Compassion Fatigue
"One death is a tragedy; a million deaths is a statistic."
This quote, attributed to Joseph Stalin, hints at something important about the limits of compassion.
We may feel outraged or sad when we read about Stalinist genocide, for instance, but we feel these emotions more readily, and often more intensely, when we hear one victim's story.
Why is that? Partly because large numbers are abstract. It's hard to imagine a million people, much less feel compassionate toward them. You might say that we're a narrative species: we respond most immediately to stories.
Unfortunately, one victim often follows another, the stories accumulate, and we may end up, as many of us did during the pandemic, feeling worn out and numb.
Compassion fatigue refers to the exhaustion and diminished compassion that results from prolonged exposure to individuals in distress. This is a well-known phenomenon among professionals who support mental, physical, and/or spiritual health, but it can affect anyone who helps or at least hears about others who are suffering.
Fatigue vs. fade
Stalin's remark refers most directly to something called compassion fade, or the tendency for compassion to decline as the size or complexity of a problem increases. Studies show that in some instances, people feel more compassion, and offer more help, when hearing about a single victim (e.g., one stranded whale) as opposed to a larger group (e.g., an endangered species of whale).
Although we can distinguish compassion fatigue from fade, in practice they work together. It's hard to stay compassionate when we know there are so many people in distress (fade) and when we continue to support or at least encounter some of those individuals (fatigue).
In my opinion, it's critical to understand compassion fatigue and how to prevent it, not just for the sake of those in the caring professions, but for everyone. We need each other. And we need more buffers for the historically unprecedented quantity and explicitness of misery we encounter in the news and social media. One victim follows another, right there on the screen. Meanwhile, some of the most pressing issues of our time – abortion rights, opioid addiction, racial and gender discrimination, the border crisis etc. – are being addressed by people who hurl slogans and insults at each other rather than treating the issues (and each other) with compassion.
In this newsletter I'll be doing two things.
First, I'll describe a new study on causes and remedies for compassion fatigue. To be honest, I won't be treating this study very compassionately. The data are flawed to the point of undermining efforts to help anyone maintain a compassionate attitude.
Second, I'll be describing a "study" I conducted myself this week. Specifically, I interviewed three professionals who work in the caring professions. What they told me sheds more light on the new study's limitations. More importantly, their beliefs about the causes of compassion fatigue, and their strategies for dealing with it, are both inspiring and useful.
New study overview
The new study, authored by Drs. Izzy Gainsburg (Stanford) and Julia Lee Cunningham (University of Michigan), was published last week in Psychological Science, one of the leading psychology journals.
Gainsburg and Cunningham's essential claim is this: If you believe that compassion is a limited, easily exhausted resource, you will readily develop compassion fatigue.
In other words, your beliefs about the nature of compassion become a self-fulfilling prophecy. If you think compassion is easily depleted, that's what you'll experience. After feeling moved by one person's suffering, you'll feel numb toward the next one.
On the other hand, if you think compassion is relatively unlimited, you'll be less prone to compassion fatigue. Each person's suffering will elicit a fresh and strongly compassionate response.
Gainsburg and Cunningham used the phrase "compassion mindset" to describe a person's beliefs about the limits of compassion. Their central claim is that a limited compassion mindset - i.e., the belief that compassion is readily exhausted – contributes to compassion fatigue.
Evidence for this claim came from four separate studies. I'll have the most to say about Study 1, as the statistical mischief is much the same across studies.
Study 1
This study focused on a national sample of 310 adults who participated online.
To measure compassion mindset, participants used a 6-point scale to rate their extent of agreement with four statements (e.g., "Even after feeling deep compassion, you can continue to feel compassion toward others."). Responses to the four statements were averaged to produce a single score. A lower score means that the person considers compassion to be a more limited resource.
To measure compassion fatigue, participants viewed nine captioned photos of people in distress. After viewing each photo, the participant was asked “To what extent do you, personally, feel an emotional response of compassion when looking at this photo?” Participants responded on a scale ranging from 0 (none at all) to 100 (an extreme amount). Each participant's responses were averaged to produce a single score, with lower scores indicating greater compassion fatigue. (The researchers assumed that even if everyone responded equally compassionately to the first photo, the onset of compassion fatigue would impact average scores across the entire set of nine.)
The main finding was that compassion mindset predicted compassion fatigue. Participants who considered compassion more of a limited resourced tended to feel less compassion toward the people in the nine photos, and their compassion tended to decline more from one photo to the next.
Study 2
Study 2 was similar to Study 1, but participants were asked about compassion fatigue during the pandemic. They used a 7-point scale to rate how much they agreed with five statements such as "Over the course of the COVID-19 pandemic, my compassion response has weakened over time.". The higher the rating, averaged across the five statements, the greater the person's compassion fatigue. The results were the same as in Study 1: The more limited the mindset about compassion, the greater the self-reported compassion fatigue.
Study 3
Study 3 was essentially the same as Study 1, except that prior to completing the main tasks, participants listened to an 8.5 minute podcast. Half of the podcasts emphasized that compassion is limited and exhaustible, while the other half described compassion as limitless. This manipulation had the expected influence. Participants who heard the limited-compassion podcasts subsequently described compassion as more limited than participants who heard the unlimited-compassion podcasts. And, as in Study 1, the more limited the view of compassion, the greater the compassion fatigue for the nine photos.
Study 4
Study 4 repeated Study 3, but instead of measuring compassion fatigue, the researchers measured the extent of career advice that participants provided to students who were described as having lost jobs or internships owing to COVID-19. The podcasts once again had their intended effect, and participants who heard the limited-compassion podcasts offered lower-quality advice on resumes and other job-related materials provided by the students.
Study takeaways
On the face of it, the findings of these studies seem clear and point to two conclusions:
(a) Beliefs about compassion are self-fulfilling prophecies. Someone who thinks compassion is limited will experience more compassion fatigue than someone who considers it limitless.
(b) Beliefs about compassion are malleable. If someone tells you that compassion is limited, you'll consider it more limited and experience more compassion fatigue than you will if they had told you that compassion is unlimited.
That second conclusion is encouraging, because it suggests that beliefs about compassion can be changed. If you can persuade people that compassion is unlimited, they'll become more compassionate.
What's wrong with this picture?
To be honest, I was startled by how abruptly this study falls apart upon closer scrutiny.
1. The researchers didn't actually measure compassion mindset.
In their General Discussion, Gainsburg and Cunningham acknowledged in passing the following limitation to their compassion mindset measure:
"participants may have interpreted the scale items as statements about their personal experiences of compassion, rather than as “generic you” statements."
In other words, when participants saw a statement such as "Even after feeling deep compassion, you can continue to feel compassion toward others", they assumed that "you" referred to themselves rather than to people in general.
I interpreted the scale this way, and I suspect that most if not all participants did too. (The researchers posed no questions about people in general; rather, they asked each participant about their own demographics, their own anticipated and actual compassion fatigue, etc.)
Why is this important?
If participants think that the mindset questions pertain to themselves personally, then they're not describing their general views on compassion. They're just speaking for themselves. One person says, in effect, I quickly run low on compassion. Another person says, in effect, my compassion is unlimited. Thus, it's no surprise that when viewing the nine photos, the first person reports greater compassion fatigue than the second person does.
In other words, the studies merely show that people know themselves.
This is analogous to my asking you how fast you run, then testing your speed. If you say you're slow, it may turn out that you're right. But you won't run slowly because you think you're slow. Rather, what's happened is that you simply recognized, even before you started running, that you're a slow runner.
Of course, mindsets can influence behavior, and self-fulfilling prophecies do occur sometimes. Just not in this study.
2. The demand characteristics were overwhelming.
A demand characteristic is anything that leads participants to guess what a study is about. This can happen consciously or unconsciously, and it's a problem if it causes participants to change their behavior (e.g., to meet the researchers' expectations).
Gainsburg and Cunningham acknowledged the possibility of demand characteristics, but they didn't comment on the implications.
The ultimate purpose of this research was to better understand compassion fatigue, so that better solutions can be developed. The results of Study 3 and Study 4 were encouraging in this regard, because they showed that beliefs about compassion are malleable. In each case, the podcasts influenced participant beliefs.
Or did they? Here are some excerpts from the two podcasts the researchers used:
"There are limits to people’s capacity to feel compassion... people cannot truly feel compassion for all of COVID’s victims... people helping those suffering from COVID-19 day in and day out will ultimately feel emotional fatigue. Ultimately, people will run out of compassion. It’s human nature."
"People can feel unlimited amounts of compassion... people can feel compassion for all of COVID’s victims, even when they haven’t met them... people can help those suffering from COVID-19 day in and day out without any feelings of emotional fatigue. Ultimately, compassion can fuel itself. It’s human nature."
Imagining hearing one of these podcasts, with its particular message reiterated again and again with concrete examples and expert testimonials. Then, you're immediately asked to perform a task involving compassion. Whether you're aware of it or not, your responses on the task may become more aligned with the content of the podcast you just heard, simply because that appears to be what's expected of you.
None of the effects in this study were very strong, statistically speaking. Demand characteristics only needed to have influenced a small number of participants in order to create those effects. This doesn't mean that anyone's mindset has changed.
A source of hope
Here's some good news: In Study 2, participants were asked how often they've cared for people impacted by COVID-19, and how often they engage with news reports that describe the suffering that COVID-19 has caused. Compassion fatigue was actually lower among participants who spent more time caring for others, as well as among participants who engaged more frequently with the distressing news reports. These findings had nothing to do with participant mindsets.
The researchers labeled these two findings as "counterintuitive" and promptly ignored them. Why? Perhaps because the findings clash with the narrative they'd been developing.
According to the researchers, persuading people that compassion is unlimited can make them more compassionate.
According to the researchers' own data, some people are just more compassionate, in life and in the lab, even though (or perhaps because) they routinely support others and encounter more suffering on the news.
Rather than ignoring the "counterintuitive" Study 2 data, we might take it as a source of hope. Supporting people in distress, or at least being aware of their plight, doesn't necessarily diminish our compassion.
Another source of hope
As I mentioned, the new study was published in Psychological Science, a leading journal that's known for clever findings that don't always withstand close scrutiny.
I realize that with respect to the flaws of this study, I don't sound very compassionate. It's true; I'm not. But I do feel bad for those who need our compassion, as well as for the professionals who are most at risk for compassion fatigue.
I reached out to three of those professionals to learn their perspectives. Although I didn't ask them to comment on this study, what they shared with me illustrated some of its limitations, while also providing some inspiring and genuinely useful food for thought.
Compassion mindset and compassion fatigue
Here's one of the questions I asked the professionals:
"If a person believes that the ability to feel compassion is easily exhausted, do you think this person is more prone to compassion fatigue than a person who believes that compassion is an unlimited psychological resource?"
Gainsburg and Cunningham would say yes, with an exclamation point. Demonstrating that was the purpose of their study. Here's an alternative perspective, nicely articulated by Carly Wielstein, a marriage and family therapist based in L.A.:
"Perhaps if a person recognizes compassion as a resource that depletes quickly, they might be able to protect it or enlist protective factors to aid in keeping themselves from fatigue or burnout. Someone who thinks compassion is an unlimited resource may not recognize if and when they start to be impacted."
In other words, Gainsburg and Cunningham may have gotten it backwards. At least among professionals whose work relies heavily on compassion, the more exhaustible they consider this precious resource, the more carefully they may preserve it. This possibility was echoed by Vivi He, a licensed professional counselor in Plano, Texas:
"If a person believes that compassion is an unlimited psychological resource, the person may not be aware of compassion fatigue, or deny the fatigue, which could actually make it more severe."
A third professional offered a different perspective. Major Stephanie Okolo, a supervisory chaplain at Camp Casey in South Korea, responded in a way that's more consistent with Gainsburg and Cunninghams's view:
"If a person believes their ability to feel compassion is limited, they may be more conscious of it running out, leading to heightened stress, making them more susceptible to compassion fatigue. Conversely, if someone perceives compassion as an unlimited resource, they might approach their role with more resilience and stamina."
Major Okolo took a step beyond Gainsburg and Cunningham by offering a nuanced explanation for why compassion mindset predicts compassion fatigue. If you think compassion is limited, but you practice compassion, you'll become stressed as you feel it diminishing.
Of course, this may be true for some people, while the opposite, as articulated by Wielstien and He, is true for others. Gainsburg and Cunningham's data are consistent with just about any possibility, because their statistical effects were quite small. (The correlations between compassion mindset and compassion fatigue were .27 or less in all relevant cases.)
The problem with small correlations is similar to a problem with means that I've commented on in other newsletters: they gloss over what may turn out to be important sources of diversity in the data.
For this reason, even if you take a more charitable view of Gainsburg and Cunningham's study than I do, it would be irresponsible to go around assuring people that their capacity for compassion is infinite, or at least very large. At best, this might be useful for some people. At worst, it could promote the sort of neglect that Wielstein described.
What can we do to reduce compassion fatigue?
I enjoyed seeing what the professionals had to say about preventing or reducing compassion fatigue. I think there's useful information here for everyone, even if your job doesn't depend quite so heavily on a compassionate attitude.
Major Okolo emphasized the importance of proactively seeking support, via self-care strategies as well as both informal and formal interactions with colleagues:
"To cope, I ensure to take time for self-reflection, prayer, and rest. I've also sought peer support from fellow chaplains and attended regular supervisory sessions to address unresolved emotions or traumas. It's crucial for me to remember to seek guidance, just as those under my care seek guidance from me."
Vivi He also emphasized the importance of proactive self-care, noting that you want to address compassion fatigue before you become overly fatigued. Carly Wielstein described some of the concrete strategies she uses, such as "traveling, reading for pleasure, being social with friends and family, exercise, time in nature, limited screen time, consuming art such as film and live theatre". In addition, Wielstein pointed to the importance of reflecting on the suffering she encounters in her work:
"I practice a spiritual and mindful way to make sense of the suffering I may be inundated with. I am not religious, so for me, I work to make sense of suffering and the heavy nature of continually caring for those who are in such despair, by engaging in mantras that inform my belief that suffering is universal, and that holding on to the suffering of others does not position me as a better helper to anyone, rather it becomes so consuming and tiresome that I will be ineffective."
It's interesting to see how Wielstein relies on a philosophical observation (the Buddhist theme that suffering is universal) to meet a practical need (staying helpful as a counselor). She also described a specific cognitive strategy:
"I use a visual exercise as an active practice to cope with compassion fatigue: I see myself picking up the person's suffering and holding it with them, so it is not as heavy, and helping them find a different way to hold it or help them find a place to set it down. But I do not take it from them, and I do not take it home with me."
Compassion is a finite resource. All of the professionals I interviewed said as much. As Vivi He put it, "psychological resources are limited, whether you believe it or not". But perhaps we can find ways of using this resource without using it up, the way a hybrid vehicle can recharge its battery while being driven. Following Wielstein, we can pick up – or at least pick up on – other peoples' suffering, help however we can, and at the same time find ways to set the burden down and care for ourselves too.
Thanks for reading!