A Conversation with Janet Cromer on Compassion Fatigue, Stress Resilience, and the New Normal for Family Caregivers

Brain Injury Blog

A Conversation with Janet Cromer

by Barbara Stahura

How did you learn about compassion fatigue? Was it after your husband, Alan, suffered an anoxic brain injury and you became his caregiver?

Janet M. CromerI had known about compassion fatigue for 25 years before that, as a medical and psychiatric RN. I ran programs to help medical professionals deal with stress. My interest in it goes back to the 1970s, when I trained with Dr. Herbert Benson (author of The Relaxation Response) when information about mind-body medicine began coming out. I also worked with a cancer program for people with cancer and their family caregivers.

When I became Alan’s caregiver, all this knowledge helped, but it didn’t prevent my having compassion fatigue. There is so much trauma for the caregiver. Like trying to have a relationship with a person with a very changed personality, or 24-hour caring for someone who can’t keep himself safe, or where the caregiver gets the brunt of the anger of the person with the brain injury. I did meditation and yoga and saw a therapist occasionally. Alan’s brain injury wasn’t stable, and he also developed dementia and Parkinson’s Disease.

Why did you decide to share what you had learned by writing tip cards for Lash and Associates and facilitating workshops about compassion fatigue?

Compassion fatigue took on a different tone for me after I’d been through it. I co-founded and helped facilitate a large support group for people with brain injury and family caregivers, and I heard just how burned-out and exhausted and depleted the caregivers felt. And how they felt guilty for not being able to always be patient or understanding.

I also belonged to a national group for family caregivers called Wellspouse and found out that caregivers were experiencing hypervigilance and anxiety even months or years after their spouses had died. They were having a post-traumatic reaction that wasn’t being recognized by their doctors. I wanted to raise awareness in the medical community and help prevent compassion fatigue. We do a great service for families if early on we can teach them how to reduce the stress response and evoke the relaxation response as a foundation.

So many family caregivers struggle in isolation, often for a long time, and they experience all kinds of terrible stress. Would you talk about that?

There are lots of risk factors and stressors. “Living loss” is one of the biggest ones. Also called ambiguous loss, it’s a complicated grieving process that happens when a person is still physically a part of the family but is very changed emotionally or cognitively. There are losses of the mutuality in the relationship, and the person with the brain injury might not know the caregiver as an individual any more. Relationships change.

Another stressor is the complex medical care that many family caregivers are now expected to provide at home. This can include giving IV fluids, dressings, respirators, suctioning, and feeding tubes. You’re in over your head, and what do you do if there’s a problem and no one else is around?

Personal safety is another risk. Sometimes a person with a brain injury is violent or verbally abusive. Caregivers are ashamed to talk about it or report it, so keeping it hidden makes it even more stressful. Or perhaps the survivor can’t take the responsibility for rehabilitation or refuses to do therapy, that’s another stress.

And there are what I call “triple-duty caregivers,” who are caring for young children and also have an older child or a spouse with a brain injury, and oh by the way, Mom has dementia so we brought her to live with us. For someone who has their own history of trauma or abuse, that can get stirred up again while caring for another traumatized person. There are lots of big risks for compassion fatigue in all these situations.

What is compassion fatigue?

It’s a form of complete exhaustion that affects the body, mind, and spirit. It results from caring for someone going through severe trauma or illness. It’s a cumulative process, building up over time. It’s beyond burnout, which comes from doing a tough job without enough resources. Compassion fatigue includes burnout along with the responsibility to the relationship you have with the other person. It’s a relational condition and is a result of prolonged exposure to having to be empathic to someone else’s trauma or suffering.

We need to diagnose it in ourselves and admit that something isn’t right. It affects us emotionally, physically, cognitively. Physically, it shows up as hypervigilance, always being alert, perhaps bad dreams about the first time you saw your family member in the ICU or the accident. Headaches and stomach troubles are common. It can also lead to high blood pressure.

There are emotional signals, too. Often humor gets us through a lot. Caregivers might notice they’re losing their sense of humor and becoming more cynical. There’s a feeling that no matter what you do, it’s not enough. People can feel numb and withdrawn, which they think is better than feeling anything. And compassion fatigue affects how we think. There can be trouble focusing or concentrating. So we can’t remember important things, and it gets harder to solve problems. It feels like our brain is totally overloaded.

It affects our behavior too. We’re not as patient or can be sarcastic or mean. The most dangerous symptom is secret behaviors, like drinking, smoking, or eating too much. These work for a little while but lead to problems of their own.

Resilience plays a huge role in how well caregivers fare. What is resilience? 

Resilience combines parts of your personality and life experiences with learning new skills to better handle situations and to thrive. If you’re resilient, you can manage stress and change and find a new direction.

How can caregivers and survivors become resilient even if they weren’t before?

First, acknowledge and grieve losses. Remember that the attitude we build and the ways we look at ourselves and our situation can strengthen or weaken us. So one way to become more resilient is to get to know the person you are now, and to take very good care of your body in basic ways. Use deep breathing for relaxation and reversing stress. Explore your feelings with someone you trust. Engage your creativity. This may take a new form, something you haven’t done before, like a new hobby. Or take a class, and try to bring a beginner’s mind to it and have fun. Be very curious about yourself, other people, and the world so that you can reach out and become the best you can be. Make new friendships. Go to a new place. Try a new food. Begin to journal. Enjoy life.

After a brain injury, a family eventually settles into their new normal. How can caregivers adjust for the long haul?

Start by laying down a foundation for your own health and well-being—and believing that you deserve it. Many caregivers have told me that, after a while, others assign them worth only as a caregiver. Even their doctor says, “You must care for yourself so you can care for your husband.” Believe that your worth as an individual human being comes first.

Form a supportive circle of people who understand and encourage one another to pursue their own goals and dreams.  Connect in person or online. Be open to new possibilities, and build a positive outlook. Face problems head-on. Facilitate family members growing into new roles. Replenish hope, strength, and joy.

About the author

Janet Cromer, RN, MA, LMHC

Her award-winning book, Professor Cromer Learns to Read, is the story of caring for her husband, Alan. She also writes a blog for Psychology Today, and has written a blog and tip cards for Lash & Associates:

December 19, 2012










6 responses to “A Conversation with Janet Cromer on Compassion Fatigue, Stress Resilience, and the New Normal for Family Caregivers”

  1. Dear Kristen,
    You are living with such stress that I encourage you to find some support and help for yourself as you consider your options. It may be with a clergy if faith is important to you or a psychologist, counselor or social worker, but the stresses that you describe can be harmful for your physical and emotional well being. While you can not control your husband’s actions or decisions, you can make choices about your life and whether you wish to continue being a caregiver in an abusive or neglectful situation. ZSince you already have symptoms of PTSD it is even more critical that you find some support. These decisions are agonizing and there is no “right” or “wrong” choice, but please make taking care of yourself a priority. Too often caregivers sacrifice their well being.

  2. Kristen Durboraw says:

    What DO you do when the person refuses to accept, believe, or get help for the issues resulting from the brain injury? In my case, it even involves long term infidelity, for which he will not even go to counseling, alone or together. And his daily inability to initiate things or overall inability to manage anything more complicated in life than basic house chores and playing his sports leaves me concerned about the future. Now, he is drinking himself to death, after being sober for four months, forced into outpatient rehab groups after threatening people’s lives by text messages. We tried living separately. ..He can’t do it. As he is doing this suicide by alcohol, he constantly reminds me how I “did this to him” by my anger and words after the affair and to doctors and friends after we realized that his 30 year old left frontal skull fracture and years of alcohol had damaged him. His real age seems to be about 12 (the age he started drinking). His injury was at 17 and was never recognized as a contributor to his lack of ambition or independence or his emotional instability and immaturity. He wants to leave this earth. I have PTSD, and he refuses to get help. I think he knows, and he says things sometimes that indicate it,but he just wants out of this life rather than trying to do any hard work that could help him. Too much trauma. Was also born with a cleft palate to an alcoholic father and a dysfunctional home. I have to leave for a vacation. Letting the right people know, but can’t handle the moral choice to call 911 or not when he daily refuses help and won’t let me take him to the hospital, even though he is sick and hasn’t eaten in 3 weeks. Oh, and if I keep his keys and money from him, the nonstop harangue for me to go get him booze is unbearable and I have to leave the house and stay away. This is SO SAD.

  3. Yes you have permission to post excerpts providing you include a link back to the full article and the source. Thanks for your interest.

  4. Mario says:

    Hey mate, really love your researches and articles, would you mind if I include some of them in my own work, with quotes of course? Thanks in advance…

  5. Janet Cromer says:

    Hello JoAnn,

    You are certainly a veteran of many battles yourself. I found it very helpful to take part in online forums and support groups with people in a similar situation. The Wellspouse Association is a great organization. Find them at http://www.wellspouse.org. Does the VA offer online support groups? You are so right that loneliness is like a physical pain in the heart. I went through a long grieving process to face the ways in which Alan had changed and then find new things to respect and like about him. But it was a form of death. I had to stop myself from looking at old photos and daydreaming about the life Alan and I had before his brain injury. That was the only way I could focus on the present and who we were now. I put new pictures of us around the house-going out to lunch, playing with our dog, trying a new craft project. After Alan died in 2005 I found myself grieving for both the husbands he had been. It also helped me to form a few new friendships with people I met in support groups. One friendship was completely online – we never met in person, but felt like we were close friends. That’s the wonder of the Internet! Try to give yourself some breaks to enjoy your own interests and do things that make you feel happy and whole at least temporarily. And I’m sending you a warm hug from one caregiver to another!

  6. joann says:


    I’m an old campaignor as well..this August it will be 9 yrs since my husband Joe had his accident. We have been married for almost 39 yrs. Joe is also a Nam combat vet as well, he lives at home for the past 7 yrs. What I’ve been finding the hardest is trying to find a support group nearby that I can talk to..right now I have no one. We have two sons – one lives in NYC, the other is also a U.S. Marine vet from Iraq and Afghanistan. It’s been hard for them as well. I miss my best friend ..and I’m lonely ..the hardest thing for me is to forget who Joe was and to remember who he is now..I’ve been “holding down the fort”..and I guess the isolation is tough ..Joe is my best friend. We have no means of transport so it isolates us even more..I’m a vet’s wife and I know how to adapt and overcome..but I just miss my Joe..

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