The Cost of Caring: Causes of Compassion Fatigue

A few days ago, I had the privilege of listening to Patricia Smith speak on Compassion Fatigue at the Disaster Behavioral Health Conference in Salem (OR). She spoke about how she had spent most of her life as a journalist but one day she needed a change and ended up working in animal welfare. It was this avenue that lead her to become interested in how doing caregiving work affects the caregiver. She spoke about how she didn't have a clue how much constantly giving to others, whether human or animal was changing her and how one day she had an emotional meltdown at the sight of a man bringing in a litter of spring kittens. It was the third litter he had brought to the shelter and she just lost it, berating the man and using all sorts of indelicate language. She walked out of that encounter and up to her boss admitting she needed a change. The change led her to researching and writing about compassion fatigue.

Dr. Charles Figley, Director, Tulane Traumatology Institute defines compassion fatigue as, "a state experienced by those helping people or animals in distress. It is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper." Different than burnout, which is when we shut down, compassion fatigue leaves us vulnerable because we are sucked into the situation we are dealing with. As 911 Dispatchers, this occurs when we have a hard time balancing our caring with a health detachment. Our shield protecting our emotion from the caller or the field responder gets broken down and we take on their stress and trauma.  We may not recognize that this is happening until we look at some of the symptoms of compassion fatigue: isolation, emotional outburts, apathy, impulse to rescue anyone in need, excessive complaints, cynicism, rejection of others, hypervigilance, hyperarousal and persistent physical ailments. I'm sure in this list we recognize a number of our  coworkers and for most of us, ourselves.

So what causes compassion fatigue? Smith outlined a number of reasons.

Other-Directedness: Putting the needs of others before our own

Being other-directed is the opposite of being self-directed. Although a certain amount of putting other people's needs before our own is good, it's when we forget to put any of our own needs first that we start to struggle. First responders (and that means us) are notorious for self-sacrifice. We sacrifice our eating, our sleeping, our relationships, our health to our calling. We're awful at self-care always prioritizing everything above it.

Providing service to others with stress and trauma

As 911 Dispatchers, this could be our motto. It's what  we do day in and day out. When was the last time you answered an emergency or non-emergency public safety call and the person on the other side was having a stressful or traumatic event? Like it's been said  a million times, nobody calls us on a good day. We have to provide service no matter what is happening on the other end of the phone or the radio. Hundreds of times a day.

Lack of personal and/or professional coping skills

We'd all like to believe that we have all the healthy coping skills that we need to make it through a career as a 911 Dispatcher. I wish this were true. Even though we are having more dialogue about what these skills look like it is still hard to put them into practice. I wish it were as hard to incorporate the unhealthy ones, like drinking and overeating. The healthy ones include, practicing mindfulness and gratitude, eating well, exercising, interests and relationships outside public safety, etc. Professional coping skills include, empathetic detachment, clear boundaries between work and life, and taking breaks.

Overdeveloped sense of responsibility

How many times have I heard coworkers describing 911 callers and field responders as "mine." As in, "my officers." It ups the ante when it's in a statement like, "It's my job to make sure my officers go home at the end of the day." We feel it is our responsibility to keep everyone safe. But, in reality, all we can really control is how well we do our job. We don't have any control over the outcome of any situation. We can't control whether someone ambushes an officer on our frequency or if the suicide call we're handling ends up in tragedy. Deep down, I think we all know we aren't responsible but we overdevelop this sense because it's too hard to think about the alternative which is we really have no control at all.

Practice of minimizing traumatic events

We work in a culture where it's still viewed as weak if we have a normal reaction to a traumatic event. We're still afraid our coworkers will judge us and think that we can't handle our jobs, especially the newer we are. Once we incorporate this stuffing of trauma into our practice, it's hard to get out of it. Something awful happens and we just laugh and blow it off. We talk about it veiled in dark humor and refuse to really think about it. Again, if we didn't minimize the tragedies of life we would have to admit we have no control and that's not going to happen easily.

History of unresolved childhood trauma (ACEs)

The final cause of compassion fatigue are the Adverse Childhood Experiences (ACE) that we hold inside. Many of us came into the helper profession because we either needed help when we were a child and someone gave us that help or we needed help, didn't get it and decided we were going to be the helper we never had. So many of us have experienced traumas early in life and have yet to address the score our body is keeping in reference to them. Take these ACEs and pile on the stress and trauma we encounter as 911 Dispatchers and you can see how easy it is to eventually crumble. Whether it's compassion fatigue or burnout, if you are struggling there is help. You are not alone. You are not weak and you are not inept. Seek out peer support, a trusted supervisor, EAP, or a professional counselor. There are also a number of forums focused on 911 Dispatcher health and wellness. You can do this job and you can be happy and healthy doing it.