Just about this time last year, I wrote a post on compassion fatigue. In that post, I discussed how there is no standardized definition of compassion fatigue. The definition has evolved over time and is often used in conjunction with burnout and secondary stress. This can be helpful, as they often go hand in hand. However, this can also result in these terms being overused, muddying their meaning. Without clarity, it can be difficult to know what we are really dealing with and what we might need. The final challenge with understanding compassion fatigue is that it hasn’t been studied very much among therapists. The research has focused on nursing and mental health providers in general. In my first post, I noted that much of the research I found that was most helpful came from veterinarian medicine.

As a result, I opted to present my own working definition, as influenced by Viktor Frankl, logotherapy. I proposed: What if compassion fatigue is about losing connection to the meaning of our work? And in turn, struggling with the existential suffering this disconnect creates?

Compassion Fatigue and Social Justice

I recently revisited my contemplations on compassion fatigue when preparing a lecture on it from a social justice lens. To do so, I needed to take a step back. Back from just the individual. My post and previous lectures on compassion fatigue fell into the common colonial, capitalistic trap of focusing too heavily on the person. While I did promote healing through community, I didn’t sufficiently acknowledge the socio-political factors that create, maintain, and perpetuate compassion fatigue.

We Are Not Ok

Even before the free fall of 2025, we as mental health care practitioners were not ok. Our managed health care system prioritizes numbers over people, among patients and providers alike. The pandemic was a wake-up call to the severity of how providers have been dehumanized and asked to push through at all costs. Mental health care is an industrialized complex of its own, rooted in a dichotomized medical diagnostic system. A system originating in slavery and racism to classify behaviors as socially acceptable, or not, by white European standards. A system that does not account for (nor care much about) the complexities of the human, individual, collective, and intergenerational experience.

Now, only halfway through 2025, it is getting scarier and scarier. Adriana Smith’s body was kept functioning, without family consent, for her baby’s gestation to go to term. Porsha Ngumezi died because she did not get the D&C she needed; she is the third woman in Texas to die as a result of abortion bans. Transgender clinics have been shut down across the country; bans preventing Trans youth from getting care are being upheld. Medicare and Medicaid are at risk of being cut. Kyle Lewis will no longer receive the experimental cancer treatments that saved his life. There are proposed cuts to HIV research and prevention programs. Necessary medical information has been removed from crucial websites. Insurance companies may not cover COVID-19 vaccinations following the revocation of its recommended status. Those with autism and autism spectrum disorders, and their families, face ongoing misunderstanding and stigmatization. And the list goes on.

Under these conditions, how can we not feel worn-out, hopeless, and sense that no matter what we do, it can’t possibly be enough?

An Act of Social Justice

Talking about compassion fatigue is and of itself an act of social justice. Doing so challenges ableist norms of health and wellness that imply sick days are only for severe circumstances and that asking for help is a weakness. It also goes against European models of viewing providers as separate from those who are “sick.” In this separateness, they are then expected to be experts and blank slates who should always be skillful, cope effectively in their own work and lives, leave personal lives at the door, and have all the answers. It challenges capitalistic values of worth based on productivity, wherein burnout is glorified and viewed as a marker of success. Lastly, this conversation calls out violent patriarchal structures and systems that do not protect their own (often while promoting a “family” mentality in the workplace, with “open door” policies, and pizza parties to boost morale).

A New(er) Definition of Compassion Fatigue

If compassion fatigue isn’t just about the individual, though it is still connected to losing a sense of meaning, is compassion fatigue:

Loss of connection to the meaning of the work, as influenced by structural oppression, resulting in suffering? And what if we cope with and build resistance to compassion fatigue through decolonization and community?

A Dialectical Process

As with much of my efforts towards refiguring my conceptualizations of the mental health care system, I turn to Decolonizing Therapy. Dr. Mullan posits that the act of decolonizing therapy is:

…a process full of dichotomies and paradoxes.  A personal, yet collective journey; a lonely yet supported journey; a political and healing journey; an abolishing and merging journey; a practical and scientific, yet ancestral and fluid healing journey (Mullan, 2023, p. 3).

As applied to compassion fatigue, I see all of this as true, all at the same time. Thus, posit that it is a dialectical process. One where we recognize that the onus is not on us as individuals to prevent compassion fatigue. We didn’t create, nor can we (overnight, readily, or on our own) dismantle the systems that make compassion fatigue inevitable. And we have to start where we can, with what is within our control, which is ourselves. And, we have to hold the systems accountable and engage in collective action.

What does this look like?

It looks like some of the things I discussed in my last post. Self-reflection, learning what our compassion is telling us about what we need, celebrating the wins, finding joy, and being in community. Though now we take that reflection deeper and acknowledge factors beyond ourselves. Some questions to consider are:

• How are the systems you are a part of, part of the mental health industrial complex?
• Who are the stakeholders in your education/work? How does their agenda impact you?
• In what ways is the system where you learn/work fostering compassion satisfaction versus contributing to compassion fatigue? 

• What ableist views are promoted in your place of work? Which of these have you internalized?
  • How do those views impact your self-reflective practices and ways of seeking help?
• What capitalistic views are promoted in your place of work? Which of these have you internalized?
  • How do they influence your decision-making around taking time off; accepting new clients? 
  • How do they impact how you measure making a difference? Doing enough? BEING enough?
• What patriarchal views are promoted in your place of work? Which have you internalized?
  • Based on your gender identity, how do they guide your allowance for rest?
• What colonialist views are promoted in your place of work? Which have you internalized?
  • How do they manifest in your professional identity? Expert? Rescuer?

Revisiting the Starfish Analogy

As I was working on the lecture, I realized there is a significant flaw in the starfish analogy. Why is there only one person out there trying to rescue the starfish? In the spirit of decolonizing, recognizing that we are all in this together, and each has a unique role to play, I propose a new version of this story. One where there are many people on the beach, gathering starfish and returning them to the ocean. And another group of people are making sandwiches to feed those on the beach, and another to provide hats and sunblock. Yet another group is researching why the starfish were swept to land in the first place and figuring out how to prevent it from happening again in the future. We cannot, and are not meant to do this alone.

For Clinicians: How do the systems in your work, your world, impact your compassion fatigue? What does community look like and mean to you? What does meaning in your work look like to you? How do you find it when it has been lost?

For Those Seeking Healing: You may be seeking care because of your struggles with compassion fatigue as a therapist or other provider of care. It is not your fault you are struggling. You did not create the conditions of your compassion fatigue. You are not alone.