Turning compassion fatigue upside down

Image: C Curve sculpture by Anish-Kapoor

Research is all very well, but what if the results force you to rethink existing beliefs and behaviours? I’ve just been challenged like that about a compassion course I co-tutor.

The course emerged out of hospital corridor conversations where staff talked about how exhausted, stressed and burnt out they felt. My colleague and I responded by creating a workshop that incorporated a wide range of academic literature, practical resources and a safe space for people to reflect on practice.

Most of the people attending have found it worthwhile, in part because we’ve placed considerable emphasis on the idea that self-care is essential for healthcare providers’ health and well-being. That’s appealing, especially if you’re a baby boomer like me, a group so focused on personal development that we became known as the ‘me generation’. But does that self-absorption have flow-on benefits?

Shane Sinclair and his Canadian research team are turning that idea upside down by suggesting that ‘coupling the concept of self-attitude and self- care with compassion diminishes the inherently relational, prosocial, action-orientated, and selfless nature of compassion’. (Sinclair et al. 2017)

Being selfless is something that my mum talked about, a lot. Her knowing was shaped by growing up in the 1920’s and living through World War II. It also came from her values that were deeply grounded in The Good Samaritan story.

This 2,000-year-old parable talks about a guy who is attacked by robbers on a busy road and left for dead. Religious people travelling to a festival at the temple pass by but the Samaritan, seen as the outsider in the culture of the day, takes time to care and what’s more, pays for the guy’s stay at the local inn. Today, the event would be a Facebook sensation.

Naming and shaming the religious people is a common response to this story but it’s not quite that straightforward. Look a little deeper and you’ll find that they had rules, expectations and cleanliness laws to comply with. In short, their higher power, or ruling authority made it hard for them to act compassionately in the moment.

In the 1970’s Princeton University recreated the situation with 67 seminary students. (Darley, John M, Batson 1973) Some had to prepare a talk on The Good Samaritan, variable time pressures were applied to participants and all were set up to find a suffering person on the way to deliver their presentation. 40% offered some help to the victim, however, only 10% helped when they were in high hurry situations and some even stepped over the person in their haste.

The researchers concluded that people in a hurry are less likely to help others even if they are deeply immersed in a classic text like The Good Samaritan. Furthermore, it appears that it’s not callousness that explains a failure to stop and offer help; instead, it’s a conflict between the desire to help and meeting the needs of the higher power. Failures of compassion are as much about systems as they are about individuals.

None of this was new to me, in fact, we’ve used the learnings from the Princeton research in our compassion courses. What I found so challenging was the awareness that we may have been putting an emphasis on self-care because it was easier than the organisational change needed to embed compassionate action in systems and processes.

All of us working in health are captive to some higher power. It may be procedures and guidelines, cleanliness rules, professional bodies, academic research, politics, targets, all of which can stimulate an internal conflict with our desire to act compassionately.

However, as Sinclair and team point out, allowing and empowering healthcare staff to be able to meet the suffering of someone beyond themselves, ‘may have a corollary effect on self-kindness, job-satisfaction and a positive self- attitude’. It’s a win-win if we work together. Strange how my mum knew that.

Darley, John M, Batson, C. Daniel. 1973. “From Jerusalem to Jericho: A Study of Situational and Dispositional Variables in Helping Behavior.” Journal of Personality and Social Psychology 27 (1): 100–108. https://faculty.washington.edu/jdb/345/345 Articles/Darley & Batson (1973).pdf.

Sinclair, Shane, Jane Kondejewski, Shelley Raffin-Bouchal, Kathryn M. King-Shier, and Pavneet Singh. 2017. “Can Self-Compassion Promote Healthcare Provider Well-Being and Compassionate Care to Others? Results of a Systematic Review.” Applied Psychology: Health and Well-Being, April. doi:10.1111/aphw.12086.

Image: C Curve sculpture by Anish Kapoor photographed at Cleveland Museum of Art

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