In April this year, a woman calling herself Apathetic Idealist wrote to an advice columnist at the New York Times, asking for help in overcoming a sense of political paralysis. This condition, which was keeping her from engaging in “real action”, began in November 2016, when Donald Trump won the US presidential election. “I continue to be outraged by this administration’s treatment of Latinos, Native Americans, Muslims, LGBT folks, women and so many others,” she wrote. “But I’m struggling to summon a response.”
“I have no doubt that many people can relate to your letter. I can relate to it,” began the response from the columnist, Roxane Gay. “It is damn hard to expand the limits of our empathy when our emotional attention is already stretched too thin.”
This seems to be an increasingly common condition. Glance at Twitter or Facebook, and you’ll probably see someone say, “I’m so tired”. There is so much bad news that it feels like we’re running out of emotions. I can relate to Apathetic Idealist, too. For the past several months, I have experienced a creeping psychic exhaustion. “I’m in a numb period,” I tell my friends when they send me frantic texts about the day’s events or ask me how I’m holding up.
It wasn’t always like this. In the months after Trump’s election, my husband, John, printed out the phone numbers of our government representatives in Colorado, where we live, and stuck them on the fridge. We started calling them weekly, demanding, even begging them to fight on our behalf – to defend the Americans with Disabilities Act, to fight the attacks on minorities and immigrants and trans people, to fight for gun control. They were supposed to be working for us, weren’t they? My heart would beat faster as I made these calls, trying to translate my anger and fear into something coherent.
Sometimes the public outcry seemed to work. A rushed Republican bill to repeal and replace the Affordable Care Act – a flawed but important step toward universal healthcare, established under Barack Obama – failed to find support. It felt like a victory. But a few months later, those same senators cut billions from government healthcare programmes under the guise of “tax reform”. I made a number of calls to my representatives about the tax plan, but it didn’t help; this time, the Republicans in Congress had enough votes to pass their plan into law.
I haven’t called my senators in months. It was starting to feel like a waste of time and energy. On most occasions, our Republican senator’s office doesn’t even answer the phone. Most of the time, outrage itself feels largely useless. Stay mad, social media activists like to say. How hard is it to stay mad, I remember thinking last year – just watch 20 seconds of any news clip. But it did, in fact, get hard to stay mad. The news is still horrifying, at home and around the world; I know this intellectually, but the physical feeling of horror is gone.
There’s a clinical name for what Apathetic Idealist and many of us are feeling: it’s called compassion fatigue. Psychologist Charles Figley defines compassion fatigue as “a state of exhaustion and dysfunction, biologically, physiologically and emotionally, as a result of prolonged exposure to compassion stress”. Symptoms include behavioural changes (becoming easily startled, a reduced ability to remain objective), physical changes (exhaustion, anxiety and cardiac symptoms) and emotional changes (numbness, depression, “decreased sense of purpose”). It is an important framework in professions such as nursing, where over-exposure to trauma can lead to health problems for the nurses and worsened outcomes for patients. But it can and has been applied to the general population, too, especially when we are saturated with pleas for attention.
Though the term is relatively new, the idea of compassion fatigue has been around for centuries. As historian Samuel Moyn recently put it: “Compassion fatigue is as old as compassion.” And the anxieties that come with our awareness of compassion fatigue go back just as far. According to Moyn, the 18th-century philosophers and moralists who “rooted ethics in sentiment and sympathy” were simultaneously troubled that “devoting oneself to an ethic of exposure and sensitivity to others’ suffering (or of engagement and action to relieve it) might lead to a numbed ethical sense”. It was partly this worry that emotional fatigue could undermine our morals that led Immanuel Kant to abandon sentimentalism for an ethics based in reason – a more objectivealternative, at least in theory.
The debate around the value of compassion has continued into the 21st century. There are those who argue, following Kant, that a subjective experience of empathy should not be required for moral action, and those who go further, contending that empathy actually gets in the way of morality. But the more commonly held view today seems to be that empathy is vitally necessary, not just for direct human interaction, but as a spur to solve the world’s most pressing problems. Why would we come to the aid of people who are suffering, the thinking goes, if we don’t on some level feel their suffering, too?
If it is true that empathy is a necessary motivator for making the world a better place, what happens when we feel bombarded every day with the details of local and global disasters, with every shocking crime, political scandal and climate calamity here and abroad? The war in Syria. Refugee crises. Melting sea ice. Professionals on the frontlines of trauma are trained to watch for signs of “compassion fatigue”, but lately it feels as if everyone is at risk. After a year of news addiction that left me with insomnia and heart palpitations, I’m starting to detach. Is there any way around it? What happens when the world wants more empathy than we can give?
The term “compassion fatigue” first appeared in print in a 1992 article by the writer and historian Carla Joinson. While observing nurses in emergency departments, Joinson noticed “a unique form of burnout that affects people in the caregiving profession”. A nurse named Jackie had recently lost her favourite patient, despite “desperate efforts” to save her. Afterwards, Jackie had complained of “lingering feelings of helplessness and anger”. Likewise, a surgical nurse named Marian reported going through a period of “despair and frustration” that almost drove her to leave the profession – until she started to practise a kind of strategic remove.
Before it had an official name, something similar to compassion fatigue had been recognised in medical literature. By 1980, the Diagnostic and Statistical Manual of Mental Disorders claimed “knowing of others’ traumas can be traumatising”. Though it was not yet well defined, there was a sense that proximity to trauma could itself be damaging, like secondhand smoke.
In the early 90s, Figley explored these ideas further. He identified how professionals providing “empathic support” to people with post-traumatic stress disorder can themselves begin to exhibit some of the same symptoms as their patients, such as anxiety and other emotional changes. According to Figley, trauma spreads to people who work in areas such as healthcare – not only because they are more likely to be exposed to those who are traumatised, but because caring is often inherent to their sense of self: empathy as a liability. Figley, who had served in Vietnam, went on to adopt and popularise Joinson’s term, and became a major advocate for compassion fatigue awareness.
If you have ever cared for a sick parent, or child, you might recognise the symptoms of increased stress: the bad sleep, bad moods, bad stomach. I have experienced compassion fatigue as a caregiver myself. My husband has a chronic illness, and when he started getting ill, several years ago, we didn’t know what was wrong. He would be struck with sudden vertigo and trapped on the couch, panicked, for hours. On other days, he was too dizzy to drive, or too unsteady to walk without a cane. Even more worryingly, his hearing started fluctuating, the levels changing from day to day, sometimes better in one ear and worse in the other. This made his work particularly difficult – he was teaching at a university at the time. Throughout it all, he had roaring tinnitus, which he compared to hair dryers, vacuum cleaners, jet engines, sirens, and on one occasion, a UFO landing. Some days he could barely hear anything, and it seemed that any day, he might wake up with no hearing at all, unable to work or communicate, even with me. John was in his 30s.
Because he couldn’t reliably drive or talk on the phone, I became John’s assistant, ferrying him to class when he was well enough to teach, cancelling his classes when he couldn’t leave the house, calling doctors and insurance companies, driving to appointments. I still had a full-time job, too. I hated these new and sudden demands on my time and energy, but I hated even more how easily frustrated I would get. If he asked for help when I was busy, I would snap at him, then feel awful about it. Many nights we stayed up late, exhausted; we lay in the dark side by side, worrying and arguing.
“Stress” doesn’t quite capture this era in our marriage; we felt terror and despair. I was afraid for John, yes, but I also felt alone, starved of compassion. I remember thinking (and maybe saying, shamefully) that I wanted someone to take care of me. I was pouring all my emotional resources toward John, and it seemed that he was hoarding his, spending all his feeling on himself. (And wasn’t that natural? Aren’t there times when we deserve to collect, rather than pay out, sympathy?) Studies have shown that stress, anxiety and uncertainty can reduce our levels of empathy. But it felt more like my empathy was being used up faster, due to greater demand.
The effects of compassion fatigue on healthcare workers are real and documented. Left untreated, it leads to reduced quality of care, an increase in clinical errors, and high employee turnover. Caregivers take these symptoms home, as well, harming their relationships with friends and family. Accordingly, caregivers are instructed to monitor themselves for signs of compassion fatigue. A textbook authored by Figley includes self-assessments to test your “ego resiliency”, “self-compassion” and “post-traumatic growth” – that is, the “positive changes that some trauma survivors report as a result of the struggle to cope with traumatic events”. In the US, there seems to be a fixation on these positive narratives; thus, after a terrorist attack or similar disaster, some will claim it has made them “stronger than ever” – the Hollywood ending for real-world trauma.Caregivers are coached to follow various established guidelines of self-carein order to ward off compassion fatigue, or to recover if it has already struck. These include physical, psychologicaland social commitments such as maintaining healthy eating and sleeping habits, making time for relaxation and meditation, and building a social support network, including at least two people who can be counted on to be “highly supportive”. If trauma is communicable, one hopes those supporters have a support network of their own.
“On any given workday, I’m interacting with many people who are literally having the worst days of their lives,” says an acquaintance of mine who works as a hospice nurse. But she is conscious of the risk of giving any one patient or family too much of her attention and energy. “I don’t try to put myself in my patients’ shoes or try to feel what they’re feeling – although this sometimes happens anyway,” she told me. “I need to maintain my emotional endurance by not using it all up in my first years of being a nurse.”
My day job is nowhere near that harrowing; I work in marketing. But when I try to keep up the work of an informed citizen, I too feel that my emotional endurance is being tested. There’s a sticky note on the wall by my desk that says: “BE AN ACTIVIST.” It has been there so long that I hardly see it anymore. I worry sometimes that I haven’t paced my outrage.
Not long after compassion fatigue emerged as a concept in healthcare, a similar concept began to appear in media studies – the idea that overexposure to horrific images, from news reports in particular, could cause viewers to shut down emotionally, rejecting information instead of responding to it. In her 1999 book Compassion Fatigue: How the Media Sell Disease, Famine, War and Death, the journalist and scholar Susan Moeller explored this idea at length. “It seems as if the media careen from one trauma to another, in a breathless tour of poverty, disease and death,” she wrote. “The troubles blur. Crises become one crisis.” The volume of bad news drives the public to “collapse into a compassion fatigue stupor”.
Susan Sontag grappled with similar questions in her short book Regarding the Pain of Others, published in 2003. By “regarding”she meant not just “with regard to”, but looking at: “Flooded with images of the sort that once used to shock and arouse indignation, we are losing our capacity to react. Compassion, stretched to its limits, is going numb. So runs the familiar diagnosis.” She implies that the idea was already tired: media overload dulls our sensitivity to suffering. Whose fault is that – ours or the media’s? And what are we supposed to do about it?
By Moeller’s account, compassion fatigue is a vicious cycle. When war and famine are constant, they become boring – we’ve seen it all before. The only way to break through your audience’s boredom is to make each disaster feel worse than the last. When it comes to world news, the events must be “more dramatic and violent” to compete with more local stories, as a 1995 study of international media coverage by the Pew Research Center in Washington found.
Advert-supported media channels survive on attention, and this leads to sensationalism and images meant to shock: starving, bloated children, cities ravaged by war. But these images, by design, are upsetting, and eventually we turn away – a form of self-preservation. And when a story isn’t hot any more – that often meant low newspaper sales in the 90s; now it would be judged by a lack of clicks – the media tends to move on. As Tom Kent, a former international editor with the Associated Press, tells Moeller: “We cover things until there’s not much new to say.” In other words, crises often get boring before they get better.
In 1991, Moeller says, Americans focused more on cyclones and earthquakes than other, slower global crises, such as famine in Africa, because they saw the natural disasters as “one-shot problems with specific solutions”. There were clear ways to help, finite amounts of aid that would make a substantial difference. Famine, on the other hand, had been going on for years, despite it being a cause célèbre in the 80s, when benefit concerts and charity records had raised tens of millions of dollars of humanitarian aid. For many people, it had probably come to seem like an intractable crisis.
The fact that coverage of slowly unfolding, complex disasters tends to be limited is a problem; that the public aren’t interested is another. But there may be a good reason for both, beyond moral decrepitude. Numbness or indifference to real atrocity may, from the outside, seem callous. But as Figley has argued, compassion fatigue, in the medical sense, stems from a desire to help. There is no compassion fatigue without compassion: the caregivers at risk see somebody suffering, and they want to reduce that suffering. But they can’t always succeed. Compassion fatigue, then, is stymied compassion.
If caregivers are at risk because they give care to the traumatised, then empathetic news consumers are at risk because they consume the news. Just opening Twitter on your phone, or looking at the TV in a bar, exposes you to enormous problems you can’t possibly solve. Perhaps you can help, but the difference that an individual contribution makes – placing a call, voting, going to a protest – often feels imperceptible.
Compassion is generally seen as pure virtue, but is it always selfless? In The Science of Evil, psychologist Simon Baron-Cohen cites multiple studies that reveal an “empathy circuit” in the brain. These are the parts of the brain that usually activate when, for example, we look at a needle piercing someone else’s hand – the psychology-experiment version of watching the scene in Un Chien Andalou, Luis Buñuel’s surrealist film in which a man appears to slice through a woman’s eyeball with a razor. (It’s actually a sheep’s eye.) I cringe and look away because on some automatic level I imagine it happening to me. In some sense, having empathy is a way of feeling compassion for myself.
Human propensity to empathy, Baron-Cohen claims, much like height and other traits, follows a normal distribution, the so-called bell curve. This means that a select few people have extraordinarily high levels of empathy – he offers anti-apartheid activist Desmond Tutu as an example – while some at the other end of the curve have zero empathy, including people with narcissistic personality disorder and psychopaths. (My mother once told me she had read that the two professions that test highest for psychopathy are surgeons and Buddhist monks – presumably because both require detachment. It sounds like dubious science, but does suggestanother way in which empathy can be a liability: a barrier to objectivity or enlightenment.) The fact that most people are in the middle of the curve, Baron-Cohen writes, suggests that “moderate empathy levels are most adaptive”. Most adaptive for what, we might ask – proliferation of the species, or good ethics? And are policies that favour local proliferation actively harmful to populations farther away?
Average empathy will fail some of the time; we will fail to feel what others are feeling, as the hospice nurse I know put it, even if we try. And this may be a rational response, whether consciousor automatic. Empathy, like any bodily process, has a cost. Hunger would be meaningless if it didn’t make you eat. What good is compassion if it doesn’t translate into concrete, external action? Perhaps it is rational to cut off the supply of emotion if it amounts to wasted energy.
Can compassion fatigue be avoided, given our unprecedented access to appalling events around the world at every moment? Searching for solutions to apathy in the age of daily mass shootings, I found an article by a family therapist, written in November 2017:
“Can I be honest? When I read that [many of] the victims of the mass shooting at a church in Sutherland Springs in Texas were children, I paused, then turned the page, disgusted and angry. Not just at the shooter, but at the people who died as well. It’s awful to admit this, but I can’t shake the thought that people died because they refused to listen to social scientists who kept telling them that guns cause gun violence.”
The therapist identifies his victim-blaming reaction as a classic case of compassion fatigue, then outlines some solutions to the syndrome. First, the therapist suggests it is necessary to “personalise the tragedy”. “Read the stories of each of the dead and connect with them as people, not nameless victims. This simple act of reading their stories can maintain compassion and protect us from apathy.” (Can it, I wonder? This could be effective for any given mass shooting, but if we read up on the victims of every mass shooting, won’t the hundreds of details begin to blur together?) Secondly: “Be outraged … Don’t give into the desire to withdraw.” (This seems like telling someone the solution to cancer is “don’t have cancer”.) And third: “If you are still feeling burnt out emotionally, look for a tragedy closer to home.”
This last tip struck me as particularly inane, as though compassion were an end in itself. Shouldn’t we fight compassion fatigue because we worry that paralysis and apathy will make the world worse? I don’t hope to increase my empathy for its own sake, especially by way of nearby tragedies. In any case, the tragedies are there – my husband’s condition has been diagnosed, but that’s what he would call a pyrrhic victory; the condition is deteriorating and has no known cure. I have a friend whose wife is dying of cancer; he has had to pay for her treatment through crowdfunding campaigns. This isn’t unusual. Everyone has their own local tragedy.
Moeller claims compassion fatigue is not inevitable, and that the media can fight it by providing coverage that is neither formulaic nor sensationalised. “More graphic is not better,” she writes. Sontag, for her part, believed fatigue was a reasonable response to a barrage of terrible images: “Someone who is perennially surprised that depravity exists, who continues to feel disillusioned (even incredulous) when confronted with evidence of what humans are capable of inflicting in the way of gruesome, hands-on cruelties upon other humans, has not reached moral or psychological adulthood.” In this view, compassion fatigue is a coming of age.
On the other hand, if we feel entitled to apathy, or even self-righteous about our apathy, it can become an easy excuse for moral laziness. In 2000, the New Yorker published a cartoon that showed two men in suits walking past a disgruntled-looking homeless man asking for money. One suit says to the other: “Here I was, all this time, worrying that maybe I’m a selfish person, and now it turns out I’ve been suffering from compassion fatigue.”
I have reached the point where being shocked feels normal; it is a fact I hold in my mind but don’t feel in my body. I would like to follow the guidelines of self-care, to preserve my “emotional endurance”, not as a professional caregiver, just as a regular person who cares about the world. So I take breaks and try to reduce my stress. I go out with friends, I watch old poker tournaments on YouTube. But my breaks are getting longer. They feel dangerously close to avoidance.
That distance is better, I suppose, than feeling hopelessly enraged. But what is my responsibility? How much am I supposed to know about global suffering, and what can I really do with that knowledge? Social media, 24-hour news, alerts on my phone – the demands on our compassion are much higher than a caveman or Kant had to contend with. It is overwhelming, even paralysing, and very likely makes me less effectual in the local spaces where I might actually be able to do some good. Whether or not I keep up with everything happening everywhere, all the time, I know that the information exists; that awareness alone is fatiguing. It’s very easy to succumb to fatalism, which is perhaps the logical extension of compassion fatigue – believing that we’re screwed no matter what we do is mysteriously tempting.
Do we need to feel bad in order to do good? The psychologist Paul Bloom, who wrote a book called Against Empathy, argues – or perhaps hopes – that we can be moral without depending on empathy, which is biased and unreliable. We shouldn’t dole out aid in accordance with the amount of sympathy we feel for people; we should help the people who need the most help. The answer, in Bloom’s mind, is not to dial up our sympathy for everyoneto unsustainable levels, but dial it down so we can approach problems more logically. Even Baron-Cohen, who equates “empathy erosion” with evil, concedes that there are people with zero empathy who are also rigidly moral; they do it by systematising right and wrong. This seems to prove that good ethics don’t depend on the feeling of empathy. However, most of us are not that systematic.
On New Year’s Day in 2017, John and I invited an activist we know over for dinner, an older man with much more experience in organising than us. While they talked and planned, I cooked and drank wine and grew maudlin. “Stop despairing!” our friend snapped at me. “That’s not a strategy.”
The next time I saw him, a couple of months later, he apologised for having raised his voice and conceded that there are many forms of activism. “Maybe writing can be yours,” he said. I had skipped several public protests in the interim, feeling I had too much other work to do. But I was heartened that people I knew attended. I liked the photos they posted on social media – I felt inspired by the size of the crowds, knowing others had the time and energy to march in the streets for what we all believed.
It is comforting to think that when we’re too fatigued to fight, someone else will take the lead. It is, perhaps, too comforting.