Short: How to Avoid Compassion Fatigue

Why Empathy Must Remain at One Remove

By Dr Neel Burton — Psychiatrist, philosopher, and wine writer; Fellow of Green Templeton College, University of Oxford; author of over twenty books.

Empathy is, in a sense, the opposite of anger. In anger, we are imprisoned in ourselves and unable to see another person’s perspective. We see in people only what they have done to us. With empathy, we reach out to the other and try to see the world through their eyes.

But if we take this reaching out too far and begin to merge with them, it can become a problem. The suffering of our patients can become both corrupting and exhausting.

Sympathy vs Empathy

The danger becomes clearer if we distinguish between sympathy and empathy. If a friend has lost a parent, and I say, “I’m sorry,” that’s sympathy—which is simple concern for another person’s suffering. If I imagine what that loss feels like from within my friend’s world, that’s empathy.

The power—and the danger—of empathy lies in its particularity. It’s not merely a matter of imagining myself in someone else’s situation. I must imagine myself as them, in that situation. I need to understand who they are, where they have come from, and where they are trying to go. As John Steinbeck wrote, ‘It means very little to know that a million Chinese are starving unless you know one Chinese who is starving.’

Why Empathy Must Remain at One Remove

Yet, to imagine myself in someone else’s shoes is not to become that person. Empathy must remain at one remove. That distance enables me to think objectively and be of help. After all, if I drown alongside a drowning person, I can hardly pull them out of the water.

If that boundary collapses, empathy can corrupt as well as exhaust us. It can lead us to favour the person before us over the many people we cannot see. And, as empathic distress, it can lead to compassion fatigue and burnout.

Regulating empathy, therefore, is not callousness but the condition of effective care.

Doctors who understand their patients without being engulfed by them are not only more effective but more fulfilled in their work.

Ultimately, the doctor’s task is not to carry the patient’s pain, but to stand close enough to understand it—and far away enough to help.