The phrase ‘the elephant in the room’ refers to a truth that is very visible but which everybody pretends not to see. It can refer to a problem that it is even much known about but which nobody wants to speak about. It is impossible to ignore an elephant that is in the middle of a living room, but one can pretend not to see it and this avoid putting the problem at the centre of people’s attention and relationships. To address it would create a difficult malaise that would be difficult to bear, but to ignore it does not eliminate its presence. Sooner or later the elephant moves, attracts attention to it, and can cause injury it would have been possible to avoid. It is then realised that many people knew about it but that nobody, for a whole variety of reasons, had the courage to break the silence.

If you go to visit a friend who has a grave illness (you know this and so does he) and try to avoid talking about anything that even remotely touches on the problem you are pretending not to see a large elephant that is between you and him. Its presence, which is real even if minimised, deforms your relationship and prevents you from continuing to be the friend whom he needs at that moment in order to express ‘freely’ his pain, his fears and his hopes: everything that is inside him and he cannot always say to other people.

Addressing difficult subjects is hard but in the right way and at the right time they have to be addressed. When the person you love is aware if his situation, it can be of great help to speak about it and it will be up to him to let you know whether that is the right moment or whether it is better for the elephant to remain in the room, at least for a little while more. One needs sensitivity, common sense and honesty, but it is important not to allow the elephant in the room to dominate and to condition your life, breaking the most beautiful things that you have, including relationships of love and friendship. There are also offences that must be called by their name. Only in this way can the elephant be removed, can one look a person in the eyes and proceed along the difficult pathway of forgiveness and reconciliation.

The image of the elephant in the room is used by various authors to speak about various problems: to admit and overcome the shame of being wrong; to accept that one is frail and vulnerable; to denounce acts of violence and forms of injustice of various kinds; to address the subject of the death of a parent with children of various ages; and yet other problems as well. Some authors speak about an elephant that does not want to show itself because of the emotional burden that accompanies compassion and possible burn out, that is to say that experience that many professionals undergo after entering the world of help and care with great motivations: feeling emotionally drained, emptied, treating people badly and experiencing a feeling of failure.

I was attracted by the title of an article in English that speaks about the belief that ‘compassion costs nothing’ as an elephant in the room. The two authors of the University of Birmingham, a city in the middle of England, state that good compassionate care is the result of the actions of an individual but also of organisations which, in creating a culture that gives importance to compassion in taking care of other people, do not avoid looking the emotional cost for professionals of caring for the sick, and helping those people who are most frail, in the face. This is an elephant in the room that people pretend not to see and thus this elephant is not addressed, although its effects are quite often seen. And care is not always compassionate. Compassion in the various situations of care has a cost that should be called by its name and addressed. Only in this way can one impede the elephant from escaping one’s control; the ‘burden of compassion’ makes itself suddenly felt and it provokes disasters.

To humanise care also means to ‘take care of those people who provide care’, that is to say to demonstrate compassion towards these people as well. Compassion is a special sensitivity towards the suffering of other people that leads to a commitment to try to alleviate it; it pre-supposes attention being paid to the needs of other people and being aware of their typology. But it also requires a motivation to act and the capacity to do this in the most professionally effective way possible. There are relational abilities and precise capacities that must be learnt and those who have directive roles in organisations have the task of creating work environments in which compassionate care can be expressed and grow.

Compassion that expresses itself in care has its emotional costs and only by addressing this elephant in the room together can we control its problematic effects and produce possible forms of satisfaction. Before the situation spins out of control.