Burnout and Crazy Cat Ladies

Question: What do professional burnout for nurses and crazy cat ladies have in common?

Answer: Pathological altruism.

This, according to a recent NYT book review “The Pathological Altruist Gives Till Someone Hurts.” (Natalie Angier, 10-3-11). The book is an anthology entitled Pathological Altruism  (Barbara Oakley, et al, editors/ Oxford University Press) due out December 2011. Altruism—behavior aimed at helping another person. True altruism is said to spring from empathy (vs. self-interested egoism). Authors included in this book link pathological altruism to animal hoarding, anorexia, personality disorders, codependency, and professional burnout for health professionals—especially nurses.

Barbara Oakley seems to have gotten the idea for this anthology while she was researching and writing her somewhat creepy (among other things—a cover photo of a black-widow spider), cumbersomely titled book Cold-Blooded Kindness: Neuroquirks of a Codependent Killer, or Just Give Me a Shot at Loving You, Dear, and Other Reflections on Loving That Hurts (Prometheus Books, 2011). A pseudo-scholarly take-off on Capote’s In Cold Blood, her book examines the story of Carole Alden, a Utah artist who killed her husband in what she claims was self-defense/Battered Woman’s Syndrome—but who was sentenced to 15 years for manslaughter. A collector of animals (and of drug-addicted men), Carole was known for her compassion.

But Oakley contends that Caroles’ type of compassion is an example of diseases of caring, of empathy gone awry. She quotes research by Jean Decety, a University of Chicago scientist who examines the neural pathways that underlie empathy. According to Decety, empathy has four components. Empathy is a mixture of all four, and if any one of them gets distorted—by genetics, developmental issues, or stress—empathy can become pathological. Decety’s four elements of empathy are:

1)   ability to share someone else’s emotions

2)   awareness of yourself and other people—and knowledge of where you “end” and where others begin

3)   the mental flexibility to set your own perspective aside and view things from another person’s perspective

4)   the ability to consciously control your emotions. (as quoted pg 57 Cold-Blooded Kindness)

Empathy can either lead to compassion/acts of kindness, or it can lead to empathic distress when the suffering of others becomes or compounds our own suffering. Empathic distress is something that nurses are particularly prone to, leading to burnout. There are empathy brain cells (of course!) called mirror neurons located in the right frontoparietal lobe—in left-handed people. And they’ve identified this area as being active when health care professionals are able to emotionally distance themselves from images and sounds of a patient’s pain and suffering. Researchers are looking at ways of teaching health care providers to be able to emotionally distance themselves “just enough” to protect themselves, while still providing compassionate care. A different kind of Universal Precautions.

In the NYT article referenced above, Angier writes, “Train nurses to be highly empathetic, and, yes, their patients will love them. But studies show that empathetic nurses burn out and leave the profession more quickly than do their peers who remain aloof.”

We know that educating nurses to be aloof Nurse Ratcheds isn’t the answer to burnout prevention. I think that a lot of what is called burnout in nurses is really moral distress: wanting to do the right thing by a patient, but being blocked by factors in the health care system that are outside the nurse’s control. And for prevention of real burnout in nurses, I think we can do a better job in nursing education—by helping students (and ourselves) examine and process the sometimes complex and unsavory motivations for ‘doing’ nursing. Otherwise we will continue to graduate burnout-to-be nurses, along with future crazy cat ladies (and lads).