CHAPTER 3
What about Me?
The Importance of Self-Care
The Peace of Wild Things
When despair for the world grows in me
and I wake in the night at the least sound
in fear of what my life and my children’s lives may be,
I go and lie down where the wood drake
rests in his beauty on the water, and the great heron feeds.
I come into the peace of wild things
who do not tax their lives with forethought
of grief. I come into the presence of still water.
And I feel above me the day-blind stars
waiting with their light. For a time
I rest in the grace of the world, and am free.
—WENDELL BERRY*
I HATE TO FLY, so I am one of those nervous airplane passengers who reads all the emergency instructions and listens intently to flight attendants when they demonstrate how to put on an oxygen mask. “Put on your own mask before you help others,” they remind us. In his poetic way, Wendell Berry urges us to do the same thing: stop, rest, and catch your breath when you are feeling overwhelmed, fearful, and worried. As the Bible says, restore your soul by still waters. This is the essence of Self-Care: be tender with yourself so you can be more compassionate toward others.
Self-Care might seem like a lofty goal for those whose lives have been uprooted by trauma. When trauma strikes a loved one, or when the effects of trauma build to a crescendo over time, family and friends are thrust into the role of caregiver—a role they probably aren’t prepared to assume. I remember telling a friend that I felt lost in the “bewilderness” when Michael was diagnosed with PTSD. In an effort to do everything they can for their loved one, caregivers frequently neglect their own needs. Things are already out of balance because of the trauma itself, and as more and more focus is directed toward their loved one, this imbalance grows even greater. In the words of one firefighter, “Sometimes your ‘trauma trunk’ just gets too full.”
We’re so worried about my cousin who has been trying his best to care for his partner who was diagnosed with PTSD from the effects of a chronic illness. On top of everything else, they had a house fire and lost everything and had to move out for ten months, so now they’re dealing with that trauma too. He’s got to handle all the insurance problems, the house reconstruction—everything—by himself. They live in a little town four hours away, so they’re pretty isolated. He sounded so down and exhausted when we last spoke with him and scared us a little when he said, “I don’t think I can do this any longer.”
Whether a loved one’s trauma symptoms manifest immediately or show up years later, education and good Self-Care are essential tools for coping with the shock wave effects of trauma. Dormant symptoms that could reemerge after an event or a sudden personal loss might be milder and more temporary if you and your loved one have prepared yourselves by learning about triggers and ways to minimize the damage of retraumatization.
While our individual circumstances are as varied as our individual stories, I am willing to bet that if you made a list of things to take care of today, you would not be on it. Caring for a trauma survivor with deep psychological wounds is a demanding and often thankless task because at times they may be incapable of feeling anything, let alone gratitude. They might be sullen or angry, and that anger may be directed at you because they haven’t yet uncovered the root of it or recognized it as a trauma symptom. They may not be able or willing to work through difficult problems or interactions in a loving way with you and other family members. They may also be in denial about their post-traumatic symptoms.
My husband has PTSD, and sometimes I feel like a single parent. One day when I had a lot of errands, I asked him if he would vacuum. I came home after dropping my daughter off and he still hadn’t done it. When I asked him about it, he blew up, yelling, “I’ve always gotta do everything onyour time.” He grabbed the vacuum and just kept shouting, “Happy now? Happy now?” If I didn’t have God, I’d be locked up right now. I suffer from depression and anxiety issues, yet I’m working full time, running the household, doing yard work, and trying to raise children.
Balance and Boundaries
After many years of relative silence about his combat experience, there came a time when it seemed like all Michael thought or talked about was Vietnam. On the surface, I appeared to be the picture of encouragement, but things got out of balance. My resentment grew in direct proportion to my “selflessness.” I gave up my computer and office so he could write about war. I stayed out of his way. Sometimes he’d wake me up late at night to read me what he’d written, and I’d listen, both as a supportive spouse and as a writing teacher. When I tried to talk about my feelings or my writing, he’d often cut me off, interrupt me, or tell me to go to sleep. I shrank further into his shadow, wondering, when will it bemy turn?
Trauma throws lives and family dynamics off balance and can shift the healthiest of boundaries. Appropriate boundaries are the way we differentiate ourselves from others. They protect and preserve our individuality and help us keep our self-esteem intact. When trauma comes, appropriate boundaries are easier to describe than they are to set. Trauma survivors might establish rigid boundaries, shutting out those who care for them the most. On the other hand, their family and friends might have few boundaries or forget about boundaries altogether as they focus more and more on their loved one and less and less on themselves.
Messages we received as children about rules and boundaries might be reactivated, and we find ourselves responding to the trauma in much the same way we saw our parents and even grandparents handle crises when we were kids. I came from an enmeshed family system with weak boundaries where members got all tangled up and involved in each other’s problems and lives. Michael, however, came from a disengaged family system where isolation and secrets were the norm. As his trauma symptoms grew more severe, he retreated. In an attempt to rescue him, I invaded. Michael was too numb to know his needs, let alone express them. I knew my needs, but suppressed them in favor of what I imagined his needs to be.
Healthy boundary setting often starts by reminding yourself that you didn’t cause your loved one’s trauma, and—as much as you may want to—you cannot cure it. Remember the Serenity Prayer? Change what you can change.
My brother has definitely challenged my boundaries and tested my boundary-setting skills. I think this is because of his PTSD. But the more I learn about trauma, the better I’m getting at setting appropriate boundaries with him. It’s still hard, but I keep trying because it’s important for me to have a relationship with my brother.
Simply put, when we set boundaries, we set limits. We learn when to say no, and when we say yes, we do so out of choice, not guilt or obligation. As we become more aware of our own needs and feelings, we become more respectful of others’ needs, feelings, and limitations. We concentrate more on improving ourselves and less on controlling or fixing a loved one. Setting boundaries is such a grown-up thing to do!
A dear friend modeled healthy boundary setting on a recent visit. When the National Guard fired shots on May 4, 1970, that killed four Kent State University students in Ohio, he was close enough to see one of them fall, and rushed to her side to help. She died as he tried to hold her neck together until the ambulance came, and he still harbors the memories of that traumatic experience. When we asked him to join us at a rally a while ago, he grew quiet and seemed a little anxious, but was able to explain how political gatherings are one of the triggers that reignite the trauma of that day decades ago. He didn’t make up an excuse or risk a relapse of symptoms by thinking he had to come along to please us. We so appreciated his honesty, and because he was so clear, we were able to give him our genuine support. He honored his boundaries by staying home; we honored ours by going.
We take care of ourselves when we accept responsibility for the consequences of our own actions and reactions, and sort out what we can and cannot control. By taking personal responsibility, we move beyond blame and shame. We are bound to make mistakes, but we don’t punish ourselves unmercifully for them; we learn from our mistakes and move on. We learn to quiet that incessant chatterbox inside our head that drones on and on with negative self-talk, and replace it instead with a loving voice that convinces us we are strong and worthy. We understand that we have choices, and that we can choose to take the path that contributes most to our personal growth and happiness.
Signs and Symptom of Stress
I have a cartoon on my office wall of a zebra gazing back at his rear end with alarm because his stripes are coming off, unraveling like a ribbon. The caption, “I think I’m having stress!” makes me smile and serves as a reminder that unless I take care of myself, stress can creep in, threaten my health, and possibly lead to depression.
We know from the volumes that have been written on stress management that we all need to get enough sleep, eat nutritiously, and exercise. Yet naps, vegetables, and yoga are probably the last things on your mind as you try to keep your household running smoothly in the aftermath of a loved one’s trauma. You may have growing financial concerns if your loved one is unable to work. Your own job performance may suffer because your home environment is chaotic. Your loved one’s insomnia or nightmares might be disrupting your sleep, and you find yourself exhausted during the day. You might be angry or frustrated because your loved one refuses to get treatment for post-traumatic symptoms. Or—if they are getting treatment—trauma issues could seem to loom even larger as they devote necessary time and energy to therapy and you are left to deal with day-to-day family matters.
We worried constantly about my sister when her young son was diagnosed with terminal cancer. My brother-in-law went to pieces and couldn’t work, so in addition to the emotional turmoil she was having, she had to worry about how she was going to pay the bills, keep her job, care for her son and her other two kids, and keep her marriage together. The family tried to help her, but we all live across the country, so it all fell on her.
Left untended, long-term stress can lead to serious health problems. Among other things, stress can raise blood pressure, suppress the immune system, increase the risk of heart attack and stroke, give you headaches and stomach problems, disrupt your sleep, or lead to eating disorders and depression.
Review the following list of common warning signs and symptoms of stress to see how close you are to stress overload:
Cognitive Symptoms
- Memory problems
- Inability to concentrate
- Lapses in judgment
- Pessimism
- Anxiousness
- Constant worry
Physical Symptoms
- Aches and pains
- Diarrhea or constipation
- Nausea, dizziness
- Chest pain, rapid heartbeat
- Frequent colds
Emotional Symptoms
- Moodiness
- Irritability or short temper
- Agitation, inability to relax
- Feelings of being overwhelmed
- Sense of loneliness and isolation
- General unhappiness
Behavioral Symptoms
- Eating too much or too little
- Sleeping too much or too little
- Isolating yourself from others
- Using alcohol, cigarettes, or other drugs to relax
- Acting out nervous habits, such as nail biting
It’s important to see a doctor for a full medical evaluation if you are experiencing a number of these symptoms. The longer you ignore them, the more serious they can become.
Think of stress as the tension on a violin string. If there is too much tension, the string snaps. If the string is too loose, the sound is listless and hollow. Again, it comes back to balance. A little stress can energize us and keep us sharp; too much stress can break us. When we tune into our bodies and our minds, slow down a little, and take care of ourselves, we strike a balance. We realize that we can compose the music of our own lives.
Stress Management
We can’t eliminate stress completely, but we can learn to identify it and reduce it using some simple tools of Self-Care. Just as parents give their children a timeout when they get overstimulated, we can give ourselves a timeout when a stressful situation arises by counting to ten, breathing evenly and deeply, or perhaps changing the subject—all strategies that can release and shift the tension of the moment. Adding something beautiful to our lives like music or flowers, and taking time to breathe in and focus on the beauty, can also create an emotional shift.
Gardening is very powerful for me—digging and connecting physically with the earth to participate in the creation of something beautiful or nourishing is very healing. It is like trauma had the power to take away the ground beneath me. Feeling and actively living with that ground brings some core strength within me “back home.”
If possible, try to get outside at least once a day for a short walk or a quiet moment. Wear comfortable and loose clothing whenever possible. Try to eat nutritious and regular meals, and avoid abusing alcohol or drinking too much caffeine. Try to get enough sleep. Find a safe place to feel, express, and embrace your feelings. Consider a warm bath or getting a pedicure. Watch a light-hearted movie, and laugh. Laugh often.
Another stress-busting technique is contained in the two-letter word “no.” It’s perfectly okay to decline an invitation occasionally, to tell the PTA president you aren’t able to chair this year’s fun fair but you would be happy to bake some bars or help in some other way.
When my husband was recovering, the old tapes of “you have to be nice to people and be a good hostess” got replayed and I never considered I had the right or choice to say I wanted to be alone. There was a solid stream of people at the hospital, but they pressed against the wall, afraid to come close. I guess they just needed to see him alive.
It’s all right to ask friends and relatives not to call during dinner, and it’s all right to tell someone you will call them back if it’s not a convenient time. It’s fine to ask people not to stop by without notice. It’s even permissible to say no to your children when they beg for an unnecessary toy or pair of designer jeans. And when you’re dog-tired and overwhelmed, it’s okay to say no to household chores once in a while, and yes to a long soak in the tub or a few more hours of sleep.
Stress’s Cousin: Depression
Too much stress for too long a time can make us more vulnerable to depression—a common yet serious medical illness that can affect all aspects of life if left untreated. Symptoms of depression, which mirror the symptoms of stress, last for more than a few weeks and can make it difficult to function in daily life. Depressed individuals might feel hopeless, disinterested in things that used to be pleasurable, or even suicidal. When we are depressed, it is also common to be plagued with cognitive distortions—what those in Twelve Step recovery groups often call “stinking thinking.”
The idea that our feelings result from the messages we give ourselves is at the heart of cognitive therapy. In Feeling Good: The New Mood Therapy, Dr. David D. Burns explains how our thoughts or perceptions (our “cognitions”) can direct our feelings. Until I got help with my depression, I didn’t realize how distorted my thinking was. I made sense to me.
When we slip into distorted thinking, we have a tendency to see the world as black and white—we live in an always or never world. Burns writes that distorted thinkers are often convinced others are looking down on them, and jump to negative conclusions. (If a friend doesn’t call or if someone isn’t paying close enough attention to you, they must hate you.) Distorted thinkers think at the extremes. They might magnify their faults out of proportion while they play down any strengths they have. They may also confuse their emotions for facts. It’s an “I feel therefore it is” approach to life. (If I’m angry, you must have done something contrary.) Burns maintains people in despair also tend to beat themselves up for what they think they should and shouldn’t do, ultimately creating self-loathing, shame, and guilt because they feel they are constantly falling short of their expectations. Distorted thinkers also label themselves based on their failures (I should have done a better job) and take responsibility for any negative (If my traumatized loved one withdraws, I must have done something wrong).
Distorted thinkers don’t only blame themselves. To feel better about themselves, they often blame others for their unhappiness. (The clerk at the store put me in a bad mood, my friend made me miss exercise class, my boss made me look stupid, the mechanic hates women, God is punishing me.) They avoid taking responsibility by holding others responsible. But they gradually feel worse as their list of scapegoats gets longer, their trust level plummets, and their sadness intensifies.
When my therapist suggested I read Burns’ book, I felt like a curtain had been lifted. There wasn’t a wizard behind it, only a mirror, only me pulling the levers, controlling the thoughts. I was both elated and terrified to realize how powerful my thoughts were, and how negative or distorted thoughts could paralyze me. It was so much easier to blame Michael or PTSD for all my problems than to accept responsibility for my own thoughts, feelings, actions, and reactions.
The good news is that depression is a very treatable condition. The Web site www.depression-screening.org offers a confidential screening for depression that can help you determine if you should seek professional help. As with any other illness, you should see your doctor if you think you might be depressed. Mental Health America (www.nmha.org) also provides free information on depression, its treatment, and local screening sites.
Nurturing Yourself
It may be taking every ounce of energy and patience you possess to juggle day-to-day responsibilities as you support your traumatized loved one, and the idea of carving out time for yourself might even sound like one more thing to add to your “to do” list. Even if your loved one is getting psychological or physical help from outside sources, you are no doubt being called upon to be the head, heart, and hands for your family while your loved one is recovering from the effects of trauma. On the days you feel your life is falling apart, think of Self-Care as the glue that helps hold it all together. (But try to practice it on the in-between days too).
Pause for a moment and think about how much time you devote to your loved one’s care and trauma-related problems. Now think about how much time you spend caring for yourself. Are things too far out of balance?
Pay It Forward was a popular movie in 2000 in which a young boy urges people to do three good deeds for others when a good deed is done for them. His rationale was that if everyone did this, kindness would spread and the world would become a better place. How about “paying it inward” by doing three nice things for yourself today? The care, concern, and love you show your loved one are valuable and tender gifts. Now it’s time to be tender with yourself and allow that Self-Care to grow exponentially. When we are kind to ourselves, our capacity for kindness to others magnifies.
Ask for, and Accept, Help
Did you hear the one about the guy in the flood? As the rains came day after the day, the river on which his house was located rose higher and higher until the authorities finally gave the word to evacuate. Neighbor after neighbor packed their belongings and left their homes, but the man refused to go with them. “God will take care of me,” he told them confidently when they begged him to leave. “I’ll just stay here and pray. I’m sure God will save me.” The water rose higher, rushing into the first floor of the house. Undaunted, the man went to his second-story bedroom to pray some more. When people in a boat came by pleading with him to leave, the stubborn man shouted from his second-story window, “Thank you, but I’m going to stay. God will take care of me.” And still the river kept rising, finally forcing the man to seek refuge on his rooftop. As he sat on his roof praying, a helicopter flew overhead, dangling a rope ladder for the man to climb. But the stubborn man waved the helicopter away, shouting, “I’ll be okay. God will take care of me.” Still, the river was more stubborn than the man and it rose high enough to swallow both the house and the man, who still sat praying upon the roof. He was a little miffed when he got to heaven. “God, I prayed and prayed. Why didn’t you save me?” God, looking just a tad impatient, answered, “I sent the sheriff, a boat, and a helicopter. What more did you expect?”
Sometimes we’re like the stubborn man. We get so distracted waiting for help to arrive that we don’t notice when it’s right before our eyes. Our pride, fear, uncertainty, or just plain exhaustion can overwhelm us and keep us isolated on our rooftops. But if we reach out and embrace the hands that are extended to us, wonderful things can happen. Community can happen.
I was retired as a NYC firefighter because of a lung condition when 9/11 happened, and had just finished training in massage, body, and emotional release work. This saved me, because it gave me the chance to use this at the Family Assistance Center at Pier 94. Everyone forgets that each one of the survivors is just the first domino that sets hundreds of family dominoes on their own journeys of pain. Take each life lost on 9/11 and multiply that by ten or twenty family members, then multiply that by all their friends, and you have a world of pain and trauma to heal.
Charles Dickson, a North Carolina clergyman and chemistry instructor, urges us to take some lessons from the geese when it comes to getting help. He writes that whenever a goose falls out of the flock’s V formation, it suddenly feels the increased air resistance of trying to fly alone, so it quickly learns to get back into formation to take advantage of the drafting power of the bird in front of it. By flying together this way, the whole flock can fly much farther. “If we have as much sense as the geese, we will be willing to accept help when we need it as well as lend help to others when they need it,” writes Dickson.
There are three basic steps in asking for help. The first step is to identify your problem or need or fear. Often just naming a pain or difficulty is a release because by doing so, you give yourself permission to be vulnerable, to be less than perfect. When we expect perfection, we operate in a world of illusion. We judge ourselves by impossible standards and berate ourselves when we fail to meet our unreachable goals.
After you have a pretty good idea of why you need help, the second step is to figure out who can most appropriately give you the help you need—understanding that you cannot predict the responses you’ll receive. Some people may disappoint you by not being readily available, and others will totally surprise you by their willingness to come to your aid.
Think about aspects of your life and your family’s lives, and brainstorm a list of people or organizations you could contact if a need arose in a particular area. Enlist your loved one in compiling this list, so you’ll have it if an emergency arises and they are unable to help. Who would help you with a house or car repair? Who can take care of the children if you need child care?
It is also fine—and a good idea—to ask your loved one during a calm period who you should call if a trauma-related, emotional crisis arises. Think of this person as having attributes similar to those of a sponsor for a recovering person. It should be someone who is familiar with your loved one’s trauma—perhaps another trauma survivor who is solid in their own recovery (although the trauma experience may differ from your loved one’s)—who would know ahead of time who to call and where to go for help.
My girlfriend is not a vet, but she has PTSD, and one night she had a pretty scary meltdown. I called my vet friend with PTSD for help, and he knew just what to do. He came over immediately with a list of emergency numbers in his hand. He was able to calm her down and we didn’t need them, but it was great knowing we both had that kind of help when we needed it.
The third step is to actually ask for the help you need. To ask for help is to practice humility, a noble virtue. Philosopher Simone Weil called humility “compassion directed to oneself.” You are worthy of tenderness, and you are entitled to compassion from others and from yourself.
Be as specific and as clear as you can be in your request for help. And if people aren’t able to help you, accept their answer at face value. They might have other commitments, or they might not be able to help for some complicated and personal reasons unknown to you. Think about the times a favor has been asked of you and the times you have not been able to do that favor for whatever reason. If person A can’t help you, say “thank you” anyway and call person B. If person B can’t help, think about an organization or professional you could turn to.
When our thirty-year-old son was diagnosed with a stage four melanoma, I felt helpless. People asked what they could do, but I was too overwhelmed to think of anything to tell them. Then I got a note from a friend with a list of choices like, deliver a meal, take a walk with me, bring over a movie, get some dishes I can throw, meet me in New York for his surgery. I loved her for offering such tangible things instead of the vague “if there is anything I can do,” which puts more of a burden on the caregiver. Embedded in that generous list was a sense of humor and warmth that made it possible for me to accept her offer to be with me while he had his surgery.
Enlist family members to help you with household chores and meals—including the trauma survivor if she or he is able. If you have kids, teach them how to make their own breakfast, how to set the table, load and empty the dishwasher, and clean their rooms. Praise them for their competence. Even small children can be assigned household responsibilities that can increase as they grow older.
Keeping up routines can reassure all family members that there is normalcy even in the midst of abnormal situations. Honor your traditions such as Friday night pizza and home movies. If Saturday is chore day, try to keep to that schedule. Attend religious services if that is what your family has always done. Such familiar patterns give your loved one a solid foundation on which to build some healing strategies. If something happens to change your plans, try to be flexible and carry on with the routine the next week.
When my wife was first diagnosed with PTSD, we all tiptoed around her, trying to give her space, keep things quiet, and do everything for her. Finally, one day she told us that our attempts to be the perfect family were driving her nuts and making her feel even weirder than she already did. We all laughed, and got back to being our regular, imperfect selves.
Stay Connected—with Others and with Yourself
Try to make space and time every day (or several days each week) to catch up on what each family member is doing or feeling. These needn’t be forced encounter groups. Just carving out time to be together without distractions often opens the door to casual check-ins and gives you an opportunity to gauge how everyone is handling the aftereffects of your loved one’s trauma. Turning off the phone or not answering the phone during dinner is a start. Or try playing a board game or cards during the week and see what conversations are sparked.
When our daughter was very seriously injured in a violent attack, it turned our family upside down. One of our biggest challenges as parents has been to continue to balance the attention we give her with attention to our two younger children. We were in a local malt shop one afternoon when a young mother and her two children in the next booth caught my attention. After they got settled and placed their order, the mom turned to her son and daughter and asked, “What did you learn today, and what made you laugh?” The question seemed comfortable and routine, a daily practice for this family. With this simple ritual, this mother was giving her children permission to express themselves and giving them the message that they—and their thoughts and feelings—were important. We adopted the same daily practice, and it’s worked wonders with all of the kids.
Of course, there will be days when your best intentions will have to be thrown out the window. Try to be gentle with yourself and your family during such detours and accept them as just that—temporary bends in the road, not an exploded highway you can never return to again.
Finally, remember to schedule—not wish or try or hope, but actually set aside—time for just yourself. If you have kids and your loved one is unable or unwilling to babysit, barter child care with a friend and give yourself a night off. You might want to use Julia Cameron’s idea of making an “artist’s date” with yourself. In her book The Artist’s Way: A Spiritual Path to Higher Creativity, Cameron instructs us to set aside a block of time every week reserved only for ourselves. You might take a walk or go out to dinner with a friend, visit a museum, or curl up with a good book.
As a wife of a PTSD spouse, I definitely get my down times, more than I would like to admit as my hubby refuses to get help. We also have a young son, and I have to referee . . . [from the time] my husband comes home from work until the time our son goes to bed. They consistently try to battle each other then come to me. I have learned that shower time is MY time. I have to watch my stress and anxiety, as I get frequent migraine headaches and then all three of us are grouchy! And I get as much sleep as I can, after “my” time on the computer.
Treat your time as sacred. Write it on your family’s engagement calendar in bold letters, and then highlight it with a neon magic marker. You might just convince yourself you deserve it, and you are modeling something invaluable to your children: the importance of tenderness to self.
Organize
Take time to make time. Prioritize. Consciously choose what you need and want to do each day so you are spending more of your time the way you want to spend it. Sometimes it may be worth it to stay up late to clean or to fix that leaky pipe if these things are getting to you. At other times, you may temporarily opt for messiness and a bucket in order to do something enjoyable or get some sleep.
Make written lists of your daily activities, and label the most urgent things you have to do. Cross off things as you accomplish them. Try to schedule appointments and errands back-to-back so you can consolidate trips. Put a family engagement calendar on the wall or refrigerator to record each member’s activities and appointments.
Plan ahead. Try to set aside one day a week for shopping and other errands and chart your course ahead of time for maximum efficiency. Use the Internet to find a store that has a particular item in stock, rather than traveling all over town to locate it. If you’re in charge of finances, try to pay your bills at one time, and file receipts immediately.
Compassion Fatigue
My three-year-old grandsons gave me a refresher course in compassion not long ago on a sleepover when they were chatting over the sides of their porta-cribs like two friends over a backyard fence. One held a little fabric bunny, the other a shiny little purple lizard, and they were having a “conversation” with their respective toys. “Oh, look,” said the lizard. “I only have one eye.” “It is okay,” assured the bunny. “I have a heart, but I have no eyes.” “I feel better now,” said the lizard.
Compassion literally means “to suffer with,” and that is just what can happen to those who practice great empathy—they absorb the pain and trauma of others until they themselves become mentally, physically, and spiritually exhausted. This condition is often called “compassion fatigue.” J. Colleen Breen, the author of Making Changes: A Guidebook for Managing Life’s Challenges, describes it as a kind of “soul sadness” because there is an inner, core reality that closes down when people become so overwhelmed by the needs and concerns of others that they forget to take care of themselves.
Medical and mental health care professionals, emergency care workers, clergy, counselors, and volunteers who work with very sick or troubled people are particularly susceptible to compassion fatigue—as are family and friends of trauma survivors. Breen, a licensed social worker, says she has worked with thousands of caregivers who have so overextended themselves in the service of others that they suffer from “care-giving shutdown.” They often become withdrawn and joyless, irritable, depressed, uninterested in intimacy and sex, and feel like they’re “just going through the motions” of their lives or jobs with no sense of purpose or meaning. They might also employ what Breen calls negative coping skills, by turning to smoking, drinking, using drugs, or practicing addictive behaviors.
When additional stress from caring for a traumatized loved one is added to the mix of grief, worry, and empathy we’ve already got stored up inside ourselves from the cares and concerns of our day-to-day life and jobs, we become like overinflated balloons, ready to burst from all we are trying to contain. We might have nightmares, develop stress-related illnesses, or exhibit the other symptoms of compassion fatigue (which also are a lot like post-trauma symptoms).
We’ve been so worried about our friend who has been the primary caretaker for his wife. He refuses help and has been trying to handle everything himself. Finally, it got to be too much and he ended up in a hospital for a couple of days. He was so emotionally and physically exhausted that the doctors said his brain just shut down. He doesn’t even remember going to the emergency room. Maybe this will be the turning point for both of them getting the help they need.
Because compassion fatigue adversely affects body, mind, and spirit, it makes sense to concentrate on those areas when attempting to treat or prevent this condition. Overstressed caregivers need some kind of physical regimen to deal with the stress that settles in their bodies. It is equally important to take quiet time for reflection, prayer, or solitude and engage creatively with things other than caregiving. Ease your mind by turning off television or radio news and taking a break from newspapers when the weight of the world seems too much to bear. And take care of yourself by asking for help.
The families of persons with PTSD are increasingly vulnerable to divorce, domestic violence, aggression, depression, and anxiety. Support for family members is needed to prevent what is now referred to as compassion burden. Partners are vulnerable to overcompensating for the trauma survivor and taking on unrealistic levels of family responsibility. Family and friends become familiar with the survivor’s triggers and can exert inordinate energy to manage or avoid them. In the face of trauma symptoms, they may lose track of their own reality and their need for calm, rest, fun, and care. A wise therapist once told me she no longer believes there is such a thing as individual suffering. Families need to create time and space away from the trauma.
Don’t wait until the pipe breaks, the dog runs away, your child gets sick, or a relationship is in shambles to get a support network in place. Approach this task like a detective, uncovering clues and leads over time. Ask people at your children’s school, your workplace, your grocery store, or your place of worship for ideas and information. Having these resources on hand will also help your loved one when they are feeling overwhelmed and can’t think where to turn for help.
*Copyright © 1999 by Wendell Berry from The Selected Poems of Wendell Berry. Reprinted by permission of Counterpoint.