Over-caring? How to Stop Depleting Yourself

There is a common misconception in our society that martyrdom is heroic and to be applauded. Unrealistic work schedules and a culture of emergency are built on the foundational belief that putting others' needs before our own is the best way to care for others.

However, if the recent pandemic showed us anything, it was that operating in a culture of emergency is only sustainable in the short term. Many health care professionals were optimistic that the media spotlight on the "battle against COVID" would finally illuminate where the system was cracking and usher in reform. Instead, backlogs for routine treatments grew, and the pressure on staff increased, causing many to abandon the profession they'd striven so hard for.

Much of the disillusionment and exhaustion was attributed to "compassion fatigue," suggesting that we can care too much. While I can totally relate to the physical, mental, and emotional exhaustion that can stem from working too many hours, I am curious whether compassion fatigue is an inevitable outcome of overwork, or whether it happens when we close our hearts.

Compassion and care in their purest forms can both be practiced from a full heart, which is constantly replenished by the energy of connection. If that is the case, when we are truly present with each other, it is an energizing rather than a depleting experience that nurtures both the caregiver and receiver.

It might be helpful to take a closer look at what causes the depletion in ourselves when we are caring for others. Perhaps "over-caring" happens when there is too much focus on the destination and not enough on the source of true care and the shared journey.

When caring for others, we can mentalize, empathize, sympathize, or offer compassion.

Mentalization helps us understand the suffering of others based on our own interpretation. This is the basis of medical training, offering empirical data as a reference point. With practice, we run the risk of being too dispassionate. Sympathy helps us feel with another person based on our own emotional interpretation—for example, the relatable experience of losing a loved one. Empathy happens when we feel the emotions of another person as if we were standing in their shoes. It is a phenomenon of resonance. An example is when a baby starts crying when their mommy cries. Compassion is when we resonate with someone without losing our center. It is based on the intention to extend care from a source of love, which is limitless and inexhaustible.

All are useful. However, some can deplete our energy if we get entangled in difficult emotions and mentalization without connecting to the source of compassion. When we separate out our shared humanity and don't take the time to connect with our own hearts and those of our patients, being driven purely by measurable outcomes and a ticking clock, we become the equivalent of an appliance without a power source. Imagine vacuuming your house all day without plugging into an electrical socket—exhausting! This may feel like compassion fatigue, but it is actually fatigue due to overwork and lack of self-care, i.e., compassion unplugged.

An alternative is a heart-based approach, where we allow ourselves to feel our own feelings and those of our patients while maintaining connection. When we dare to care with the whole of our being in this way, expanding the feedback from our five senses by being more present together, it's possible to create a "resonant field" that a patient can feel. This, in turn, generates a therapeutic alliance that revitalizes patients and caregivers by deepening communication and trust. This is true, nearly inexhaustible compassionate care.

How to practice heart-based care

The five most depleting states of awareness that can disconnect us from the source of our compassion are:

1. Future desires. Outcome-driven desires, such as healing a wound, ending pain, advancing your career, or receiving a reward, can keep you distracted and unfulfilled. Living with an "I will be happy when…" attitude keeps compassion for yourself and others at arm's length.
2. Aversion based on past experience. Whenever we feel dislike, judgment, or rejection, what we are really practicing is non-acceptance of what's happening in the moment. "I will stop suffering when…" just means we are giving our power to the past and putting our energy into reliving previous experiences rather than being curious to see what could unfold instead.
3. Indifference and non-engagement. These two states represent an absence of feeling, which leaves us disconnected from the wellspring of compassion and vitality that lives in our hearts. "I will only engage if…" sets up conditions that mean we are unable to draw from this heart-well spontaneously.
4. Restlessness. Ever been ambushed by your monkey mind? Doom scrolling, fidgeting, or losing patience with your patients are all evidence that you wish you were elsewhere, which depletes your attention and energy in the moment.
5. Scepticism, cynicism, and doubt. If you've recently caught yourself thinking, "I will only trust if…" it's likely that you have been nudged out of your heart center and are feeling the cold breeze of doubt. This disposition builds a wall of resistance between you and the natural state of compassion and connection that springs from your heart.

The "cure" for all of these distractions is practicing presence. When we are truly present with ourselves and in coherence with our hearts, it is possible to tap into a resonant field of compassion that can keep us and our patients connected and energized.

When you find yourself feeling depleted or disconnected, take a moment to accept and acknowledge your feelings. You cannot change something unless you are prepared to first hold it. Once you are in touch with how you feel, see if you can find the value in the experience you are having right now. When you come into the present moment and reconnect with your heart in this way, you will start to feel more energized and will be empowered to practice compassion from a full cup.

There are many schools of thought on how to build a bridge to a near-constant source of energy: for example, breathing techniques, movement, tapping, stretching, laughter, or even sitting and doing nothing. They are underpinned by the instruction to "be before you do."

If you are one of the few who have mastered being fully present at all times, congratulations! Otherwise, perhaps you would join us in our curiosity, staying open to the possibility that compassion fatigue may only be possible when we forget to stay present and keep our hearts open.