“Max,” a 69 year old retired farmer and friend, takes care of his wife who suffers worsening premature dementia. Max also looks after his widowed 90 year-old mother who lives alone but is unable to drive a car and needs help with most tasks she could handle easily when younger, like paying her bills, housekeeping and cooking.
Max told me a few months ago he loved his wife and mother, but he often found himself getting into angry exchanges with them. He also couldn’t understand why he was having trouble sleeping because he felt tired much of the time and was physically worn out at the end of the day.
Max said he felt like “Betty,” his wife: restless, confused, at a loss for words and empty inside. 
“Max,” I said, “you have good reason to feel like you do. It’s a normal response to giving almost constant care.” It’s called secondary traumatic stress.
Secondary traumatic stress (STS) is common among persons who regularly give care to others in their occupations and daily lives. Sometimes called compassion fatigue or burn-out, STS often occurs when we become overwhelmed with giving care to others.
Symptoms include: inability to relax, distressing thoughts of the events that traumatized the person being care for, hypervigilance, restricted outlook and inability to focus on the future, feelings of detachment, irritability or angry outbursts, difficulty sleeping, lethargy and depressed mood.
A July 2012 article in Psychology Today by Dr. Susanne Babel indicated 87 percent of emergency medical technicians, emergency room nurses, and law enforcement personnel reported symptoms similar to post traumatic stress disorder (PTSD) after caring for severely traumatized persons. 
When managing behavioral health programs in response to tornadoes, floods, drought and Hurricane Katrina on behalf of the state of Iowa, I saw how some crisis counselors became anxious and depressed when helping victims adjust to their traumas.
People in the “helping professions,” such as medical healthcare, counseling and lawyers for trauma victims, are prone to develop symptoms similar to the persons they are caring for. Persons who are conscientious, sensitive to others’ needs or who believe “true love” means always placing another person’s needs first, are especially likely to develop STS.
STS versus compassion fatigue/burn-out. It is important to distinguish between overly identifying with the persons being cared for and becoming tired of giving constantly.
Fearing that the persons one is caring for might suffer more and wanting desperately to prevent their suffering are typical of STS. Some care-givers, like Max, unknowingly acquire some of the same behavioral symptoms as the recipients of care.
Trauma care providers and family members of severely injured militia may become excessively vigilant about preventing further harm to those they care for. They may overly empathize with the persons they assist. 
People with compassion fatigue/burn-out can so become emotionally drained they have little reserve energy and capacity to minister. Unwittingly, they may resent further demands on them; their resentment is a signal they should take a break from their duties. 
Constant giving without reciprocity leads to burn-out. Max had not had “a day off” for a long while when he told me about his frustrations.
He soon asked for help from his adult children in the care of their mother. The three children, and sometimes their spouses and the grandchildren, took turns coming home periodically to assist Max and Betty. 
Max signed up for home health services to assist his mother with house-cleaning, laundry chores and food preparation when Meals on Wheels was unavailable. Max still managed his mother’s finances and transported her to appointments, usually with Betty, which gave her an outing as well.
Respite care is available to most caregivers. Most state-operated human service departments and private social service agencies routinely offer in-home respite care for foster parents and caregivers of dependent adults. Therapeutic adult day care services are available in many areas of the country, although less available in rural locations.
ARCH National Respite Network (www.archrespite.org) offers a national respite locator service to help caregivers and professionals find respite services in their community. The network also lists state affiliates and information about various types of respite care and covering their costs.
Critical Incident Stress Management (CISM) is available to assist EMTs, law enforcement officers, fire fighters, crisis counselors, nurses and anyone else involved in search and recovery missions, rescue operations and mass traumas such as the recent Oklahoma tornadoes. Most hospitals and behavioral healthcare clinics have trained providers on their staff or affiliate with a regional provider of CISM.
CISM helps workers defuse their emotional reactions to severe trauma exposures through debriefing sessions and follow-up counseling as needed by individuals. CISM helps prevent STS.
Max is a different man today than he was a few months ago because he now knows the signals of emerging compassion fatigue and STS. He takes time to restore himself so he can care for the persons he loves.

Dr. Rosmann is a Harlan Iowa psychologist and farmer. Readers can contact Dr. Rosmann at the website www.agbehavioralhealth.com.

By Mike Rosmann, Ph.D.

Share your thoughts. Email Dr. Rosmann at [email protected], or visit his website at www.agbehavioralhealth.com.  You can call him at his office in Harlan, Iowa at 712-235-6100.