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Systemic Compassion: Seeing Your Suffering Inside the System That Shaped It

RELATIONAL TRAUMA • July 27, 2026

Ahuva at Her Desk, an Hour Before the Board Call

It’s 7:40 on a Tuesday morning in March, and Ahuva is sitting at her desk with a cold cup of tea and three tabs open: the board deck, a spreadsheet of major-donor pledges, and an email draft to her mother that she’s been rewriting for two days. She’s 47, the executive director of a mid-size nonprofit she helped build from a two-person operation into an organization with a real budget and a real staff. The framed photo on her desk is from the gala eight months ago, her in a navy dress, shaking hands with a donor who wrote a six-figure check. She has not slept more than five hours a night in three weeks.

“I keep a list,” she tells me, the first time we meet. “Every year since I was maybe twenty-six. Everything I should have done better. Every board member I disappointed, every grant I didn’t get, every year my fundraising numbers dipped even a little. I know it’s not rational. I know the org grew four hundred percent under me. But I have this list, and it’s very long, and I look at it more than I look at anything I’ve actually accomplished.”

Sitting across from Ahuva that first session, I felt something I’ve come to recognize in a particular kind of client: driven, competent, carrying an entire organization on her back, and somehow still convinced that every shortfall is a personal moral failure rather than the predictable output of an underfunded sector, an overextended staff, and a fundraising model that asks one person to be simultaneously visionary, accountant, therapist, and saleswoman. Ahuva wasn’t wrong that she’d made mistakes. She was wrong about what the mistakes meant.

She pulled out her phone at one point, scrolling to show me a photo from the gala, the same one framed on her desk. “Look at that,” she said. “Everyone thinks I have it together. My board thinks I have it together. I don’t know how to tell them that I sat in the parking garage for twenty minutes this morning before I could make myself come inside.” This is a sentence I hear in some form from nearly every driven woman I work with, a version of the gap between the person other people see and the person who exists at 6am with nobody watching.

What Is Systemic Compassion?

Before we go further, I want to name the framework precisely, because it gets misunderstood in both directions. Some people hear “systemic” and think it means nothing is your fault. Other people hear “compassion” and think it means going soft on accountability. Systemic compassion is neither of those things.

I’ve come to think of this as answering two questions in sequence, not in competition. The first question is: given everything this person inherited, what would we expect to see? The second question is: now that we can see it clearly, what does this person want to do about it? Skipping the first question and going straight to the second is where a lot of self-improvement culture goes wrong. It hands people a to-do list for change without ever helping them understand why the pattern was there in the first place, which means the change doesn’t stick, because nobody addressed the actual architecture underneath it.

Think of it like a doctor treating a fever without asking what’s causing it. You can bring the temperature down for an afternoon with medication alone, but if there’s an infection underneath, the fever comes back, often worse, because the actual cause never got addressed. A lot of the advice aimed at driven women, work less, set better boundaries, learn to say no, is medication for the fever. It’s not wrong, exactly. It’s just incomplete without the diagnostic step underneath it: why did this particular woman build a life where saying no felt dangerous in the first place?

The Research Behind It: Why Context Changes the Nervous System

I recently went back and reread Judith Lewis Herman’s Trauma and Recovery, a book I first read in graduate school and have returned to probably a dozen times since. Herman, a psychiatrist who spent decades treating survivors of chronic interpersonal trauma, makes an argument in that book that still reorganizes how I think about clinical work: that the symptoms we call pathology are frequently the survivor’s best available adaptation to an impossible environment, not evidence of a broken person. She wasn’t writing specifically about executive directors or corporate attorneys. But the logic holds. A nervous system that learned to over-function under pressure because under-functioning once had real consequences is not malfunctioning when it keeps over-functioning years later. It’s doing exactly what it was trained to do.

What Neff’s work gave me, and what I didn’t fully appreciate until I’d been in practice for years, is a research-backed answer to the fear I hear constantly from clients like Ahuva: that self-compassion will make them soft, will lower the bar, will give them permission to stop trying. Her studies point the other direction. People who practice self-compassion after failure tend to take more responsibility for their mistakes, not less, and they tend to try again faster, because shame is a terrible motivator and a worse teacher. Harsh self-judgment doesn’t produce better performance. It produces exhaustion that looks like performance for a while, until it doesn’t.

I also think often of Arlie Hochschild, PhD, the sociologist at UC Berkeley whose book The Managed Heart named something I now see everywhere in my caseload of driven women: emotional labor, the unpaid and largely invisible work of managing your own feelings and other people’s feelings simultaneously, often as an unspoken condition of your job or your role in the family. Hochschild was writing about flight attendants in the 1980s. I hear the same architecture in a 2026 nonprofit executive director’s voice when she describes performing calm for her board while her actual internal state is closer to a five-alarm fire.

How Systemic Compassion Appears in Driven Women

Ahuva’s list, the one she keeps of every disappointment and shortfall, didn’t start with the nonprofit. It started, she told me during our fourth session, with her mother, who ran a small accounting firm out of their house and who measured a day’s worth by the number of client files closed. “If I got a ninety-four on a test, she wanted to know about the six points,” Ahuva said. “Not in a cruel way. She really believed this was how you built a strong person. And it worked, kind of. I built a strong person. I also built a person who cannot look at a ninety-four without seeing the six.”

Here’s where the two systems layer on top of each other, because this is rarely just one thing. Ahuva inherited a family system that equated worth with output. She then walked directly into a nonprofit sector that runs on chronic underfunding, board members who mean well but don’t understand operations, and a cultural expectation that women in leadership should be endlessly resourceful without ever appearing tired. Her family system trained the muscle. The nonprofit sector gave that muscle a lifetime of reps.

What I’ve come to call the double architecture is this layering: a personal history that primes a specific vulnerability, meeting a larger system that exploits that exact vulnerability. Ahuva’s perfectionism didn’t develop in a vacuum, and it isn’t sustained in a vacuum either. Naming both layers, the mother’s accounting-firm math and the nonprofit’s structural underfunding, doesn’t erase Ahuva’s agency. It just means we stop pretending the fix is “try to care less,” as if the caring were the problem rather than the conditions that made caring feel like the only safe strategy.

By our eighth session, Ahuva brought the list back up, unprompted. “I looked at it again this week,” she said. “And for the first time I didn’t just see the failures. I saw a kid who figured out that being useful was the safest thing to be, and then I saw an entire industry that rewards exactly that kid for burning herself down to the wick.” She didn’t throw the list away. She just started reading it differently.

Where Self-Blame Actually Comes From

Agnieszka came to me eighteen months into her job as a hospital pharmacist, 39 years old, a decade of ICU and oncology pharmacy experience behind her, sitting in my office with her badge still clipped to her scrub top from a shift that had ended two hours earlier. “I made a dosage error in January,” she said. “A small one. Caught before it reached the patient. Nobody was hurt. I have not stopped thinking about it since January.”

She described the eleven-hour shifts, the chronic understaffing, the pharmacy software that crashed twice a week, the hospital’s cost-cutting that had eliminated a second pharmacist on her shift the year before. She described all of this clearly, almost clinically, and then, in the same breath, without any apparent awareness of the contradiction, she said: “But it’s still on me. I’m the one who’s supposed to catch everything.”

I felt the particular ache I feel with clients who can narrate the entire structural picture with total accuracy and still land, every single time, on themselves as the sole point of failure. Agnieszka wasn’t unaware of the system. She could describe it better than most consultants I’ve heard. What she hadn’t yet done was let that description change how she felt about herself. It’s a specific kind of clinical puzzle: a client whose analysis is sharp and whose self-compassion is nearly absent, as if the two capacities had developed on entirely separate tracks.

Jean Baker Miller, MD, the psychiatrist whose 1976 book Toward a New Psychology of Women helped found what’s now called relational-cultural theory, wrote about a pattern she saw constantly in women: an internalized sense that any relational or systemic failure must be a personal one, because women are so often raised to hold responsibility for the emotional and functional wellbeing of every system they’re part of. Agnieszka held the hospital’s understaffing the way she’d probably have held a family crisis: as hers to fix, hers to feel guilty about, hers alone.

She told me, in a later session, about growing up the oldest of four children in a household where her mother worked nights and her father traveled for work most weeks. “Somebody had to make sure my brothers got fed and got to school,” she said. “That was me starting around age eleven. Nobody assigned it to me exactly. It just became mine.” What Miller’s framework helped me name for Agnieszka was the direct line between that eleven-year-old organizing her siblings’ mornings and the thirty-nine-year-old pharmacist who still, on some level, believes that if anything in the system fails, it must be because she personally didn’t hold it tightly enough.

Where does that wiring actually come from? Not from a single source. It comes from a family of origin that may have taught a child that her job was to keep things running smoothly. It comes from a culture that still, in 2026, expects women in caregiving-adjacent professions to absorb structural failure as personal failure. And it comes from workplaces that benefit, financially and operationally, from employees who blame themselves instead of raising their hands to say the system itself is broken. Self-blame is not a character flaw. In a lot of cases, it’s a trained response that some systems actively depend on.

What this looks like in practice, on an ordinary Tuesday, is a pharmacist double-checking every calculation three times instead of the standard two, staying forty minutes past the end of her shift to review charts nobody asked her to review, and going home so depleted she can’t hold a conversation with her husband about anything beyond what to order for dinner. The vigilance isn’t dramatic. It’s quiet, constant, and exhausting in a way that rarely appears on a performance review, because it looks like diligence rather than what it actually is: a nervous system that never fully stands down.

Both/And: Shaped by Systems, Responsible for Your Healing

This is the section where systemic compassion tends to get misread, so I want to be direct about it. You can be truly and deeply shaped by systems that were not fair to you, and you can still be the person responsible for your own healing. These are not competing claims. They’re both true at the same time, and trying to collapse them into one or the other is where people get stuck.

I watched this play out with Ahuva. Understanding the double architecture, her mother’s accounting-firm math layered onto a chronically underfunded sector, gave her something enormously important: it took the moral weight off her exhaustion. It stopped being evidence that she was fundamentally not enough and started being a comprehensible response to a comprehensible set of pressures. But understanding didn’t do her healing for her. She still had to learn to sit with a ninety-four without hunting for the six points. She still had to have a hard conversation with her board about staffing before her exhaustion turned into something worse. Nobody else could do that part. The system explained the pattern. It didn’t dissolve the work of changing it.

Agnieszka’s version of the same both/and looked like this: she could hold, at the same time, that her hospital’s staffing decisions created conditions where errors become more likely, and that she still wanted to build her own checks, her own margin, her own recovery practices, not because the error was purely hers to prevent, but because she is the one who has to live inside her own nervous system every day she goes to work. “I stopped needing it to be either the hospital’s fault or my fault,” she told me, months later. “It’s both. And ‘both’ is actually easier to work with than ‘either.'”

Both/and thinking is harder than either/or thinking, because either/or gives you a tidy villain. Either you’re the problem, or the system is the problem, and once you’ve assigned blame you can stop thinking about it. Both/and asks you to keep two true things in your hands simultaneously: you did not create the conditions that shaped you, and you are still the one who gets to decide what happens next inside them.

I want to name why this is so hard, because it isn’t a failure of willpower. The human brain is built to prefer a single, simple cause. Holding two true things at once, especially two things that seem to pull in opposite directions, takes real cognitive and emotional effort, and it takes practice. I tell clients that both/and thinking is a skill, not a personality trait, which means it can be built the same way any skill gets built: slowly, with repetition, often with a therapist or coach in the room to catch you when you slide back toward the easier, more familiar extreme.

The Systemic Lens: Naming the Water You’re Swimming In

bell hooks wrote, in Feminist Theory: From Margin to Center, about the difficulty of seeing the structures you’re embedded in, precisely because they’re the water you’re swimming in rather than an object you can hold up and examine. I think about that line constantly in session, because most of my clients were never taught to name the larger forces acting on their private lives. They were taught to look inward for explanations, which is a much smaller and much more painful place to search.

Here’s what the systemic lens actually asks you to name, out loud, specifically: the economics of your industry, the caregiving expectations placed on your gender, the racial or ethnic assumptions embedded in how your competence gets evaluated, the religious or cultural inheritance that shaped what “a good daughter” or “a good employee” is supposed to look like, the historical moment you were born into. None of these are abstractions when you get specific enough. Agnieszka’s hospital cut a pharmacist position to hit a quarterly budget target. That’s not a vague structural force. That’s a line item, made by named people, in a specific fiscal year, and it changed what was physically possible for her to catch on a twelve-hour shift.

Kimberlé Crenshaw’s foundational work on intersectionality, first laid out in her 1989 legal scholarship, gave the field language for something clinicians had been observing without naming: that systems of disadvantage don’t operate as single, separate forces, they compound. A driven woman moving through a demanding career isn’t dealing only with gender expectations, or only with family-of-origin patterns, or only with industry economics. She’s often dealing with several of these forces stacked on top of each other, each one making the others harder to see clearly, because you’re standing inside all of them at once.

Judith V. Jordan, PhD, of the Stone Center at Wellesley, has spent much of her career arguing that Western psychology overvalues independence and undervalues the relational and cultural context a person is embedded in. Naming the systemic lens is not an academic exercise. It changes what a Tuesday feels like. It’s the difference between a woman lying awake at 2am convinced there’s something uniquely wrong with her, and a woman lying awake at 2am who can say, clearly, “my industry underpays and understaffs people in my role, my culture told me I had to be endlessly capable, and my family taught me that struggling was the same thing as failing.” The second version doesn’t fix the insomnia by itself. But it gives her something to work with besides her own perceived brokenness.

What Systemic Compassion Is Not

I want to be precise here, because this is where the framework can be misused, and I’ve seen it misused. Systemic compassion is not a blanket excuse for harmful behavior. Understanding why someone developed a defensive or hurtful pattern is not the same as saying the pattern gets to continue unchecked, or that the people affected by it should simply absorb the impact. If Ahuva’s perfectionism started spilling over into unreasonable demands on her staff, understanding where that perfectionism came from would not make those demands acceptable. Context explains. It doesn’t excuse.

Systemic compassion is also not a diagnosis, and it’s not a substitute for clinical evaluation. If what you’re experiencing includes persistent depressed mood, panic, intrusive memories of a specific traumatic event, or thoughts of harming yourself, those symptoms need assessment by a licensed mental health provider, and in some cases a physician, not a blog framework. This piece describes a clinical lens I use in therapy and coaching work. It is not a stand-in for an actual evaluation of your specific situation. If you are in crisis or having thoughts of harming yourself or someone else, please contact 988, the Suicide and Crisis Lifeline, or your local emergency services. These symptoms warrant a proper clinical evaluation, not a blog framework.

And systemic compassion is not permission to stop trying, to stop showing up for your own life, or to hand your agency over to “the system” as a way of avoiding the harder, slower work of change. Gabor Maté, MD, whose book When the Body Says No explores the connection between chronic stress and physical illness, has been careful to note that naming a systemic or relational cause for suffering is the beginning of a healing process, not its endpoint. Understanding why you developed a pattern is the diagnostic step. What you do next is still, entirely, yours to build.

I’ve watched clients try to use systemic language as a way to stay stuck, and I want to name that honestly too. “My family made me this way” or “the system is rigged” can be entirely true statements and still function as a wall instead of a door, if the sentence stops there. The test I use with clients is simple: does naming the system open up a next step, or does it close the conversation down? If a client says, “my industry underpays and understaffs people like me, and here’s what I’m going to do about my own workload,” that’s systemic compassion doing its job. If the sentence ends at the first half, indefinitely, something else is happening, and it’s worth bringing that pattern into the room with a therapist rather than assuming the framework itself has failed.

How to Practice Systemic Compassion

None of this is a guarantee, and it’s not a five-step formula that resolves in a week. But here’s what I’ve watched actually help clients like Ahuva and Agnieszka move from self-blame toward something more workable.

Start by writing down the actual systems involved, specifically, not vaguely. Not “the patriarchy” in the abstract, but the specific policy, the specific family rule, the specific budget decision. Specificity is what makes the systemic lens usable instead of just comforting for an afternoon. If Ahuva had written “my organization is underfunded,” that would have stayed abstract enough to feel unchangeable. What she actually wrote was closer to: her sector receives a fraction of the philanthropic dollars that flow to larger, more established institutions, her board’s bylaws haven’t been updated to reflect the organization’s current size, and her own mother measured love in units of productivity. Each of those is specific enough to work with. None of them is an excuse.

Separate the explanation from the excuse, out loud if you need to. Say the sentence: “This makes sense given what I inherited, and I am still the person who gets to decide what I do about it.” Both halves matter. Neither half is optional.

Notice when you’re using self-blame as a stand-in for control. A lot of chronic self-blame is a way of feeling like you have power over an outcome that was actually shaped by forces well outside your control. It can feel safer to believe you personally failed than to sit with the discomfort of a system that was never built to hold you fairly.

Look for the physical signal that tells you which mode you’re in. For a lot of my clients, pure self-blame has a specific bodily quality: a tightening in the chest, a collapsing posture, a familiar internal voice that sounds a lot like a parent or an old teacher. Systemic compassion, when it’s working, tends to feel different in the body. Clients describe something closer to a widening, a small exhale, room to think instead of a spiral. Learning to notice that physical difference in real time, in the middle of an ordinary Tuesday, is often more useful than any intellectual understanding of the framework, because the body tends to know before the mind catches up.

Bring this into a real conversation with a therapist or coach who can hold both layers with you, the personal history and the structural context, without letting you collapse into either extreme. This is not work most people can do cleanly alone, because the pull toward either total self-blame or total system-blame is strong, and it takes another person in the room to keep both truths in view at once.

Ahuva didn’t throw away her list. She started adding a second column next to it: not excuses, just context. Six points lost on a test, raised by a mother who equated worth with output. A grant not won, in a funding environment where her entire sector is chronically underfunded. The list got longer, in a way. It also, finally, got kinder.

Agnieszka’s version showed up differently. Nearly a year into our work together, she told me she’d started leaving her badge in her car instead of wearing it into the house. Small, almost invisible. But she described it as the first boundary she’d ever drawn between the hospital’s understaffing and her own nervous system, a way of telling herself, physically, that the shift had ended even when the mental vigilance hadn’t fully caught up yet. “I’m not fixed,” she said. “I still check things three times. But I don’t hate myself for it the way I used to, and some days I only check twice.”

Systemic compassion doesn’t answer that question for you. It just clears away some of the noise, the misplaced shame, the borrowed guilt, so you can actually hear yourself answering it.

What I keep coming back to, after years of doing this work with driven women, is that the women who arrive in my office rarely need to be convinced they’re capable. They’ve already proven that, often many times over, to boards and colleagues and patients and clients. What they need is a way to stop treating every system’s failure as evidence of their own. That’s not a lowering of the bar. It’s a correction of a misattribution that’s been running, quietly, since long before they ever walked into a boardroom or a hospital pharmacy.

Related Reading

• Herman, Judith Lewis. Trauma and Recovery: The Aftermath of Violence, from Domestic Abuse to Political Terror. New York: Basic Books, 1992.
• Neff, Kristin. Self-Compassion: The Proven Power of Being Kind to Yourself. New York: William Morrow, 2011.
• Miller, Jean Baker. Toward a New Psychology of Women. Boston, MA, 1976.
• Maté, Gabor. When the Body Says No: Understanding the Stress-Disease Connection. Hoboken, NJ: Wiley, 2003.
• hooks, bell. Feminist Theory: From Margin to Center. Boston: South End Press, 1984.

References

1. Hochschild, Arlie Russell. The Managed Heart: Commercialization of Human Feeling. Berkeley: University of California Press, 1983.
2. Crenshaw, Kimberlé. “Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics.” University of Chicago Legal Forum 1989, no. 1 (1989): 139-167.

Warmly, Annie

Medical Disclaimer