When Systems Forget to Feel: Structural Trauma Hiding in Plain Sight

"The greatest injustice is not simply that people are harmed. It is that systems can become so accustomed to suffering that they no longer recognize the humanity standing before them." — Mary Coughlin

Every so often, a story emerges that stops us in our tracks — not simply because of the suffering it reveals, but because of the question it leaves behind.

How could this happen?

Recently, I found myself reading the findings of a U.S. Senate investigation into the medical treatment of women detained in ICE custody. The report describes women subjected to excessive and often unnecessary gynecological procedures, failures of informed consent, and profound lapses in oversight. Whether every allegation ultimately satisfies the threshold for criminal prosecution is a question for the legal system.

That said: How does a system become capable of overlooking harm that is occurring in plain sight?

Or, maybe the better question is: What conditions allowed the harm to become ordinary?

That is the language of structural trauma.

We often think of trauma as something one person does to another — a violent act, an abusive relationship, a catastrophic event. Those experiences matter deeply. But trauma also lives in systems. It lives in cultures where power eclipses relationship. Where policies become more important than people. Where efficiency outruns humanity. Where fear silences those who know something is wrong. And, where vulnerability becomes invisible because those with the least power also have the least voice.

Structural trauma is rarely announced with malice. More often, it emerges quietly through normalization. Harm becomes routine. Procedures become protocol. Compliance replaces curiosity. People stop asking whether something is right because everyone assumes someone else already has.

This is not unique to immigration detention.

It happens in healthcare.

It happens in education.

It happens in child welfare.

It happens in workplaces.

It happens anywhere hierarchy is allowed to outrank human dignity.

As a neonatal nurse practitioner, I have seen how easily systems can unintentionally create trauma while believing they are delivering excellent care. A premature infant experiences dozens — sometimes hundreds—of painful procedures. Parents are separated from their newborn because "that's just how we've always done it." Clinicians become so overwhelmed by workload and moral distress that survival replaces presence.

None of these moments are typically born of cruelty. Yet each has the potential to shape biology, relationships, trust, and lifelong health. Trauma is not defined solely by intent. It is defined by impact.

That distinction matters.

One of the greatest misconceptions about trauma-informed care is that it is primarily about kindness. It is not. Trauma-informed care is about accountability. It asks us to examine not only individual behavior but the relational ecology in which that behavior occurs. It asks difficult questions. Who has power? Whose voice is missing? Who benefits from the current structure? What warning signs are being dismissed? What has become so normal that we no longer recognize it as harmful?

These are uncomfortable questions because they require us to move beyond blaming individuals.

Individual accountability matters. But systems also have responsibilities. When multiple people witness harm and nothing changes...When oversight exists but fails...When those who speak up are ignored...When people with the least power bear the greatest burden...We are no longer looking only at individual failure. We are witnessing systemic failure.

This is why psychological safety matters. This is why relational leadership matters. This is why trauma-informed organizations matter.

Not because they make people feel comfortable. But because they create cultures where harm is visible, voices are protected, and repair is expected. The opposite of trauma is not comfort. It is relationship. It is agency. It is dignity. It is the ability to say, "Something isn't right here," and know that someone will listen.

The Senate investigation should not simply provoke outrage about one detention center or one physician. It should invite us to look more honestly at ourselves. Where have our own systems stopped listening? Where have we mistaken efficiency for excellence? Where have we become so accustomed to suffering that we no longer see it?

Every institution — whether a hospital, a school, a corporation, a government agency, or a community organization — exists within a relational field. The quality of that field determines whether people experience safety or fear, belonging or exclusion, dignity or dehumanization.

When relationships are grounded in trust, transparency, humility, and accountability, healing becomes possible. When those qualities erode, trauma does not simply happen. It becomes organized.

Perhaps that is the greatest lesson of all. Structural trauma is rarely invisible. It is rendered ordinary by systems that no longer notice the humanity before them.

The measure of a just society is not whether it occasionally uncovers harm. It is whether it cultivates relationships, cultures, and institutions so deeply rooted in human dignity that harm struggles to take root in the first place.

Justice is not found only in accountability after injury. Justice is found in the daily practice of creating conditions where every life is seen, every voice can be heard, every concern is welcomed, and every person's humanity remains intact in the eyes of the system entrusted to their care.

This is the deeper invitation of trauma-informed work. Not simply to recognize trauma when it has occurred. Not merely to respond with compassion after the fact. But to become faithful stewards of the relational conditions that make healing—and justice—possible.

The future of trauma-informed care is not simply preventing harm. It is cultivating systems that remain profoundly, relentlessly human. Because healing begins the moment people remember one another's humanity. And justice begins the moment the systems we create refuse to let that humanity disappear.

Take care and care well, Mary

Author's Note: This reflection was inspired by the findings of the bipartisan U.S. Senate Permanent Subcommittee on Investigations into the medical treatment of women detained in ICE custody. If you'd like to read the report for yourself, you can access it here: https://www.hsgac.senate.gov/subcommittees/investigations/library/files/majority-and-minority-staff-report_-medical-mistreatment-of-women-in-ice-detention/