Compassion Fatigue

Caring For The Caregivers: The State Of Mental Illness
Thursday, November 12, 2009

Katy Aisenberg, a psychologist in private practice in Cambridge, reflects on recent events and the often invisible stress that mental health providers endure:

As the nation held its breath, waiting for news about health care, violent acts were committed against a caregiver to the mentally ill and by a caregiver himself. The psychiatrist in Fort Hood who shot military men and women was preceded by a more intimate tragedy. At Massachusetts General Hospital a bi-polar man, at an outpatient appointment, attacked his psychiatrist, a female doctor and was killed by a security guard who happened on the scene.

The following day I sat in my office and wondered, not for the first time, if I might get killed by a patient or have a death on my hands. And I thought (unlike many) how amazing it is that these events do not happen daily.

Mental illness shows no prejudice: it is invisible and slippery. Progress is difficult to measure and the care is given by people who are tired, severely underpaid, suffer compassion fatique and vicarious traumatization. We live in two worlds — often at the boundary of madness. Then we walk back into the bright, well-lit rooms of our homes or our children’s school and try to forget what we know.

But at such an important moment of change, as we contemplate our American health care “system” we need to review the state of mental illness. Thirteen years ago I began treating young women who were dying from eating disorders. I was tremendously optimistic about change in my field. Taboos were lifted and therapy became widely acceptable as did new and effective psychotropic medication.

Yet, in fact, the opposite has happened. I see more and younger women succumb to eating disorders. We know what treatment is but there are fewer places for this treatment. I also see the power of our modern culture: we speed up our pace of achievement but are fed less nourishment. We have less free time, vacation time, time with our own children. Rarely do we have time to read and reflect upon what we do. We refuse ourselves the precise self-care which we insist is essential for our patients.

Mental illness — the invisble dark cloak of depression, the shaking hands of the anxious, the rude voices of schizophrenia — is one of America’s untouched frontiers. We believe that people with cancer are due every bit of bone marrow they can find. Yet we leave our ill to sit in squalor with demons in their heads. No one visits or calls. Loneliness is the chief complaint of most of my patients.

Something in us still dares not name mental illness when we see it. Others of us trust everyday that the relationship we have formed with our patients—the web of connection thrown over an abyss, will hold. The anxiety, depression, and psychosis caregivers metabolize is staggering. We do it because we are curious, compassionate and believe we are not doing hospice work. I remain deeply troubled as to why this profession goes undervalued when it is lifesaving and lifeaffirming.

Our country is still adolescent. We believe death will not happen to us. We believe that unattractive aging is optional. We believe there is an ‘us and a ‘them.’ Until that prejudice is dropped and we understand that mental illness is often a cruel accident of birth, we will never provide adequately for mental illness in those we care for or those who give care. The valedictorian of the class, the doctor’s wife who requires weekly restraints, the college roommate who kills himself while writing a book….all of these real people are just a few cracks in the pavement away from us. There is nothing especially ‘other’ about mental illness. Perhaps that is why it scares us so.