The short version: Structural violence is harm done by the way systems are arranged rather than by any one person: housing you can’t afford, care you can’t reach, work that doesn’t cover your life. Distress produced by those conditions is a normal response, not a disorder. Naming it accurately reduces shame and changes what therapy is for. It does not replace the need for the conditions to change.
If you have anxiety and you live one missed paycheck from losing your housing, you have been told the anxiety is the problem. I want to put that the other way around.
Your reactions are not a sign that something is wrong with you. They are what a person does under conditions that would produce them in nearly anyone. That is not a comforting reframe. It is the more accurate description, and accuracy turns out to matter for what happens next.
What structural violence means
Structural violence is harm that comes from how social and economic systems are arranged, rather than from anyone’s intent. It’s called violence because people are injured by it. It’s called structural because it’s built into how things are organized rather than done by a person you could point at. The term comes from the physician and anthropologist Paul Farmer, who used it to describe suffering produced by arrangements rather than by attackers.
If someone hits you, that’s direct violence. If the system makes it so you can’t afford healthcare or housing while working full-time, that’s structural violence. Both cause real harm. Only one has someone to be angry at, which is part of why the second is so disorienting.
What it looks like day to day:
- Housing costs that take most of your paycheck
- Care that is technically available and practically out of reach
- Work that doesn’t pay enough to live on
- Debt that follows you for decades
- Workplaces that ask for more each year and give less
How conditions become symptoms
Housing
When most of your income goes to rent, or you’re one paycheck from losing your home, your body stays alert. That alertness isn’t a disorder. It’s a threat-detection system doing what it’s for, in the presence of a real threat.
A study of people in Barcelona who had sought help for housing insecurity found poor mental health in around 85 to 89 percent of them, against roughly 15 to 20 percent in the city’s general population, and worse again where food or energy insecurity sat on top of it. That is a group already in crisis rather than a cross-section of renters, so treat it as a picture of what stacked insecurity does, not as a general rate. It is also cross-sectional, which means it shows the two travelling together and cannot prove one produces the other.
What I can say from the room is narrower and more useful: your 3am thoughts about rent are not distorted thinking. They are an accurate read on an insecure situation.
Care you can’t reach
When you’re unwell and can’t afford treatment, hopelessness is a reasonable conclusion, not a cognitive error. When insurance denies the care you need, or you choose between a prescription and groceries, feeling defeated is proportionate.
I saw this with clients who lost Medicaid coverage in late 2025. Their depression deepening wasn’t therapy failing. It was a normal response to losing essential support with little warning.
Money
Living paycheck to paycheck keeps a body braced. When survival feels uncertain, thinking clearly, managing feelings and planning ahead all get harder. That isn’t a personal failing. It’s what happens to attention and judgment when basic needs aren’t secure.
Why “just change your thinking” isn’t enough
A lot of therapy focuses on changing thoughts and behaviors. Those skills are real and I use them. But applied on their own to a situation that is actually harmful, they ask you to adapt to something that should change.
It’s like being taught to breathe deeply while the building burns. The breathing helps. It is not the response the situation calls for.
What helps more is what some call critical consciousness. In practice that means:
- Seeing how your conditions affect your mental health
- Understanding that your struggles often make sense given your situation
- Moving from “what’s wrong with me” toward “what’s happening to me”
- Recognizing the patterns you share with other people in the same position
That last one does more work than it looks like. Isolation is most of what makes structural harm feel like personal defect.
What you can do while the conditions don’t change
I want to be careful here, because this is where writing like this usually goes wrong and hands you a self-improvement list for a problem that isn’t about you.
Practice structural self-compassion. When you ask “what’s wrong with me,” also ask “what’s wrong with this situation.” Both questions have answers. Only one of them is about you.
Find people who get it. Mutual aid groups, community organizations, political parties that take these problems seriously. Connection does something that insight alone doesn’t.
Prepare before you need to. Knowing where to go for housing help, care, or food before a crisis reduces how much of the crisis is panic.
Get involved at whatever pace is yours. Organizing can be steadying. It is also not required of you, and it is not a measure of whether you’re coping well.
What this looks like in therapy
In my practice we look at how your own history meets the conditions you’re living in. We don’t skip the personal material: trauma history, relationships, patterns that are genuinely yours. We also don’t pretend therapy happens in a sealed room. The same lens runs through the rest of my work, including psychedelic harm reduction and integration and ketamine-assisted psychotherapy.
Many clients find it useful to understand their anxiety in the context of housing insecurity, or to see depression as connected to care they can’t reach rather than to something defective in them. That usually reduces shame, and reduced shame tends to free up room to act.
You might find this kind of therapy useful if you feel like you’re failing despite doing everything right, if you carry shame about money or housing, or if you want to understand how your conditions and your mental health are connected.
It’s worth saying that the reverse holds too, and it has been studied. Ontario ran a basic income pilot and cancelled it partway through. Researchers afterward interviewed 46 of the recipients about their lives before, during and after it: housing stability, social inclusion, a sense of security and their mental health had all improved on the payments, and those gains were threatened or reversed when the payments stopped. The authors argue the cancellation itself can be seen as an act of structural violence. Conditions change people’s mental health in both directions, which is the whole point.
I should say plainly what therapy can’t do. It cannot raise your wages or lower your rent. I recognize that my providing therapy exists within capitalism and is therefore exclusive and limited. Individual work and collective action are different tools, and the second one is not something I can offer you in an office.
Moving forward
Your struggles make sense. Your reactions are proportionate. The systems producing them are what need to change, not you.
Therapy offers real tools and real support, and it isn’t the only route. Lasting mental health also takes security, community, and systems that actually serve people. Both kinds of work matter, and each makes the other more possible.
You’re not broken. You’re a person living in a world that often fails to support people. Seeing that clearly is where something better starts.
If you’d like to talk about whether this way of working fits your situation, get in touch and we can start with a 15-minute call.
Peter H. Addy, PhD, LPC, LMHC is a Portland-based licensed psychotherapist specializing in psychedelic-informed and harm-reduction psychotherapy, ketamine-assisted psychotherapy, and chronic pain. His research background includes postdoctoral work at Yale School of Medicine on psychedelic substances. Learn more about my practice →
