In monetary policy of the United States, the term Fedspeak (also known as Greenspeak) is what Alan Blinder called "a turgid dialect of English" used by Federal Reserve Board chairmen in making wordy, vague, and ambiguous statements. The strategy, which was used most prominently by Alan Greenspan, was used to prevent financial markets from overreacting to the chairman's remarks. The coinage is an intentional parallel to Newspeak of Nineteen Eighty-Four, a novel by George Orwell.
Fedspeak when used by Alan Greenspan is often called Greenspeak.
An alternative definition of Greenspeak is "the coded and careful
language employed by U.S. Federal Reserve Board Chairman Alan
Greenspan."
Edwin le Heron and Emmanuel Carre state that "Nowadays,
'Fedspeak' (Bernanke, 2004) means clear and extensive communication of
the Fed's action." Chairman Ben Bernanke and Chairwoman Yellen
have effected a major change in Fed communication policy departing from
the obfuscation that characterized the previous three decades. In 2014 a
new detailed level of Fed communication was dubbed Fedspeak 3.0. In 2018, Chairman Jerome Powell would begin press conferences with a summary statement in plain English, in contrast to his predecessors who would read lengthy prepared statements loaded with monetary policyjargon.
Origin
The
notion of fed speak originated from the fact that financial markets
placed a heavy value on the statements made by Federal Reserve
governors, which could in turn lead to a self-fulfilling prophecy.
To prevent this, the governors developed a language, termed Fedspeak,
in which ambiguous and cautious statements were made to purposefully
obscure and detract meaning from the statement.
Though previous "Fed" chairmen Arthur Burns and Paul Volcker
were known for blowing smoke, both literally and figuratively, when
appearing before Congress, Alan Greenspan is credited with making
Fedspeak a "high-art".
It is unclear whether the term Fedspeak was used widely prior to
Greenspan, but with historical hindsight the modern term could be used
to describe Burns's and Volcker's method.
Usage by Alan Greenspan
He used to take pride in the resulting
obfuscation—even characterizing his own way of communicating as
'mumbling with great incoherence'. In a famous incident, he once told a
US senator who claimed to have understood what the famously obscurantist chairman had just said, "in that case, I must have misspoken".
— How do central banks talk?
Although it was originally believed by some that Alan Greenspan,
who is generally credited for popularizing Fedspeak, may have used such
language unintentionally, he revealed in his 2007 book The Age of Turbulence,
that the method of avoiding the issues directly when a clear message
was not desired was indeed intentional. Greenspan states that the
confusion, which often resulted in conflicting interpretations, was used
to prevent unintended jolts to the markets as confusing statements were
typically ignored.
He noted that he came upon the dialect while at the Fed: "What
I've learned at the Federal Reserve is a new language which is called
'Fed-speak'. You soon learn to mumble with great incoherence."
In an interview with 60 Minutes's Lesley Stahl
on September 16, 2007, Stahl stated how "In public, Greenspan was
inscrutable whenever congress asked about interest rates. He resorted to
an indecipherable delphic dialect known as fedspeak" to which Greenspan
responded that "I would engage in some form of syntax destruction which
sounded as though I were answering the question, but in fact, had not."
When Stahl noted that Greenspan's responses were "impenetrably
profound" and that this resulted in "two newspapers getting opposing
headlines coming out of the same hearing", Greenspan responded that "I
succeeded".
In an interview with CNBC's Maria Bartiromo on September 17, 2007, when asked to describe Fedspeak, Greenspan described it as:
It's a—a language of purposeful obfuscation to avoid certain
questions coming up, which you know you can't answer, and saying—'I will
not answer or basically no comment is, in fact, an answer.' So, you end
up with when, say, a Congressman asks you a question, and don't wanna
say, 'No comment', or 'I won't answer', or something like that. So, I
proceed with four or five sentences which get increasingly obscure. The
Congressman thinks I answered the question and goes onto the next one.
In an interview with BusinessWeek in August 2012, when asked "about practicing the art of constructive ambiguity", Greenspan replied:
As Fed chairman, every time I expressed a view, I added or subtracted
10 basis points from the credit market. That was not helpful. But I
nonetheless had to testify before Congress. On questions that were too
market-sensitive to answer, 'no comment' was indeed an answer. And so
you construct what we used to call Fed-speak. I would hypothetically
think of a little plate in front of my eyes, which was the Washington Post,
the following morning's headline, and I would catch myself in the
middle of a sentence. Then, instead of just stopping, I would continue
on resolving the sentence in some obscure way which made it
incomprehensible. But nobody was quite sure I wasn't saying something
profound when I wasn't. And that became the so-called Fed-speak which I
became an expert on over the years. It's a self-protection mechanism ...
when you're in an environment where people are shooting questions at
you, and you've got to be very careful about the nuances of what you're
going to say and what you don't say.
Examples of Greenspeak
The Fed has a language all its own, and unfortunately, the folks over at Rosetta Stone have yet to create a program to help laypeople understand what the hell the fed is talking about.
As of 2011, the Federal Reserve Bank of Dallas
website still maintains a "Greenspeak" page with dozens of excerpts
from Greenspan's past statements as head of the Federal Reserve Bank.
Each quotation has a pointer to its full context in his speech, and is
posted without commentary or interpretation.
The members of the Board of
Governors and the Reserve Bank presidents foresee an implicit
strengthening of activity after the current rebalancing is over,
although the central tendency of their individual forecasts for real GDP
still shows a substantial slowdown, on balance, for the year as a
whole.
— Alan Greenspan,
Testimony from the Federal Reserve Board's semiannual monetary policy
report to the Congress before the Committee on Banking, Housing, and
Urban Affairs, U.S. Senate on February 13, 2001
Risk takers have been encouraged by
a perceived increase in economic stability to reach out to more distant
time horizons. But long periods of relative stability often engender
unrealistic expectations of it[s] permanence and, at times, may lead to
financial excess and economic stress.
Clearly, sustained low inflation
implies less uncertainty about the future, and lower risk premiums imply
higher prices of stocks and other earning assets. We can see that in
the inverse relationship exhibited by price/earnings ratios and the rate
of inflation in the past. But how do we know when irrational exuberance
has unduly escalated asset values, which then become subject to
unexpected and prolonged contractions as they have in Japan over the
past decade?
I would generally expect that today
in Washington DC the probability of changes in the weather is highly
uncertain, but we are monitoring the data in such a way that we will be
able to update people on changes that are important.
— Alan Greenspan, Greenspan describing the weather in response to a question by Owen Bennett-Jones on BBC's The Interview (October 2007)
Other usage
In the 2010s, the Federal ReserveOpen Market rate-setting committee (FOMC) began publishing dot plots to tabulate all individual committee member projections of target interest rates in a single graphic. In 2016, the president of the St. Louis FedJames Bullard began a movement away from the dot plot exercise, citing a gap of opinion between market economists and FOMC members. As of 2018,
the FOMC has continued to publish dot plots in its economic
projections, detailing the variety of opinions of the committee members
for the "appropriate target range for the federal funds rate" in future
years.
Commentary
The
University of Virginia Writing Program Instructor Site offers some
selected quotations from Greenspan, with a suggestion that students be
given writing exercise assignments of clarifying their expression of
ideas.
A public relations
firm cites an example of "Greenspeak" as the statement of one of the
"master practitioners of creative ambiguity over the years". The brief
essay mentions two other master practitioners of obfuscation, Hubert H. Humphrey and Casey Stengel.
The overall tone of the essay is one of awed admiration for a
sometimes-necessary skill in obscurantism. In closing, the writer notes
that, "As professional performers say, to deliberately sing off-key
requires a highly skilled singer."
Writer's block is a condition, primarily associated with writing,
in which an author loses the ability to produce new work or experiences
a creative slowdown. This loss of ability to write and produce new work
is not a result of commitment problems or lack of writing skills.
The condition ranges from difficulty in coming up with original ideas
to being unable to produce a work for years. Writer's block is not
solely measured by time passing without writing. It is measured by time
passing without productivity in the task at hand.
Throughout history, writer's block has been a documented problem.
A representation of writer's block by Leonid Pasternak (1862 – 1945)
Professionals who have struggled with the affliction include authors such as F. Scott Fitzgerald and Joseph Mitchell, comic strip cartoonist Charles M. Schulz, composer Sergei Rachmaninoff, and songwriter Adele.
Early Romantic writers did not understand much about the topic; they
assumed writer's block was due to a power that did not want them to
write anymore. It became slightly more recognized during the time of
French Symbolists who had famously recognized poets that gave up writing
early into their career because they couldn't find the language to
convey their message. During the period of the Great American Novel it was very widely recognized as something that would block a writer and cause them emotional instability.
Research concerning this topic was done in the late 1970s and 1980s.
During this time, researchers were influenced by the Process and
Post-Process movements, and therefore focused specifically on the
writer's processes. The condition was first described in 1947 by
Austrian psychoanalyst Edmund Bergler, who described it as being caused by oral masochism, mothers that bottle fed and an unstable private love life. The growing reputation of psychiatry in the United States made the term gain more recognition. However, some great writers may have already suffered from writer's block years before Bergler described it, such as Herman Melville, who quit writing novels a few years after writing Moby-Dick.
Causes
Writer's block may have several causes. Some are creative problems that originate within an author's work itself. A writer may run out of inspiration, or be distracted by other events. A fictional example can be found in George Orwell's novel Keep the Aspidistra Flying, in which the protagonist Gordon Comstock struggles in vain to complete an epic poem
describing a day in London: "It was too big for him, that was the
truth. It had never really progressed, it had simply fallen apart into a
series of fragments."
Other blocks may be produced by adverse circumstances in a writer's life or career: physical illness, depression, the end of a relationship, financial pressures, or a sense of failure.
The pressure to produce work may in itself contribute to writer's
block, especially if they are compelled to work in ways that are against
their natural inclination (e.g. with a deadline or an unsuitable style
or genre). The writer Elizabeth Gilbert,
reflecting on her post-bestseller prospects, proposed that such a
pressure might be released by interpreting creative writers as "having"
genius rather than "being" a genius.
It has been suggested that writer's block is more than just a
mentality. Under stress, a human brain will "shift control from the cerebral cortex to the limbic system".
The limbic system is associated with the instinctual processes, such as
"fight or flight" response; and behavior that is based on "deeply
engrained training". The limited input from the cerebral cortex hinders a
person's creative processes, which is replaced by the behaviors
associated with the limbic system. The person is often unaware of the
change, which may lead them to believe they are creatively "blocked". In her 2004 book The Midnight Disease: The Drive to Write, Writer's Block, and the Creative Brain (ISBN9780618230655), the writer and neurologistAlice W. Flaherty has argued that literary creativity is a function of specific areas of the brain, and that block may be the result of brain activity being disrupted in those areas.
Dr. Flaherty suggested in her writing that there are many diseases that
may impact ones ability to write. One of which she refers to is Hypergraphia,
or the intensive desire to write. She points out that in this
condition, the patients temporal lobe is afflicted, usually by damage,
and it may be the same changes in this area of the brain that can
contribute to writer's blocking behaviors. Not to be confused with writer's block, agraphia
is a neurological disorder caused by trauma or stroke causing
difficulty in communicating through writing. Agraphia cannot be treated
directly, but it is possible to relearn certain writing abilities.
Physical damage can produce writer's block. If a person
experiences tissue damage in the brain, i.e. a stroke, it is likely to
lead to other complications apart from the lesion itself. This damage
causes an extreme form of writer's block known as agraphia.
With agraphia, the inability to write is due to issues with the
cerebral cortex; this disables the brain's process of translating
thoughts into writing. Those with this disorder are typically born able
to process this information correctly, meaning regardless of previous
abilities, one can develop this form of writer's block due to solely
physical injury.
Brain injuries are an example of a physical illness that can cause a
writer to be blocked. Other brain related disorders and neurological
disorders such as epilepsy have been known to cause the problem of
writer's block and hypergraphia, the strong urge to write. Some
other causes of writer's block has been due to writer's anxiety.
Writer's anxiety is defined as being worried with one's words or
thought, thus experiencing writer's block.
For a composition perspective, Lawrence Oliver says, in his
article, "Helping Students Overcome Writer's Block", "Students receive
little or no advice on how to generate ideas or explore their thoughts,
and they usually must proceed through the writing process without
guidance or corrective feedback from the teacher, who withholds comments
and criticism until grading the final product." He says, students "learn to write by writing", and often they are insecure and/or paralyzed by rules.
Phyllis Koestenbaum wrote in her article "The Secret Climate the
Year I Stopped Writing" about her trepidation toward writing, claiming
it was tied directly to her instructor's response. She says, "I needed to write to feel, but without feeling I couldn't write."
To contrast Koestenbaum experience, Nancy Sommers expressed her belief
that papers do not end when students finish writing and that neither
should instructors' comments. She urges a "partnership" between writers and instructors so that responses become a conversation.
Mike Rose states that Writer's Block can be caused by a writers
history in writing, rules and restrictions from the past. Writers can be
hesitant of what they write based on how it will be perceived by the
audience.
James Adams notes in his book, Conceptual Blockbusting,
various reasons blocks occur include fear of taking a risk, "chaos" in
the pre-writing stage, judging versus generating ideas, an inability to
incubate ideas, or a lack of motivation.
Treatment
As far as strategies for coping with writer's block Clark describes: class and group discussion, journals, free writing and brainstorming, clustering, list making, and engaging with the text. To overcome writing blocks, Oliver suggests asking writers questions to uncover their writing process. Then he recommends solutions such as systematic questioning, freewriting, and encouragement. A recent study of 2500 writers aimed to find techniques that writers themselves use to overcome writer's block.
The research discovered a range of solutions from altering the time of
day to write and setting deadlines to lowering expectations and using
mindfulness meditation. Research has also shown that it is highly
effective if one breaks their work into pieces rather than doing all of
their writing in one sitting, in order to produce good quality work.
It's also important to evaluate the environment in which the writing is
being produced to determine if it is the best condition to work in. One
must look into theses different factors to determine if it is a good or
bad environment to work in.
Psychologists who have studied writer's block have concluded that it is
a treatable condition once the writer finds a way to remove anxiety and
build confidence in themselves.
Garbriele Lusser Rico's concern with the mind links to brain lateralization, also explored by Rose and Linda Flowers and John R. Hayes among others. Rico's book, Writing the Natural Way
looks into invention strategies, such as clustering, which has been
noted to be an invention strategy used to help writers overcome their
blocks,
and further emphasizes the solutions presented in works by Rose,
Oliver, and Clark. Similar to Rico, James Adams discusses right brain
involvement in writing. While Downey purposes that he is basing his approach in practical concerns,
his concentration on right brain techniques speaks to cognitive theory
approach similar to Rico's and a more practical advice for writers to
approach their writer's block.
Mind Mapping,
is suggested as another potential solution to writers block. The
technique involves writing a stream of consciousness on a horizontal
piece of paper and connecting any similar or linked thoughts. This
exercise is intended to help a writer suffering from writers block to
bypass the left hemisphere of their brain and access the right
hemisphere more directly.
Other research exemplifies neurological malfunctions as the
primary cause of these factors. Similar to the aforementioned brain
lateralization, it's only different in that Malcom T. Cunningham shows
how these malfunctions were even linked to trauma both mental and
physical.
Other more modern ways to cope come from ideas such as The Brand
Emotions Scale for Writers (BESW), coming from the basis of the Differential Emotions Scale,
the BESW works with grouping emotions into either states or traits and
then making those either Positive, Negative Passive, or Negative Active.
Researchers can assess subjects with more clarity now, giving writers a
better chance to get more work done if left in the right emotional
state since the data openly shows the writers with Positive emotions
tended to express more than writers with Negative Passive or Negative
Active.
"Politics and the English Language" (1946) is an essay by George Orwell
that criticised the "ugly and inaccurate" written English of his time
and examines the connection between political orthodoxies and the
debasement of language.
The essay focuses on political language, which, according to
Orwell, "is designed to make lies sound truthful and murder respectable,
and to give an appearance of solidity to pure wind". Orwell believed
that the language used was necessarily vague or meaningless because it
was intended to hide the truth rather than express it. This unclear
prose was a "contagion" which had spread to those who did not intend to
hide the truth, and it concealed a writer's thoughts from himself and
others. Orwell encourages concreteness and clarity instead of vagueness, and individuality over political conformity.
Summary
Orwell relates what he believes to be a close association between bad prose and oppressive ideology:
In our time, political speech and
writing are largely the defence of the indefensible. Things like the
continuance of British rule in India, the Russian purges and
deportations, the dropping of the atom bombs on Japan, can indeed be
defended, but only by arguments which are too brutal for most people to
face, and which do not square with the professed aims of political
parties. Thus political language has to consist largely of euphemism,
question-begging and sheer cloudy vagueness. Defenceless villages are
bombarded from the air, the inhabitants driven out into the countryside,
the cattle machine-gunned, the huts set on fire with incendiary
bullets: this is called pacification. Millions of peasants are
robbed of their farms and sent trudging along the roads with no more
than they can carry: this is called transfer of population or rectification of frontiers.
People are imprisoned for years without trial, or shot in the back of
the neck or sent to die of scurvy in Arctic lumber camps: this is called
elimination of unreliable elements. Such phraseology is needed if one wants to name things without calling up mental pictures of them.
One of Orwell's points is:
The great enemy of clear language
is insincerity. When there is a gap between one's real and one's
declared aims, one turns as it were instinctively to long words and
exhausted idioms, like a cuttlefish spurting out ink.
The insincerity of the writer perpetuates the decline of the language
as people (particularly politicians, Orwell later notes) attempt to
disguise their intentions behind euphemisms and convoluted phrasing.
Orwell says that this decline is self-perpetuating. He argues that it
is easier to think with poor English because the language is in decline;
and, as the language declines, "foolish" thoughts become even easier,
reinforcing the original cause:
A man may take to drink because he
feels himself to be a failure, and then fail all the more completely
because he drinks. It is rather the same thing that is happening to the
English language. It becomes ugly and inaccurate because our thoughts
are foolish, but the slovenliness of our language makes it easier for us
to have foolish thoughts.
Orwell discusses "pretentious diction" and "meaningless words".
"Pretentious diction" is used to make biases look impartial and
scientific, while "meaningless words" are used to stop the reader from
seeing the point of the statement. According to Orwell: "In certain
kinds of writing, particularly in art criticism and literary criticism,
it is normal to come across long passages which are almost completely
lacking in meaning."
Five passages
Orwell
chooses five passages of text which "illustrate various of the mental
vices from which we now suffer." The samples are: by Harold Laski ("five negatives in 53 words"), Lancelot Hogben (mixed metaphors), an essay by Paul Goodman on psychology in the July 1945 issue of Politics ("simply meaningless"), a communist pamphlet ("an accumulation of stale phrases") and a reader's letter in Tribune
(in which "words and meaning have parted company"). From these, Orwell
identifies a "catalogue of swindles and perversions" which he classifies
as "dying metaphors", "operators or verbal false limbs", "pretentious
diction" and "meaningless words". (See cliches, prolixity, peacock terms and weasel words.)
Orwell notes that writers of modern prose tend not to write in concrete terms but use a "pretentious latinized style" (compare Anglish).
He claims writers find it is easier to gum together long strings of
words than to pick words specifically for their meaning—particularly in
political writing, where Orwell notes that "[o]rthodoxy ... seems to
demand a lifeless, imitative style". Political speech and writing are
generally in defence of the indefensible and so lead to a euphemistic
inflated style.
Orwell criticises bad writing habits which spread by imitation.
He argues that writers must think more clearly because thinking clearly
"is a necessary first step toward political regeneration". He later
emphasises that he was not "considering the literary use of language,
but merely language as an instrument for expressing and not for
concealing or preventing thought".
"Translation" of Ecclesiastes
As a further example, Orwell "translates" Ecclesiastes 9:11:
I returned and saw under the sun,
that the race is not to the swift, nor the battle to the strong, neither
yet bread to the wise, nor yet riches to men of understanding, nor yet
favour to men of skill; but time and chance happeneth to them all.
– into "modern English of the worst sort":
Objective consideration of
contemporary phenomena compels the conclusion that success or failure in
competitive activities exhibits no tendency to be commensurate with
innate capacity, but that a considerable element of the unpredictable
must invariably be taken into account.
Orwell points out that this "translation" contains many more
syllables but gives no concrete illustrations, as the original did, nor
does it contain any vivid, arresting images or phrases.
The headmaster's wife at St Cyprian's School,
Mrs. Cicely Vaughan Wilkes (nicknamed "Flip"), taught English to Orwell
and used the same method to illustrate good writing to her pupils. She
would use simple passages from the King James Bible and then "translate" them into poor English to show the clarity and brilliance of the original. Walter John Christie, who followed Orwell to Eton College, wrote that she preached the virtues of "simplicity, honesty, and avoidance of verbiage", and pointed out that the qualities Flip most prized were later to be seen in Orwell's writing.
Remedy of Six Rules
Orwell
said it was easy for his contemporaries to slip into bad writing of the
sort he had described and that the temptation to use meaningless or
hackneyed phrases was like a "packet of aspirins always at one's elbow".
In particular, such phrases are always ready to form the writer's
thoughts for him, to save him the bother of thinking—or writing—clearly.
However, he concluded that the progressive decline of the English
language was reversible
and suggested six rules which, he claimed, would prevent many of these
faults, although "one could keep all of them and still write bad
English".
Never use a metaphor, simile, or other figure of speech
which you are used to seeing in print. (Examples that Orwell gave
included "ring the changes", "Achilles' heel", "swan song", and
"hotbed". He described such phrases as "dying metaphors" and argued that
they were used without knowing what was truly being said. Furthermore,
he said that using metaphors of this kind made the original meaning of
the phrases meaningless, because those who used them did not know their
original meaning. He wrote that "some metaphors now current have been
twisted out of their original meaning without those who use them even
being aware of the fact".)
Never use a long word where a short one will do.
If it is possible to cut a word out, always cut it out.
Never use a foreign phrase, a scientific word, or a jargon word if you can think of an everyday English equivalent.
Break any of these rules sooner than say anything outright barbarous.
Publication
"Politics and the English Language" was first noted in Orwell's payment book of 11 December 1945. The essay was originally published in the April 1946 issue of the journal Horizon (volume 13, issue 76, pages 252–265); it was Orwell's last major article for the journal. The essay was originally intended for George Weidenfeld's Contact magazine but it was turned down.
From the time of his wife's death in March 1945 Orwell had
maintained a high work rate, producing some 130 literary contributions,
many of them lengthy. Animal Farm
had been published in August 1945 and Orwell was experiencing a time of
critical and commercial literary success. He was seriously ill in
February and was desperate to get away from London to the island of Jura, Scotland, where he wanted to start work on Nineteen Eighty-Four.
"Politics and the English Language" was published nearly simultaneously with another of Orwell's essays, "The Prevention of Literature".
Both reflect Orwell's concern with truth and how truth depends upon the
use of language. Orwell noted the deliberate use of misleading language
to hide unpleasant political and military facts and also identified a
laxity of language among those he identified as pro-Soviet. In "The
Prevention of Literature" he also speculated on the type of literature
under a future totalitarian society which he predicted would be
formulaic and low grade sensationalism. Around the same time Orwell
wrote an unsigned editorial for Polemic in response to an attack from Modern Quarterly. In this he highlights the double-talk and appalling prose of J. D. Bernal in the same magazine, and cites Edmund Wilson's damnation of the prose of Joseph E. Davies in Mission to Moscow.
Critical reception
In his biography of Orwell, Michael Shelden called the article "his most important essay on style", while Bernard Crick made no reference to the work at all in his original biography, reserving his praise for Orwell's essays in Polemic, which cover a similar political theme.
John Rodden asserts, given that much of Orwell's work was polemical,
that he sometimes violated these rules and Orwell himself concedes that
if you look back through his essay, "for certain you will find that I
have again and again committed the very faults I am protesting against". Rodden also says that Terry Eagleton had praised the essay's demystification of political language but had later become disenchanted with Orwell.
Linguist Geoffrey Pullum—despite
being an admirer of Orwell's writing—criticised the essay for "its
insane and unfollowable insistence that good writing must avoid all
phrases and word uses that are familiar". Orwell's admonition to avoid using the passive voice has also been criticised. Merriam–Webster's Dictionary of English Usage
refers to three statistical studies of passive versus active sentences
in various periodicals, stating: "the highest incidence of passive
constructions was 13 percent. Orwell runs to a little over 20 percent in
'Politics and the English Language'. Clearly he found the construction
useful in spite of his advice to avoid it as much as possible".
Introductory writing courses frequently cite this essay.
A 1999 study found that it was reprinted 118 times in 325 editions of
58 readers published between 1946 and 1996 that were intended for use in
college-level composition courses.
In 1981, Carl Freedman's
article "Writing Ideology, and Politics: Orwell's 'Politics and the
English Language' and English Composition" set in motion a "wide variety
of critiques, reconsiderations, and outright attacks against the plain
style"
that Orwell argues for. The main issue found was Orwell's "simplistic
faith about thought and language existing in a dialectical relation with
one another; others quickly cut to the chase by insisting that
politics, rightly considered, meant the insertion of an undercutting whose before every value word the hegemony holds dear".
These critics also began to question Orwell's argument for the
absoluteness of the English language, and asked whose values and truths
were being represented through the language.
Orwell's writings on the English language have had a large impact
on classrooms, journalism and other writing. George Trail, in "Teaching
Argument and the Rhetoric of Orwell's 'Politics and the English
Language'", says that "A large part of Orwell's rhetorical approach
consists of attempting at every opportunity to acquire reader
participation, to involve the reader as an active and engaged consumer
of the essay. Popular journalism is full of what may be the inheritance
of Orwell's reader involvement devices". Haltom and Ostrom's work, Teaching George Orwell in Karl Rove's World: 'Politics and the English Language' in the 21st Century Classroom,
discusses how following of Orwell's six rules of English writing and
speaking can have a place in the high school and university setting.
Connection to other works
Orwell's preoccupation with language as a theme can be seen in protagonist Gordon Comstock's dislike of advertising slogans in Keep the Aspidistra Flying, an early work of his. This preoccupation is also visible in Homage to Catalonia, and continued as an underlying theme of Orwell's work for the years after World War II.
The themes in "Politics and the English Language" anticipate Orwell's development of Newspeak in Nineteen Eighty-Four. Michael Shelden
calls Newspeak "the perfect language for a society of bad writers ...
because it reduces the number of choices available to them".
Shelden says that Newspeak first corrupts writers morally, then
politically, "since it allows writers to cheat themselves and their
readers with ready-made prose".
According to the World Health Organization (WHO), occupational burnout is a syndrome resulting from chronic work-related stress,
with symptoms characterized by "feelings of energy depletion or
exhaustion; increased mental distance from one’s job, or feelings of
negativism or cynicism related to one's job; and reduced professional
efficacy." While burnout may influence health and can be a reason for people contacting health services, it is not itself classified by the WHO as a medical condition.
In 1974, Herbert Freudenberger
became the first researcher to publish in a psychology-related journal a
paper that used the term "burnout." The paper was based on his
observations of the volunteer staff (including himself) at a free clinic
for drug addicts.
He characterized burnout by a set of symptoms that includes exhaustion
resulting from work's excessive demands as well as physical symptoms
such as headaches and sleeplessness, "quickness to anger," and closed
thinking. He observed that the burned-out worker "looks, acts, and seems
depressed." After the publication of Freudenberger's original paper,
interest in occupational burnout grew. Because the phrase "burnt-out"
was part of the title of a 1961 Graham Greene novel A Burnt-Out Case,
which dealt with a doctor working in the Belgian Congo with patients
who had leprosy, the phrase may have been in use outside the psychology
literature before Freudenberger employed it. Wolfgang Kaskcha has written on the early documentation of the subject.
Christina Maslach
described burnout in terms of emotional exhaustion, depersonalization
(treating clients, students, and/or colleagues in a cynical way), and
reduced feelings of work-related personal accomplishment. In 1981, Maslach and Susan Jackson published the first widely used instrument for assessing burnout, the Maslach Burnout Inventory. Originally focused on the human service professions (e.g., teachers, social workers), its application broadened to many other occupations. The WHO adopted a conceptualization of burnout that is consistent with Maslach's.
Today, there is robust evidence that burnout reflects a depressive condition.
The Royal Dutch Medical Association treats "burnout" as a defined subtype of adjustment disorder. In The Netherlands burnout is included in handbooks and medical staff are trained in its diagnosis and treatment.
Regarding the International Statistical Classification of Diseases and Related Health Problems
(ICD), the ICD-10 edition (current 1994-2021) classifies "burn-out" as a
type of non-medical life-management difficulty under code Z73.0.
It is considered to be one of the "factors influencing health status
and contact with health services" and "should not be used" for "primary
mortality coding". It is also considered one of the "problems related to life-management difficulty". The condition is only further defined as being a "state of vital exhaustion".
The ICD-10 also contains a medical condition category of "F43.8 Other reactions to severe stress" (sometimes known as neurasthenia), which some (including the Swedish National Board of Health and Welfare)
believe defines the more serious cases of burnout. Swedish sufferers of
severe burnout are treated as having this medical condition. This category is in the same group as adjustment disorder and posttraumatic stress disorder, other conditions caused by excessive stress that continue once the stressors have been removed.
A new version of the ICD, ICD-11, was released in June 2018, for first use in January 2022. It has an entry coded and titled "QD85 Burn-out". This describes the condition in this way:
Burn-out is a syndrome conceptualized as resulting from
chronic workplace stress that has not been successfully managed. It is
characterized by three dimensions: 1) feelings of energy depletion or
exhaustion; 2) increased mental distance from one’s job, or feelings of
negativism or cynicism related to one's job; and 3) reduced professional
efficacy. Burn-out refers specifically to phenomena in the occupational
context and should not be applied to describe experiences in other
areas of life.
This condition is classified under "Problems associated with
employment or unemployment" in the section on "Factors influencing
health status or contact with health services." The section is devoted
to reasons other than recognized diseases or health conditions for which
people contact health services.
In a statement made in May 2019, the WHO said "Burn-out is included in
the 11th Revision of the International Classification of Diseases
(ICD-11) as an occupational phenomenon. It is not classified as a
medical condition."
The ICD's browser and coding tool both attach the term "caregiver
burnout" to category "QF27 Difficulty or need for assistance at home
and no other household member able to render care". This acknowledges that burnout can occur in this context.
The ICD-11 also has the medical condition "6B4Y Other specified disorders specifically associated with stress", which is the equivalent of the ICD-10's F43.8.
The American Psychiatric Association
says "it is estimated that 2 out of 5 psychiatrists have professional
burnout," and believes that "addressing this problem has become one of
the most pressing issues for medicine."
Instruments
In 1981, Maslach and Jackson developed the first widely used instrument for assessing burnout, namely, the Maslach Burnout Inventory (MBI).
Consistent with Maslach's conceptualization, the MBI operationalizes
burnout as a three-dimensional syndrome consisting of emotional
exhaustion, depersonalization, and reduced personal accomplishment. Other researchers have argued that burnout should be limited to fatigue and exhaustion. Exhaustion is considered to be burnout's core.
There are, however, other conceptualizations of burnout that
differ from the conceptualization adopted by the WHO. Shirom and Melamed
with their Shirom-Melamed Burnout Measure conceptualize burnout in
terms of physical exhaustion, cognitive weariness, and emotional
exhaustion;
however, an examination of Shirom and Melamed's emotional exhaustion
subscale indicates that the subscale looks more like a measure of
Maslach's concept of depersonalization. Demerouti and Bakker (with their Oldenburg Burnout Inventory) conceptualize burnout in terms of exhaustion and disengagement. There are other conceptualizations as well that are embodied in these instruments: the Copenhagen Burnout Inventory, the Hamburg Burnout Inventory, Malach-Pines's Burnout Measure, and more. Kristensen et al. and Malach-Pines (who also published as Pines) advanced the view that burnout can also occur in non-work roles such as that of spouse.
The Utrecht Work Engagement Scale (UWES), was released by
Wilmar Schaufeli and Arnold Bakker in 1999. It measures vigour,
dedication and absorption; positive counterparts to the values measured
by the BMI.
In 2010, researchers from Mayo Clinic used portions of the MBI, along with other comprehensive assessments, to develop the Well-Being Index,
a brief nine-item self-assessment tool designed to measure burnout and
other dimensions of distress in health care workers specifically.
The core of all of these conceptualizations, including that of
Freudenberger, is exhaustion. Alternatively, burnout is also now seen as
involving the full array of depressive symptoms (e.g., low mood, cognitive alterations, sleep disturbance). Marked differences in understanding of what constitutes burnout have highlighted the need for consensus definition.
Subtypes
In 1991, Barry A. Farber proposed that there are three types of burnout:
"wearout" and "brown-out," where someone gives up having had too much stress and/or too little reward
"classic/frenetic burnout," where someone works harder and harder,
trying to resolve the stressful situation and/or seek suitable reward
for their work
"underchallenged burnout," where someone has low stress, but the work is unrewarding.
Caregiver burnout
Bodies such as the US government's Centers for Disease Control and Prevention, the American Diabetes Association, and Diabetes Singapore
identify and promote the phenomenon of "diabetes burnout." This relates
to the self-care of people with diabetes, particularly those with
type-2 diabetes. "Diabetes burnout speaks to the physical and emotional
exhaustion that people with diabetes experience when they have to deal
with caring for themselves on a day-to-day basis. When you have to do so
many things to stay in control then it does take a toll on your
emotions... Once they get frustrated, some of them give up and stop
(maintaining) a healthy diet, taking their medications regularly, going
for exercises and this will result in poor diabetes control."
Autistic burnout
"Autistic burnout" is a term used to describe burnout when it occurs in people with Autistic Spectrum Disorder (ASD).
In this population, in addition to the typical symptoms it can cause
"autistic regression," an increase of autistic symptoms. It is
"regression" in the sense that the afflicted has typically had a
similarly high level of symptoms in the distant past, and the burnout is
perceived to be regressing them to this earlier state. It is also known
as "decompensation", because the compensations the person usually makes
are no longer being made.
Such burnout sometimes leads to permanent disability or suicidal behavior. It need not be caused by workplace stress, but can also be caused by the stress of social interaction or other sources. Spoon theory is sometimes used to understand people in this situation.
Relationship with other conditions
A growing body of evidence suggests that burnout is etiologically, clinically, and nosologically similar to depression.
In a study that directly compared depressive symptoms in burned out
workers and clinically depressed patients, no diagnostically significant
differences were found between the two groups; burned out workers
reported as many depressive symptoms as clinically depressed patients.
Moreover, a study by Bianchi, Schonfeld, and Laurent (2014) showed that
about 90% of workers with full-blown burnout meet diagnostic criteria
for depression. The view that burnout is a form of depression has found support in several recent studies.
Some authors have recommended that the nosological concept of burnout
be revised or even abandoned entirely given that it is not a distinct
disorder and that there is no agreement on burnout diagnostic criteria.
Postpartum depression
is a form of depression recognised by the DSM that differs mainly from
major depressive disorder in that it has a specific trigger.
Liu and van Liew wrote that "the term burnout is used so
frequently that it has lost much of its original meaning. As originally
used, burnout meant a mild degree of stress-induced unhappiness. The
solutions ranged from a vacation to a sabbatical. Ultimately, it was
used to describe everything from fatigue to a major depression and now
seems to have become an alternative word for depression, but with a less
serious significance" (p. 434).
They also argue that burning out can trigger four distinct kinds of
depression, each with their own recommended treatment. These are adjustment disorder with depressed mood, major depressive disorder, dysthymia, and bipolar disorder.
Tamar Kakiashvili et al. however argued that while there are
significant overlaps in symptoms between burnout and major depressive
disorder (aka "depression"), there is much endocrine evidence to suggest
that the biological basis of burnout is vastly different to typical
depression. They argued that antidepressants should not be used by
people with burnout as they make the underlying hypothalamic–pituitary–adrenal axis dysfunction worse.
Despite its name, atypical depression, which is seen in the above
table, is not a rare form of depression; the cortisol profile of
atypical depression is similar to the cortisol profile in burnout.
Commentators advanced the view that burnout differs from depression
because the cortisol profile of burnout differs from that of melancholic
depression; however, as the above table indicates, burnout's cortisol
profile is similar to that of atypical depression.
It has also been hypothesised that chronic fatigue syndrome is caused by burnout.
It is suggested that the "burning out" of the body's stress symptom (by
any of a wide range of causes) can lead to chronic fatigue.
"Occupational burnout" is known for its exhausting effect on sufferers. Overtraining syndrome, a similar but lesser exhausting condition to CFS has been conceptualised as adjustment disorder, a common diagnosis for those burnt out.
Risk factors
Evidence
suggests that the etiology of burnout is multifactorial, with
dispositional factors playing an important, long-overlooked role. Cognitive dispositional factors implicated in depression have also been found to be implicated in burnout. One cause of burnout includes stressors that a person is unable to cope with fully.
Burnout is thought to occur when a mismatch is present between
the nature of the job and the job the person is actually doing. A common
indication of this mismatch is work overload, which sometimes involves a
worker who survives a round of layoffs, but after the layoffs the
worker finds that he or she is doing too much with too few resources.
Overload may occur in the context of downsizing, which often does not
narrow an organization's goals, but requires fewer employees to meet
those goals.
The research on downsizing, however, indicates that downsizing has more
destructive effects on the health of the workers who survive the
layoffs than mere burnout; these health effects include increased levels
of sickness and greater risk of mortality.
The job demands-resources model
has implications for burnout, as measured by the Oldenburg Burnout
Inventory (OLBI). Physical and psychological job demands were
concurrently associated with the exhaustion, as measured by the OLBI. Lack of job resources was associated with the disengagement component of the OLBI.
Maslach, Schaufeli and Leiter identified six risk factors for
burnout: mismatch in workload, mismatch in control, lack of appropriate
awards, loss of a sense of positive connection with others in the
workplace, perceived lack of fairness, and conflict between values.
Effects
Some research indicates that burnout is associated with reduced job performance, coronary heart disease, and mental health problems.
Examples of emotional symptoms of occupational burnout include a lack
of interest in the work being done, a decrease in work performance
levels, feelings of helplessness, and trouble sleeping. With regard to mental health problems, research on dentists and physicians
suggests that what is meant by burnout is a depressive syndrome. Thus
reduced job performance and cardiovascular risk could be related to
burnout because of burnout's tie to depression. Behavioral signs of
occupational burnout are demonstrated through cynicism within work
relationships, such as coworkers, clients, and the organization.
Other effects of burnout can manifest as lowered energy and
productivity levels, with workers observed to be consistently late for
work and feeling a sense of dread upon arriving. They can suffer
decreased concentration, forgetfulness, increased frustration, or
feelings of being overwhelmed. They may complain and feel negative, or
feel apathetic and believe they have little impact on their coworkers
and environment. Occupational burnout is also associated with absences, time missed from work, and thoughts of quitting.
Chronic burnout is also associated with cognitive impairments such as memory and attention.
There is a growing amount of research suggesting that burnout can
manifest differently between genders, with greater incidence of
depersonalisation among men and higher emotional exhaustion among women.
Treatment and prevention
Health
condition treatment and prevention methods are often classified as
"primary prevention" (stopping the condition occurring), "secondary
prevention" (removing the condition that has occurred) and "tertiary
prevention" (helping people live with the condition).
Primary prevention
Maslach
believes that the only way to truly prevent burnout is through a
combination of organizational change and education for the individual.
Maslach and Leiter postulated that burnout occurs when there is a
disconnection between the organization and the individual with regard
to what they called the six areas of worklife: workload, control,
reward, community, fairness, and values. Resolving these discrepancies requires integrated action on the part of both the individual and the organization. With regard to workload, assuring that a worker has adequate resources to meet demands as well as ensuring a satisfactory work–life balance could help revitalize employees' energy. With regard to values, clearly stated ethical organizational values are important for ensuring employee commitment. Supportive leadership and relationships with colleagues are also helpful.
One approach for addressing these discrepancies focuses
specifically on the fairness area. In one study employees met weekly to
discuss and attempt to resolve perceived inequities in their job.
The intervention was associated with decreases in exhaustion over time
but not cynicism or inefficacy, suggesting that a broader approach is
required.
Hätinen et al. suggest "improving job-person fit by focusing
attention on the relationship between the person and the job situation,
rather than either of these in isolation, seems to be the most promising
way of dealing with burnout.". They also note that "at the individual level, cognitive-behavioural strategies have the best potential for success."
Burnout prevention programs have traditionally focused on cognitive-behavioral therapy (CBT), cognitive restructuring, didactic stress management, and relaxation. CBT, relaxation techniques
(including physical techniques and mental techniques), and schedule
changes are the best-supported techniques for reducing or preventing
burnout in a health-care setting. Mindfulness therapy has been shown to
be an effective preventative for occupational burnout in medical
practitioners.
Combining both organizational and individual-level activities may be
the most beneficial approach to reducing symptoms. A Cochrane review,
however, reported that evidence for the efficacy of CBT in healthcare
workers is of low quality, indicating that it is no better than
alternative interventions.
For the purpose of preventing occupational burnout, various
stress management interventions have been shown to help improve employee
health and well-being in the workplace and lower stress levels.
Training employees in ways to manage stress in the workplace have also
been shown to be effective in preventing burnout. One study suggests that social-cognitive processes such as commitment to work, self-efficacy, learned resourcefulness, and hope may insulate individuals from experiencing occupational burnout. Increasing a worker's control over his or her job is another intervention has been shown to help counteract exhaustion and cynicism in the workplace.
Additional prevention methods include: starting the day with a
relaxing ritual; yoga; adopting healthy eating, exercising, and sleeping
habits; setting boundaries; taking breaks from technology; nourishing
one's creative side, and learning how to manage stress.
Barry A. Farber suggests strategies like setting more achievable
goals, focusing on the value of the work, and finding better ways of
doing the job, can all be helpful ways of helping the stressed. People
who don't mind the stress but want more reward can benefit from
reassessing their work-life balance
and implementing stress reduction techniques like meditation and
exercise. Others with low stress, but are underwhelmed and bored with
work, can benefit from seeking greater challenge.
Kakiashvili et al. say that "medical treatment of burnout is
mostly symptomatic: it involves measures to prevent and treat the
symptoms." They say the use of anxiolytics and sedatives
to treat burnout related stress is effective, but does nothing to
change the sources of stress. They say the poor sleep often caused by
burnout (and the subsequent fatigue) is best treated with hypnotics
and CBT (within which they include "sleep hygiene, education,
relaxation training, stimulus control, and cognitive therapy"). They
advise against the use of antidepressants as they worsen the hypothalamic–pituitary–adrenal axis
dysfunction at the core of burnout. They also believe "vitamins and
minerals are crucial in addressing adrenal and HPA axis dysfunction",
noting the importance of specific nutrients.
Burnout also often causes a decline in the ability to update information in working memory. This is not easily treated with CBT.
One reason it is difficult to treat the three standard symptoms
of burnout (exhaustion, cynicism, and inefficacy), is because they
respond to the same preventive or treatment activities in different
ways.
Exhaustion is more easily treated than cynicism and professional
inefficacy, which tend to be more resistant to treatment. Research
suggests that intervention actually may worsen the professional efficacy
of a person who originally exhibited low professional efficacy.
Employee rehabilitation is a tertiary preventive intervention
which means the strategies used in rehabilitation are meant to alleviate
burnout symptoms in individuals who are already affected without curing
them.
Such rehabilitation of the working population includes
multidisciplinary activities with the intent of maintaining and
improving employees' working ability and ensuring a supply of skilled
and capable labor in society.
Compassion fatigue is a condition characterized by emotional and physical exhaustion leading to a diminished ability to empathize or feel compassion for others, often described as the negative cost of caring. It is sometimes referred to as secondary traumatic stress (STS).
According to the Professional Quality of Life Scale, burnout and
secondary traumatic stress are two interwoven elements of compassion
fatigue.
Compassion fatigue is considered to be the result of working
directly with victims of disasters, trauma, or illness, especially in
the health care industry. Individuals working in other helping professions are also at risk for experiencing compassion fatigue. These include child protection workers, veterinarians, teachers, palliative care workers, journalists, police officers, firefighters, animal welfare workers, public librarians, health unit coordinators, and Student Affairs professionals.
Non-professionals, such as family members and other informal
caregivers of people who have a chronic illness, may also experience
compassion fatigue.
The term was first coined in 1992 by Carla Joinson to describe the
negative impact hospital nurses were experiencing as a result of their
repeated, daily exposure to patient emergencies.
People who experience compassion fatigue may exhibit a variety of
symptoms including lowered concentration, numbness or feelings of
helplessness, irritability, lack of self-satisfaction, withdrawal, aches
and pains, or work absenteeism.
Journalism analysts argue that news media have caused widespread
compassion fatigue in society by saturating newspapers and news shows
with decontextualized images and stories of tragedy and suffering. This
has caused the public to become desensitized or resistant to helping
people who are suffering.
History
Compassion
fatigue has been studied by the field of traumatology, where it has
been called the "cost of caring" for people facing emotional pain.
Compassion fatigue has also been called secondary victimization, secondary traumatic stress, vicarious traumatization, and secondary survivor. Other related conditions are rape-related family crisis and "proximity" effects on female partners of war veterans. Compassion fatigue has been called a form of burnout
in some literature. However, unlike compassion fatigue, “burnout” is
related to chronic tedium in careers and the workplace, rather than
exposure to specific kinds of client problems such as trauma.
fMRI-rt research suggests the idea of compassion without engaging in
real-life trauma is not exhausting itself. According to these, when empathy was analyzed with compassion through neuroimaging,
empathy showed brain region activations where previously identified to
be related to pain whereas compassion showed warped neural activations.
There is some recent academic literature suggesting that
compassion fatigue is a misnomer and should be replaced with the term,
empathy fatigue. Evidence supporting this change comes from a
burgeoning literature examining the neurophysiology of empathy versus
compassion meditation practices.
Whereas empathy can be defined as feeling what another feels and
cumulative negative effects over time can come from the accretion of the
assumptions of others painful emotions and experience. Compassion
relates to a feeling of caring, loving or desire to improve the lot of
others and may or may not require awareness of others feeling and
emotions, but instead arises from a humanistic or even altruistic desire
for subject to be free of suffering. Studies of training of compassion
practices among health care provides has demonstrated positive effects
compared to empathy practices which do not improve provider functioning.
In academic literature, the more technical term secondary traumatic stress disorder may be used. The term "compassion fatigue" is considered somewhat euphemistic.
Compassion fatigue also carries sociological connotations, especially
when used to analyse the behavior of mass donations in response to the
media response to disasters. One measure of compassion fatigue is in the
ProQOL, or Professional Quality of Life Scale. Another is the Secondary
Traumatic Stress Scale.
Risk factors
Several
personal attributes place a person at risk for developing compassion
fatigue. Persons who are overly conscientious, perfectionists,
and self-giving are more likely to suffer from secondary traumatic
stress. Those who have low levels of social support or high levels of
stress in personal life are also more likely to develop STS. In
addition, previous histories of trauma that led to negative coping skills, such as bottling up or avoiding emotions, having small support systems, increase the risk for developing STS.
Many organizational attributes in the fields where STS is most
common, such as the healthcare field, contribute to compassion fatigue
among the workers. For example, a “culture of silence” where stressful
events such as deaths in an intensive-care unit are not discussed after
the event is linked to compassion fatigue. Lack of awareness of symptoms
and poor training in the risks associated with high-stress jobs can
also contribute to high rates of STS.
In healthcare professionals
Between 16% and 85% of health care workers
in various fields develop compassion fatigue. In one study, 86% of
emergency room nurses met the criteria for compassion fatigue. In another study, more than 25% of ambulance paramedics were identified as having severe ranges of post-traumatic symptoms. In addition, 34% of hospice nurses in another study met the criteria for secondary traumatic stress/compassion fatigue.
Compassion Fatigue is the emotional and physical distress caused
by treating and helping patients that are deeply in need, which can
desensitize healthcare professionals causing them a lack of empathy for
future patients. There are three important components of Compassion Fatigue: Compassion satisfaction, secondary stress and burnout.
It is important to note that burnout is not the same as Compassion
Fatigue; Burnout is the stress and mental exhaustion caused by the
inability to cope with the environment and continuous physical and
mental demands.
Healthcare professionals experiencing compassion fatigue may find
it difficult to continue doing their jobs. While many believe that
these diagnoses affect workers who have been practicing in the field the
longest, the opposite proves true. Young physicians and nurses are at
an increased risk for both burnout and compassion fatigue.
A study published in the Western Journal of Emergency Medicine revealed
that medical residents develop Compassion Fatigue and within this group
medical residents who work overnight shifts and that work more than
eighty hours a week are in higher risk of developing Compassion Fatigue.
In these professionals with higher risk of suffering from Compassion
Fatigue, burnout was one of the major components. Burnout is a prevalent
and critical contemporary problem that can be categorized as suffering
from: emotional exhaustion, de-personalization, and low sense of
personal accomplishment.
They can be exposed to trauma while trying to deal with compassion
fatigue, potentially pushing them out of their career field. If they
decide to stay, it can negatively affect the therapeutic relationship
they have with patients because it depends on forming an empathetic,
trusting relationship that could be difficult to make in the midst of
compassion fatigue. Because of this, healthcare institutions are placing
increased importance on supporting their employees emotional needs so
they can better care for patients.
Another name and concept directly tied to compassion fatigue is
moral injury. Moral injury in the context of healthcare was directly
named in the Stat News article by Drs. Wendy Dean and Simon Talbot, entitled "Physicians aren’t ‘burning out.’ They’re suffering from moral injury."
The article and concept goes on to explain that physicians (in the
United States) are caught in double and triple and quadruple binds
between their obligations of electronic health records, their own
student loans, the requirements for patient load through the hospital
and number of procedures performed – all while working towards the goal
of trying to provide the best care and healing to patients possible.
However, the systemic issues facing physicians often cause deep distress
because the patients are suffering, despite a physician's best efforts.
This concept of Moral Injury in healthcare is the expansion of the discussion around compassion fatigue and 'burnout.'
Caregivers
Caregivers
for dependent people can also experience compassion fatigue, which can
become a cause of abusive behavior in caring professions. It results
from the taxing nature of showing compassion for someone whose suffering
is continuous and unresolvable. One may still care for the person as
required by policy, however, the natural human desire to help them is
significantly diminished desensitization and lack of enthusiasm for
patient care. This phenomenon also occurs among professionals involved in long-term health care, and for those who have institutionalized family members. These people may develop symptoms of depression, stress, and trauma. Those who are primary care providers for patients with terminal illnesses are at a higher risk of developing these symptoms. In the medical profession, this is often described as "burnout": the more specific terms secondary traumatic stress and vicarious trauma are also used. Some professionals may be predisposed to compassion fatigue due to personal trauma.
Mental health professionals
Mental
health professionals are another group that often suffer from
compassion fatigue, particularly when they treat those who have suffered
extensive trauma. A study on mental health professionals that were
providing clinical services to Katrina victims found that rates of
negative psychological symptoms increased in the group. Of those
interviewed, 72% reported experiencing anxiety, 62% experienced
increased suspicion about the world around them, and 42% reported
feeling increasingly vulnerable after treating the Katrina victims.
Social workers are being exposed to stressful experiences in their day
to day work activities. Many social workers are at a constant battle
not only within their casework but within themselves. A social worker's
career comes at a personal price with putting personal beliefs aside,
managing compassion fatigue, and getting the mental help needed to cope
with the traumas that are dealt with daily. The way a social worker
feels must be put aside when in the field due to the possibility of
those feeling swaying the appropriate action that must be taken. If a
social worker is consciously aware of compassion fatigue and burnout
happening within themselves early on, then they hold capability to seek
the help needed to combat them before any negative impression is felt
externally. Being able to objectively evaluate situations at work aides
in keeping social workers professionally safe. Self-awareness of
compassion fatigue and burnout flow into the mental and physical
management that keep those feelings under control. When a social worker
puts in the time to take care of themselves their personal life and work
life are both positively influenced.
Critical care personnel
Critical
care personnel have the highest reported rates of burnout, a syndrome
associated with progression to compassion fatigue. These providers
witness high rates of patient disease and death, leaving them to
question whether their work is truly meaningful. Additionally, top-tier
providers are expected to know an increasing amount of medical
information along with experienced high ethical dilemmas/medical
demands. This has created a workload-reward imbalance—or decreased
compassion satisfaction. Compassion satisfaction, relates to the
“positive payment” that comes from caring.
With little compassion satisfaction, both critical care physicians and
nurses have reported the above examples as leading factors for
developing burnout and compassion fatigue.
Those caring for people who have experienced trauma can experience a
change in how they view the world; they see it more negatively. It can
negatively affect the worker's sense of self, safety, and control.
In ICU personnel, burnout and compassion fatigue has been associated
with decreased quality of care and patient satisfaction, as well as
increased medical errors, infection rates, and death rates, making this
issue one of concern not only for providers but patients. These outcomes also impact organization finances.
According to the Institute of Medicine, preventable adverse drug events
or harmful medication errors (associated with compassion
fatigue/burnout) occur in 1% to 10% of hospital admissions and account
for a $3.5 billion cost.
Those with a better ability to empathize and be compassionate are at a higher risk of developing compassion fatigue.
Because of that, healthcare professionals—especially those who work in
critical care, are regularly exposed to death, trauma, high stress
environments, long work days, difficult patients, pressure from a
patient’s family, and conflicts with other staff members- are at higher
risk.
These exposures increase the risk for developing compassion fatigue and
burnout, which often makes it hard for professionals to stay in the
healthcare career field. Those who stay in the healthcare field after
developing compassion fatigue or burnout are likely to experience a lack
of energy, difficulty concentrating, unwanted images or thoughts,
insomnia, stress, desensitization and irritability. As a result, these healthcare professionals may later develop substance abuse, depression, and suicide.
A 2018 study that examined differences in compassion fatigue in nurses
based on their substance use found significant increases for those who
used cigarettes, sleeping pills, energy drinks, antidepressants and
anti-anxiety drugs. Unfortunately, despite recent, targeted efforts
being made to reduce burnout, it appears that the problem is increasing.
In 2011, a study conducted by the Department of Medicine Program on
Physician Well-Being at Mayo Clinic reported that 45% of physicians in
the United States had one or more symptoms of burnout. In 2014, that
number had increased to 54%.
In student affairs professionals
In
response to the changing landscape of post secondary institutions,
sometimes as a result of having a more diverse and marginalized student
population, both campus services and the roles of student affairs
professionals have evolved. These changes are efforts to manage the
increases in traumatic events and crises.
Due to the exposure to student crises and traumatic events,
student affairs professionals, as front line workers, are at risk for
developing compassion fatigue. Such crises may include sexual violence, suicidal ideation, severe mental health episodes, and hate crimes/discrimination.
Some research shows that almost half of all university staff
named psychological distress as a factor contributing to overall
occupational stress. This group also demonstrated emotional exhaustion,
job dissatisfaction, and intention to quit their jobs within the next
year, symptoms associated with compassion fatigue.
Factors contributing to compassion fatigue in student affairs professionals
Student affairs
professionals who are more emotionally connected to the students with
whom they work and who display an internal locus of control are found to
be more likely to develop compassion fatigue as compared to individuals
who have an external locus of control and are able to maintain
boundaries between themselves and those with whom they work.
In lawyers
Recent
research shows that a growing number of attorneys who work with victims
of trauma are exhibiting a high rate of compassion fatigue symptoms. In
fact, lawyers are four times more likely to suffer from depression than
the general public. They also have a higher rate of suicide and substance abuse.
Most attorneys, when asked, stated that their formal education lacked
adequate training in dealing with trauma. Besides working directly with
trauma victims, one of the main reasons attorneys can develop compassion
fatigue is because of the demanding case loads, and long hours that are
typical to this profession.
Prevention
There
is an effort to prepare those in the healthcare professions to combat
compassion fatigue through resiliency training. Teaching workers how to
relax in stressful situations, be intentional in their duties and work
with integrity, find people and resources who are supportive and
understand the risks of compassion fatigue, and focus on self-care are
all components of this training.
Personal self-care
Stress reduction
and anxiety management practices have been shown to be effective in
preventing and treating STS. Taking a break from work, participating in
breathing exercises, exercising, and other recreational activities all
help reduce the stress associated with STS. Conceptualizing one's own
ability with self-integration from a theoretical and practice
perspective helps to combat criticized or devalued phase of STS. In
addition, establishing clear professional boundaries and accepting the fact that successful outcomes are not always achievable can limit the effects of STS.
Social self-care
Social support and emotional support can help practitioners maintain a balance in their worldview.[54]
Maintaining a diverse network of social support, from colleagues to
pets, promotes a positive psychological state and can protect against
STS.
Self-compassion as self-care
In order to be the best benefit for clients, practitioners must maintain a state of psychological well-being.
Unaddressed compassion fatigue may decrease a practitioners ability to
effectively help their clients. Some counselors who use self-compassion
as part of their self-care regime have had higher instances of
psychological functioning.
The counselors use of self-compassion may lessen experiences of
vicarious trauma that the counselor might experience through hearing
clients stories. Self-compassion as a self-care method is beneficial for both clients and counselors.
Mindfulness as self-care
Self-awareness as a method of self-care might help to alleviate the impact of vicarious trauma (compassion fatigue).
Students who took a 15 week course that emphasized stress reduction
techniques and the use of mindfulness in clinical practice had
significant improvements in therapeutic relationships and counseling
skills.
The practice of mindfulness, according to Buddhist tradition is to
release a person from “suffering” and to also come to a state of
consciousness of and relationship to other people's suffering.
Mindfulness utilizes the path to consciousness through the deliberate
practice of engaging “the body, feelings, states of mind, and
experiential phenomena (dharma).” The following therapeutic interventions may be used as mindfulness self-care practices:
