Compassion Fatigue

You’ve heard of “burnout,” right? Your work environment is making you miserable, so miserable that you feel unfulfilled, depleted of energy, stripped of all motivation to effect change in the workplace. If you’re a healthcare professional, undoubtedly, you know all too well about burnout. But then there’s “compassion fatigue.” While individuals working in any kind of job setting can experience burnout, compassion fatigue is unique to those exposed to trauma while working in a helping profession: nurses, firefighters, police. Because you’re in the helping profession, you feel the onus is on you to save peoples’ lives, to make them better, to alleviate their pain, so you sign up for extra shifts, and, if you’re a nurse, offer to take care of the sickest patients. But what happens when your patients have little, or no family support, or are constantly ringing the call bell, making demands (get me water, I need more pain meds, I need something to help me sleep)? You feel like Sisyphus – no matter how many times you push the boulder up the hill, it keeps rolling back down into your weakened arms. You’re worn down, irritable, angry. That’s compassion fatigue, when you can no longer muster the sympathy to care for your patients because you’ve been exposed to the same kinds of patients again and again, and have answered an uncountable number of call-bell dings, but the bells keep dinging, and you want to keep helping, but, at the same time, you want to run.

It’s worth noting, however, that compassion fatigue doesn’t necessarily mean individuals experiencing it lack compassion, not at all. They still care about their patients. Instead, as a nursing professor at the College of Nursing at University of Arizona says, compassion fatigue is more like feeling too “full,” and even suggests a different name for it: “emotional saturation.”

Not only are healthcare professionals at risk for compassion fatigue, though, family members caring for loved ones with, say, a traumatic brain injury or dementia, are at risk too. Even those who hear about another’s traumatic experience over and over again are affected. I bring these scenarios into the mix because, sadly enough, I suffered from compassion fatigue when I worked tirelessly to navigate my father’s emotional swings, and, as he slipped into Alzheimer’s, made sure he was safe at home because he had insisted he never be put in a nursing home. And I’m witnessing compassion fatigue again, as my husband and his siblings stumble then pick themselves each day, determined to keep their aging mother safe from the ravages of dementia.

But it is possible to care too much, so much that it hurts. When I say hurt, I mean really hurt, as in traumatized hurt. Being pre-occupied with others’ suffering can cause “secondary traumatic stress” for the helping individual. It’s not unusual to experiences symptoms of post-traumatic stress disorder: anxiety, hyper-vigilance, irritability, impatience, withdrawal, poor concentration, sleep disturbance, nightmares, the list goes on.

What’s the cure for compassion fatigue? Boundaries and self-care. In other words, set limits, say no even when you want to say yes, remind yourself to take time out, meditate, go for a walk, keep a journal, draw, listen to your favorite music, dance, do yoga, take a bath, read a novel, watch a funny movie. Watch the sun set. Watch the sun rise.

For more resources on how to evaluate whether or not you have compassion fatigue and how to prevent/treat it, go to compassion fatigue and healthy caregiving.

 

 

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Multi-tasking and Cognitive Costs

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As you read this blog post, is your smartphone on speaker, playing bad “hold music” while you wait for a “live” voice to answer? Or maybe you’re glancing back and forth from the computer screen to your phone, responding to text messages in between reading a few sentences of this post. Multi-tasking is in vogue; it’s hip, cool. And how many times do you see “ability to multi-task a must” in help-wanted advertisements? But while we believe we’re multi-tasking, the truth is we’re not at all. A neuroscientist at MIT says that what we’re actually doing is “switching from one task to another very rapidly.” And, though we believe multi-tasking means greater productivity, each time we do this, he adds, there are “cognitive costs.”

Multi-tasking increases levels of the stress hormone cortisol, and the flight-or-fight hormone adrenaline, both over-stimulating the brain and creating what I call “brain fog,” causing loss of focus. To make matters more complicated, multi-tasking creates an addictive-like feedback loop in the pre-fontal cortex, ironically, the area of the brain responsible for helping us stay on task. In other words, our brains are rewarded for losing focus. Multi-tasking is like using cocaine; the more one uses it, the more one wants it, needs it. So when you talk on the phone, check your email, send a text message, boil water for tea, your brain is stimulated by a rush of endogenous opioids. (“More, please!”) Think of potato chips, ice cream, candy – they taste good going down, but the empty-calorie effect brings your brain, and you, to a crashing halt. And making the brain shift from one task to another causes it to burn extra oxygen and glucose, the very ingredients needed to stay on task. When this happens, you might feel wrung-out, ready for a long nap. What happens when you lose steam? You get frustrated, and anxiety ensues, triggering another blast of cortisol to your brain. You can’t think straight. You become more frustrated, and angry. Maybe you get so angry you take it out on others.

And the more you multi-task, the more decisions you need to make: should I answer that phone call, text, or email? Should I go to the grocery store now or later? Which apple should I buy: a Fuji or a Delicious? When making these decisions, you consume so much energy that you end up making poor decisions when it comes to more important issues, like loaning money you don’t have to an unreliable family member, or going out for drinks and getting so drunk that you can’t get out of bed the next morning to make it to that job interview your father-in-law hooked up for you. (Now you’re in trouble.)

Also, researchers have found that multi-tasking can reduce one’s IQ by as much as fifteen points. This decrease is similar to what researchers would expect from smoking pot or staying up all night. If you’ve ever pulled an all-nighter studying, or smoked pot, you know what it feels like: your brain might as well be stuffed with gauze.

Enough of the harsh truth. Instead, here are some tips to help you resist the temptation to multi-task. Shut off your cell phone when working, and place it far out of reach. If you can’t bring yourself to shut off your phone, envision a stop sign each time it rings or buzzes, and say to yourself, “No, I’m not responding.” Make a list of priorities each day and check them off when complete. Dedicate time each day to complete mindless tasks, like folding the laundry or emptying the dishwasher.  Keep your office door closed so others know you don’t want to be disturbed. Put a do not disturb sign on your door. Plaster your office door with yellow caution tape, set up a trap, eat a lot of garlic. Tie yourself to a ship’s mast – it worked for Odysseus, even though he did put up quite the fight.

Of course, I’m thinking big here with these tips, and you might be laughing at this post, saying, “She’s got to be out of her mind to think I can give up multi-tasking. Tell my boss this, and I’ll be fired in a New York minute.” The key is to guard against multi-tasking whenever possible; start small. Maybe it’s shutting off your cell phone for an hour each day for a week, then two hours the next week. Believe me, I too am victim to multi-tasking. In fact, while writing this post my cell phone rang. (I forgot to shut it off.) Guess whose name lit up on the screen? “Mom.” Yep, I answered it.

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Music and Memory

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While researching the effects of music on memory for an article I recently wrote for my local newspaper, I had the opportunity to speak with a participant of an adult day program in the area. Like most of the other participants, he has Alzheimer’s. When speaking with him, he shared with me his life-long passion for classical music, and invited me to listen to one of his favorite albums that he just happened to have with him at the program that day. He slipped it onto the 1940’s turntable situated in the center of the homelike furnished room, then lowered the needle onto the record. He started humming to the piano solo, snapping his fingers, sweeping his arms through the air, performing a music conductor’s dance.

The music did something for him, to him. Perhaps you know what that feels like. When you hear a specific song from your past, what happens? You can’t help but time-travel in your mind, linking that song to a long-ago, meaningful event, like the day you got married, or your high school senior prom, or the one, and only, time you sang Karaoke. Research indicates that listening to music activates regions in the brain responsible for motor activity, emotions,  creativity, and autobiographical memories. Listening to music is particularly beneficial to those suffering from memory loss, whether it’s from a traumatic brain injury, dementia, or Alzheimer’s.  Music calms ceaseless brain static, helping one to focus on the present and recall  long-term memories.

Dan Cohen, a social worker who founded the non-profit Music and Memory, recognizes the benefits of music, particularly for those suffering from memory loss. His wish to be able to listen to his favorite 60’s music if he were living in a nursing home was the driving force behind his idea to bring iPods, or other digital music technology into elder care facilities, with the  goal of delivering personalized music to the residents, thereby improving quality of life. The miracle-like effects of Music and Memory are evident in the documentary “Alive Inside.” The film features a nursing home resident wearing an iPod, listening to his favorite Cab Calloway songs. Within seconds of hearing the first song, he re-awakens, the music stirring him from his sedate, nearly unresponsive state. His eyes snap fully open, his voice singing in a clear vibrato, as if someone just reset his memory’s circuit breaker.

When I told my husband and two of his adult daughter’s, Rachel and Hannah, about Music and Memory during a recent family gathering we decided to make a list of our favorite songs to share with one another. We each took turns playing them on our iPhones, and, as we did, something remarkable happened: a flash-flood of melodic memories. “Hobo’s Lullaby!” Hannah called out. “Remember, Rachel, Dad used to play it all the time.” Then it was Rachel’s turn: “I learned this Fleetwood Mac song on my guitar. When was that, like ten years ago?” When I played “Cat’s in the Cradle” by Harry Chapin, I felt as if I was back in high school again, singing out loud with my friends, “And the cat’s in the cradle and the silver spoon, little boy blue and the man in the moon …”

Which songs jump start your time-travel engine? Where do those songs take you?

 

 

 

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Traumatic Brain Injuries and Homelessness

Homeless_TBI

On February 2, the groundhog declared, “There is no shadow to be cast. An early spring is in my forecast!” This is good news for homeless people, who endure long, cold days trying to keep warm, crouched in the corner of parking garages, curled up on floors of abandoned houses, or huddled together in makeshift tents. But for more than half of homeless men, they have even more to contend with than weather – traumatic brain injuries. With 600,000 homeless Americans shivering on the streets on any given night, this issue commands attention.

Studies have shown that most of the men surveyed sustained traumatic brain injuries prior to being homeless, many occurring during their early teenage years. The most common cause of traumatic brain injuries was attributed to assaults. A large percentage of homeless people studied grew up in chaotic households and experienced chronic childhood abuse, contributing to poor school performance, substance abuse, violent behavior, and arrests – as many as half of New York City teenagers who have been arrested have sustained traumatic brain injuries in the past.

What’s more disturbing is that many individuals reported that the harm they suffered as children, including the neurological outcomes, went untreated because their abusers attempted to shield their injuries from others. The statistics, however, do reveal the magnitude of the impact trauma has on the lives of individuals who have sustained such injuries.

The upside of all this research is the new knowledge we have gained, the knowledge that helps us assist the 600,000 homeless surviving on the streets – the confused, scared, lonely and lost individuals who are as human as the rest of us.

 

 

 

 

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What Not to Say to Someone with a Brain Injury

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At the Vermont Brain Injury Conference last fall, a TBI survivor, who sustained his injury years ago, spoke to an audience of nearly four hundred people. He didn’t have any visible scars, difficulty with speech, or an obvious limp to his gait. He spoke clearly and eloquently, and, in fact, was back in school pursuing a college degree. Because he appears healthy and strong, he explained how those without a TBI often don’t know what to say to him when they learn that he sustained a TBI. I recall him saying to the audience something like, “I’m me.” In other words, he was affirming his TBI, not from the perspective of a victim, but from the perspective of an individual who has accepted his disability, who has learned to cope with the challenges he faces each day, and who wants others to know that, though he looks “normal,” he cannot do everything others can do.

He left me thinking, thinking a lot, about how confusing a TBI is for those who do not have one, especially if they cannot see or hear it – the scars, the limp, the slowed speech. We all mean well (or I like to think so), and when we meet someone with a TBI, or any kind of disability, it’s natural to want to offer an opinion or suggestion, even if it’s unsolicited. I’ve done it myself, and I have a TBI. A few months ago, when walking on the treadmill in the gym where I live, a middle-aged woman with a cane shuffled in, one foot dragging along the carpet. The arm on the same side of the dragging foot hung limp. Her speech was slurred when she said hello. I assumed she had had a stroke. I smiled at her and introduced myself. I watched her struggle to lift herself up onto the seat of the stationary bike, and suggested that she might want to try the recumbent bike. She responded with a soft voice, saying that she had trouble adjusting the seat of the recumbent bike. I offered to help her, but she said she could manage herself. “Are you sure?” I asked. “Yeah, I’ll figure it out.” She did. Though I was being helpful, I wasn’t. She needed to figure out, on her own, how to adjust the seat. If she needed my help, she would have asked me.

While we may mean well when interacting with someone who has an invisible TBI, or any invisible disability, there are an untold number of statements we may find ourselves saying (some of them people have said to me), that are not helpful, but hurtful. It can be said that such statements are not only meant as an attempt to be helpful, but also as a diversion from facing our own morbidity, and mortality. For instance, it’s easier to say to someone with a TBI, “But you look great,” than to say nothing at all, which would leave too much space in your mind for thoughts of your own vulnerability.

To learn what not to say to people with a TBI, go to Brainline. This same site offers other communication strategies when interacting with TBI survivors, including those with post-traumatic stress disorder. But please know that by sharing this list, my intention is not to be prescriptive or didactic. Dare I say it … it’s my way of making a suggestion. (Maybe I’m not being very helpful, but I can only hope so.)

Thanks for considering these tips!

 

 

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Visual Art and the Brain

Do you enjoy drawing, coloring, painting? So what if you are not a Picasso or a Van Gogh.  What I’m about to share with you just might inspire you to head out to your local art shop for colored pencils and a drawing pad. Research suggests that creating visual art enhances memory, and improves interactions between certain parts of the brain. Based on feedback from a small group of retirees, improvement in brain functioning may also strengthen one’s psychological state of mind.  This seems logical. After all, as researchers say, “The creation of visual art is a personal integrative experience—an experience of ‘flow,’ in which the participant is fully emerged in the creative activity.” With that integration, brain connections are strengthened, which, in turn, boosts self-confidence.

For individuals with a TBI, art is a form of therapy. It restores connections in the brain damaged by trauma. This restoration process is called neuroplasticity: the changes in nerve pathways of the brain that affect behavior. Yes, we can actually re-wire our brains by intentionally changing the way we think and do things. Since 2010, therapists at the National Intrepid Center of Excellence (NICoE), at Fort Belvoir, Virginia have been using art as a tool in treating war veterans who have sustained TBIs.

Art therapy does more than help to heal an injured brain. Jackie Briggs, a therapist at NICoE says, “For service members who might already have trouble expressing themselves … art therapy gives them a chance to use free expression, allowing whatever needs to bubble up from below the surface to be seen and evaluated.” When thoughts “bubble” up, service members gain a better understanding of their symptoms such as irritability, anxiety, and depression. With that deeper understanding, their relationships benefit, because they are able to effectively unearth their buried feelings and thoughts.

At NICoE, service members decorate blank papier-mâché masks. The reasoning behind using this form of art therapy is based on how trauma works; it blocks the part of the brain responsible for speech and language. The image of the mask itself is tangible, a concrete method of showing how service members are feeling. As one of the therapists at NICoE says, “the masks have given service members a visual voice.” The added benefit is that they know they are not being judged, or critiqued. Making the masks affords them the opportunity to explore, engage in the process of creating something that encourages free expression.

The formof art doesn’t matter. Art is art. Juliet Madsen, a veteran of two wars who sustained a TBI when a roadside bomb hit her convoy, likes to doodle. In an email exchange with her this past fall this is what she had to say about doodling:

Doodling stimulates your creative side, allows your body to calm down, takes the active stresses and puts them on the back burner, can sometimes give you an artistic answer to your problems if you open to it, and gives you a time out… I am a big fan. Once you are an accomplished Doodle Artist take a set of colored pencils to your work or thin point sharpies, then you are really working it.

Juliet inspired me. I bought myself a sketchpad and sharpie and started doodling. I’m now a big fan too!

Are you a doodler, a painter, a sketcher, a creator of masks? If not, why not join in. Grab a sharpie, a pen or pencil, a paintbrush. As Juliet said, “Stimulate your creative side.”

Cheers to free expression, to an integrative experience – and to a healthy brain!

If you want to learn more about the masks service members have created, read the “The Invisible War on the Brain,” published in February 2015 by National Geographic.

http://ngm.nationalgeographic.com/2015/02/table-of-contents

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