Ideas of vicarious trauma have long been applied to healthcare and disaster relief workers as well as mental health professionals who work with severely traumatized populations. Other labels capturing facets of vicarious trauma have included secondary post-traumatic stress disorder (PTSD) and compassion fatigue.
These concepts however, are rarely applied to loved ones (friends and family) impacted by illness. The foremost author on compassion fatigue, Charles Figley, has used the term “family burnout” to describe the impact of caregiving for family members with medical illness.
Compassion fatigue can be applied to caregivers, especially those who become engulfed by their caretaking role. Becoming compulsive about caretaking is likely a way caretakers try to avoid overwhelming feelings of grief, sadness and loss. Through this lens, some caregivers may suffer from the avoidance symptom observed in PTSD; they cut off their feelings and become focused on survival of the person they are worried about. They may also try to manage their own survival by eliminating difficult feelings.
Loved ones who are impacted by traumatic illnesses can suffer from the misperception that they are overly responsible for the health and well being of a patient. Feeling supremely liable when someone is sick has a similarity to those with PTSD.
Witnessing the ways that illness can be traumatic for patients results in a unique kind of helplessness for loved ones. They can often do nothing to help during traumatic hospitalizations or when someone is dying. In the face of such helplessness and the need to watch someone else’s intense suffering, people over-inflate the sense of control they have. This can become problematic when loved ones imagine that they influence things that cannot be controlled.
For example, several people have told me that they have felt that if they decide to leave a terminally ill person in the hospital to get something to eat, that their absence, even if it were for 20 minutes, would cause the patient to die.
Such ideas torture loved ones and reflects the kind of over-responsibility that some can be subject to. It is as if those who have no control find ways to feel responsible. This is a common strategy when we feel helpless.
As children, when we face uncertainties from our parents, we blame ourselves. This is often the only reasonable developmental strategy when we are young, but it does not differ from how some adults handle illness. When we feel out of control we find ways to be in control, even if this is not rational.
Feeling overly responsible provides a quick fix in terms of giving us a feeling of more control, but does not work in the long run. We cannot really influence the trajectory of illness in those we care for.
However defined, compassion fatigue, secondary trauma, vicarious trauma are deleterious to loved ones. Illness is a family disease. Loved ones need just as much support as patients do.