Prolonged Complex Compassion Fatigue: An Outcome of Caring Deeply

by Kay F. Klinkenborg

I have a new phrase, “Prolonged Complex Compassion Fatigue”¹ to describe our accumulated experiences as we enter the third year of a world pandemic. No one debates that it is/ has been a time of extraordinary stress from the COVID pandemic with persistent residual feelings of worn out, more tired consistently, restless and discouraged. The words, COVID/ Pandemic Fatigue has shown up in various media forms in an attempt to describe our collective prolonged response. COVID has challenged every social structure in our world. And it has impacted every person in the world.

The deaths from COVID are staggering and the tsunami leaves a wake of aching hearts with complicated grief, discouragement, fear of the future and much more. What medical health care workers, first responders and hospital/nursing home staff have experienced is beyond the scope of this article…they are traumatized with resulting PTSD..way beyond compassion fatigue.

What we are experiencing is individualized, but also collective. I chose to call this experience ‘complex’ because it has multiple layers of impact. COVID-19 has exacerbated already-existing global issues of climate change, political unrest, and systemic injustice. There is an added existential worry/anxiety. A predictable outcome from caring and loving in a time of crisis. We have done nothing wrong. Caring and loving is how we are designed by the Creator. But the prolonged intensity, unpredictability, isolation, constant adaptation and worrying about your own and other’s safety has a wearing impact. It is because we have and do care that we are experiencing this phenomena. No one is exempt.

Registered nurse Carla Joinson (1992) coined ‘compassion fatigue’ to describe a unique form of burnout that affected caregivers and resulted in a “loss of the ability to nurture.”² This form of burnout was related to a variety of stressors, including long hours, heavy workload without any signs of potential time to rest and restore.

Dr. Charles Figley, PhD was the first professor (University of Florida) to lecture on trauma and mentioned the phrase ‘compassion fatigue’ as similar to ‘secondary traumatic stress syndrome (STS)’; resulting from over extended exposure to traumatic stresses of time in caring. He also noted that it was similar to PTSD, but that it came through a secondary source…the patient.²

From 1995 to 2005 I conducted workshops for all levels of professionals in the caring fields on the topic “Compassion Fatigue”. It also occurs in a time of disaster in dealing with multiple traumatized people in extenuating circumstances over a period of time…just like the last two years. Until now, the term has been limited to nurses, doctors, therapists, clergy: all professionals in care giving careers and care-givers of ill family members or friends.

What are signs/symptoms of compassion fatigue?

Feeling exhausted physically and psychologically.
Feeling helpless, hopeless or powerless.
Feeling irritable, angry, sad or numb.
A sense of being detached or having decreased pleasure in activities.³
Disrupted sleep, anxiety, headaches, stomach upset, irritability
Decreased sense of purpose
Self-contempt
Difficulties with personal relationships⁴

I find we are experiencing an extraordinary unprecedented more complex form of compassion fatigue. It is expanded because of the prolonged, unpredictable and unknown outcome of the pandemic and added existential worries. The professional literature I have reviewed, local and national news stories and feature articles in newspapers and magazines are all reporting about this intense time of stress. I add the following complex responses:

Existential Worries

Complicated grief because of isolation when loved ones are critical or dying
Job security
Up ended routine life schedules, always adapting, no ‘norm’ to reset which is unnerving
Unpredictable health care availability, unprecedented medical care staff shortages
US divisive politics (Note: this is experienced by Red and Blue constituents)
World conflicts, potential new wars
Starvation, droughts
Loss of homes
Natural disasters on the rise: fires, floods, tornadoes, tsunamis, etc.
Violence and hate crimes on the rise around the world
Climate change.
This is not the end of the existential worry list.¹

More intense responses to prolonged complex compassion fatigue

Malaise: a mind/spirit/ brain fatigue. I can’t think my way through this.
Finding ourselves alarmed that concentration capacity has decreased
Unconsciously consumed with keeping up with news/ media; needing the most current statistics/stories; obsessed with Internet or Facebook
Free-floating anxiety; especially when outside one’s home or in groups/ shopping for necessities; keeping self and loved ones safe
Depressed, feeling blue but unable to connect it to a specific reason
Spiritual questioning: “where is God in this?”; or even wondering if God exists or is present.
“The issues are so big, I have no idea where to start, self-care is slacking, demotivated, can’t push myself to do what I know to do.”
“I am one person, no way can I impact these big social issues.”¹

Exhausted! Bone tired! Deep chronic fatigue that a week off doesn’t resolve. And in our retirement community I often hear: “this is not how I intended to spend the last good physical capable years of my life.” This isn’t the only age group to lose some dreams. We have all lost some dreams.

In a recent article: “Mental Health Therapists Worried About America”⁵, the research of 1, 320 therapists across the US, found that anxiety and depression are significantly on the rise and the most frequent reason to seek help. The rise in needs for counselors was even across Red and Blue states.⁵

Rise in relationship issues: couples have too much together time…no space to breath and do self-care; financial stresses are increasing couple difficulties; substance use/abuse on rise; arguing more; children at home doing school. Political disagreements increasing major stress for immediate and extended family members. One in four providers said suicidal thoughts were among the top reasons for clients reaching out for help.⁵

Every major news outlet and newspapers have published articles of concern about the mental well-being of our children and youth. How has this impacted their learning, their social skills or view of the world?

Suicide rates are on the rise of young people from age 11-22 years of age.⁵ One 10 year old boy told his therapist he was having “sad panic mode” in describing being overwhelmed.⁵

Just reading this article is likely triggering one or more of the above stress responses. So what is one to do to cope with Prolonged Complex Compassion Fatigue?

Back to the basics is a trite statement. Digging deeper for coping skills, exploring new coping strategies are options. But what does that mean?

I want to begin with one primary focus: developing a resilient focused mind set. How do begin to take care of ourselves with intention and practice to diminish the impact that will continue to come our way? For as all reports indict: “this isn’t over yet.”

RESILIENT FOCUSED MIND SET

Resilience is the capacity to recover from difficulties; toughness. The ability of a substance or object to spring back into shape; elasticity.⁸ Psychologists have found these skills can be learned.⁷

YOU CAN DO THIS ONE HARD THING!

For I am convinced that neither death, nor life, nor angels, nor rulers, nor things present, nor things to come, nor powers, nor height, nor (bathos) the deep, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord. Romans 8: 38-39 NRSV.

I do not intend to be glib, but…you have used a lot of unidentified positive skills these first two years of pandemic and existential worries. Make a list of ‘how did you do this?’ You did make good choices. Learned to do different from some choices, but you kept moving forward. Creation is a continual evolution…we are continuing to evolve as people. If we did the last two years, we can do the years ahead of us too. Yes, its hard but there have never been any promises that life would be easy.

YOU ARE NOT ALONE IN THIS!

The Bible has 365 separate quotes of: “fear not for I am with you.” If it is that frequent, obviously history notes leaning on God (Divine) has proven to be of comfort and to own we are not alone. In addition, three characteristics that remind us of our competency. “For God hath not given us the spirit of fear; but of power, and of love, and of a sound mind.” 2 Timothy 1:7.

The Quran shares similar beliefs: “My mercy encompasses all things.

[Quran] 7:156. “So verily, with this hardship, there is relief. [Quran 94:5]

YOU COME LEARNING HOW TO DO THIS!

Resilience requires this steadiness of mind and willingness to ‘be with’ suffering rather than turning away from it.⁹ As Poet Robert Frost said, “The best way out is always through.”⁹ We aren’t supposed to have all the answers about how to adapt to crises. This didn’t come with a manual. Paul, the Apostle wrote: “I can do all things through Christ which strengtheneth me.” Philippians 4:13 NRSV.

Extend grace to yourself! Only then can you extend grace to others. You don’t have to know the future. You don’t have to have all the answers. Come with an open mind and heart to find a more peaceful way to be.

REASONABLE EXPECTATIONS

“Hope is not the conviction that something will turn out well but the certainty that something makes sense, regardless of how it turns out.”⁶ Letting go of our expectations..’what should be’ compared to ‘what is’, wastes a lot of mental energy. Obsessing about facts we can’t change is sitting in ‘what should be’. ‘What is’ gives you choices about how to spend your time; what to read, etc. This is healthy movement and not being frozen or immobilized.

Dr. Michael Yapko cautions about ‘global thinking’: generalizing one thing to all things.⁷ An example: one rapid test clinic for COVID wasn’t using certified testing equipment; thus all clinics aren’t using certified testing equipment. Dangerous thinking pattern when you pause to contemplate this type of generalization. People who do a lot of ‘global thinking’ have a high predictability of depression according to Yapko.

We live in an uncertain unpredictable time. Learning to ‘go with the flow’ and trust that we can respond with wise choices can be a powerful confidence builder.

WHAT AM I TO LEARN FROM THIS?

Back to Havel’s quote: “Hope is not the conviction that something will turn out well but the certainty that something makes sense, regardless of how it turns out.”⁶ You can’t learn from the present, if you are locked into focus on the past.⁷

Whether it is locked in your childhood pain, or betrayal as an adult, it is a waste of your spiritual and mental energy to ruminate on the past. In this moment, this time this space: What are you to learn?

Who are you going to chose to be…not who was I? Step into the future. The old gospel hymn: “We’ve Come This Far By Faith Leaning on the Lord,” was a childhood favorite of mine. It pulled me forward when I was frightened; it pulled me through intense therapy to heal deep wounds; and it is pulling me forward to be engaged, productive and repeating my personal mantra: “What return can I make?”

A resilient mind set is my responsibility; that is my choice. Each of us can practice and hone this skill set. Yes, we will ebb and flow in our moods and response to these continued stressors. I pray by the grace of God I will continue to learn from this scary unpredictable time in which I live. This is resilience!

¹Klinkenborg, K.F. (Jan 24, 2022) W.I.S.E. Steering Committee Retreat for Church of the Palms, Sun City, AZ. (first use of term and defined).

² Compassion fatigue: toward a new understanding of the costs of caring. In Stamm BH (Ed.): Secondary Traumatic Stress: Self-Care Issues for Clinicians, Researchers, and Educators. Lutherville, MD: Sidran Press; 1995. https://www.dvm360.com/view/compassion-fatigue-and-burnout-history-definitions-and-assessment

³https://www.stress.org/military/for-practitionersleaders/compassion-fatigue

⁴ https://www.psychologytoday.com/us/basics/compassion-fatigue

⁵New York Times, Dec 17, 2022. “Mental Health Therapists Worried About America.”

⁶Havel, Vaclav: playwright, essayist, poet, former dissident and 1st President of the Czech Republic (1936-2011).

⁷Yapko, Michael. May 14, 2018. “Keys to Unlock Depression: Why Skills Work Better than Pills.” Speech for Australian Psychology Society.

⁸Oxford Dictionary

⁹Search Inside Yourself Research Institute: https://siyli.org/compassion-resilience/