Saturday, November 7, 2009

Fort Hood: What Compassion Fatigue Is, and Isn't

As we all know by now, the alleged shooter in the Fort Hood massacre is a psychiatrist. There is a lot of speculation in the media right now that he suffered from "compassion fatigue," "vicarious traumatization," "secondary trauma" or "secondary PTSD." In many of these articles these terms are used interchangeably. The basic idea of all of these articles is that the shooter's treatment of people who had been traumatized caused his own traumatization. However, since virtually none of the reporters involved had ever heard of compassion fatigue before Thursday, there is a lot of oversimplification of the facts in the search for answers.

I have no first-hand information about whether this man suffered from compassion fatigue or anything else, and I (unlike both those who think he did and those who think this was religiously-motivated terrorism) am not going to speculate. We have absolutely no facts at all on which to base a diagnosis. What I do have, however, is some information about compassion fatigue that might be helpful at least in understanding what everyone is talking about.

There are two big risks that people who work with trauma victims face: burnout and compassion fatigue. Burnout is just what it sounds like, and just what it is in any line of work. It's the slow and steady deterioration of satisfaction with your job and your willingness and ability to do it well. It's what makes you not want to get up and go to work in the morning. Burnout can be associated with the stressfulness of the job, and listening to people's trauma is stressful. Among trauma interventionists, burnout manifests in not caring much about the stories you hear or the people who tell them, in not doing what you know needs to be done for them, and in quitting your job or volunteer position.

The second risk is compassion fatigue. Compassion fatigue, unlike burnout, usually comes on fast. A single story or a small set of them get to you in a serious way, and you start showing the same symptoms you would if you were exposed to a traumatic event: trouble sleeping, irritability, impaired judgment, appetite changes, nightmares, startling easily, etc. This is not the person who says, "Gee, I really don't feel like going to work today." This is the person who is afraid to get out of bed.

One of the most commonly used screening tools for burnout and compassion fatigue, as well as job satisfaction, in those who work with traumatized people, is the Professional Quality of Life Scale Compassion Satisfaction and Fatigue Subscales—Revision IV (Pro-QOL R-IV). Interestingly enough, when I went looking for a copy for reference for this post, I found it on the website for the Army Behavioral Health Provider Resiliency Training program.

Some of the questions on the Pro-QOL that relate specifically to compassion fatigue can help you understand what exactly it is:
  • I jump or am startled by unexpected sounds
  • I find it difficult to separate my personal life from my life as a helper
  • I feel as though I am experiencing the trauma of someone I have helped
  • I avoid certain activities or situations because they remind me of frightening experiences of the people I help
  • As a result of my helping, I have intrusive, frightening thoughts
  • I can't recall important parts of my work with trauma victims
Clearly, this is serious stuff. And clearly, it needs to be addressed. But just as most people exposed to trauma experience these symptoms and recover, most of us who work with them recover if we show signs of compassion fatigue.

Compassion fatigue and secondary PTSD are not synonymous. Post traumatic stress is a typical reaction of a normal person to an abnormal event. Post traumatic stress disorder is when it lasts, does not resolve, and interferes with functioning. Similarly, compassion fatigue is a normal hazard of the job. The vast majority of people who experience it get some support, back off their work for a while, and return to normal functioning.

So, could the shooter at Fort Hood have had secondary PTSD? Sure. Do we know that he did? No. And is it inevitable that someone in his position would be in that much trouble psychologically? Certainly not. Trauma is contagious, yes, but the contagion is also avoidable, given the right supports. What we don't know is whether this particular psychiatrist had those supports in place.

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Naomi Zikmund-Fisher
is a clinical social worker, former school Principal and a Crisis Consultant for schools and community organizations. You can learn more about her at
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