“Who can take away suffering without entering it?”
– Henri Nouwen, The Wounded Healer, 1972
Early research about secondary traumatic stress and related concepts such as burnout began to spike after the events of September 11, 2001. Now, trauma research looks at the effects of secondary, or “vicarious” trauma, in many populations of caregivers—not only emergency responders, but also health care workers, social workers, therapists, and many others.
A major contributor to the research on secondary traumatic stress is Charles Figley. He suggested the phrase “compassion fatigue” as a synonym for secondary traumatic stress, hoping it would be less of a stigmatized term. While many researchers define compassion fatigue in slightly different ways, Figley describes compassion fatigue as a state in which a caregiver experiences tension and preoccupation with the traumatized persons he or she is serving, often re-experiencing the traumatic events associated with the client, along with avoidance, numbing, or persistent states of arousal (such as anxiety) related to reminders of the client’s trauma.
Burnout is a similar and often overlapping phenomenon, which is often brought about not simply by witnessing others’ trauma but by providing care in an institutional culture or environment that lacks adequate support for caregivers. Burnout usually develops over time, but compassion fatigue can emerge rapidly in response to witnessing the trauma of others. Compassion fatigue and burnout can leave caregivers unable or uninterested in hearing more of others’ traumatic experiences.
Relatively little research has been done on how compassion fatigue manifests among clergy and other religious caregivers. A few studies have looked at clergy burnout and how clergy may be at even greater risk for secondary traumatic stress because, compared with other occupations, they may have less forewarning about its effects and how to address them. I also suspect there are particular vulnerabilities shared by those of us who enter our caregiving roles with a sense of divine calling and with faith commitments that tug us toward responding to the suffering in our midst. Our motivations are laudable, but it is crucial that we equip ourselves with the knowledge and support to make our efforts sustainable over time. To share with others in their suffering, we must find ways to remain emphatic. This sounds so straightforward, but our capacity to empathize can be imperiled when vicarious trauma renders us unable to be fully present to others.
When we talk about the toll of caring for others, the image of the “wounded healer” often gets mentioned, especially in pastoral care literature. The wounded healer is a concept found in many cultures, but in pastoral care it usually refers to the wounded healer image articulated by Henri Nouwen, a Catholic priest, in his book The Wounded Healer (1972). The image gets mentioned so often, I believe, because it resonates with our experiences of discovering the toll it can take on us when we seek to care for others’ burdens. I worry, however, that the image has been applied in sloppy ways, sometimes even dangerously affirming that the wounds of caregiving are just something we are supposed to accept or endure unquestioningly. Some talk of what it means to be a wounded healer can turn into a glorification of these kinds of wounds, and I don’t think that’s what Nouwen meant, nor what our faith commitments ask of us. When Nouwen articulated wounded healers in ministry, he meant to reassure us that we all come into ministry with wounds of some sort, wounds that don’t make us ineligible for ministry but rather can be woven into the fabric of our identity and ministry. He didn’t mean that our wounds are an excuse to care poorly for ourselves in the midst of trying to provide excellent care for others.
It’s remarkable to me that Nouwen named loneliness as perhaps the most common wound among those in ministry. A sense of isolation or alienation can ensue when we are experiencing secondary trauma and compassion fatigue. What are we to do with these wounds?
I don’t think Charles Figley was intending to invite theological reflection when he coined the phrase “compassion fatigue,” but in fact there is deep theological richness around the concept of compassion, which literally means to suffer with. While the idea of compassion fatigue can conjure up an image of an empty tank, as though we can just “run out” of compassion like a car might run out of gas, there’s also an opportunity to think of compassion as a renewable resource. An individual caregiver might struggle with compassion fatigue, but when compassion is enacted in community, the loneliness of the caregiving burden can be addressed more effectively.
In addition, calling to mind the bottomless nature of divine compassion can also remind us that we draw from a well that is much deeper than our own. In doing so, we also exercise self-compassion, which is actually beginning to stand out in research as an antidote to compassion fatigue. Self-compassion goes beyond self-care; it encourages us to show kindness to ourselves, rather than judgment, and to connect with the reality that all humans are limited and imperfect. These efforts can help us remain in the crucial relationships of support that will sustain us in our caregiving efforts.
Nouwen suggested that hospitality and community were the sources of potential healing in the face of our wound of loneliness. As future research continues to examine ways to understand and address compassion fatigue, I think we will continue to see affirmations of the importance of relationships and communities of support. I’m grateful that ICTG exists as one such vital community of learning and support for those who work so diligently toward healing in the midst of trauma.
 Figley, C. (2002). Compassion fatigue: Psychotherapists’ Chronic Lack of Self Care. Journal of Clinical Psychology, 58(11), 1433–1441.