The Collapse of Institutional Empathy

How public institutions offload the labor of care onto individuals without resources or support.

Bureaucracy demands consistency from the people it serves. Most disabling conditions do not operate on predictable timelines or offer stable patterns of recovery.

Institutional empathy is often most visible at the point where public systems are meant to protect people from circumstances beyond their control. I have a lifelong genetic condition known as hypermobile Ehlers-Danlos syndrome, which affects my connective tissue and causes widespread joint instability, chronic pain, and fatigue. I also experience severe symptoms of POTS and dysautonomia, which interfere with my autonomic functioning and can lead to sudden drops in blood pressure, fainting, and unpredictable collapse. These episodes, often referred to as drop attacks, have sent me to the emergency room more than once. The unpredictability and severity of these symptoms make it impossible for me to work a traditional 9-to-5 job or maintain the consistency that most employment demands.

Between 2015 and 2018, I spent years navigating the U.S. disability system while trying to manage these conditions. I gathered letters from doctors and filled out government forms to prove what my medical records had already made clear. I spent hours on hold with the Social Security Administration and in waiting rooms across multiple clinics, trying to maintain the documentation required to stay enrolled in the federal disability benefits program.

As part of my continued eligibility, I was required each year to re-establish that my disability still existed, even though nothing about my condition had improved or resolved. I was still living with the same disabling condition I had documented the year before, but the rules required me to start from scratch. The evaluation process used by the Social Security Administration focused less on medical need and more on procedural compliance. I was expected to submit the right forms, meet every deadline, and use language the agency would recognize. Missing even one of those steps could result in disqualification, regardless of whether my health had improved. To remain enrolled, I had to translate my medical history and symptoms into documentation the Social Security Administration could process, using codes, standardized forms, and timelines that allowed for no disruption or delay.

The yearly documentation requirement introduced a contradiction that was structurally embedded in the Social Security disability program. The agency had already determined that my condition met the federal criteria for long-term disability, yet I was still required to re-verify my symptoms on a fixed annual schedule. The program did not account for the variability that defines most chronic conditions. I was responsible for meeting strict deadlines, maintaining updated medical records, and submitting paperwork that complied with administrative procedures outlined by the Social Security Administration. The same symptoms that prevented me from working a full-time job often interfered with my ability to complete these procedural tasks. Rather than accommodating that reality, the disability system rewarded procedural consistency and penalized fluctuations in capacity, even though the people it was designed to serve often experience instability as a central feature of their conditions.

The challenges I faced navigating the Social Security disability program reflect a broader pattern in institutional design. When empathy is not embedded in the regulations and decision-making processes of federal benefit programs, efforts to access support are often treated as disruptions rather than as legitimate needs. My case illustrates how bureaucratic structures penalize the very conditions they were created to accommodate.

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Who Institutional Empathy Was Meant to Serve

Empathy was never meant to be earned. It was designed to meet people in their need, not their compliance.
(Who – The individuals and communities most affected by its absence.)

The erosion of institutional empathy is not limited to disability benefits. Historically, public systems in the United States were created to meet essential needs that could not be fulfilled through private means. In 1935, the federal government established Social Security to provide income for older adults and disabled workers who could no longer rely on wages. Three decades later, Congress created Medicare to extend health coverage to seniors, and Medicaid to provide low-income families with access to medical care. In 1975, the Individuals with Disabilities Education Act ensured that children with disabilities could attend public school with federally mandated accommodations. The Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) were introduced to support food and income security for families living below the poverty line. The Department of Veterans Affairs expanded services to meet the needs of individuals returning from military service with physical injuries or psychological trauma. Social Security Disability Insurance (SSDI) and Medicaid offered financial assistance and coverage to people whose long-term health conditions made full-time employment impossible. Each of these federal programs reflected a shared belief that care should be treated as a public responsibility. Social policy in the mid-20th century acknowledged aging, illness, poverty, and disability as recurring realities that required long-term, institutional support. The federal government did not expect individuals to resolve systemic barriers on their own. Responsibility for essential care was placed on public institutions and codified through legislation and national policy. This vision of care placed responsibility on public institutions and the policies that shaped them.

The disappearance of institutional empathy most directly harms individuals who rely on public systems to meet basic needs. People with disabilities, low-income families, older adults, and children in public education often depend on stable housing, consistent medical care, and access to schooling. In these communities, acknowledgment does not mean sympathy. It means timely service, adequate funding, and policy enforcement that treats their circumstances as valid. The impact of institutional failure does not stay confined to those already living in crisis. Over time, the absence of institutional care, including the kind delivered through policy, infrastructure, and public service, begins to shape every part of public life. When empathy is no longer present in education, health care, housing, or legal systems, the consequences ripple outward, reaching people who once assumed those services would be there when needed.

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What Institutional Empathy Is

Institutional empathy refers to a system’s ability to respond to the people it serves with context, flexibility, and respect for lived experience. Empathy at scale is not a feeling. Institutional empathy is a system’s ability to recognize need and respond with care.

Institutional empathy rarely disappears all at once. This quality is often lost gradually rather than all at once. The erosion typically begins with budget cuts, staff shortages, or policy changes that prioritize efficiency over care. These adjustments may appear temporary, but over time, they reshape how public institutions operate. Schools, hospitals, housing authorities, and government agencies begin to prioritize administrative targets instead of human outcomes. As procedures become more rigid, the systems designed to offer protection start excluding the very people they were created to support.

In health care, the erosion of institutional empathy often becomes visible in how patients are evaluated and treated. Many are expected to describe their symptoms using clinical terminology, complete detailed forms, and present their experiences in a format that aligns with billing or diagnostic frameworks. These procedural expectations can exclude individuals with chronic illnesses, psychiatric conditions, or diagnoses that fluctuate in presentation. A 2022 survey conducted by MITRE and Harris Poll found that more than half of Americans felt their symptoms were ignored, dismissed, or disbelieved during medical visits. This pattern is frequently reported by individuals with chronic conditions, psychiatric diagnoses, or illnesses that are not outwardly visible. Patients also describe being treated more like a chart than a person. Providers focus on forms, protocols, or diagnosis codes, often at the expense of listening to the person in front of them. A 2023 Harris Poll conducted in partnership with TIME found that 72% of adults said the health care system failed to meet their needs in at least one area. These numbers point to a broader pattern: empathy is increasingly displaced by administrative caution, and patient outcomes are often shaped more by risk avoidance than by care. Patients with chronic illnesses, trauma-related diagnoses, and functional neurological conditions frequently report that their symptoms are dismissed or disbelieved during clinical intake. This pattern is especially common when symptoms do not appear on standard diagnostic tests, fluctuate from day to day, or are associated with psychological distress. These patterns reflect a broader shift in which administrative efficiency is prioritized over patient-centered care. Individuals with variable or non-visible conditions, including autoimmune disorders, trauma-related symptoms, and functional neurological syndromes, are frequently miscategorized, deprioritized, or excluded from appropriate care pathways.

In the public education system, institutional empathy often breaks down in the implementation of accommodations. Students who receive special education services for disabilities, neurodevelopmental conditions, or trauma-related challenges are frequently disciplined for behavior that stems from unsupported needs. A 2021 fact sheet from the California Department of Justice reported that students with disabilities are disproportionately suspended or expelled, often for conduct directly related to their condition. Although the Individuals with Disabilities Education Act (IDEA) mandates the provision of accommodations, enforcement is inconsistent and frequently depends on whether a parent or caregiver is available to navigate the advocacy process.

At the same time, public school teachers are expected to manage overcrowded classrooms, address behavioral disruptions, and meet standardized academic benchmarks. A 2024 report by the Pew Research Center found that 84% of teachers in the United States do not have enough time during the school day to complete core responsibilities such as lesson planning, grading, and meeting individual student needs. In this environment, student behavior is evaluated through a lens of compliance rather than understanding. When students fall behind, they are often labeled as disruptive. Teachers are evaluated based on their ability to maintain order, not on their ability to identify and respond to the root causes of student difficulty.

In the criminal and civil justice systems, institutional empathy often fails to appear where it is most needed. Legal processes are structured around the evaluation of evidence, procedural timelines, and adversarial confrontation,none of which are designed to account for psychological trauma or vulnerability. Survivors of domestic violence, sexual assault, or abuse frequently report retraumatization during court proceedings. This may occur through aggressive cross-examinations, the dismissal of testimony based on perceived credibility, or extended delays that prolong contact with abusers.

Even in cases where legal institutions claim to support vulnerable populations,such as family courts, immigration hearings, or victim advocacy divisions,the policies and procedures that guide those systems often reproduce harm. Survivors may be asked to recount traumatic events repeatedly, defend their choices under scrutiny, or navigate complex legal processes without adequate representation. The result is a system that recognizes harm in principle but often fails to offer protection in practice.

One of the clearest signs that structural empathy has failed is the way systems begin to treat time. People are asked to wait for care, answers, or support,sometimes for months, sometimes for years. But if they arrive late, miss a step, or misunderstand a form, the system punishes them without exception. There is no grace. There is no pause for understanding. The institution remains rigid, even when the person in front of it is falling apart.

These moments may seem like isolated inefficiencies, but they point to something larger. A system that cannot respond to the emotional and human realities of the people it serves is no longer functioning with empathy. It may still be active, but it has stopped being humane.

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Where Institutions Lost Their Empathy

The spaces we were taught to trust have become places where pain is processed, not seen.
(Where – The spaces that once promised protection now deliver harm.)

We were taught to believe that institutions would help carry the weight of being human. A school might notice a child's potential before the world convinced them otherwise. A hospital could offer healing when the body faltered. Government, even with its flaws, still had the responsibility to intervene. In spaces built around faith, people gathered in sorrow with the hope that it would be seen and held.

These beliefs were not naive. They formed the foundation of civic life. Over time, that foundation began to crack. Many of these institutions still operate, but their ability to care has diminished.

In schools, children arrive carrying pain they do not always know how to name. Their distress is often read as defiance. The system documents behavior but does not ask what that behavior might be trying to communicate. Teachers are overextended, and counselors are stretched thin. The structure does not allow them to give the care they still want to provide.

In hospitals, care is often shaped by what insurance allows rather than what a patient needs. People without coverage are left to choose between treatment and financial ruin. Those with coverage still find themselves battling for approval. Relief becomes a privilege, not a guarantee. The body is no longer a site of healing. It becomes a site of negotiation.

During the COVID-19 pandemic, millions turned to the government for guidance. What they encountered was delay. Relief was slow to arrive or never came. Rent was still due. Parents skipped meals so their children could eat. The distance between public messaging and lived experience widened until trust fell through it.

Even in religious spaces, empathy began to disappear. In the Southern Baptist Convention, survivors of clergy abuse were disbelieved, silenced, or ignored. Internal records revealed decades of concealment. Church leaders documented abuse but protected the institution instead of the people harmed by it.

The justice system offered little shelter. Kalief Browder was sixteen when he was accused of stealing a backpack. He spent three years in Rikers Island,most of it in solitary confinement,without ever being convicted. After his release, he died by suicide. His story is not an outlier. It is a record of how justice disappears when human dignity is no longer part of the equation.

In 2014, the Department of Veterans Affairs was investigated after reports emerged that dozens of veterans had died while waiting for medical care. A federal audit confirmed that staff at multiple VA hospitals had maintained unofficial waitlists to hide the length of time patients waited for appointments. These shadow records allowed the agency to report shorter wait times and meet internal performance metrics, even as patients went untreated. The Department of Veterans Affairs did not lose track of these individuals through oversight. These omissions were deliberate acts of concealment within a system more focused on appearance than accountability. The veterans affected had already qualified for care, but the structure they depended on failed to deliver it in time.

Some never lived long enough to escape the system. Gabriel Fernandez was eight years old when he died as a result of severe abuse inflicted by his guardians. In the months leading up to his death, his teacher submitted repeated reports of concern to social workers. The Los Angeles County Department of Children and Family Services received multiple referrals, and law enforcement had been contacted at least once. Each agency involved had access to evidence of Gabriel’s ongoing mistreatment, including visible injuries and consistent testimony from adults in his life. Despite these warnings, no effective intervention took place. By the time the Department of Children and Family Services took formal action, it was to document Gabriel’s death. The agencies tasked with protecting his safety had the information they needed to act, but failed to respond in time.

The institutional breakdowns described in these cases are not isolated incidents. Each example, whether in education, health care, child welfare, or veteran services, reflects a moment when public systems were expected to respond with care but failed to act. When agYes.encies prioritize reputation, liability, or internal metrics over the needs of the people they serve, they lose their capacity to protect. These systems may continue to operate on paper, but they no longer fulfill their original purpose.

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How Institutional Failure Follows Us Home

Systemic neglect is never just systemic. It becomes personal.
(How – The absence of empathy in systems reshapes the way people live, trust, and cope.)

When institutions fail to deliver care, the consequences extend beyond the moment of denial. People begin to internalize what those systems teach them—often unintentionally. A student who was repeatedly punished for requesting support may avoid asking for help later in life. A patient whose symptoms were dismissed during medical appointments may hesitate to report new ones. A tenant who was evicted after raising concerns about housing conditions may stop trusting public assistance altogether. These responses are not irrational. They are the result of repeated exposure to systems that penalize vulnerability.

In this context, self-protection often replaces help-seeking. Survivors of trauma, patients with chronic illness, and individuals living in poverty may begin to withdraw from programs designed to serve them. The more often care is delayed, denied, or undermined, the more difficult it becomes to believe that the system will respond at all. Institutional silence produces behavioral adaptations: silence, over-compliance, avoidance, or strategic masking.

Over time, the responsibility for care shifts to individuals who are already overwhelmed. Friends are expected to provide trauma support. Partners are asked to manage mental health crises. Coworkers and strangers are expected to respond to grief or volatility with clinical precision. As systems retreat from responsibility, the pressure to respond falls on those with no formal training, no structural support, and often, no capacity to carry the emotional load.

When this redistribution becomes the norm, relationships begin to fracture. People are not failing each other—they are reaching the limit of what can be held privately. Institutional failure does not just erode trust in government or policy. It erodes the foundation of collective care.

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The Weight We Weren’t Meant to Carry

Empathy cannot remain sustainable when it is offloaded onto individuals without institutional support.

Public institutions were designed to carry the responsibilities that are beyond the capacity of individual households, families, or personal networks to manage sustainably. When those institutions no longer provide consistent access to health care, housing, education, or legal protection, the responsibility for care is redistributed without structure. In the absence of professional infrastructure, family members, teachers, and friends are expected to provide support, stability, and crisis intervention. The demands placed on these individuals are not accompanied by training, compensation, or institutional backing.

This redistribution of responsibility does not expand the availability or quality of care within the community. It only shifts the burden onto individuals who are already at their limit. A partner may become the sole emotional support for someone experiencing mental health instability. A teacher may be expected to manage the behavioral symptoms of untreated trauma without access to school-based mental health staff. A friend may be asked to absorb grief or crisis that would otherwise fall under the care of trained professionals. The individuals taking on these roles are not failing. They are navigating responsibilities that exceed what any person should be expected to manage without support.

This shift in responsibility has long-term consequences for both individuals and communities. As care becomes informal and unsupported, relationships begin to absorb responsibilities that exceed what personal relationships can consistently manage. Friends may begin to distance themselves when they are expected to provide emotional support without guidance or resources. Family members often struggle to meet caregiving demands that would typically fall under the responsibility of trained professionals. Emotional strain builds in private until it begins to fracture connection. These outcomes are not the result of neglect. They are the result of asking individuals to carry what public systems once shared.

Empathy cannot be sustained without infrastructure. Empathy requires support from systems that distribute responsibility across public institutions rather than assigning it to individuals. When public systems step back from their role in providing care, the responsibility does not disappear. The labor involved in supporting those in crisis is often absorbed by individuals who lack training, resources, or institutional support. A society that relies on personal relationships to absorb structural failure will eventually exhaust the very people it depends on. When care is privatized without support, empathy, when left unsupported, becomes fragile, uneven, and unsustainable.

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Postscript: A Note on Substance Use

Since writing this essay, new data from the CDC shows that drug overdose deaths in the United States fell by 27 percent in 2024—the most significant decline in five years. Public health experts credit this progress to expanded access to naloxone, wider treatment availability, and the continued shift toward harm-reduction strategies. These improvements did not happen by accident. They reflect a growing willingness among some institutions to meet suffering with compassion instead of punishment. It is a reminder that when empathy is rebuilt systemically, healing is not just possible—it becomes measurable.