Compassion fatigue is normal during abnormal times

In recent weeks even the most cautious members of my family, friends and colleagues have started to relax their stringent adherence to Covid-19 safety measures. They are arranging social gatherings, travelling across the country, returning to work, shopping with greater freedom, washing their hands less frequently and even leaving their homes without wearing a mask.

This is in stark contrast to the vigilance we exercised in the early days of our national lockdown. Remember when you would wash every item you brought back from the grocery store? Or when no more than two persons could travel in a vehicle, and the passenger sat in the back seat? Or when we ran in circles on our balconies and backyards to get our exercise? Being careful seemed so important and necessary! After all, we were protecting ourselves, and others, from being infected with a possibly deadly virus.

When South Africa went into lockdown on March 26, we had only 218 reported cases of coronavirus infection. The first two Covid-19-related deaths were reported a day later. Understandably, we were shocked and afraid. I am sure we can all remember the first time that we heard of a relative, friend or co-worker who was infected with the coronavirus. Some of us have also had to suffer the loss of family and friends who succumbed to Covid-19. And of course, some of us are among the nearly 593 000 (at time of publication) people who were infected with the virus and have recovered (approximately 663 000 people were infected).

The pandemic is not only a health tragedy in South Africa. It is also an economic disaster, putting further strain on an already faltering economy. The media has reported  large scale suffering from hunger, the brutality of increased gender-based violence, the loss of job security for many South Africans, and the failure of our education system that has left teachers vulnerable and learners even further behind in their schooling. It is likely to take decades to address some of these problems. This will almost certainly be hampered by ongoing corruption in both the government and the private sector.

Yet for the majority of South Africans life seems to be “returning to normal”. We have numbed ourselves to the images of frontline workers dressed in personal protective equipment caring for desperately sick people in hospitals. We hardly seem to notice when the daily news reports that another 100 or so people have died as a result of Covid-19 overnight, and that the death toll now sits at around 16 000. These are no longer the faces of people – they are just a number.

Why have we stopped caring?

We are suffering from a condition known as compassion fatigue. Compassion fatigue is common among those who are constantly exposed to unresolvable suffering. It is most often reported in the so-called caring professions (nurses, doctors, social workers, religious leaders). Research has shown that when a person is constantly confronted by suffering, their response to the suffering becomes less pronounced over time. This is the body’s way of coping with the pain and trauma of witnessing and experiencing the suffering of others.

When we see someone suffer, or hear about someone suffering, a part of our brain is activated that causes us to recreate the experience of the other person in our own imagination. We feel something of their pain. This is a pre-cognate reaction – in other words it happens in that deep part of our brain that responds to pain without thinking. This capacity for empathy is believed to have evolved in all mammal brains (to different degrees) in order to evoke the responses of care and the avoidance of danger.

When we imagine the suffering of another, we are instinctively motivated to avoid it ourselves. We also tend to shield those that we care for from harm. Similarly, when we see someone suffering, we are also instinctively prompted to help them ease their pain. The offering of care and the avoidance of pain have served to preserve life and so they have become hard-wired into the functioning of our brains.

However, my research, and that of others, shows that while our brains are wired for survival and the avoidance of pain and threat, they also adapt to avoid emotional pain and psychological threats. Over time, as we are exposed to ongoing pain and suffering of others, we become less and less sensitive to it. Our emotional reaction to their pain is less severe. We rationalise what we hear and see, moving from the emotional centre of the brain to the cognitive and rational functions. 

Over time, we are no longer shocked to hear that 100 people died in the last 24 hours from a virus that each one of us could be infected with. We are no longer thinking about 16 000 individuals  ̶  mothers, fathers, sons, daughters  ̶  who have died; we are thinking about a number, a statistic.

Research further shows that compassion fatigue can also occur in groups – such as communities, or nations. For example, a community may become accustomed to certain forms of suffering, or abuse, and normalise them. 

Gender activists frequently point out the abnormally high rates of rape, femicide and gender-based violence in South Africa. In America, for example, the frequent mass shootings, or the killing of black people by the police, are rationalised and diverted from painful experiences into political debates.

Compassion fatigue on a personal and a structural level can lead to a loss of perspective. It may cause us to mis-recognise the humanity of others, hindering us from adequately and effectively responding to suffering and pain. Just as we would not want to be treated by an uncaring doctor or nurse, we also should not want to live in a society that does not care about the suffering of its fellow citizens.

In his 1947 novel The Plague, Albert Camus tells the story of the arrival of a plague in the Algerian city of Oran. After facing great tragedy and hardship, the citizens of Oran start to normalise their lives. Camus, however, uses his novel to illustrate how abnormal some aspects of their normal lives actually are.

It is important that we recognise when compassion fatigue starts to set in. We must guard against it in our closest relationships, and also name it when we see it in our communities and social systems. 

To show compassion requires an ongoing choice to recognise the humanity of those who suffer. It requires the courage to face pain and discomfort. To create a more compassionate society, we will have to face the reality of our shared humanity, our shared frailty, and our need for one another. We will have to avoid the instinct to escape or simply ignore what causes pain and suffering. In these difficult times we could all do with a little more care, a more humane and compassionate society.