When the System Is the Stressor: How Oppression Impacts Mental Health
Sometimes it’s not your coping skills.
It’s not your “mindset.”
It’s not that you need to meditate harder.
Sometimes the system is the stressor.
We live in a society shaped by structural racism, economic inequality, sexism, environmental injustice, and institutional stigma. These are not abstract academic terms. They are daily lived experiences. And they get under your skin. Literally.
When you are navigating chronic discrimination, unstable housing, crushing debt, inaccessible healthcare, or constant microaggressions, your nervous system does not interpret that as “social theory.” It interprets it as threat.
And chronic threat changes the brain and body.
Chronic Stress Is Not a Personal Failure
This isn’t random. These systems are interconnected. Housing impacts education. Education impacts employment. Employment impacts insurance. Insurance dictates care.
And when care is denied, delayed, or dehumanizing? That compounds trauma.
People come into therapy exhausted. Not weak. Exhausted.
Exhausted from proving they deserve care.
Exhausted from navigating systems not built for them.
Exhausted from paying into structures that harm them.
The Betrayal of Paying to Be Harmed
Alright, let’s talk about healthcare. I worked inside large healthcare systems, including Kaiser Permanente, which operates as both the hospital and the insurance provider.
Pause there.
When the same entity that decides what care is “medically necessary” is also the one financially responsible for paying for that care, we have a conflict of interest built into the structure.
People pay monthly premiums. They trust that when they are in crisis (suicidal, manic, dissociating, unraveling) their insurance will protect them. WRONG.
They are told:
“Not severe enough.”
“Not meeting criteria.”
“Outpatient is sufficient.”
“You will see a therapist every 4-6 weeks.”
“I think group therapy will work instead.”
“We are conserving services.”
Conserving.
As if someone’s nervous system collapse is a luxury item.
There is something uniquely destabilizing about being in a mental health crisis and realizing the institution you fund does not see your suffering as urgent enough to invest in.
That betrayal hits deep. And Kaiser isn't the only corporation within the healthcare system contributing to societal harm unfortunately. You could not imagine the things I witnessed while working at inpatient facilities.
My Cognitive Dissonance in the System
I entered healthcare wanting to be part of change.
I wanted to be the therapist that marginalized communities rarely get to experience. I wanted to disrupt harm from the inside. I believed that if people like me were in these systems, we could soften them.
I remember sitting in meetings where insurance representatives would deny continued inpatient coverage because, essentially, “the patient will always have trauma.”
As if trauma is a personality trait.
As if complex PTSD resolves on a billing cycle.
As if someone can “graduate” from generational harm in 72 hours.
I heard variations of:
“They need to learn to cope.”
“They’ve had this for years.”
“This is chronic.”
Chronic does not mean undeserving.
Sitting in those rooms created cognitive dissonance in my own body. I wanted to advocate fiercely for patients. And I did. But I was also participating in a machine that rationed care.
It wore on me.
There is a particular kind of moral injury that comes from witnessing people be denied care for financial reasons while you are tasked with stabilizing them.
My nervous system paid for that contradiction.
When Systems Gaslight
The annoying part about systemic oppression is that it often convinces people that their suffering is individual. If you are depressed while living in poverty, the narrative becomes that you lack resilience. If you are anxious while navigating racism daily, the narrative becomes that you need medication without acknowledging the racial trauma. If you are burned out from working three jobs with no healthcare access, the narrative becomes that you need better time management. But who are we kidding?! Picking yourself up by your bootstraps is the American way.. I guess.
That is gaslighting at scale.
Systems create the conditions and then pathologize the response.
Institutional Stigma and “Medical Necessity”
Institutional stigma shows up in subtle and overt ways:
Mental health coverage that is more restrictive than physical health coverage.
Underfunded community programs.
Long waitlists while people deteriorate.
Jails functioning as de facto psychiatric facilities.
When someone in psychosis ends up incarcerated instead of treated, that is not a personal failing. That is a policy failure.
When a patient with suicidal ideation is discharged because insurance will not authorize more days, that is not because they “didn’t try hard enough.”
It is because profit margins often outrank human margins.
And yes, that frustrates me. I have witnessed this with friends and family members growing up and it is still happening to them now. Getting regular calls from an “inmate” without a history of violence that should have mental health support for his psychosis has been my reality for awhile now. I can know all of the resources, but it doesn't stop the system from doing what it is set out to do.
The Psychological Toll of Oppression
Let’s name what happens over time:
Hypervigilance from racism and discrimination
Anxiety and depression linked to financial instability
Trauma symptoms from gender-based violence
Substance use as coping for chronic stress
Internalized shame from institutional stigma
Physiological wear and tear from constant cortisol activation
The body keeps score of inequity.
You cannot breathe through structural injustice away.
You cannot journal your way out of housing instability.
You cannot positive-think your way out of systemic sexism.
Therapy can help build resilience. It can support nervous system regulation. It can help untangle internalized oppression. But therapy alone cannot dismantle oppressive systems.
And pretending it can is unfair to clients.
To Those Navigating These Systems
If you feel angry, that makes sense.
If you feel tired of fighting for basic care, that makes sense.
If you feel betrayed by institutions you trusted, that makes sense.
You are not “too sensitive.”
You are not “treatment resistant.”
You are not broken because you struggle under chronic inequity.
You are reacting to environments that would strain anyone.
Why I Still Do This Work, Well Kina
Even after the cognitive dissonance.
Even after the moral fatigue.
Even after recognizing how taxing it was on my own mental health.
I still believe in being a presence people do not typically get to experience in healthcare spaces. I ultimately decided working in hospitals was not my calling, but I remain committed to this work. And working to help people manage these tricky systems. Being outside of these facilities has provided me the freedom to meet people in their homes, attend their medical appointments with them, offer services for those displaced or incarcerated, and coordinate care with companies without the threat of termination (as Kaiser threatens to replace their therapists with A.I.).
But I also believe in naming corruption. In acknowledging conflicts of interest. In saying out loud that a hospital being its own insurance company creates structural incentives that do not always align with patient well-being.
Change requires honesty.
And honesty includes admitting that systemic oppression is not just a social justice issue. It is a public mental health crisis.
Until we address structural racism, economic inequality, healthcare profiteering, sexism, environmental injustice, and institutional stigma, we will continue treating symptoms while ignoring causes.
And that, too, is exhausting.
But if you are navigating this right now, know this:
Your distress is not happening in a vacuum.
Your body is not defective.
Your anger is data.
And you deserve care that honors the full context of your life, not just the diagnostic code attached to it.
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