Onion cells - via Wikipedia
In autoimmune disease the body fights off its own healthy cells. The same is true of a toxic organizational culture. During a flareup, healthy activities of any kind - such as offering thoughtful feedback - may be treated as a threat by the system.
In autoimmune disease there are many healthy periods and the illness is not centered in one particular organ. You don't know when the next flare up will come, or what body part will be affected.
The same is true of the toxic culture. There are many happy and healthy times, and many parts and people that work extremely well under the circumstances. Many may even believe that "nothing is wrong" -- that is, until the next seemingly inexplicable "attack."
With autoimmune, attacks are often brought on by stress. The same is true of a toxic culture. Things are fine until something goes wrong, and the dis-ease beneath the surface comes rumbling forward. The response is therefore out of proportion and people are jarred out of their sense of security.
In autoimmune, problems look generic until you find out there is way more under the surface. You think "a headache is just a headache" and superficially blame an ordinary known trigger.
Similarly in a toxic culture, you may draw simple associations between employee complaints and their cause.
Lack of recognition, confusing processes, bad bosses are all ordinary triggers for employee dissatisfaction and common complaints. But when the problem is systemic, all of these triggers are not the real point and addressing them individually won't solve the problem.
Worse yet, if you don't know the problem is systemic you may attack triggers that are actually healthy. For example a boss who implements corrective measures will necessarily trigger huge complaints and the unhealthy parts of the system will try to eject them. Yet those complaints are a sign that something positive is happening. Understood correctly, the negative feedback is actually a plus.
It follows that just like with autoimmune, in a toxic culture the numbers don't tell the story alone; what you see is not what you get, and the seeming problem is really a manifestation of something else. You need anecdotal feedback to get a sense of context around activity.
Finally with autoimmune, the condition never really resolved, and you need a team of specialists to maximize quality of life and length of lifespan. Similarly in a toxic culture, you have to accept that longstanding problems and pain points will never really heal.
The goal in addressing a toxic culture is not perfection. It is to make explicit among the workforce at all levels that things have gone wrong at the systemic level and so we shouldn't be fooled when symptoms flare up.
Ideally the message is, we have to work together to reduce our collective stress and live well and healthily in a working, productive community. This will sometimes mean change actions that feel bad. Ultimately though the closer we get to objective measures of cultural health, the more easily flareups should resolve.
And we can stop living by quantitative measures of satisfaction alone, turning instead to focus groups, interviews, ethnographies, and other sources of qualitative data.
* All opinions my own.