Imagine This…

by Dr. Mary Schoenfeldt

Trauma, Resilience, Self-Care, Burnout, Compassion Fatigue, PTSD and Post Traumatic Growth… all common words these day, aren’t they? They have become such everyday familiar words we use them freely in conversation, but what do they really mean? And more importantly, why does it matter to you?

Imagine this… your home is destroyed in a disaster… or your community is shattered by an unimaginable act of violence against innocent people. You watch responders of all kinds drive 100 mph hour with lights and sirens blaring to the scene to help. You think this is the worst it can possibly get. But you are wrong, the worst moments are after the responders have done their initial jobs, and now the reality of the situation begins to set in, and you realize it isn’t over yet… it really is just beginning as you grapple with what has to be done and you aren’t sure you are up to the task. You don’t even know where to begin.

This is the experience of those who look to others for help to manage the unimaginable or try to make sense out of the senseless.

How do you cope? Who comes to help? How do THEY cope? What skills will be needed?

CAN YOU HELP? The answer to that last question is a definite YES. There are many professional and not professional helpers… Emergency Managers, Health Care, Behavioral and Mental Health Specialists, Land Use Planners, Law Enforcement, Teachers, Early Childhood Educations Specialist, Senior Care Managers, Firefighters, Transportation Specialists, Food Service Managers, Clergy, Volunteer Program Coordinators, Housing Specialists.. the list goes on and on of those who contribute to community recovery and resilience following a crisis or disaster. The HSEM Program can integrate all those disciplines by collective education and coordination. We need you.

When we talk about disasters either as professionals, non professionals or community members, our conversation is peppered with words like traumatized, resilient, compassion fatigue and so on.

Let’s start with definitions as each of our words that have taken on new meanings over the past few years.

Trauma is defined as a perverse problem that results from exposure to something that has long lasting adverse effects on the individual functioning. Research of brain science tells us trauma can change the neurological paths in the brain. But recently it has come to be interpreted as most anything that negatively impacts us emotionally. Although experiences of all kinds… disasters, pandemics, abuse, or impactful experiences can be hard to handle and leave a lasting impact, many don’t meet the clinical definition of trauma BUT, can be managed to reduce the impacts.

Resilience is the ability to bounce and adapt. The core ingredient of resilience is to be flexible and adaptable under stress. Think about a rock and a tennis ball. If you throw the rock down to the ground, it stays there but if you throw a tennis ball in the same place, it bounces back. What’s the difference? The material in the tennis ball can absorb the pressure of hitting an unmovable object (the floor), adjust its shape, transfer the energy and use it to recover and move in a different direction. Notice something else though, the tennis ball doesn’t come back to the exact same place…your hand. Where it goes depends on multiple factors, the force it left your hand, the direction it was pointed, and the overall environment it’s in. So it is with resilient people, organizations and communities. Stress and pressure will change them, but having the agility and ability to adjust and adapt will make the difference.

Self-Care is really about putting yourself on your own list. And that takes courage. To put yourself on your own list in a culture that encourages… no almost demands… multi-tasking, doing for others, being involved in multiple projects or organizations, working, going to school, managing a family with all their individual demands, walking the dog, and being available if someone needs something day or night is challenging to say the least. Self-care is more than the occasional bubble bath or 20 minutes to sit down and read a book.

Self-care is courageously setting boundaries that say, “I’m not checking my phone for emails after 6 pm in the evening. I’m going to add some form of additional physical activity into my schedule every day for at least 10 minutes. I’m going to make that doctor or dentist appointment I’ve been putting off because I’m so busy doing other things I can’t see how I can fit one more thing into my calendar.” It’s saying, “Yes, you are on my list of priorities, but so am I”. It takes courage, but you can do it.

Now let’s talk about Compassion Fatigue and Burnout as these terms are often interchanged to mean the same thing.

They aren’t. They are two very different conditions and require separate measures to mitigate them.

Compassion Fatigue is the cost of caring, and the vehicle of transmission is empathy. The bigger your heart and your desire to make a difference for someone who might be suffering, the more vulnerable you are to compassion fatigue. Compassion, by definition, has two components, first, the ability to notice if someone seems to be suffering, and second, the desire to make a difference for that person and alleviate their suffering. There are many good people who may not be compassionate to others… they simply don’t notice others’ pain or feel as though they want or need to do something to lessen it. And there are others, maybe like many of us, who can’t look away from someone who is hurting or stop themselves from wanting to help. Compassion Satisfaction is what we get when we notice, do something, and know we’ve made a difference, and it energizes us. We are excited to get up in the morning and feel proud of ourselves for what we do and who we are.

But being compassionate is exhausting. We can move from compassion satisfaction to Compassion Fatigue. The more we encounter others’ pain, the more we listen. We work to alleviate their stress and pain, and we will begin to take on their stories. One person’s experiences adds to the top of another and then another and another. The load gets heavier and heavier, and if we don’t do something to interrupt that process, it becomes chronic for us.

Think about holding a glass of water.. hold it in your hand with your arm extended in front of you. Then ask yourself, “How heavy is it?” Can you hold it there? Can you hold it for two full minutes? What about for 10 full minutes or even 20? My guess is you started by saying, “Sure, I can hold that glass of water,” but as time goes by, the demands became greater, and it became more and more difficult to the point that at 20 minutes, you may have even done some physical damage to your shoulder! Now let me go back to the original question.. how heavy was that glass of water? What changed as time went on? The answer would be that the difference was not how heavy it was in the first place but how long you were holding it. That’s what it is with compassion fatigue.. it’s not what we do but how long we do it without making adjustments or taking a break.

With the water, we might set it down for a few seconds, adjust our arm to a different position, prop our arm on something, or support it with our other hand. We might even hand it to someone else and ask them to hold it for a few minutes while you take a break and physically move those sore muscles from holding it.

To go on with the water analogy, know that you will need to pick that glass up, again and again, to continue holding it.. that’s who you are. Compassion Fatigue management works the same way… set boundaries, step away for a bit, ask for help now and then, physically move and know you will pick up where you left off and keep doing what you do. The ideal for us is to balance that compassion satisfaction… I make a difference… with the compassion fatigue that comes with it by intentionally managing the consequences.

Compassion Fatigue is the kind of tired that a good night’s sleep won’t fix.

Burnout is most often about the system or organization we work for. It’s the sense that our environment doesn’t support what we do. We stop trying, and we do our jobs in a perfunctory manner… we do it as a routine duty with little interest or care. We don’t have a sense of control over how we function or what we do or are asked to do tasks that conflict with our sense of self. Burnout is often associated with a lack of support from management. The primary difference between Compassion Fatigue and Burnout is that Compassion Fatigue is about us managing our stress and pressures, and Burnout is about the system we are in. The management activities are different for each.

Now imagine this, the disaster hits our community, and those professional, non-professional helpers and community members come together as a coordinated and knowledgeable group to work together to mitigate the impact of that disaster. Will some in our community be traumatized? Yes, they will. Will some of our responders experience compassion fatigue as a result of the work they do? Yes, they will. Can our community be resilient and bounce back, maybe even in a better form? YES! Especially if we all connect and learn from each other now and coordinate when that disaster hits.