By: Alejandro Chaoul, Ph.D., Lorenzo Cohen, Ph.D., and Kathrin Milbury, Ph.D., The Integrative Medicine Program, MD Anderson Cancer Center, Houston, Texas
Cancer does not solely affect individuals. It affects the larger community, which consists of families, friends, neighbors and coworkers. Witnessing a loved one overcoming or struggling with cancer may foster feelings of joy or sorrow. These deep emotions are rooted in our heart's ability to have compassion. The Latin for compassion -- "com-pati" -- means, "to suffer with." Consequently, family members, particularly patients' spouses/partners, "suffer with." When caregivers witness their loved one hurting from cancer and its treatment, they hurt as well. In fact, our own research reveals caregivers experience symptoms such as psychological distress, fatigue, and sleep disturbances just as much or even more than patients. The first step in compassion is often the feeling of empathy toward those who suffer, which in turn produces the genuine desire to help. Empathy, as in being in someone else's shoes, without progress to true compassion can be detrimental in the long run for the caregiver.
Caregivers devote their love and energy to someone's life. However, their ability to respond empathically for prolonged periods of time can be limited and may result in "vital exhaustion," a state of emotional numbness in which we are emotionally drained and cannot respond effectively to other's needs, including patients, and even ourselves. Roshi Joan Halifax, who recently lectured at MD Anderson Cancer Center and conducted a workshop on fostering compassion for faculty, staff, and MD Anderson leadership referred to this as a "pathological altruism." The antidote to this state is seeking a deeper understanding and practice of compassion. A definition of compassion that she embraces from Tania Singer states that compassion is "the emotion one experiences when feeling concern for another's suffering and desiring to enhance that person's welfare." As Dr. Halifax points out, in the medical and nursing literature we find the term "compassion fatigue," which is really referring to "pathological altruism" or "vital exhaustion." In her view, however, we cannot be fatigued by pure compassion.
To understand and practice compassion, and to provide loving and quality care, it is important for caregivers and health care professionals to be mindful of their own suffering, distress, and needs. Kristin Neff and others call this "self-compassion," an important first step in developing true compassion for others. In fact, numerous studies reveal self-compassion is related to improved psychological well-being and the ability to respond compassionately to others.
Self-compassion is not ego-centric or selfish as in "putting oneself first." Rather, taking care of ourselves first enables us to effectively care for others. On an airplane, we always hear "put your oxygen mask on first before helping others." Without self-care and self-compassion we cannot be effective caregivers for extended period of times. Self-care can include joining a support group, meditation or other mind-body class, a spiritual support-group or other self-care approaches. Whether a patient, caregiver, or health care professional, self-compassion and self-care may lead to enhancing meaning and finding benefit in challenging situations that can otherwise lead to suffering.
In order to connect to compassion, whether for ourselves or others, there are a few skills that are important to cultivate. Based on Dr. Halifax's extensive work on compassion, she has developed the wonderful mnenomic G.R.A.C.E. to highlight five key steps in the cultivation of compassion. One begins by Gathering attention, being focused and balanced; then Recalls intention and motivation, both affective and cognitive; Attunes somatically and cognitively to oneself and then to the other; Considers what will serve; and finally Engages, and concludes. In other words, in order to engage fully in a compassionate interaction, one needs to start by learning how to connect more fully with oneself, both at a somatic and cognitive level. For instance, a physician friend, Dr. Jim Duffy focuses his intentions as he washes his hands with soap or gel before entering the patient's room. This simple act can be one practical way to start implementing the G.R.A.C.E. model, and can be a big step forward in caring for our patients and ourselves.
As Dr. Halifax states in her TED talk, "it takes a Strong Back and a Soft Front ... tremendous back strength to uphold oneself in the midst of difficult conditions, but it also takes a soft front -- or openness to the world as it is, to have an undefended heart."