Compassion Fatigue: an institutional issue

Michael McCabe

‘Most young doctors enter medicine with quite a profound desire to help other people. Somehow, across the first decade or so of training and work, that diminishes.

We call it compassion fatigue – the idea that doctors have a finite reservoir of caring that drains away over time, leaving some of them a cynical, couldn’t-give-a-damn husk of inhumanity.’
Nathan Consedine (North & South, September 2015, p.60)

The Greek word for compassion ‘splagchnizomai’ literally means ‘to be moved’ in ‘one’s bowels.’ Emotions were viewed as ‘residing’ in the bowels – literally ‘in the guts.’ Thus, a person without compassion was essentially unmoved by the plight of another and could be described as being ‘hard’, ‘heartless’, or ‘harsh’ with ‘no reach’ inside them.

Compassion fatigue is not limited to the healthcare professions. It is part and parcel of any professional role that involves advocacy for or care of others – it is potentially the Achilles’ Heel of all professions. Professional life is marked by the complex interplay between personal well-being, workload, role expectations, rapidly changing social and cultural norms, and by systemic issues, such as the strengths and particular shortcomings of the institutions in which the professions reside. Frequently the professional is caught in the crossfire of one or more of these dynamics with the result that his or her energy and passion for the profession and its goals dissipates. That feeling, described by many today, ‘of getting through the night’, is most notably marked by a reduced ‘reach’ of compassion, and, frequently, by cynicism.

Given its multi-dimensional nature and causation, compassion fatigue requires addressing on several levels – at a personal level, and at a communal or institutional level.

At a personal level compassion can only be sustained if the professional ‘tends to the soul.’ Being an advocate and caring for others drains the advocate and empties the caregiver. Whatever a person’s faith dimension or motivation, such roles demand ‘Sabbath’ time – times of refreshment and re-creation, times of rest and review in which we ‘listen again’ to our souls and nurture them in healthy and life-giving ways.

While bread-winners may well recognise this need for rest and recreation, such a ‘Sabbath’ break is not always possible given financial pressures on families and individuals and the demands of the profession. That is why the culture of the particular institution, be it healthcare, medicine, law, or religious faith, also requires refreshment and renewal if it is not to exacerbate or even be complicit in compassion fatigue amongst its personnel.

However, institutions themselves can demonstrate compassion fatigue, evident above all in the ways in which they respond to those who are most vulnerable, including the demands placed on personnel, the language used, and the prevailing attitudes and mind-sets of those vested with power. Nowhere is this insight being illustrated more profoundly than in the leadership and vision of Pope Francis.

In the recent Synod on the Family, Pope Francis gave a clear illustration of the need for the Church to return to the ‘compassionate reach’ of the gospel. In doing so he challenges those who would tie mercy and compassion to obedience to the law. For example, in his closing homily, commenting on the story of the healing of Bartimaeus, the blind beggar, he said,

“This can be a danger for us: in the face of constant problems, it is better to move on, instead of letting ourselves be bothered. In this way, just like the disciples, we are with Jesus but we do not think like him. We are in his group, but our hearts are not open. We lose wonder, gratitude and enthusiasm, and risk becoming habitually unmoved by grace. We are able to speak about him and work for him, but we live far from his heart, which is reaching out to those who are wounded. This is the temptation: a ‘spirituality of illusion’: we walk through the deserts of humanity without seeing what is really there…a faith that does not know how to root itself in the life of people remains arid and, rather than oases, creates other deserts.”

At the conclusion of the Synod Pope Francis then offered a number of antidotes to compassion fatigue, at both a personal and institutional level, including

Attempting to see the ‘issues having to do with the family’ in the ‘light of the Gospel’ without ‘falling into a facile repetition of what was obvious or has already been said.’
‘Seeing difficulties and uncertainties which challenge and threaten the family in ‘the light of the Faith, carefully studying them and confronting them fearlessly, without burying our heads in the sand.’
Portraying, once again, the vitality and vision of the Catholic Church, ‘which is not afraid to stir dulled consciences or to soil her hands with lively and frank discussions about the family.’

While Pope Francis was speaking specifically about the family, his wisdom and courage gives fresh heart to all caregivers and advocates of compassion and mercy and reminds us not to neglect the ways in which ‘compassion fatigue’ may permeate the very institutions within which we practice our respective professions.

Rev Dr Michael McCabe is the founding director of The Nathaniel Centre and Parish Priest of Our Lady of Kapiti Parish, Te Whaea o Kāpiti.