The Power of Compassion: How Structural Violence Affects Our Mental Health
Under President Trump’s leadership, our country has seen a rise in cruel policies that directly impact the most vulnerable members of our society. From the slashing of Medicaid funds to the recent civil commitment executive order, which claims to be focused on treatment but is actually further criminalizing poverty and homelessness, it is clear that those in positions of power are not prioritizing the well-being of marginalized individuals.
As a provider who works with the unhoused, I have witnessed firsthand the difficulties that our society has created for this marginalized community. From accessing basic necessities like housing and healthcare, to receiving adequate treatment for mental health and substance abuse issues, it is a constant battle for those living on the streets. As a result, I am forced to watch countless individuals suffer from systemic neglect, abuse, erasure, and silencing.
This daily struggle takes a toll not only on those who are directly impacted, but also on the healthcare workers and advocates who are trying to provide care and support. It is a complex ethical dilemma to navigate when there is little we can do to address the root causes of these issues. This constant bumping up against barriers to care can lead to what those in the public health space call moral injury.
Moral injury is a little-diagnosed condition that can affect anyone who engages with systems that are tasked with providing care, but do not align with the reality of neglect under capitalism. It is a persistent distress that stems from personal experiences that disrupt one’s sense of goodness in themselves, others, institutions, or higher powers, as well as one’s beliefs about right and wrong, good and evil.
As a healthcare worker, I understand this personally. Years ago, I had an experience that deeply impacted me. While working on an evening outreach in Skid Row, our team came across a man in his 40s who was trapped in his car due to sudden paralysis in his legs. We offered to call an ambulance, but he refused, stating that he had been praying for three days and believed that God would send help.
In that moment, I realized that his refusal to seek hospital support was not because he did not care about his own health. Instead, it was more likely that he feared how he would be treated in the hospital. Research has shown that those on the margins of society are acutely aware of how they are perceived and treated in systems of care.
Despite our efforts to support him and get him home safely, the man tragically passed away the following day. His death was a devastating reminder of the barriers that exist for the most vulnerable in our society and the consequences of neglect and systemic oppression.
This experience had a profound impact on me, both personally and professionally. I struggled with feelings of self-blame, guilt, and a loss of faith. It affected my relationships, my work, and my overall well-being. I experienced symptoms similar to those of PTSD, such as traumatic thoughts, sensitivity to light and sound, migraines, stomach problems, and suicidal ideation. Simply existing became a painful struggle.
This is the reality for many healthcare workers, advocates, and individuals who are directly impacted by structural violence and systemic neglect. No amount of burnout prevention can remedy the mental health impact of living and working in a society that punishes poverty and vulnerability.
As psychiatrist and Holocaust survivor Viktor Frankl once said, “Everything can be taken from a man but one thing: the last of the human freedoms – to choose one’s attitude in any given set of circumstances, to choose one’s own way.” As someone who identifies as an atheist, Western, feminist Buddhist, I believe that part of both spiritual and social liberation comes from being empathetically witnessed by our community, from access to personal pleasure and joy, and from a willingness to face our shadows.
But in a society that punishes poverty and vulnerability, these freedoms are not easily attainable for many individuals. And those who work to provide care and support are constantly confronted with the moral injury of navigating systems that do not align with the reality of neglect and systemic oppression.
In order to truly address the mental health impact of structural violence, we must first address the root causes of poverty and inequality in our society. We must advocate for policies that prioritize the well-being of all individuals, regardless of their socio-economic status. This means investing in social safety nets and adequately funding essential services such as healthcare and mental health treatment.
As a society, we
