Navigating Burnout: Going to the Edge of Empathy and Taking One More Step — A New Compassionate Approach to Training As a Healthcare Professional
January 7, 2021
““Do the best you can until you know better. Then when you know better, do better.” –Maya Angelou”
Being compassionate feels like it is getting harder these days. Suffering is in our daily peripheral nervous system and lived experiences. Sometimes it feels like hardship crawls into our bones and circulates in our lymphocytes. Witnessing suffering ignites a visceral reaction within us.
For those of us who have chosen a career around helping and caring for others, driven by the motivation to alleviate suffering—healthcare professionals, educators, social workers, therapists, etc.—we are confronted daily by obstacles to acting with compassion. A common obstacle is noting that the visceral reaction can be tremendously hijacking, and if you have ever sat across from someone who is in tremendous pain, you know what I am talking about. To most carers on the frontlines this is firsthand experience. We can at times, feel hopeless, helpless, worry we don’t have the right words, or training to hold all of this, help this, cure this, fix this. Now what? No one likes to admit, “I don’t know what to do.”
The reality is there may be nothing we CAN do to help. We just have to sit there and be a witness.
That feeling is immense…as a caretaker sitting across from someone’s pain and trauma. It is full gas and full brake pedals on at the SAME time. It can feel like it is plunging into our chest cavity, spreading open our rib cage and reaching in squeezing our heart. This happens at a velocity of full steam ahead. Before we know it, we are in the contagion of the activation, spiraling energy, myriad critical self-talk, doubt, not good enough, not trained enough, not experienced enough vortex. The lever was pushed, the valve opened, the kinetic energy was transferred. INTO us. We somehow absorbed it all. We entered into a kind of reversible emergent phenomenon resulting in the entire system to thrust into INCREASED distress and suffering. Now we are both distressed! So who’s in charge?
Wait! This isn’t my suffering. This is someone else’s suffering. So why does it feel as if it is now my suffering?
This state being described is EMPATHY. And it is called “being human.” It is a fundamental principle of compassion, in fact it is the first stage to compassion. We are innately born to recognize distress signals, which is shown in the neuroscience research of mirror neurons. We receive body cues through seeing the striated muscles in eyes, we hear signals through tone of voice, we see people’s facial expressions, quivers of lips, body posturing and behaviors that are clear indicators of “man, this person is in pain.” In empathy, we essentially enter into resonance with the feelings of another. We feel “with” them.
We have to be able to see and feel suffering in order to then know we want to alleviate it. If we don’t recognize suffering in others, it can be an indication of a dampened empathic response system or abnormal connectivity between the insula and the ventromedial prefrontal cortex, an area important for empathic decision-making, in our brain. This would make life very hard. Just imagine for a moment a world without this human response.
Is empathy required for compassion? Yes
Is empathy a guarantee for compassion? No
Often this first stage of empathy gets derailed before it actually IS compassion. It stays stuck in this stress response. It gets caught in a negative feedback loop of ruminating nervous system responses and is known in neuro-psychology as “empathy distress.”
Empathy distress is NOT compassion. Empathy distress is a super-highway to the felt-sense and physiological undercurrent of BURNOUT. Burnout can be hard to detect until all too often it ends in a blunt forced reaction of “I QUIT!”
This might be a called for response to save yourself in that moment, but what would happen if we actually trained in detecting burnout well before that abrupt two-choice life dilemma forcing us down the road less travelled?
Compassion, fully engaged and altruistic in nature, is the antidote to burnout. Despite our current buzzword of “compassion fatigue” researchers are discovering there is actually no such thing (the gamut of work by Dr. Tania Singer, Matthieu Ricard, Dr. Richard Davidson and many other pioneers in this field).
Compassion is not fatiguing. In brain scans engaged compassion actually shows up in an entirely different area of the brain. Regions that are linked to value and reward. It snaps the pre-frontal cortex back on, where wise decision-making is housed showing activity in the medial orbitofrontal cortex and the ventromedial prefrontal cortex. Who cares about all that mumbo jumbo, all you really need to know is that compassion doesn’t deteriorate. It is caring without deterioration.
It is rejuvenating. Motivating. And promotes our wellness. It is immune system boosting and psychologically resilient. Thankfully we can train in this so we can keep helping in the ways we intended to. We can stay on the travelled road and perfect our craft of caring without the cost.
Knowing the difference between empathy and compassion is a critical insight. The next step is to get really good at distinguishing the difference in our perceived felt-sense. Train. And practice. Even just knowing when you are stuck in empathic distress can change the situation a little bit.
Of course, we are all going to get derailed. Especially if who we see in pain is really close to us. There is no perfect in a practice. But we can institute wise compassion, and helping from here, from our pre-frontal cortex, I have to say, looks and FEELS very different.
Empathy distress, often confused with compassion, to use Pema Chodron’s words is “Idiot Compassion.” It is incomplete and has been disrupted and can become a truly human obstacle to compassion. We know we are there, because we FEEL that we are there. And it doesn’t feel good. We lose all sense of ourselves. Boundaries are lost and the pervasive space is diffuse with the black smoke of suffering.
We tried this. It didn’t feel good. Let’s not do this anymore.
A new medical model needs to be inspired. We need to be teaching how to HOLD ONTO OURSELVES. We shift feeling “with” another (empathy), to feeling “for” another (compassion).
To use the words of Roshi Joan Halifax PhD.: “What if the problem is not that we care too much or too little, but that we are not caring in the right way. We’ve been going about compassion all wrong.”
At the edge of empathy, take the next step.
Train in Compassion & Resiliency. Cultivate a skill set that sets you apart.
