Overcoming Disaster Fatigue, Part 1: The Challenges

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

“One death is a tragedy; a million deaths is a statistic.”

One of my colleagues, one of the most empathic, compassionate, and appropriately knowledgeable psychiatrists I know, recently shared this concern as the Texas flood tragedy was unfolding:

“Personally, I am concerned that I am developing a hard shell and do not have the expected and appropriate grief for these mounting tragedies. Pains me to think I am hardening.”

That colleague is certainly not the only one, not by any means. Whatever psychiatrist listserves and caucuses I have been involved with have become quiet about the polycrisis. I even miss the volatile interactions and disagreements about the wars and political divisiveness.

Usually in a disaster, humanity is at its best in responsiveness and help. One reason is that we can usually come into that with sufficient emotional reserve and available time. We also will usually have specific ways to help out. Certainly, that has been true in the Texas flash flood tragedy.

However, when the acute stage is over, the involvement of others inevitably dissipates and recommendations for change, as in mass shootings, disappear. To make matters worse, those encountering major trauma, as well as those closely connected, may just be starting to have such delayed reactions as survivor guilt and delayed posttraumatic stress disorder.

Generally, helping patients in everyday clinical psychiatry is easier because they can be focused on one by one. While a principle can be applied to millions, that can feel disconnected to the victims. But if a practice has a lot of difficult and unstable patients, or a lack of needed resources and psychiatrist support, a sort of disaster fatigue is liable to emerge. In addition, we always have to monitor our possible countertransference intrusions of our own personal issues.

Similarly, parenting and other workplaces are increasingly at risk for burnout. In all such caring situations, there are challenges to watch for. Some are:

• Emotional fatigue. Although we go into the helping professions with emotional reserves, we vary individually and are stressed variably.
• Compassion fatigue. Compassion for others can lead to appropriate action, but systems or personal circumstances can block that.
• Burnout. When the system blocks too much of our healing abilities, we can start burning out, as in our ongoing physician burnout epidemic.
• Learned helplessness. There is a legendary frog experiment of being thrown into a water bin that is being gradually heated until the frog is cooked to death, instead of jumping right out of acute hot water.

The clues that one is becoming overcome with disaster fatigue includes mental, physical, and effectiveness signs: isolation, numbness, tiredness, overwhelmed, obsessive, self-blame, headaches, increased blood pressure, substance abuse, mistakes, and the “hardening” my colleague mentions, among other things.

Tomorrow: some solutions.

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He presented the third Rabbi Jeffrey B. Stiffman lecture at Congregation Shaare Emeth in St. Louis on Sunday, May 19, 2024. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.