had a name: compassion fatigue.
The term “compassion fatigue” was first coined by psychologist Charles Figley in the 1980s. He defined it as “a state of exhaustion and dysfunction, biologically, physiologically and emotionally, as a result of prolonged exposure to compassion stress.” In other words, compassion fatigue is a form of secondary traumatic stress, after experiencing compounding emotional and physical burdens from helping others. It manifests in a reduced capacity for empathy going forward. Once Figley formulated it, the concept was embraced openly by the psychology community, particularly within the context of occupations that involve a lot of emotional strain. However, the condition has never been featured in any edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the American Psychiatric Association’s official list of diagnosable mental illnesses. As a result, people struggling with compassion fatigue are trivialized and met with contempt by some of the public, accused of simply being ‘tired of being nice.’ Alternatively, its symptoms are sometimes misassigned to burnout or depression.
The misdiagnosis of compassion fatigue is somewhat understandable, as there are overlaps in its presentation with many other mental illnesses. Compassion fatigue manifests in the form of mental, behavioral, and physical changes. The most common effects are cognitive and emotional; with patients having an impaired sense of judgment, loss of morale, mental strain, exhaustion, or decreased self-worth. Sometimes, they undergo an altered perception of identity or worldview. It can also result in psychosomatic conditions, such as gastrointestinal problems, frequent colds, sleep disturbance, and recurring nightmares. In addition, compassion fatigue may lead to behavioral adjustments, like a higher tendency towards isolation, irritation, excessive blaming, and compulsivity. In his book, When Helping Hurts, Dr. Frank Ochberg explains these drastic shifts in persona as “emotional blunting – whereby you react to situations differently than one would normally expect.”
While it’s true that compassion fatigue has similar signs to burnout, and the existential despair associated with fatigue can potentiate into depression or PTSD, compassion fatigue has a unique etiology that must be recognized. An incorrect diagnosis can be mismanaged with unnecessary medication, exacerbating the problem. Unlike burnout, which is typically work-related, or depression, which has a broad range of causes and effects, compassion fatigue arises specifically from the internalization of others’ pain. It emerges as a means of protection, as a coping mechanism for a diminishing ability to handle devastation. In terms of treatment, medicating fatigued patients with antidepressants is dangerous and draining. Furthermore, compared to burnout, compassion fatigue has a more sudden onset and a shorter recovery time, especially if recognized early and handled correctly. However, burnout becomes very relevant when someone’s compassion fatigue is a product of their occupation.
Empathy is a valued trait in a number of occupations and is even considered essential for healthcare professionals, humanitarian aid workers, therapists, first responders, social activists, and journalists, among others. These professions interact with people in vulnerable or difficult positions, and workers’ responsibility is often to help them. As a necessary product of these jobs, though, workers are constantly exposed to pain and suffering; leading many of them down the rabbit hole of compassion fatigue.
When compassion fatigue was first identified as a problem, it was only studied within an occupational context; multiple research studies identified psychological distress and emotional trauma as factors that cause compassion fatigue and job burnout. In fact, compassion fatigue has always been a major factor in leading people to retire early or turn to other careers. As explained by law professor and human rights fieldworker Margaret L. Satterthwaite, it’s a terrible dilemma: “We want to have human responses; that’s a good thing. You have to have empathy; you have to care. That is the reason any of us do this work. But…I realized I felt like a weighted down sponge that can’t take anything more in.” As a solution, she declared that anyone in this position needs “a set of tools” to help with trauma processing and self-care, including recommendations on healthy practices, methods for setting boundaries, and access to counseling. A number of humanitarian organizations have supported this, with Save the Children offering its responders a confidential support program.
The discussion of compassion fatigue is particularly relevant today, due to the toll that the COVID-19 pandemic has taken on people working in medicine and nursing. On top of that, researchers have noticed that empathy is declining on a population level as well. A study of University of Michigan students found that empathy has decreased by over 40 percent since the 1970s. In “Is compassion fatigue inevitable in an age of 24-hour news?” The Guardian discusses how an oversaturation of global tragedy and ‘doom scrolling’ on social media is contributing to this rise in hopelessness and apathy. When we’re bombarded with a seemingly never-ending stream of calamities, how many can we bring ourselves to care about? Which ones do we choose to act on?
Now, Juliette Watt works to tackle this phenomenon as a compassion fatigue and stress management coach. She encourages her clients to practice self-care in all forms – personal, physical, and social. The first thing she teaches them is to believe that ‘I am the most important thing in my life.’ Exasperated, she poses the question, “If you can’t take care of your own happiness first, how on earth can you take care of anyone else’s?”