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For the last couple of years there has been growing research on so called compassion fatigue among social workers/therapists/social workers, and their likes. In short, compassion fatigue can be described as exhaustion and/or vicarious traumatization in different forms of healthcare/emotional labor. (https://en.wikipedia.org/wiki/Compassion_fatigue).

My question is - if and how - one can understand these phenomena based on buddhist dharma? As far as i understand there is no mentioning of these types of specific phenomena in the suttas.

A few personal hypotheses is that compassion fatigue is the result of one or more of these factors:

  • an imbalance between the five indriyas/faculties and the five pancabalani/strengths, leading to
  • akusala padhana/unwholesome effort.
  • upadana, grasping for being overtly supportive at the expense of own health, or clinging to a self-view as a tireless helper.

I realize this may seem counter to popular buddhist notions such as the brahmaviharas, for instance. I still can't help but wonder if this can explain compassion fatigue, or if there are other alternative interpretations based on a buddhist framework?

(This is a sutta reference request)

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I don't know the definition of "compassion fatigue", or who defines it.

The link you posted includes,

People who experience compassion fatigue can exhibit several symptoms including hopelessness, a decrease in experiences of pleasure, constant stress and anxiety, sleeplessness or nightmares, and a pervasive negative attitude.

Why do you say, "there is no mentioning of these types of specific phenomena in the suttas"?

Perhaps there's some traditional Buddhist practice which provides occasion for that experience -- Maraṇasati.

The "fatigue" aspect of the condition may be less than ideal -- maybe let's say, "unenlightened". There are suttas about caring for the sick, as a duty, maybe in the vinaya too, and about being sick.

But mightn't some of the other "symptoms" in that definition -- for example "decrease in experiences of pleasure" -- be to some extent or in some ways promoted by Buddhist doctrine, which might call that "dispassion" or something (depending on how you define "pleasure")

If one names a mental state or "symptom" -- for example anhedonia -- it might be difficult to say in isolation whether that state is pathological. I think that any serious diagnoses might require meeting in person (a Buddhist teacher or, like, a psychiatrist). So far as I know, practicing clinicians have their own mentors.

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  • Regarding your question "Why do you say...", i ask with emphasis on the specificity, not as a general form of dukkha. I'm asking if the fact that compassion can have a draining effect is mentioned in the suttas at all. – Erik Dec 2 '19 at 11:41
  • I think I've seen contemporary commentary that you're supposed to balance the four brahmaviharas -- so if compassion is becoming exhausted/exhausting then more of the other three. – ChrisW Dec 2 '19 at 11:45
  • If so, then it fits with the idea of balancing indriyas/pancabalani – Erik Dec 2 '19 at 12:01
  • The other two or three are often appropriate also (and maybe all, always). – ChrisW Dec 2 '19 at 12:10
  • Not sure how far this conversation should go, but i'd say that the first three brahmaviharas are all contained in the healthcare definition of compassion above. As such they all collectively run the risk of being conducive to compassion fatigue, as opposed to balancing each other (if that's what you're suggesting). My point is that these factors are not an endlessly benificient cornucopia in their own. I lean towards a balancing of brahmaviharas would have to be weighted against other factors apart from those particular three (with the exception of upeksha). – Erik Dec 2 '19 at 15:45
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Here's my two cents: I used to be a nursing assistant. I did that for about seven years. I had to quit and change careers eventually due to burn out, stress, not wanting to be complicit with the ugly side of health insurance, etc. After I quit I found that I had a lot of trouble feeling compassionate towards other people i.e. compassion fatigue. I had spent so much time and energy with so many people with extremely bad health, many of whom didn't really have a hope for recovery. It's like my compassion was used up and here it lay now like a strained muscle.

There are a lot of different angles to it. For one thing, it can be hard to identify with other people who aren't from that background when you've been in medical for so long. Other people complain about so many little things while I spent years helping nurses bandage bed sores, toileting people, washing dead bodies, talking with people about their own mortality, etc. After that, it was almost unbearable to hear people complain about getting served the wrong ice cream or having to deal with subpar customer service. Asymmetrical points of view between yourself and other can exacerbate alienation.

Also, just being around SO MUCH INTENSE SUFFERING(!) for so long is traumatic. It changes everything about how your nerves and adrenaline react to stimuli. Even a small trigger can cause you to feel so overwhelmed because your body is so used to responding to life and death situations with adrenaline. It's hard to regain a level perspective and your nerves don't know how to react to most situations.

Also also, I had seen so many cases where health insurance agencies were more interested in how to make money that how to provide compassionate care. The MOMENT somebody died, it was my job to empty their room of possessions as QUICKLY as possible so as to get a new patient in that room immediately because insurance companies don't make money on empty beds. I would hear people talk about how much money they could get from having a paralyzed patient on a ventilator because they'll be kept alive for extended periods even though there's no hope for improvement of their health. Dealing with this stuff makes you feel complicit; it makes you feel violated, like your own compassion is being used for unethical means. It makes you wonder if you're ever even doing the right thing when you exercise your compassion. It can break you.

Sorry, that's a lot to take in but it's all true. I talk about all of this to provide context and perspective. Now, how can you come back from that?

My answer is with baby steps. I find I am re-learning how to be a caring, compassionate, emotionally available person from the ground up. Acting with the level of openness and compassion you are used to right away is simply not realistic. You've got to take time with yourself to deal with these feelings and to stretch your emotions out gradually until it's no longer so draining and painful to open your heart again.

It's important to be compassionate and patient with yourself. I've had years to rebuild my sense of compassion and I STILL feel the strain sometimes. I just remember where I've come from and I remember that I'm in a learning process, or a re-learning process. I remember that it is okay to ask for help and to reach out to other people. It's also okay to fail sometimes as you make your way back.

All of that said, I'm not sure I've found a sutta that deals with this aspect specifically. Suttas have a lot to offer in terms of lessons and wisdom but it's important to be dynamic and finds ways of filling the gaps as it were. If you have an Abbott or monk you can talk to about it, do it! Someone like this with extensive practice can offer more dynamic support for something as specific as this and can offer wisdom that works in conjunction with the words you've read.

That is all for now. Thank you for your time :-)

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  • What you are describing is EXACTLY empathy fatigue and not compassion fatigue. You state it right in your answer that you found it increasingly harder to IDENTITY with those who were under your care or in bad health. But IDENTIFYING with others is mark or empathy, not a mark of compassion. Thank you for clearly showing the difference. – Yeshe Tenley May 19 at 15:56
  • Here is a good article about the difference: vox.com/conversations/2017/1/19/14266230/… – Yeshe Tenley May 19 at 15:58
  • That article is from a western mind who has figured out the difference and discovered that nearly all of western culture is confused by not seeing the difference between compassion and empathy. – Yeshe Tenley May 19 at 15:59
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Puthujjanas addicted to sensuality base their life on emotions, or more generally on what they feel. For instance they base morality on emotions and knowledge on emotions. This is a big mistake, but very normal for people infatuated with emotions.

For instance, some people like to feel sad when somebody die, and when they see that somebody they expected to be sad is actually not sadden by the death in question, they become upset and ask things like '' how can you not be sadden by the death of this person''. This is because Puthujjanas think that when they are sad, it means that they really liked the person who died, and really liking the person is a good thing in the first place, because it means ''they really cared'' about some other human (or animal). For instance, with the sutta about the death of the buddha, the Puthujjanas could not help themselves from crying a lot.. The non Puthujjanas apparently did not cry. And Humanists are absolutely obsessed with showing how much they think and care about other people. They call this 'being selfless'' and they think that being selfless is good.

Then they even say that understanding a situation is only possible by living it. For instance, they say that it is not possible to know how it feels to do base jumping, until there is the experience of basejumping. This is why people in the entertainment industry keep asking people, like athletes, ''what does it feel like to win (or lose) some contest'' and ''describe your emotions'' so that ''the audience at home watching the tv live the thrill of the victory with you (the athlete)''. This is how insane those people are.

When it comes to suffering and compassion, people think that they are good as soon as they feel sad once they think that some person is miserable. When they do not feel sad when they see what they see as '' a suffering person'' they feel bad and they say something is wrong with them. Puthujjanas have only emotions in their life so they will always try to base their behavior on them and with their very flawed ideas about morality.

Their clinging to emotions carries over to the dhamma. When it comes to the dhamma, the usual perplexity is about sotapannas. Because sotapannas still have not destroyed the asavas, not yet ''abandoned them, cut them off at the root, made them like a palm stump, obliterated them so that they are no more subject to future arising.'' , so how do they know that the destruction of the asavas exists, is possible and how do they know what to do in order to destroy the asavas (ie the noble 8 fold path)? They ask the same thing with dependent origination: how do they know that ignorance is the condition for the sankharas, when they have not ceased. or how do they know that contact conditions cravings, when they still have not destroyed cravings? How do they know that rebirths exist when they have not experience rebirth?

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It all stems from a wrong understanding, not of morality but of equanimity

Here is a quote from Shantideva's Way of the Bodhisattva / the path of light highlighting the true meaning of charity; there is no way that one can help all.

Even Buddha's compassion to liberate other beings was extended with some hesitation only to the taintless at a request of a Brahmā.

If the Perfect Charity frees the world from poverty, how could the Saviours of old have had it, since the world is still poor?

The Perfect Charity is declared to be the thought of surrendering to all beings our whole possessions and likewise the merit thereof; thus it is but a thought.

Where can fishes and other creatures be brought into safety, that I may not slay them? When the thought to do them no hurt is conceived, that is deemed the Perfect Conduct.

How many can I slay of the wicked, who are measureless as space? But when the thought of wrath is slain, all my foes are slain.

Whence can be found leather enough to cover the whole earth? But with a single leather shoe the whole ground is covered.

In like manner the forces without me I cannot control; but I will control the thought within me, and what need have I for control of the rest?

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Compassion fatigue comes from lacking the right view about morality. When there is wrong view or no view about right morality, there is no objective basis for the establishment of the equanimity required to avoid compassion fatigue. Instead, the mind of the social worker, not knowing the optimal behavioral solution, becomes emotionally caught up in the lost mind of the lost client.

For most Western Buddhists, compassion is an amoral Cultural Marxist orgy of self-acceptance; of condoning and drowning in each other's (often sexual) sins. This is why compassion fatigue occurs. Both client and therapist are swimming against the current of morality.

In MN 8, the Buddha said: "one stuck in the mud cannot pull another out of the mind". Jesus said: "when the blind lead the blind they both fall into a ditch". When both therapist & client are stuck in the mud, fatigue will occur when both don't know the way out of the mud.

Cunda, that one who is himself sinking in the mud should pull out another who is sinking in the mud is impossible; that one who is not himself sinking in the mud should pull out another who is sinking in the mud is possible. That one who is himself untamed, undisciplined, with defilements unextinguished, should tame another, discipline him, and help extinguish his defilements is impossible; that one who is himself tamed, disciplined, with defilements extinguished, should tame another, discipline him, and help extinguish his defilements is possible.

MN 8

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  • What sila are you referring to, specifically? – Erik Dec 2 '19 at 12:33
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The answer is simple. What these western academics are studying is not compassion fatigue per se, but rather “EMPATHY fatigue.” And empathy is not even close to the same thing as compassion. In fact, too much empathy can be harmful to oneself and others. This is what these western academics are finding and is also exactly what the Buddha taught.

The whole question reveals that most western culture does lot truly understand what compassion is and rather mistakes or for empathy. The two are not the same.

Here is one western mind who has figured out the difference between compassion and empathy:

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  • In what suttas did buddha teach this? – Erik May 19 at 15:54
  • Read the article above and note the references to eastern Buddhists who easily identify the western mistake of equating empathy with compassion. The Buddha taught about compassion he did not emphasize the difference with empathy because his audience at the time understood that the two were different. This is a modern western mind confusion. – Yeshe Tenley May 19 at 16:02
  • I am downvoting this as i have yet to see a sutta reference. – Erik May 19 at 16:13
  • Hi Erik, that is fine and I will try and find you a sutta reference, but until I can do that please read the article and see if you can glean anything from it. I truly think it might help as lots of people I have shared it with have responded that it was like a revelation upon finally understanding the difference. – Yeshe Tenley May 19 at 16:18
  • Btw, here is another answer where I attempted to make the same point... maybe it was more articulate? buddhism.stackexchange.com/a/28618/13375 – Yeshe Tenley May 19 at 17:02

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