Recognizing The Syndrome of Compassion Fatigue
an article by Phyllis Quinlan, PhD, RN-BC published in
The Journal of Managed Care Nursing
Recognizing The Syndrome of Compassion Fatigue
an article by Phyllis Quinlan, PhD, RN-BC published in
The Journal of Managed Care Nursing
A question that has intrigued me for years is this: how can we start exactly where we are, with all our entanglements, and still develop unconditional acceptance of ourselves instead of guilt and depression?
One of the most helpful methods I’ve found is the practice of compassionate abiding. This is a way of bringing warmth to unwanted feelings. It is a direct method of embracing our experience rather than rejecting it. So the next time you realize that you’re hooked, you could experiment with this approach.
Contacting the experience of being hooked you breath in, allowing the feeling completely and opening to it. The in-breath can be deep and relaxed – anything that helps you to let the feeling be there, anything that helps you not to push it away. Then still abiding with the urge and edginess of feelings such as craving or aggression, as you breathe out you relax and give the feeling space. The out-breath is not a way of sending the discomfort away but of ventilating it, or loosening the tension around it, of becoming aware of the space in which the discomfort is occurring.
The practice helps us to develop maitri because we willingly touch the parts of ourselves that we are not proud of [maitri is defined previously as "unconditional friendliness towards oneself"]. We touch feelings we think we shouldn’t be having – feelings of failure, of shame, of murderous rage, all those politically incorrect feelings like racial prejudice, disdain we feel for people we consider ugly or inferior, sexual addictions and phobias. We contact whatever we are experiencing and go beyond liking or disliking by breathing in and opening. Then we breathe out and relax. We continue for a few moments, or as long as we wish, synchronizing it with the breath. This process has a leaning-in quality. Breathing in and leaning in are very much the same. We touch the experience, feeling it in the body if that helps, and we breathe it in.
In the process of doing this, we are transmuting hard, reactive, rejecting energy into basic warmth and openness. It sounds dramatic, but really it is very simple and direct. All we are doing is breathing in and experiencing what’s happening, then breathing out as we continue to experience what’s happening. It’s a way of working with our negativity that appreciates that the negative energy per se is not the problem. Confusion only begins when we can’t abide with the intensity of the energy and therefore spin off. Staying present with our own energy allows it to keep flowing and move on. Abiding with our own energy is the ultimate non-aggression, the ultimate maitri.
Excerpted from the chapter “Unlimited Friendliness” “Taking The Leap: Freeing Ourselves from Old Habits and Fears”, © Shambhala Publications 2009
Welcome to Nursing Success TV: Episode 11
The Program Devoted to Celebrating the Profession of Nursing
Meditation Isn’t Enough: A Buddhist Perspective on Suicide
The news of Robin Williams’ passing is shocking and touching so many of us. I was waiting for a friend at a bar when I first heard. All around me people erupted in a variety of emotional reactions as the word quickly spread. In the time since, a common reaction has been deep sadness, often paired with a sentiment of “I never thought someone like him would kill themselves.”
What we mean when we say “I never thought someone like him…” is that we can’t wrap our minds around certain people whom we deem successful or joyful or wise suffering from the same sorts to the demons that we ourselves face. Studies have shown that one in ten people in the United States are afflicted with depression. Robin Williams is said to be one of these people. In response to the news of Williams’ death his friend Harvey Fierstein wrote, “Please, people, do not f– with depression. It’s merciless. All it wants is to get you in a room alone and kill you. Take care of yourself.”
Yet for anyone who has suffered from depression or had suicidal thoughts, you know that self-care is the last thing you want to do when you feel that down. I teach meditation, and write books about how it effects our everyday life. That is the form of self-care that I preach. The sort of people who want to learn about meditation aren’t the “All is well and good in my world” type. They are people who have come to terms with the fact that they suffer. They are people finally looking at big transitions in their life, strong emotional states, and feelings of stress, anxiety, and depression. So you would think that having taught meditation for thirteen years and worked with these people I would be a pro at this whole “take care of yourself” thing.
I have never publicly admitted this, but given the stigma around mental health issues and suicide I feel that I need to now: two years ago I was suicidal. I had written a best-selling Buddhist book and had begun working on the second one when the rug was pulled out from under me in a multitude of ways. My fiancé left me, quite out of the blue, without any recognizable reason. That set me down a self-destructive road which was only heightened when, a month later, due to budget cut-backs, my full-time job was eliminated. The straw that broke the camel’s back came a few weeks after that; one of my best friends died of heart failure at the age of 29. I felt estranged from my family, and two major support structures, my fiancé and my friend were now gone, so I began to self-medicate in a destructive way. I knew better, but the vastness of my depression consumed any thoughts around self-care and regular meditation.
I cannot explain how fathomless my sadness was during that period. I had a roof I would go up to every single day and contemplate jumping. I convinced myself that my first book was out there helping people, so maybe I should finish the second one. I sat down and wrote the second half of that book, which oddly enough comes out next month. It gave me purpose, and during that short period of time friends started to catch on something was wrong with me.
I remember a day when I was particularly low. My friend Laura asked me to dinner but I could not stand to be in a restaurant, surrounded by people who seemed normal. We sat in a nearby park as it got dark, with homeless people urinating nearby and the rats slowly coming out to play. She was very patient with me, as I was not interested in leaving. Finally she asked the question, “Have you ever thought about hurting yourself?” I broke down in tears and within the week was guided by her and others into therapy. A week later I returned to the meditation cushion. A week after that I began eating regularly. A week after that I finally got a full night’s sleep.
I mention my story because there’s not just a social stigma around mental health issues, there’s also a Buddhist one. I have seen some Buddhist teachers make remarks about depression as a form of suffering; that one should be able to meditate and have everything be okay, in lieu of prescription medication. That is not true; meditation is not a cure-all for mental illness. The Buddha never taught a discourse entitled, “Don’t Help Yourself, Continue to Suffer Your Chemical Imbalance.” If you have a mental illness, meditation may be helpful, but should be considered an addition to, not a substitution for, prescribed medication.
I write this article for two reasons. The first is to say that Robin Williams is a person. I am a person. And like all people, we struggle with a myriad form of suffering. And sometimes things feel like they are too much for us to handle. Just because Robin Williams was a comedian, a celebrity, or someone we viewed as a joyful person did not mean he wasn’t fighting demons unknown to us. I share my story in the same vein; the fact that I struggled with suicidal thoughts does not negate my years of meditation experience or understanding of the Buddhist teachings, but shows that I am human and sway to suffering like all humans are. You can be well-practiced and still struggle like anyone else. Robin Williams ended up taking his life. I was lucky in that I was able to seek help and no longer feel the way I once did. In fact, that experience only deepened my appreciation for the practice of meditation and the Buddhist teachings. In many ways, my life has turned around.
The second reason I write this article is because my life turned around because I sought help. Buddhists can’t just take everything to the meditation cushion and hope it will work out. When things get tough, as in to the point that you can’t imagine getting out of bed in the morning tough, you need help. And there should be no shame in seeking it. If you even remotely feel like you are struggling with depression, or are going through an emotional time that simply feels out of control, the best way to take care of yourself is to seek guidance from trained professionals. Sure that can be a meditation teacher, but a therapist may prove more helpful at that time. Therapy in-and-of itself can be a mindfulness practice, where you bring your full attention for an hour each week to what is expressing itself in your body and your mind.
Don’t feel like you have to go it alone. Meditation does not preclude or diminish the power of therapeutic methods. They are powerful in their own right. There are trained people out there who can work with you to navigate your suffering. Do not be scared to seek help.
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The program dedicated to celebrating the profession of nursing
I recently came across the word “compassionate” in a spiritual book entitled: Your Sorrow is My Sorrow: Hope and Strength in Times of Suffering by Joyce Rupp (1999). The Merriam-Webster dictionary lists the word compassionate as feeling or showing concern for someone who is sick, hurt, poor; having or showing compassion. Rupp, however, uses the word in a way that gave me pause, as she described events in her life that called upon her to compassionate herself. Back to the dictionary I went and learned that “to compassionate” means to ache for; bleed for; commiserate with; pity, condole with; feel for; sympathize with; and yearn over. (http://www.merriam-webster.com/dictionary/compassionate). Ultimately, the act of compassionating oneself or another, is the act of showing compassion. Compassion can be defined as sympathetic consciousness of others’ distress together with a desire to alleviate it. http://www.merriam-webster.com/dictionary/compassion). This definition pairs the awareness of another’s distress with the desire to alleviate the distress.
We have all heard the expression “you have to love yourself before you can love another”. It seems to be the same with compassion in that we must first be compassionate with or compassionate ourselves before we can compassionate others. The question is: How often do we take the time to compassionate ourselves or to really get in touch with whatever we are suffering? I have also come across another definition of compassion, succinctly put, it means to suffer with. We can now re-phrase the question to read: how often do we take the time to suffer with ourselves; to meet our suffering self? Let’s face it, suffering is physically, emotionally and spiritually painful, and a fearful prospect at that. Fear means danger….do not enter….do not go there. It is not surprising then that so many of us are running from our suffering selves in one way or another, with a host of detours taking us in other directions. Sooner or later, however, those detours will put us back on the main road again, leading us towards our destination; our rendezvous with our suffering self.
In his book The Road Less Traveled: A New Psychology of Love, Traditional Values and Spiritual Growth (1978), Scott Peck begins his first chapter with the sentence: “Life is difficult” (p. 15). He goes on to say that it is one of the “Four Noble Truths” which Buddha taught: “Life is suffering.” No one can deny that life is a series of problems producing an array of emotions ranging from fear to anguish and despair. Peck points out that these uncomfortable feelings of pain associated with problems are among the reasons we refer to them as problems in the first place. Very simply, “It is because of the pain that these events engender in us that we call them problems (p.16).” Peck believes problems not only call forth courage and wisdom but actually create them, allowing us to grow mentally and spiritually. He does admit, however, that most of us are not so wise, and fearing the pain involved almost all of us, to a greater or lesser degree, attempt to avoid problems. To avoid the suffering that results from dealing with problems, we also avoid the growth that problems demand from us (p.17). Peck goes so far as to state that the tendency to avoid problems and the pain inherent in them is the primary basis of all human mental illness. The latter then produces a condition in which we stop growing and become stuck. Eventually, the human spirit (in the absence of healing) begins to shrivel (p. 17).
The pain generated from problems we encounter can be a profound form of suffering, but I am uncertain as to whether the suffering we experience can be viewed as a problem to be solved. Perhaps I have a problem with the word, problem. Caretakers whether professional or nonprofessional are no strangers to suffering, being confronted with human pain and suffering on a regular if not daily basis. Those we care for, however, are not problems to be solved but human beings to be nurtured and loved. Problems arise when we either look upon those in need of our care as problems, or when we neglect to both love and compassionate ourselves. I return to the definition of compassion as the sympathetic consciousness of others’ distress together with a desire to alleviate it. Meeting our suffering self with compassion allows us to not only recognize our own distress but our need for healing in order to alleviate that distress.
Meeting our suffering self, compassionating ourselves, or demonstrating self-compassion has been described as having three main components: self-kindness, a sense of common humanity, and mindfulness (Neff, 2011). Self-kindness is the tendency to be caring and understanding with oneself rather than being harshly critical or judgmental. It also involves offering oneself soothing comfort in times of suffering. A sense of common humanity allows us to recognize that all humans are imperfect, fail, and make mistakes. As such it reminds us that we are not alone in experiencing our short-comings and flaws because it is all part of the human condition that we share with the rest of humanity. Finally, mindfulness is being aware of our painful feelings in a clear and balanced manner so that one neither ignores nor obsesses about disliked aspects of oneself or one’s life. (http://www.self-compassion.org/what-is-self-compassion/definition-of-self-compassion.html). .
In the physiological realm, research suggests that self-compassion may be a powerful trigger for the release the hormone oxytocin. Oxytocin is released in a variety of social situations including the act of breastfeeding an infant, positive parent-child interactions, and when someone gives or receives a soft, tender caress. Additionally, research is showing that the feelings generated by self-compassion can actually decrease cortisol levels associated with physiological and psychological stress. (http://www.self-compassion.org/the physiology of self-compassion html).
In summary, the message is clear; we owe it to ourselves and those for whom we care to compassionate ourselves. The first step on the journey is to recognize our own suffering. How do we do this? Self-awareness of those times when we are overly stressed, fatigued, discouraged, irritable and angry is a crucial part of the process. There are many relaxation techniques and deep breathing exercises and various resources available to us especially with the internet at our fingertips. There is no denying the power of mind over body and the methods we choose are most likely to be the ones with which we are most comfortable. Everyone has a place where they experience peace and joy. While we cannot be physically present in that place, we can practice traveling away to it in our mind through visual imagery. It is a known fact that pleasant thoughts produce pleasant feelings that result in positive actions. The beauty of our special place is that we can visit it as many times a day (or night) as we find the need. Prayer and meditation are likewise powerful means of compassionating ourselves and alleviating our suffering. The good news is that we can compassionate ourselves which ultimately frees us to compassionate others with the greatest healer of all, love.
Mary Ellen Luczun, MSN, RN, PMHCNS-BC
Mental Health Nursing
Touro College Department of Nursing
Neff, K (2012). The power of self-compassion. Retrieved from: (http://www.self-compassion.org/the physiology of self-compassion.html).
Neff, K. (2011). The power of self-compassion. Retrieved from (http://www.self-compassion.org/what-is-self-compassion/definition-of-self-compassion.html).
Rupp, J. ( 1999). Your sorrow is my sorrow: Hope and strength in times of suffering. New York: Crossroad Publishing Company.
Peck, S. (1978). The road less traveled: A new psychology of love, traditional values and spiritual growth. New York: Simon & Schuster.
From July 31, 2014 Nurse.com Article by Tracey Boyd