The Foreign Service Journal, March 2019

THE FOREIGN SERVICE JOURNAL | MARCH 2019 25 There was a dissonance between these symptoms and what I did for a living. I had an overseas desk job, after all. job performance, satisfaction and health. In Haiti, I was stimulated by the over- whelming need immediately upon arrival. I’d like to think I worked at my optimum level of efficiency and effectiveness for months, perhaps even a year. But then I slid down the right side of the curve into exhaustion. What Is Compassion Fatigue? The same traits that make FS profes- sionals good at their work—empathy, compassion for others and tenacity—can, when self-care is neglected, turn into compassion fatigue. Sometimes referred to as “secondary post-traumatic stress disorder (PTSD)” or “vicarious traumatization,” compassion fatigue (CF) is the extreme state of exhaus- tion experienced by people who have been exposed to trauma through their work to support suffering people or animals. CF does manifest in similar ways to PTSD. Both conditions can result in disassocia- tion or feelings of numbness, detachment/ isolation, alcohol or drug abuse, feelings of helplessness or hopelessness, insomnia, nightmares, loss of appetite or binge eat- ing, hypervigilance, and panic attacks. In me, compassion fatigue started with exhaustion, followed by six months of headaches and an overdose of stress hormones that put my nervous system on high alert. My fight-flight-freeze response was stuck in overdrive, making me con- stantly jumpy and fearful. Yet there was a dissonance between these symptoms and what I did for a living. I had an overseas desk job, after all, while CF is considered a risk among people who work more directly in helping capacities like mental health practitioners, law enforcement, emergency medical personnel, and others who deal directly with victims of trauma. But the signs and symptoms of CF were certainly there. Physical and emotional exhaustion (“burnout”)—check. Bom- bardment with grim images and stories of colleagues and Haitian citizens (indirect exposure to trauma)—check. Despite this, the drive to help led me to overextend and neglect myself for more than a year. It’s a Matter of Time Aid workers and diplomats regularly encounter situations that may elicit unhealthy stress levels. For example, between October 2012 and September 2016 the State Department managed 31 evacuations from 23 overseas posts (see map on p.26). Hundreds of Foreign Service families have been affected—and global events that cause disruption show no sign of slowing. A September 2015 report commis- sioned by USAID found that “the USAID workforce is currently exposed to severe levels of stress and is at risk for developing numerous stress-related health conditions and/or disorders.” Institutional stress is exacerbated, the researchers found, by threat exposure, operational tempo and political pressure—three things USAID personnel working in critical priority coun- tries, non-permissive environments and high-threat posts experience regularly. The State Department is addressing this new reality by expanding the Foreign Affairs Counter Threat training program, which was once reserved for FS profes- sionals working in high-threat, high-risk countries, to include those assigned to every post by the end of this year. While FACT and the high-threat secu- rity overseas seminar equip FS profession- als and their families with the skills needed to react in high-threat situations, they do not prepare them for the mental and psy- chological demands of living through crisis after crisis. This is a gap that both USAID and State are attempting to fill. The USAID Staff Care Center was established in 2012 to manage an Employee Assistance Programwith wide-ranging benefits (e.g., childcare subsidy, elder care, fitness facility access) available to both domestic and overseas staff members. In addition to counseling and psychosocial support, the SCC offers organizational resilience training. In 2016 the Department of State cre- ated the Center of Excellence in Foreign Affairs Resilience. Located at the Foreign Service Institute, CEFAR provides training and other resources to all FS professionals. CEFAR also integrates resilience-focused content into training for both new and seasoned professionals. State’s Bureau of Medical Services, CEFAR and SCC offer safety nets; but, as they say, an ounce of prevention is worth a pound of cure. Extend Compassion to Yourself and Your Team While PTSD and other mental health issues have become expected and accepted in the military, FS professionals seldom talk about it. The silence stems from fears of medical clearances being revoked and careers derailed, but there is also a societal perception that PTSD only affects veterans or victims of abuse. In fact, observing or supporting others who have experienced a traumatic event—some- thing FS professionals do on a regular