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ACADEMIA Letters Towards an Understanding of ‘Compassion Fatigue’ in the Context of the COVID-19 Pandemic Terry Hyland, Free University of Ireland Josephine Lynch, The Mindfulness Centre In the context of a COVID-19 pandemic which has thus far infected over 101 million people worldwide and resulted in over 2 million deaths [1] it would be understandable why many people – especially front line workers in health care professions and all those isolated in strict lockdown conditions – might be suffering from what has been labelled ‘compassion fatigue’ [2] However, since the quality of compassion is such a valuable aspect of social cohesion and well-being – and indeed a crucial component of universal ethical codes [3] – it is well worth attempting to gain a clearer understanding of this phenomenon. With this objective in mind, the idea of compassion fatigue will be analysed – within the framework of cognate concepts such as sympathy, empathy and self-compassion – before examining suggestions from psychologists, therapists and mindfulness practitioners for dealing with problems in this general area in times of social and emotional crisis. What is Compassion? Paul Gilbert’s work has established him as an acknowledged international authority on issues surrounding compassion and related problems and therapies, and he has produced a comprehensive range of books and articles, in addition to a useful website incorporating valuable materials in this general field [4]. Gilbert stresses the need for precision about the key concepts in this field, in addition to a careful consideration of all the scientific data concerning the evolutionary, psychological and medical evidence about compassion and its role in human behaviour. Academia Letters, July 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Terry Hyland, hylandterry@ymail.com Citation: Hyland, T., Lynch, J. (2021). Towards an Understanding of ‘Compassion Fatigue’ in the Context of the COVID-19 Pandemic. Academia Letters, Article 2064. https://doi.org/10.20935/AL2064. 1 Sara Schairer, co-founder of Compassion It, explains how sympathy – the capacity to understand another’s feeling – empathy – the ability to share another’s emotion – and compassion – the quality of responding to the suffering of another with a willingness to relieve it – though qualitatively different may be pragmatically connected. She observes that ‘When you are compassionate, you feel the pain of another (i.e., empathy) or you recognize that the person is in pain (i.e., sympathy), and then you do what you can to to alleviate the person’s suffering’ [5]. In addition to the link to motivation to act in compassionate feeling, the idea that compassion and self-compassion go hand in hand is stressed by mindfulness teachers and therapists such as Christopher Germer and Kristin Neff. In exploding myths about the putative selfindulgent and egocentric implications of compassion, Germer and Neff explain that, on the contrary, caring for the self is an indispensable prerequisite of genuinely compassionate activity. Self-compassion – which is ‘simply compassion turned inward’ – can release us from the negative self-criticism often associated with the despair and helplessness of misfiring compassion [6]. Gilbert [7] also usefully removes possible confusions about compassion in asking us to acknowledge that: it takes courage to be aware that we are biological beings, built by genes we never chose; pushed and pulled by motives and emotions that are in-built; socially shaped by environments we simply found ourselves in. This is the basis of compassionate wisdom. In terms of practical remedies, he suggests that: We can start with ourselves by spending a few moments each day thinking about how we would be if we were at our compassionate best - how we might think and act. Then we might imagine a difficulty in our lives, breathe deeply and slowly, create a friendly inner-voice tone, and imagine how this wise, compassionate part of us might address the problem. Compassion Fatigue – Facing the Challenges In a paper investigating compassion fatigue amongst medical professionals, the central concept is described as being ‘multifaceted, including physical, emotional, social, spiritual and intellectual effects’ resulting in symptoms which include ‘boredom, cynicism, anxiety, discouragement, intrusive thoughts, irritability, avoidance, numbness, persistent arousal, sleep disturbances, depression, intolerance, detachment, apathy’ [8]. It is worth stressing at the outAcademia Letters, July 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Terry Hyland, hylandterry@ymail.com Citation: Hyland, T., Lynch, J. (2021). Towards an Understanding of ‘Compassion Fatigue’ in the Context of the COVID-19 Pandemic. Academia Letters, Article 2064. https://doi.org/10.20935/AL2064. 2 set that what is often labelled as ‘compassion fatigue’ may well be simply the natural fatigue – the physical and mental exhaustion – which understandably is associated with the vicissitudes of the current pandemic. When people are locked down, isolated from friends and family, losing loved ones and being unable to visit dying relatives and – for health and social care, and other frontline staff – having to cope daily with emotional and physical stress, it is perfectly natural for people to suffer many of the symptoms noted above which are said to characterize compassion fatigue. However, the anxiety, numbness and avoidance associated with full-blown compassion fatigue represent such acute dangers to individual and social mental health – especially so in the case of key health and social care workers – that remedial work is urgently indicated. Apart from noting and acting upon the lessons to be drawn from the work of Gilbert and others outlined earlier, much can be learned from the long-term experience of mindfulness teachers and therapists in the field of compassion-focussed activity. From the work of Germer & Neff [6] and other mindfulness practitioners, it is well worth noting the following key notions: • Compassion and self-compassion are two sides of the same coin – by acknowledging that suffering is universal, we can see that caring for ourselves is inseparable from caring for others • Overcoming symptoms of compassion fatigue involves accepting that we are suffering in the first place (note, this does not mean accepting that such symptoms will endure). If we can avoid futile rumination (why me? what is wrong with me?) and experiential avoidance of negative emotions – both of which exhaust mind/body reserves – we will be better equipped to respond to life events with greater strength, enthusiasm and resilience. • Maintaining and preserving compassion in and for ourselves and others is an ongoing process which – like forms of physical training – requires attention and practice. All of these factors may be cultivated, formally, through following the training regimes recommended by practitioners in the field, and Paul Gilbert’s many writings and his Compassionate Wellbeing website [4] contain a wealth of ideas and materials in this respect. However, isolated individuals and busy healthcare workers can gain much benefit from more informal techniques recommended in mindfulness contexts such as breath and movement activities which allow us to pause and temporarily stand back from everyday automatic thought and behaviour so as to renew mental and physical wellsprings [9]. Academia Letters, July 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Terry Hyland, hylandterry@ymail.com Citation: Hyland, T., Lynch, J. (2021). Towards an Understanding of ‘Compassion Fatigue’ in the Context of the COVID-19 Pandemic. Academia Letters, Article 2064. https://doi.org/10.20935/AL2064. 3 Compassion and Ethical Conduct The crucial values associated with the compassionate mind are far too important to be allowed to be eroded by neglect or a lack of care. Compassion is the bedrock of moral life and – within Buddhist mindfulness traditions – one of the cardinal virtues conducive to the alleviation of pain and suffering in ourselves and others. In its role in disposing us to care about and respond to the suffering of others it is the glue that binds society together and allows for community harmony and wellbeing. Moreover, the compassionate motivation to help others is fundamental to continued engagement in the charitable and socially beneficial work which has marked the human response to the COVID crisis in societies around the world. As Gilbert notes, compassion ‘is perhaps the only universally recognised language with the ability to change the world’ [7]. The common mantra of ‘nobody’s safe until everybody’s safe’ which underpins such work is both an ethical mission statement and a compassionate spur to action. This is a fundamental component of Utilitarian ethics, and the moral philosopher, Peter Singer [10] has demonstrated the value and universal significance of such a moral code in his work on the importance of open-hearted generosity as a worthwhile form of life. Such ideas have inspired a global ‘effective altruism’ movement which has changed the lives of people around the world. Such altruistic motives are absolutely crucial to our continuing efforts to care for each other in these troubled times. The Buddhist teacher, Christina Feldman [11], has lectured and written extensively on compassion and related issues, and her description of the immense value of this quality of mind provides a fitting conclusion to any discussion of the topic. She observes that: Compassion is the most precious of all gifts. In times of sorrow and bewilderment, it is what restores us and offers refuge. It is the force of empathy in your own heart that allows you to reach out and touch the broken heart of another. It is rooted in theheartfelt acknowledgement that others, like ourselves, yearn to be free from suffering and harm, and be safe and happy. It is compassion that rescues us from despair and helplessness, that provides a refuge of peace and understanding, inwardly and outwardly (p.4). References [1] WHO Coronavirus Disease (COVID-19) Dashboard Data last updated: 2021/1/30, 7:49pm CET https://covid19.who.int/ accessed 31/1/21 [2] An excellent World Service treatment of the topic was broadcast on 31/1/21 available on Academia Letters, July 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Terry Hyland, hylandterry@ymail.com Citation: Hyland, T., Lynch, J. (2021). Towards an Understanding of ‘Compassion Fatigue’ in the Context of the COVID-19 Pandemic. Academia Letters, Article 2064. https://doi.org/10.20935/AL2064. 4 BBC Sounds at https://www.bbc.co.uk/programmes/p095k4vr [3] Christopher Boehm (2012). Moral Origins: the evolution of virtue, altruism and shame (New York: Basic Books) [4] Paul Gilbert. Compassionate Wellbeing https://www.compassionatewellbeing.com/compassionsafe-relating-and-world-change-lecture-series.html [5] Sarah Schairer (2017). Empathy, Sympathy and Compassion: What’s the difference?; Compassion It (5), August 27 https://compassionit.com/2017/08/27/empathy-sympathyand-compassion-whats-the-difference/ [6] Christopher Germer and Kristin Neff (2019). Teaching the Mindful Self-Compassion Program (New York: The Gulford Press) p.30 [7] Paul Gilbert (2015). Compassion: Universally Misunderstood. Huffington Post, 25/8/15 [8] Katherine Valentine Upton (2018).A n investigation into compassion fatigue and selfcompassion in acute medical care hospital nurses: a mixed methods study. Journal of Compassionate Health Care, 5(7): 2-27 https://self-compassion.org/wp-content/uploads/ 2019/08/Upton2018.pdf [9] See Terry Hyland (2011). Mindfulness and Learning (Dordecht: Springer). A valuable and practically useful website has been developed by Sam Harris available at https://www. wakingup.com/ [10] Peter Singer (2016). Famine, Affluence and Morality (Oxford University Press) [11] Christina Feldman (2005). Compassion. (Berkeley, CA: Rodmell Press) Academia Letters, July 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Terry Hyland, hylandterry@ymail.com Citation: Hyland, T., Lynch, J. (2021). Towards an Understanding of ‘Compassion Fatigue’ in the Context of the COVID-19 Pandemic. Academia Letters, Article 2064. https://doi.org/10.20935/AL2064. 5
ACADEMIA Letters Towards an Understanding of ‘Compassion Fatigue’ in the Context of the COVID-19 Pandemic Terry Hyland, Free University of Ireland Josephine Lynch, The Mindfulness Centre In the context of a COVID-19 pandemic which has thus far infected over 101 million people worldwide and resulted in over 2 million deaths [1] it would be understandable why many people – especially front line workers in health care professions and all those isolated in strict lockdown conditions – might be suffering from what has been labelled ‘compassion fatigue’ [2] However, since the quality of compassion is such a valuable aspect of social cohesion and well-being – and indeed a crucial component of universal ethical codes [3] – it is well worth attempting to gain a clearer understanding of this phenomenon. With this objective in mind, the idea of compassion fatigue will be analysed – within the framework of cognate concepts such as sympathy, empathy and self-compassion – before examining suggestions from psychologists, therapists and mindfulness practitioners for dealing with problems in this general area in times of social and emotional crisis. What is Compassion? Paul Gilbert’s work has established him as an acknowledged international authority on issues surrounding compassion and related problems and therapies, and he has produced a comprehensive range of books and articles, in addition to a useful website incorporating valuable materials in this general field [4]. Gilbert stresses the need for precision about the key concepts in this field, in addition to a careful consideration of all the scientific data concerning the evolutionary, psychological and medical evidence about compassion and its role in human behaviour. Academia Letters, July 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Terry Hyland, hylandterry@ymail.com Citation: Hyland, T., Lynch, J. (2021). Towards an Understanding of ‘Compassion Fatigue’ in the Context of the COVID-19 Pandemic. Academia Letters, Article 2064. https://doi.org/10.20935/AL2064. 1 Sara Schairer, co-founder of Compassion It, explains how sympathy – the capacity to understand another’s feeling – empathy – the ability to share another’s emotion – and compassion – the quality of responding to the suffering of another with a willingness to relieve it – though qualitatively different may be pragmatically connected. She observes that ‘When you are compassionate, you feel the pain of another (i.e., empathy) or you recognize that the person is in pain (i.e., sympathy), and then you do what you can to to alleviate the person’s suffering’ [5]. In addition to the link to motivation to act in compassionate feeling, the idea that compassion and self-compassion go hand in hand is stressed by mindfulness teachers and therapists such as Christopher Germer and Kristin Neff. In exploding myths about the putative selfindulgent and egocentric implications of compassion, Germer and Neff explain that, on the contrary, caring for the self is an indispensable prerequisite of genuinely compassionate activity. Self-compassion – which is ‘simply compassion turned inward’ – can release us from the negative self-criticism often associated with the despair and helplessness of misfiring compassion [6]. Gilbert [7] also usefully removes possible confusions about compassion in asking us to acknowledge that: it takes courage to be aware that we are biological beings, built by genes we never chose; pushed and pulled by motives and emotions that are in-built; socially shaped by environments we simply found ourselves in. This is the basis of compassionate wisdom. In terms of practical remedies, he suggests that: We can start with ourselves by spending a few moments each day thinking about how we would be if we were at our compassionate best - how we might think and act. Then we might imagine a difficulty in our lives, breathe deeply and slowly, create a friendly inner-voice tone, and imagine how this wise, compassionate part of us might address the problem. Compassion Fatigue – Facing the Challenges In a paper investigating compassion fatigue amongst medical professionals, the central concept is described as being ‘multifaceted, including physical, emotional, social, spiritual and intellectual effects’ resulting in symptoms which include ‘boredom, cynicism, anxiety, discouragement, intrusive thoughts, irritability, avoidance, numbness, persistent arousal, sleep disturbances, depression, intolerance, detachment, apathy’ [8]. It is worth stressing at the outAcademia Letters, July 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Terry Hyland, hylandterry@ymail.com Citation: Hyland, T., Lynch, J. (2021). Towards an Understanding of ‘Compassion Fatigue’ in the Context of the COVID-19 Pandemic. Academia Letters, Article 2064. https://doi.org/10.20935/AL2064. 2 set that what is often labelled as ‘compassion fatigue’ may well be simply the natural fatigue – the physical and mental exhaustion – which understandably is associated with the vicissitudes of the current pandemic. When people are locked down, isolated from friends and family, losing loved ones and being unable to visit dying relatives and – for health and social care, and other frontline staff – having to cope daily with emotional and physical stress, it is perfectly natural for people to suffer many of the symptoms noted above which are said to characterize compassion fatigue. However, the anxiety, numbness and avoidance associated with full-blown compassion fatigue represent such acute dangers to individual and social mental health – especially so in the case of key health and social care workers – that remedial work is urgently indicated. Apart from noting and acting upon the lessons to be drawn from the work of Gilbert and others outlined earlier, much can be learned from the long-term experience of mindfulness teachers and therapists in the field of compassion-focussed activity. From the work of Germer & Neff [6] and other mindfulness practitioners, it is well worth noting the following key notions: • Compassion and self-compassion are two sides of the same coin – by acknowledging that suffering is universal, we can see that caring for ourselves is inseparable from caring for others • Overcoming symptoms of compassion fatigue involves accepting that we are suffering in the first place (note, this does not mean accepting that such symptoms will endure). If we can avoid futile rumination (why me? what is wrong with me?) and experiential avoidance of negative emotions – both of which exhaust mind/body reserves – we will be better equipped to respond to life events with greater strength, enthusiasm and resilience. • Maintaining and preserving compassion in and for ourselves and others is an ongoing process which – like forms of physical training – requires attention and practice. All of these factors may be cultivated, formally, through following the training regimes recommended by practitioners in the field, and Paul Gilbert’s many writings and his Compassionate Wellbeing website [4] contain a wealth of ideas and materials in this respect. However, isolated individuals and busy healthcare workers can gain much benefit from more informal techniques recommended in mindfulness contexts such as breath and movement activities which allow us to pause and temporarily stand back from everyday automatic thought and behaviour so as to renew mental and physical wellsprings [9]. Academia Letters, July 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Terry Hyland, hylandterry@ymail.com Citation: Hyland, T., Lynch, J. (2021). Towards an Understanding of ‘Compassion Fatigue’ in the Context of the COVID-19 Pandemic. Academia Letters, Article 2064. https://doi.org/10.20935/AL2064. 3 Compassion and Ethical Conduct The crucial values associated with the compassionate mind are far too important to be allowed to be eroded by neglect or a lack of care. Compassion is the bedrock of moral life and – within Buddhist mindfulness traditions – one of the cardinal virtues conducive to the alleviation of pain and suffering in ourselves and others. In its role in disposing us to care about and respond to the suffering of others it is the glue that binds society together and allows for community harmony and wellbeing. Moreover, the compassionate motivation to help others is fundamental to continued engagement in the charitable and socially beneficial work which has marked the human response to the COVID crisis in societies around the world. As Gilbert notes, compassion ‘is perhaps the only universally recognised language with the ability to change the world’ [7]. The common mantra of ‘nobody’s safe until everybody’s safe’ which underpins such work is both an ethical mission statement and a compassionate spur to action. This is a fundamental component of Utilitarian ethics, and the moral philosopher, Peter Singer [10] has demonstrated the value and universal significance of such a moral code in his work on the importance of open-hearted generosity as a worthwhile form of life. Such ideas have inspired a global ‘effective altruism’ movement which has changed the lives of people around the world. Such altruistic motives are absolutely crucial to our continuing efforts to care for each other in these troubled times. The Buddhist teacher, Christina Feldman [11], has lectured and written extensively on compassion and related issues, and her description of the immense value of this quality of mind provides a fitting conclusion to any discussion of the topic. She observes that: Compassion is the most precious of all gifts. In times of sorrow and bewilderment, it is what restores us and offers refuge. It is the force of empathy in your own heart that allows you to reach out and touch the broken heart of another. It is rooted in theheartfelt acknowledgement that others, like ourselves, yearn to be free from suffering and harm, and be safe and happy. It is compassion that rescues us from despair and helplessness, that provides a refuge of peace and understanding, inwardly and outwardly (p.4). References [1] WHO Coronavirus Disease (COVID-19) Dashboard Data last updated: 2021/1/30, 7:49pm CET https://covid19.who.int/ accessed 31/1/21 [2] An excellent World Service treatment of the topic was broadcast on 31/1/21 available on Academia Letters, July 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Terry Hyland, hylandterry@ymail.com Citation: Hyland, T., Lynch, J. (2021). Towards an Understanding of ‘Compassion Fatigue’ in the Context of the COVID-19 Pandemic. Academia Letters, Article 2064. https://doi.org/10.20935/AL2064. 4 BBC Sounds at https://www.bbc.co.uk/programmes/p095k4vr [3] Christopher Boehm (2012). Moral Origins: the evolution of virtue, altruism and shame (New York: Basic Books) [4] Paul Gilbert. Compassionate Wellbeing https://www.compassionatewellbeing.com/compassionsafe-relating-and-world-change-lecture-series.html [5] Sarah Schairer (2017). Empathy, Sympathy and Compassion: What’s the difference?; Compassion It (5), August 27 https://compassionit.com/2017/08/27/empathy-sympathyand-compassion-whats-the-difference/ [6] Christopher Germer and Kristin Neff (2019). Teaching the Mindful Self-Compassion Program (New York: The Gulford Press) p.30 [7] Paul Gilbert (2015). Compassion: Universally Misunderstood. Huffington Post, 25/8/15 [8] Katherine Valentine Upton (2018).A n investigation into compassion fatigue and selfcompassion in acute medical care hospital nurses: a mixed methods study. Journal of Compassionate Health Care, 5(7): 2-27 https://self-compassion.org/wp-content/uploads/ 2019/08/Upton2018.pdf [9] See Terry Hyland (2011). Mindfulness and Learning (Dordecht: Springer). A valuable and practically useful website has been developed by Sam Harris available at https://www. wakingup.com/ [10] Peter Singer (2016). Famine, Affluence and Morality (Oxford University Press) [11] Christina Feldman (2005). Compassion. (Berkeley, CA: Rodmell Press) Academia Letters, July 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Terry Hyland, hylandterry@ymail.com Citation: Hyland, T., Lynch, J. (2021). Towards an Understanding of ‘Compassion Fatigue’ in the Context of the COVID-19 Pandemic. Academia Letters, Article 2064. https://doi.org/10.20935/AL2064. 5