Here is the full transcript of Amy Cunningham’s talk titled “Drowning In Empathy: The Cost of Vicarious Trauma” at TEDxSanAntonio conference.
Listen to the audio version here:
TRANSCRIPT:
Let’s Play a Game
Let’s play a little game. We’ll play a word association game. I’ll say a word, and you can picture something in your head. You can even shout it out loud. Are you ready? Cow. Okay. So, most of you maybe were thinking this. Maybe a few of you were thinking more this. And maybe some of you thought this.
We’ll do another one. Work. Awesome. So, some of you really love your work like this. Maybe a few of you were thinking this. And I wonder if anyone felt this. We’ll do just one more. PTSD, or post-traumatic stress disorder. So, most of you thought this. Maybe a few of you were thinking this. But I wonder if anyone thought this.
Compassion Fatigue
Compassion fatigue is the post-traumatic stress disorder-related symptoms that you receive vicariously as a secondary target to trauma. Compassion fatigue is experienced by those in a helping profession: doctors, nurses, counselors, therapists, police officers, and maybe even you. If your unpaid role is that of a helping professional, then you may also be affected by compassion fatigue.
If you are the middle-of-the-night phone answerer or helping a friend through addiction or anxiety, if you are raising children or caring for parents, or maybe both at the same time, if your unpaid role is that of a helping profession, compassion fatigue could be affecting you as well.
Now, what puts you at a greater risk for compassion fatigue is empathy. Those generally in a helping profession have a very strong empathetic response system. And empathy is that ability to pick yourself up and put yourself in someone else’s shoes and get it, really get where they’re coming from.
The problem with empathy is you don’t get to decide when to jump out.
And those traumas that they experience begin to change you. I remember when I was a supervisor of a therapeutic group home, and I was sitting down with one of my clients. She began to tell me the horrific and painful stories of her past. And as she laid out in detail what she had experienced, my cell phone began to vibrate. And I wanted to show her that I was listening and I cared about every word she said, so I picked it up and I silenced it and I put it back down and I continued to listen.
From that day forward, every single time I picked up my cell phone, swiped to silence it, I was transported back to her trauma. My brain had created a PTSD-related symptom that transported me back to her situation every single time for years. Now, this would be pretty normal if it happened that day after work at the grocery store, or maybe even a week or two weeks later.
But where we get concerned that maybe this trauma is starting to change you is when it’s sticking around for four weeks, six weeks, and maybe even longer. Now, for many years, compassion fatigue was confused. People called everything burnout. Until Dr. Charles Figley came around in the late ’80s and ’90s and began to do research, we called it burnout. But the truth is there’s a significant difference between burnout and compassion fatigue.
Burnout has to do with being worn out and tired and just flat out not liking your job anymore. Compassion fatigue has to do with being afraid. Compassion fatigue begins to change your hard wiring, change who you are.
The Impact of Compassion Fatigue
We see this a lot in child protective service workers. They start to become overly vigilant, believing that everyone is out to hurt them and their family. When I think of this, I can’t help but think of the nurse who came after one of my classes and said, still to this day, she can see the broken bones of the young man who was abused by his parents, that still today she knows the smell of death from a patient who laid in bed dying. These memories, they do not just go away, and they begin to change you.
But we like to make excuses because we think we’re superhuman. So, we say things like, “I’m fine. I’m a professional. I can deal with the stress.” In fact, it doesn’t even stress me out. My famous talk off was, “I’ve been doing this for 15 years. I know most people think it’s stressful, but I’m okay.”
The problem with that is when stress and trauma start to affect you, your brain and your body, they do not poll for your opinion, and they will start to show signs and symptoms because your body and your brain are shouting at you, “I am not okay. I cannot handle the trauma.”
In little ways, whether you start to have sleep problems, either you’re sleeping all the time or not able to sleep at all, another way it manifests is becoming a workaholic. Now, I know plenty of you in this room think, “Amy, there’s nothing wrong with being a workaholic. Get off my toes.” Let me tell you why it may be a problem.
Because when we start to feel like we are losing control of the world around us, what we do is we roll up our sleeves and we work a little harder. And I can work hard enough to make this trauma go away. Another sign and symptom is feeling unappreciated and under-resourced, like what you have is not enough to get the job done. Now, I’m not saying that’s not true.
Overcoming Compassion Fatigue
There’s a very good chance you are indeed under-appreciated. But when you started, when you started in this helping profession or when you started helping your friend or your family member, did you know? Did you know you were going to be under-appreciated, but you said, “It’s okay. I want to do this anyway.” “It’s okay. I love you enough.”
But then somewhere along the way, that is no longer okay with me. It is no longer okay that I am not thanked, and that I don’t have what I need to succeed. What that tells me is your circumstances, they didn’t change. You did. Maybe you changed because of life. Maybe you changed because of maturity.
But maybe you changed because of compassion fatigue. And the last symptom I want to talk with you about today is called self-entitlement. And self-entitlement is a justification of negative, maladaptive behaviors because of the positive things you do. The best way I can picture putting this is most of us went to school and got a degree or a certification to be professionals at what we do.
But the truth is, I’ll let you in on a secret, that’s not enough because we’re overachievers. So, we require little invisible badges to really be professionals. Let me tell you what these invisible badges look like. For social workers, I know it looks like this. “I stayed up all night long helping Joe Smith at the hospital. Now I’m a real social worker.”
For some healthcare professionals, I know it looks like this. “I worked two shifts in a row. Now I’m a real healthcare professional.” Where this turns into self-entitlement is when it looks like this. “I stayed up all night helping Joe Smith at the hospital. That’s why I’m a little cranky today. I’m biting everyone’s heads off. I worked two shifts in a row. In fact, I worked 60 hours this week. So, I’m getting wasted all weekend.”
We begin to justify the negative behaviors because of the positive things that we do. Now that I have thoroughly depressed you, I want to give you some good news. That compassion fatigue can be identified, arrested, and treated at any time. That you can begin this journey for post-traumatic growth. That you can be better after trauma than you ever were before.
And the best way I can think of putting this is when you think of an airplane, you know that the stewardess tells you where those exits are, and then they begin to tell you to please put your mask on you first before assisting other people. Now, every time I travel for vacations with my family, I show the stewardess that I’m listening. I get the cue card out of the backseat pocket, and I give eye contact. I’m almost the only person on the plane listening. And I show if the plane went down, I could save the plane. I’m real intense about it. And yet it never fails.
Every time they finish, they come over to me, and they say, “Excuse me, if there were a change in cabin pressure, what would you do?” And I’m a little offended. I don’t know why they ask me that. But you see, that flight attendant, they see something you don’t. They see the carry-ons that I travel with. They see this. They see me. And they see this.
You see, that flight attendant knows that no matter how much I listen to her, that I will put their masks on them first before caring for myself. But you see, she also knows that no matter how much of a super mom I believe I am, that I cannot live without oxygen. And yet every single day we do the same thing. “I put your mask on you, and your mask on you, and your mask on you, and I don’t care for myself.”
But you see, we can only give what we have. We give out of who we are. And if I don’t care for myself, I certainly cannot care for you. So, I’m going to ask you to complete a piece of homework for me. And I’m going to ask that you please do this every single day for the rest of your life. I have big expectations. I’m going to ask that you take ten. Ten minutes just for you. Ten minutes to put your mask on you first. Ten minutes to pray or meditate, to exercise or take a walk. But take ten minutes to care for you first. Take ten.
Thank you.
SUMMARY OF THIS TALK:
Amy Cunningham’s talk, “Drowning in Empathy: The Cost of Vicarious Trauma,” addresses the profound impact of compassion fatigue on individuals in helping professions. She begins by engaging the audience with a word association game to illustrate how different experiences influence our perceptions.
Cunningham then defines compassion fatigue as a form of post-traumatic stress disorder experienced vicariously through the trauma of others, particularly affecting those in caregiving roles such as doctors, nurses, and social workers. She highlights the role of empathy in exacerbating this condition, as it often leads professionals to absorb the emotional and psychological burdens of those they help.
Through personal anecdotes, she emphasizes how these experiences can alter one’s psychological well-being, leading to symptoms like hypervigilance, sleep disturbances, and a sense of burnout. Importantly, Cunningham differentiates compassion fatigue from burnout, underscoring its unique triggers and effects. Finally, she offers hope by asserting that compassion fatigue can be identified, treated, and mitigated through self-care and professional support, urging her audience to prioritize their own well-being to sustain their ability to care for others.