Empathy: An unhealthy path for veterinarians

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There's an alarmingly high rate of suicide among veterinarians. Of veterinary graduates, 14.4 percent of men and 19.1 percent of women have contemplated suicide since graduating. This is three times the national mean. Even more startling, 1.1 percent of males and 1.4 percent of females have attempted suicide since graduating from veterinary school.

According to a study published in The Lancet this January, a human physician at high risk for suicide is more likely to be a workaholic white male age 50 or older or female age 45 or older who is divorced, single or currently experiencing marital disruption and suffering from depression. Substance abuse, high-risk destructive behaviors such as excessive gambling, chronic pain or illness, and a recent change in occupational or financial status were also found to increase the potential for suicide. Increased work demands, personal losses, diminished autonomy and access to lethal means (such as medications or firearms) complete the profile. Many of these issues are also factors in the lives of veterinarians.

In our profession we are impacted by the realities of life and death, euthanasia of animals we could help, relative lack of acknowledgment and appreciation, and the financial burdens of unbearable debt loads. Yet most in the profession can balance those experiences and emotions; fortunately, few of us become clinically impacted to the point of depression and even suicide. I have often wondered why it is that while most veterinarians share these experiences, not all have such extreme reactions.

While I'm not trained in psychology or behavioral sciences, I have at times struggled with feelings of inadequacy and depression. I've made it a point to try and understand what leads to such emotional excess.

Most of us are familiar with the term “compassion fatigue.” According to the Compassion Fatigue Awareness Project (compassionfatigue.org), one expert defines this condition as “an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper.”

No surprises there. But I recently came across a term I was unfamiliar with. In a Psychology Today article, psychologist Krystine Batcho, PhD, uses the term “heartworn” to describe what happens when people are bombarded and ultimately overwhelmed by daily assaults of sadness and tragedy.

Regardless of what we call it, the results and impact can be devastating, and most veterinarians are affected to one degree or another. We're expected to be understanding, supportive, sympathetic, compassionate and empathetic. Though these terms are often used interchangeably, they're not the same thing. Empathy and sympathy are related phenomena, but they are very different.

I always understood that empathy was a wonderful thing, but recently experts have begun to assert that it can be an inappropriate and even dangerous emotional response to the suffering of others. I recently watched a YouTube broadcast of the presentation “Empathy, Is It All It's Cracked Up to Be?” by the Aspen Institute. It made me look at empathy, sympathy and compassion in a whole new way:

> Sympathy refers to commiseration, pity or feelings of sorrow for someone who is experiencing misfortune. It is a general feeling of sorrow for another person's situation and refers to feeling sorry for another's hurt or pain. People experiencing sympathy say, “I feel sad for you.”

> Compassion indicates a real desire to help, to take action in an effort to alleviate pain, sadness or suffering. People experiencing compassion ask, “How can I help?”

> Empathy involves taking on the feelings and thoughts of another and experiencing them yourself. It is putting yourself emotionally in another's shoes. Excessively empathetic people internalize another person's feelings and absorb their pain. They dwell on another's experience of sadness. The futility that results can lead to suffering, pain, loss of objectivity, severe depression and thoughts of suicide.

Because repeated exposure to sadness can result in emotional exhaustion and compassion fatigue, empathy might not be the best response for veterinarians to experience on a routine basis. Grief coupled with empathy can run amok, to the detriment of our patients, our clients and ourselves.

So keep your perspective. People may assert that there's no such thing as too much empathy, that politicians, religious leaders, community activists and everyone else should feel more empathetic. Really? I would say it's a good idea to separate empathy from compassion and sympathy.

In his book Against Empathy: The Case for Rational Compassion, psychologist Paul Bloom, PhD, elaborates on the unhealthy effects of empathy. Bloom says empathy has a “spotlight effect”-that is, the act of feeling someone else's pain causes us to zoom in on that pain. We want to do something about it, often at the expense of ourselves or other, more important causes. And frustration and disappointment at being unable to alleviate the pain of another can result in depression.

Rather than empathy, Bloom advocates for rational compassion, or “simply caring for people, wanting them to thrive.” Rational compassion is a feeling of goodwill toward our fellow humans in general.

What does this mean for you and me? We should feel and express sympathy for the situations and pain of our clients, our patients and others. We should be compassionate and take appropriate steps to help them when possible. But when it comes to sharing in their pain, we should stay in our own lane and stand in our own shoes.

Dr. Mike Paul is the former executive director of the Companion Animal Parasite Council and a former president of the American Animal Hospital Association. He is currently the principal of MAGPIE Veterinary Consulting. He is retired from practice and lives in Anguilla, British West Indies.