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January/February 2017

PTSD & Compassion Fatigue: The Pioneering Work of Charles Figley
Gian Jacopo Caraglio, Fury, circa 1525, National Gallery of Art

BY LOANA HOYLMAN

“Taking care of myself doesn’t mean ‘me first.’ It means ‘me, too.’”

— L.R. Knost

Small encounters can lead to momentous changes. In Vietnam Marine Cpl. Charles Figley began visiting children in his off hours as an antidote to the horrors of war. Rather than being depressing, the visits were mostly heartening because, as Figley said, “Well, they’re kids— resilient.”

After coming home, Figley began to work with traumatized children. He was grateful to be whole in mind and body, humbled by gratitude, scoured out by experiences, and reverent with wonder at the strength and adaptability of traumatized people. The lessons of resiliency have stayed with him throughout a long and productive career.

Figley has worked with traumatized veterans and others with PTSD, secondary PTSD, vicarious trauma, and compassion fatigue. He is founder and past president of Green Cross Academy of Traumatology, with which he worked in New York City after the September 11 attack on the World Trade Center and with the victims in Sri Lanka after the 2004 tsunami. In 2007 he provided trauma services following a mass shooting at Virginia Tech. He is a founding member of the national and the Florida State University chapter of the Collegiate Veterans Association, and he hosted the Second Annual Combat Stress Symposium. Figley—who holds a Ph.D. in health and human development—also works with historical trauma suffered by groups such as American Indians and Holocaust victims.

Figley re-affirms that it is his “mission in life to take stock of what we know about trauma and to tell laymen in language that avoids labels.” His writings cover broad spectrums of trauma and the constantly developing effects of both trauma and therapies. He was editor-in-chief of the journal Traumatology: Methods for Reducing or Eliminating Related Human Suffering.

All things have moving shadows of meaning. PTSD has many faces: compassion fatigue, vicarious trauma, PTSD, and secondary PTSD. Figley has run the gamut of understanding PTSD and other effects of trauma in all its forms. He is director of Tulane University Traumatology Institute and is associate dean in the School of Social Work. His generosity and compassionate desire to reveal the light in the darkness shows in the long list of his publications, honors, and awards.

One of Figley’s early works is Stress Disorders Among Vietnam Veterans, a compilation of writings on traumatized veterans returning home from war. This is a remarkable book. Compiled in 1978, it challenged the theory that those suffering from what is now known as PTSD only got it because of pre-existing conditions—a theory that wrote off the horrific experiences of men and women who served in Vietnam. The book’s analysis of the components of PTSD is clear and articulate, including the symptoms and causes we know today. It is also prescient in its recognition of the effects of PTSD on family and friends, what we now call secondary PTSD.

Victor J. DeFazio, one of the book’s contributors, wrote, “Mates or friends are at a loss to understand what they have done to provoke such a response [of anger, rage, or hostility]. The end results are frequent rifts between the men and their friends or families.”

A person does not have to experience trauma directly in order to get PTSD. It’s a metaphorical virus that one “catches” from another. Family members with a veteran who comes home with PTSD can suffer the same nightmares, rages, moodiness, isolation, and hypervigilance, until these factors become parts of their own brains, their own memories, their own actions.

There are other ways to be exposed to the trauma of others. People who work at jobs that require intense empathy and compassion are subject to an emotional contagion called compassion fatigue, first recognized in 1992 in nurses. Doctors, nurses, and other health care workers—especially psychology therapists—are vulnerable, as are those who work with homeless people, world disaster relief, and even veterinarians.

“Compassion fatigue is the latest in an evolving concept that is known in the field of Traumatology as secondary traumatic stress,” Figley has written. “Most often this phenomenon is associated with the ‘cost of caring.’ ”

It isn’t just one trauma story, but an accumulation of hundreds of stories, a cumulative level of trauma that affects the people who listen. According to the National Child Traumatic Stress Network, 6 to 26 percent of therapists working with traumatized populations—and up to 50 percent of child welfare workers—are at high risk of secondary traumatic stress or the related conditions of PTSD and vicarious trauma.

Domenico del Barbiere, Gloria, 1540/1545, National Gallery of Art

Most symptoms of PTSD are the same for everyone: isolation, nightmares, flashbacks, irritability, flash anger, and self-contempt. Like primary PTSD, compassion fatigue takes time to manifest, though it can seem to have arrived overnight. It is an accumulation of others’ experiences that leaves one blunted, numb, and worn out. It is not burnout, which is apathy, stagnation, and frustration concerning work. Those are elements of PTSD but without its other well-known symptoms. Compassion fatigue affects every aspect of life.

New therapies focus on memory management. People often believe that to go back into the trauma is more than they can handle. But in PTSD, compassion fatigue, and vicarious trauma, a sufferer is too often in that trauma all the time anyway, during nightmares and flashbacks. The effects of trauma color everything they do.

“Just fixing problems doesn’t work. One needs to thrive,” Figley said. “You can’t choose actions in life, but you can choose result and response.” That is, we have pliable, protean brains capable of change, transformation, even reshaping. The brain is a malleable organ, ever ready to change. We can change the effects of trauma and memory.

“We have the ability to think through issues,” Figley said. “You learn to store memory, how to cope with it, what it means. Besides, memory changes every time you remember. Also, others’ memories become your own, and you may not even know it. Their memories infiltrate your own, become interwoven.”

Anne Dietrich wrote in Traumatology, “the encoding of the information and controlling of behaviors by the brain itself acts to change brain structure and chemical processes—that is, the activity of the brain itself alters its own structure.”

Our flexible brains can learn, can be dark or light or both. They also can re-route memory and experience to better places. It isn’t the memory we change. It is the effects of memory. It is the detritus of illness that can be changed.

Word used to be that PTSD was forever, that one must suffer through it. But that’s not true. Humans are resilient.

“Trauma is memory management,” Figley said. “So if memory can be trained to do one thing, it can be trained to do other things, like take a proper place within a life, not to be the life.” Dietrich agreed: “stress-induced structural changes in the brain are potentially reversible.”

People with PTSD have to want to get better, to be rid of the nightmares and the flashbacks, to get rid of the static that fills their heads. A person’s deep self will not be “changed.” But the disconnect can be connected. A whole person can emerge, complete, without the fragmentation of daily PTSD life. There is value, not in the trauma, but in what happens afterward. Figley calls this wisdom.

For those vulnerable to compassion fatigue, debriefing with coworkers, supervisors, or colleagues is paramount for remaining healthy. Other exercises include writing journals, talking to therapists and friends, and doing artwork. Sometimes one’s own words are revelatory, a self-disclosure that informs one’s self and from that, one learns. A person may find ways to “face up to himself,” as Figley said. Disclosure makes people closer. We all have to choose well whom we talk to; someone encouraging, someone able to listen to hard stories, no platitudes, no answers, just being a presence, even if only to ourselves.

When the veil of shame and confusion is lifted, “You can see what you did right,” Figley explained. “You can see your own resiliency and courage. If you do not try to heal, you are missing out on wonderful experiences.”

It’s those experiences that Figley said will come out of the healing of trauma. There is no reason to go through life suffering from past trauma. “Here we get into the miracles of human existence,” he said, “where humans can and do get better after trauma. Not just better, but transformed, almost like being born again.”

The memories of trauma are still there, Figley explained, one’s own or those of others. But that’s all they are—memories. There is no longer the compulsion to re-live the trauma. The events take their proper place with all the other memories, integrated into a whole, not standing alone to plague and disrupt life. When memory stands alone, in flashbacks or in nightmares, fragmentation is inevitable. Memories repeat over and over, pulled apart from the rest of living, isolated in past trauma. When those same memories become integrated, one is again complete, whole, and unbroken.

People see, maybe for the first time, all the things they did right in order to live and survive. They understand they haven’t been weak; they realize they have been resilient because they have survived.

It becomes easier to relate to others because of the deep knowledge of what it is to be fragmented. There are new possibilities, new importance, new priorities. Figley said that most people experience spiritual changes, maybe in religion, maybe in existential change, or in living in different ways. “There is a sanctity of life,” he said. “Nature and music, for example, become elevations of the spirit and mind. Awe and wonder renew and transform in ways never before experienced.”

People with PTSD, including compassion fatigue, have been through hell and have learned hard lessons, many of which cannot be articulated. But they also have a bond with others who have experienced trauma in ways never felt before. As Figley attested, “There is a transformation of mind and soul. One sees that resilience and wisdom have replaced living every day in trauma.”

A great deal of help is available for people with compassion fatigue. Visit the Green Cross Foundation: Academy of Traumatology website greencross.org Green Cross is an international nonprofit for humanitarian assistance in disasters and emergencies across the globe. Figley recommends a video, “When Helping Hurts: Sustaining Trauma Workers,” from Gift from Within, 207-236-8858; giftfromwithin.org Finally, all of Figley’s books are excellent resources.


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