STAYING  HEALTHY  IN  THE  MIDST

OF  SUFFERING  AND  DISEASE

Jan Chozen Bays, M.D.

CARES NW, Legacy Emanuel Children’s Hospital, Portland, Oregon 97227

 

With optimism and compassion, people enter occupations which involve daily encounters with  disease, mental illness, and abuse and neglect.  Chronic exposure to human suffering turn optimism into despair, kindness into resignation. Talented people may leave the work before they planned or wanted to, with sadness, anger or indifference.  Or they don’t leave and remain indifferent, tired, just putting in their time until retirement.

 

Counter transference: Our deep issues have not been resolved and the material we encounter in our work with human suffering triggers old problems.

 

Burnout: Our minimum acceptable goals are too high or we insist that the world should work the right way. We resist changing our goals in response to feedback. The adaptation is to become negative,  less empathic and to withdraw.  (“I’m the only one who can do this right.” I’m irreplaceable.)

 

Vicarious Traumatization: We suffer the cumulative negative effect of experiencing many scenes of trauma, many deaths with no time to grieve. Intrusive images interfere with our clarity of mind and we  disassociate from our work, family and friends.

 

Compassion Fatigue: We suffer the cumulative emotional residue of continuously working with suffering. In instead of withdrawing we keep trying harder to give ourselves fully.

 

 

Every type of work involves occupational hazards. If we chose to work with human pain, trauma, suffering and grief, we must accept responsibility for educating ourselves about the hazards associated with this work, monitor our exposure and symptoms, and use appropriate tools to keep ourselves healthy.

 

Safety: Working with disease heightens the sense of personal vulnerability and the fragility of life.  Symptoms: imagined illnesses in ourselves and others, preoccupation with cleanliness and safety, not letting any one babysit, hypervigilance.

 

Trust: through exposure to the many ways people deceive, betray or violate the trust of others, providers may become suspicious and cynical. “I used to believe that the majority of people were trustworthy. Now I believe the opposite.” Symptoms: Self criticism, not trusting one’s own instincts, isolation.

 

Esteem: Esteem is defined as the need to perceive others as benevolent and worthy of respect. Encountering so much human pain and suffering can shatter providers’ world view and lead to cynicism, pessimism and anger at individuals or mankind in general. Or it can lead to musing about the fate of the human race.

Symptoms: degrading oneself or others (anyone not doing the work is useless), over idealization of self and others (I’m the only one who can do this right).

 

Intimacy: A sense of alienation may emerge from exposure to pain, illness and death, which cannot be shared with others, either because others pull away in horror or disbelief, or because of confidentiality requirements. It is particularly painful if your spouse cannot bear to hear what you are doing in life or what is worrying you. A “club” develops, with a sense of distrust of those outside who can never understand your world.  Symptoms: emotional numbing, withdrawal from intimacy.

 

Power or control: Two reactions are seen with repeated exposure to patient’s powerlessness. The first for a provider to try to increase their sense of power in the world, by taking self-defense classes or by becoming more dominant. The second is to experience despair about the uncontrollable forces of natural or human violence.  Symptoms: personal freedom restricted through fears and measures to relieve anxiety about safety, loss of control at work or with patients.

 

Frame of reference: “Why did this happen?” A fundamental human need is to develop a meaningful frame of reference. We try to explain or discover what we or the patient did wrong. Or we lose our frame of reference and become pervasively uneasy.  Symptoms: loss of meaning or standards.  Decision making becomes difficult or arbitrary.

               

           

- intrusion of patients’ issues into our imagination

            - loss of empathy for, and increased criticism of patients, self and others

            - self numbing through addictive behavior (including work)

            - withdrawal from intimacy - spouse, friends, community

            - new and disturbing fears –Eg. of illness in self or loved ones

            - dark humor becoming a way of life, not just shared with co-workers

            - chronic lateness, depression, low self-esteem, loss of joy

 

 

 

1.         Environmental

 

                        Balance a clinical caseload with teaching and research.

                        Limit exposure: Balance medical and non medical work.

                        Set boundaries: limit weekend and night work.  Time really off.

                        Find a way to work for social change.

 

2.         Interpersonal

 

                        Don’t work alone.

                        Get support from professional colleagues.

                        Supervision & consultation

                        Develop support groups where feeling can be discussed separate from business.

 

3.         Personal

 

Find healthy ways to mentally leave the past behind, remain in the present moment and not obsess about future problems and events.

Understand that burn out and compassion fatigue are normal responses. Use them for Growth.

                        Use individual therapy to work on areas that are particular problems.

                        Strive for a balance between personal and professional life.

Make time for non-patient related activities that renew a sense of hope and optimism. The most common are exercise, rest, gardening, music, dance, art work, pets, time with healthy children, travel, being outdoors, doing nothing!

 

4.         Spiritual

 

                        Attend to empathy

                        Stay anchored in the present

                        Develop a sense of connection to something beyond oneself

                        Seek spiritual renewal

 

From: Traumatic Stress: Countertransference and Vicarious Victimization in Psychotherapy with Incest Survivors. Laurie Ann Pearlman and Karen W Saakvitne. WW Norton & Co, New York, NY, 1995.

 

 

 

THE INNER CRITIC

 

Whenever we have high standards for our self or others, we also have the inner voice of the Critic.  When it is in balance it is a voice of discerning wisdom, but when it is out of balance it becomes a voice which relentlessly, ruthlessly points out our failures.  Hallmarks of an out of control Inner Critic: