Medicine under fireBMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6464 (Published 14 December 2016) Cite this as: BMJ 2016;355:i6464
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The editorial Medicine Under Fire raises the problem of compassion fatigue in relation to current humanitarian crises and calls for a solution, concluding:
“As we go into the next year we need to find a way to reinforce medicine’s core message: that lives matter, that human suffering calls for a response, that even war has limits.”
Any potential solution must consider the important role of the news media in reinforcing this message, because distant suffering within humanitarian crises is made visible to citizens around the world almost exclusively through the media. The health community needs to contemplate how it can persuade the media to portray humanitarian crises in ways that minimise compassion fatigue and reinforce the core ideals of humanitarianism.
It can be argued that compassion fatigue, if it exists, is the sum of three crucial problems:
Powerlessness to act
There is a perceived gulf between watching distant suffering, and acting. Susan Sontag said that, “compassion is an unstable emotion. It needs to be translated into action, or it withers”. Some believe the gap between observing human suffering, and the capacity to alleviate it, is becoming so large as to leave news audiences feeling like powerless, or even voyeuristic, spectators[2,3].
The ideals of humanitarianism would demand the reporting of humanitarian crises in an equitable way, based purely on need. However, an excess of humanitarian crises, competing for limited media space, necessitates a ranking of suffering populations. This is not based on absolute need or human cost, but on newsworthiness, a concept often tied in with wider global political interests[1-3]. Ultimately, this can foster scepticism and distrust amongst news audiences.
Indifference of scale
This relates to Stalin’s oft-quoted and discomforting tenet that “one death is a tragedy; one million is a statistic”. It seems true we might only summon meaningful moral indignation towards the plight of individuals; accounts of wider human suffering, conveyed on a large quantitative scale, become too abstract and do not provoke the same emotional response[2,3].
Nevertheless, it is important to remember that these theories regarding the origins of compassion fatigue are largely hypothetical. Qualitative research analysing audience reactions to crises in the media questions the true pervasiveness of compassion fatigue. It might be an oversimplified exaggeration. Qualitative studies suggest that audiences react in diverse ways, contingent on the style of crisis reporting. Certain editorial techniques may be especially effective at producing empowered and compassionate reactions; in particular, portrayals of suffering seem to evoke the most active responses when they achieve two things:
We should promote more emotionally attached portrayals of humanitarian crises, which tell the personal stories of people involved. Traditional journalistic values of objectivity, detachment, and impartiality, coupled with “good-taste censorship” of disturbing images can preclude harrowing individual narratives in mainstream Western news[4-6]. There is a preference for official sources and statistical data to provide a general picture of events. However, it is important not to disregard the damage to individual human lives, since personalised reports appear to trigger compassion in viewers.
Audiences can only imagine the plight of people at the moment of their suffering if they are presented with a vision of normal everyday lives beforehand. Depicting the “mundane moments that belong to all humanity” allows observers to envisage a situation in which the horror might impact on them or their loved ones. Certainly, regarding images of the Holocaust, it is often pictures of piles of victims’ shoes - the remnants of previous normal lives - which bring home the scale of the atrocities that occurred in the camps. This juxtaposition of atrocity with everyday normality has significant power to provoke empathy and news coverage could be filled with more background context to harness this.
In conclusion, those concerned with global health should question the inevitability of compassion fatigue and begin to see it as a changeable variable, dependent on the way that humanitarian crises are portrayed, particularly in mainstream news. The devastating health consequences of contemporary humanitarian emergencies will continue to mount as we enter 2017. Meanwhile, public scepticism in the so-called “post-truth” era is eroding traditional journalistic claims on truth and impartiality. In the light of these issues, the health community might begin to address the problem of compassion fatigue by advocating a more morally conscious, humanitarian journalism.
1. Höijer, B. (2004). The discourse of global compassion: The audience and media reporting of human suffering. Media, Culture & Society, 26(4), 513-531.
2. Sontag, S. (2004). Regarding the pain of others: Macmillan.
3. Boltanski, L. (1999). Distant suffering: Morality, media and politics: Cambridge University Press.
4. Bell, M. (1998). The journalism of attachment. Media ethics, 15-22.
5. Bell, M. (2008). The death of news. Media, War & Conflict, 1(2), 221-231.
6. Herman, E. S., & Chomsky, N. (2010). Manufacturing consent: The political economy of the mass media: Random House.
7. von Engelhardt, J., & Jansz, J. (2015). Distant Suffering and the Mediation of Humanitarian Disaster World Suffering and Quality of Life (pp. 75-87): Springer.
8. De Botton, A. (2014). The news: a user's manual: Vintage.
9. Zelizer, B. (1998). Remembering to forget: Holocaust memory through the camera's eye: University of Chicago Press.
Competing interests: No competing interests