Compassion Fatigue & Vicarious Trauma

In my job I hear a lot of stories. I hear stories of enormous tragedy and loss, but also stories of great strength and resilience. I have and always will consider it a great privilege to be witness to these stories and the vulnerability intertwined within the ups and downs of life. Like most helpers and healers, I would consider myself an empathetic person capable of appreciating what it might be like in someone else’s shoes.

It seems empathy is in high demand these days. Helping professionals, healers, or simply those with caring personalities may feel overwhelmed and even exhausted trying to meet this demand. Having a caring heart and a tendency to put others ahead of ourselves makes us especially vulnerable to compassion fatigue. ‘Compassion fatigue’ a term coined by Dr Charles Figley, is a “state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper”. Compassion fatigue occurs hand in hand with vicarious trauma, which is when ‘the helper’ is exposed to the traumatic experience of another and experiences a personal transformation resulting in a multitude of possible symptoms including anxiety, panic, sleep changes, depression, hypervigilance, and social isolation among others.

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Vicarious trauma and compassion fatigue may lead to feelings of being unsupported and underappreciated. We may also be a tendency to roll up our sleeves and become workaholics- in a search to find control and distractibility when we may feel powerless in other aspects of our lives. We may also find ourselves justifying maladaptive coping mechanisms because of the good and hard work we do. It may be easy to blame our struggles on circumstance and others, but ultimately we need to look within ourselves to find answers and solutions.

Vicarious trauma and compassion fatigue can occur among educators at a loss of how to comfort students fearful of tragedy, or healthcare professionals struggling to provide adequate care to desperate patients, or parents trying to nurture their children in a world that can seem so chaotic, or parents trying to nurture their parents, or leaders of faith trying to restore hope in the hopeless, or first responders repeatedly encountering the aftermath of trauma, or the countless unpaid volunteers and nurturers in our communities working hard to uplift others with often little recognition.

I have learned to be aware of my own vulnerabilities to vicarious trauma and compassion fatigue—and it has not always been easy. I have learned it is critical to have what I call “non-negotiables” or ways of coping that help keep me grounded, present, and emotionally resilient. I have learned it is best not to sacrifice these non-negotiables and if I do, it is not only a disservice to myself, but takes away from my loved ones, clients, and yes, ultimately the communities that I serve. I am not overstating my importance, but have simply grown an appreciation and awareness how my energy and actions reverberate to everyone I come in contact with—and it is the same for you.

compassion fatigue

It is easy to feel hypervigilant about all the woes and fears that may seem so imminent, which makes vigilance about our own well-being so much more important.

Many of us believe that prioritizing our own well-being aligns with selfishness. In my humble opinion, self-care is a matter of self-responsibility and has nothing to do with being selfish. Importantly, self-care and self-responsibility may also mean asking for help when we feel at a loss. We can only give what we have. It is ultimately not sustainable to be so focused on giving and not restoring. So, in the midst of widespread fear, taking inventory of what we need to keep ourselves grounded and creating dialogue is a necessity.

It is easy to feel lost, on edge, and powerless. Our reality is our perception and perception can change. So let’s help ourselves and one another see the light in the darkness. Take care everyone.

With gratitude,

Audry Van Houweling, PMHNP-BC, Owner She Soars Psychiatry, LLC.

Sisters & Silverton, Oregon2017-09-09 Audry VanHouweling Headshots (2 of 2)

www.shesoarspsych.com

Is Marijuana Harmless? No. But Let’s Get our Priorities Straight.

I have lived most of my life ‘by the books’. I think I tried marijuana once…okay maybe twice. Curiosity I suppose mixed with a bit of peer pressure back in my younger years. Despite my anticipation of some wild trip, I think I just ended up eating more potato chips and falling asleep on the couch. Underwhelming you could say.

Years later, I am now a psychiatric nurse practitioner. Having worked throughout the Northwest, you would have to be living under a rock to avoid the chatter marijuana has incited throughout our region. There has been both celebrations and staunch opposition. I have been asked many times what side I stand on and I generally give the same neutral answer: “Marijuana is not harmless. There are potential consequences and possible benefits. In most cases, there has not been enough research to allow for definitive answers. There are substances that have proven to be far more dangerous than marijuana.”

At the end of the day, thinking about my clients using marijuana quite frankly, does not haunt me.

I am haunted by clients prescribed dangerous cocktails of potentially addictive and dangerous medications.

am haunted by the ongoing laissez faire attitude still taken with alcohol and tobacco consumption- legal substances that kill far more people than all other illicit substances combined.

am haunted by the ease with which youth can procure potentially lethal doses of opioids, methamphetamines, cocaine, and alcohol.

am haunted by parents who are desperate to save their child trapped by the opioid epidemic or worse yet, devastated by a recent loss. Conversely, I am haunted by the children struggling to understand their parent’s addiction.

am haunted by the weeks, months, or even years clients in crisis will have to wait to get access to mental health care or substance abuse treatment.

Some believe marijuana to be a gateway drug and that may certainly be the case is some scenarios. For some of my clients however, marijuana has been reported to be instrumental in allowing them to give up opioids, alcohol, or methamphetamines. I am not in a place to give a verdict either way; however, it is interesting to consider recent research conducted by Livingston and colleagues (2017) via the American Journal of Public Health noting that opioid deaths declined in Colorado during the years of marijuana legalization.

The marijuana debate has been widespread and somewhat consuming, but in my humble opinion by exhausting so much time on the topic, we are neglecting priorities.

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Yes, marijuana can be associated with cognitive changes. Yes, there has been an increase in non-life-threatening marijuana related visits to the emergency rooms nationwide. Yes, marijuana (depending on some variables) may induce serious psychiatric symptoms. Are these consequences serious? Potentially, yes. Do we need more research into potential implications and side effects? Absolutely.

Have there been any recorded deaths directly related to a marijuana overdose? According to the Drug Enforcement Administration, the answer is no. None.

In regards to other statistics…

As of 2015, Oregon had the third most alcohol related-deaths in the country behind Wyoming and New Mexico.

As of 2017, Oregon had the highest number of seniors hospitalized for opioid-related issues in the country.

As of 2013, Oregon topped all other states for the non-medical use of pain relievers.

As of 2017, Oregon was ranked dead last in the country by Mental Health America for rates of mental illness and access to mental health care.

As of 2016, Oregon’s suicide rate was greater than 30 percent the national average.

In 2016 alone, more people died nationwide (64, 070) from drug overdoses compared to total lives lost in the Vietnam War (58,200).

Numbers do not lie. I am neither celebrating or condemning the legalization of marijuana. Ultimately, given priorities and our country’s hierarchy of needs, marijuana is quite simply not scary enough compared to vastly more dangerous problems currently impacting so many. My hope is that we can regroup, step down from our pedestals, and take a step back from what has become such a deeply politicized topic. We have plenty of work to do otherwise.

Thanks for listening everyone.

With gratitude,2017-09-09 Audry VanHouweling Headshots (2 of 2)

Audry Van Houweling, Owner & Founder, She Soars Psychiatry

Sisters & Silverton, Oregon 541-595-8337 www.shesoarspsych.com