How do we come back from this soul deep burnout?

"LOVE" by Ukranian Artist Alexander Milov at 2015 Burning Man. Photo by just_shot_of_jameson

If you’ve been working in this late-stage capitalistic society for any significant amount of time, you’ve probably experienced at least one cycle of burnout. Especially if you work in fields of care, meaning any work that requires you to continually give of your compassion or care; so, healthcare workers, mental health practitioners, social workers, educators, victim advocates, caregivers (of children, aging, disabled, etc.), this is all care work. I would even argue that artists are considered care workers, because we share our art, which I’ve heard some artists say is synonymous with sharing their love (but this is a topic for another essay). There is a specific toll that comes in these fields that is different from a burnout from say, a corporate or finance role (and there can still be burnout here). There are several well-known phenomena that show up specifically in care work that has been surfacing in research since the late 90’s and early 2000’s; these are compassion fatigue, vicarious trauma, and secondary traumatic stress. In early research, these terms have been used synonymously, but as more research has been conducted, these terms have each been assigned a distinct definition. Let’s get into it.

Compassion Fatigue (CF) is defined as an individual’s gradual decline in feelings of compassion and empathy toward others due to the individual’s occupation or role as a caregiver. It is characterized by symptoms including hopelessness, depression, and high levels of stress/anxiety. Often described as “having nothing left to give,” it can be compounding because individuals who give of their care and compassion professionally do so because they have a lot of compassion to begin with and find great fulfillment in helping others. It is actually the MOST compassionate and caring people who are most susceptible to CF. When CF shows up, it can impact functioning relationally, behaviorally, emotionally, physically, and/or spiritually because it doesn’t just make it harder to have compassion for clientele, but for our family, friends, communities, and for ourselves.

Vicarious Trauma (VT) is an internal transformation in cognitive schemas related to personal identity, spirituality, and world view that occurs over time due to chronic exposure to others’ trauma. Ongoing VT can result in a shift in a care worker’s world view and sense of meaning, or their capacity to make a difference or truly help. It is characterized by suspicion, pessimism, and a powerlessness toward others, making the world feel unsafe and inducing a sense that others in it cannot be trusted. For me, this shows up tremendously in my ability to trust my community (daycare, schools) with my children. I project the most obscene and gruesome scenarios into any situation where I have to leave my child in the care of others. Sound familiar to any other parents out there?

Secondary Traumatic Stress (STS) is when symptoms show up that mirror those of post-traumatic stress disorder (PTSD), so even though a specific trauma never actually occurred to you personally, you can still experience intrusive imagery and/or thoughts, hypervigilance, hyperarousal, and experiencing someone else’s traumas in memories or dreams. These experiences usually express in benign moments where something in the environment or situation is somehow reminiscent of a tragedy we’ve been exposed to or know about. And they come disguised as our very own, so it is difficult to see their connection to our exposure to another’s trauma.

I’ll share a personal example: in my work in a quality assurance role within child welfare, I had to conduct a case review following a child fatality in which a single mother of two children, ages 2 ½ and 12 months, passed away in her living room from an abscessed tooth infection which spread to her brain. The children were in the home with their deceased mother for over a week, resulting in the death of the 12-month-old dehydration. The 2-year-old survived because he was able to find ways to get food and water for himself, and there was even evidence that he had been putting food in the crib of his little sister. This case has stayed with me, and even many years later, as I was sitting in a meditative state of witnessing my thoughts, home alone after putting my own 2 ½ year old to bed, I had the most gruesome imagery overtake my whole being. For several long minutes I imagined I was shot and killed by a sniper through one of my living room windows and my baby girl would come downstairs the next morning to find her mother dead. This scenario is also laced with my own personal family trauma of losing an uncle (my mother’s brother) to gun violence in his own neighborhood, in which he was shot and killed with an AK47 on his own back patio. Typically this kind of imagery is running just under my conscious thought, but because I was sitting in meditation as this happened, I was able to witness it, interrupt it before it could influence my emotional state, flaring my nervous system into a state of fear, which would then influence my behavior (getting up to close the blinds and lock the doors).

This is one of the most extreme examples of how STS has shown up for me, but I believe it isn’t that rare for others anymore, given our hyper exposure to all the many tragedies that occur on any given day in this world where we all live. When Brene Brown vulnerably shares her own experiences of kissing her kids goodnight in one moment, and in the next viscerally imagining their deaths, any parent is able to relate. AND, these scenarios are colored and filled in with intimate detail when you are a care worker exposed to the intimate details of the tragedy, loss, and trauma of others on a regular basis. There is a real and measurable cost to caring in a world that does not innately value life, that of humans or more-than-humans with whom we share this world.

I will also add that these fields of care are predominately filled by women, with national statistics in the U.S. showing 74-94% (depending on the specific field) of healthcare and social services professionals identifying as female. Add this to the unacknowledged care work in the home and within families and the burden on women is astronomical. It’s no wonder we’re burning out. But when your identity is defined by being a caregiver (and all women in western cultures are trained and conditioned to identify as the care laborers, starting in our families, and later extending to entrainment in schools, religious institutions, and society at large), this burnout feels more like a personal failure. When we become so depleted from showing up for others in their greatest times of need, but never feel that reciprocated, the results are catastrophic.

In my experience and in my personal journey to healing after my third and most profound major burnout as a care worker and mother, I have found that actually receiving care from others is THE work. Because people can offer us support and help and love and compassion, but until we have adjusted our esteem and self-value to one WORTHY of support, help, love, and compassion, none of those things will ever truly be FELT. And we will always be pouring from an empty cup. This is the crux. This is the only path that will cure our world of burnout.

I have been devouring the research on these impacts of care work since 2019 when I started a Master’s in Social Work program and took an entire elective course on Vicarious Trauma and Compassion Fatigue. After graduation with my MSW in November of 2020, I developed a full day training curriculum, which I delivered to the child welfare workforce on a quarterly basis for 5 years. The biggest shift the research recommends is in the workforce cultures of these fields, influenced most directly through leadership and how staff within fields of care are held and supported through these negative conditions by direct supervisors. I have been in roles of implementation endeavors within the child welfare system since 2016, and my state of Nevada actually implemented a coaching initiative in 2018 in an effort to support leadership in learning how to hold space for staff in child welfare as they encounter these harrowing impacts to their personal functioning. In 2023, I was sent through a coaching certification program and tasked with hosting coaching trainings twice a year for leadership and providing direct 1:1 coaching support to new supervisors throughout the initiation into their roles. All this to say I have seen and worked hard to create these shifts from a macro/systems perspective in this particular field of care for the last decade, but I have yet to see any successful shift in the high burnout rate, which averages 18 months in child welfare.

There is something the research has missed or not considered. And I believe that something is in each care worker’s individual capacity to receive. To experience FELT safety, love, and compassion requires deep inner work. Inner work of deconstructing what women are entrained to believe they are worthy of from our earliest ego development. This is the journey I have been on for the last 3 years and I want to share my story in hopes it can inspire, shape, and bring an awareness to a process each self-identified caregiver will have to undergo if she is to continue giving of her love in this world. And OH! How this world needs your love! But most importantly, how YOU need your love and the love of others.