“No, it’s just not in your head!” Gaslighting in Healthcare

Written by Dr. Shreyjit Kaur

Gaslighting is a form of psychological abuse where a person in power or greater authority uses manipulation to make another person doubt his or her own experiences, memory, perceptions, judgment, or in worst cases even sanity. Victims of gaslighting may develop anxiety, depression, or emotional instability, further discrediting them.

The origins of the term “gaslighting” can be traced back to the 1944 movie ‘Gaslight’ starring Ingrid Bergmann. It tells the story of a man who forces his new wife to doubt her sanity through a series of manipulative schemes. Among these cruel yet subtle torments, he gradually dims their home’s gas-fueled lights while vehemently denying doing so, causing his wife to doubt her perception of reality and sanity.

Medical gaslighting is a term used to describe physicians or medical practitioners who falsely deny or dismiss a patient’s medical condition altogether; such as incorrectly advising patients that they are not truly ill, or blaming a patient’s physical illness or symptoms on psychological causes.

Some phrases acting as a red flag to medical gaslighting are:

  • Minimizing debilitating symptoms – “Your pain can’t be that bad.”
  • Blaming symptoms on a mental illness – “It’s all in your head!” or “You’re just tense!”
  • Assuming a diagnosis based on sex, race, identity, age, gender, ethnicity, or weight – “All you need to do is lose some weight.” Or “You’ve got to expect this as you age.” Or “This is happening due to hormones!”
  • Refusing to order important tests– “I know you don’t have “XYZ”, I do not need an MRI to tell me this. I know how to do my job.”
  • Refusing to discuss health issues with the patient or berating the patient for trying to ask questions – “Who is the doctor here, you, me, or Google?”

Medical gaslighting is more commonly experienced by certain vulnerable sections of society such as women, people of color, elderly people, people of the LGBTQ+ community, or individuals with ‘stigmatized’ medical conditions such as obesity, mental illness, and illnesses that do not yet have clear diagnostic tests, e.g. myalgic encephalomyelitis/chronic fatigue syndrome, fibromyalgia, chronic pain, endometriosis, irritable bowel syndrome, etc.

Medical gaslighting is primarily driven by a toxic power differential between the patient and the physician escalated by a condescending and chauvinistic attitude. Also much of the research which forms the basis of diagnostic and treatment protocols historically involved white males, under-representing other populations. Thus, most of the time, it is assumed that what is known about white males will simply translate into other groups, which may not always be true. For example, angina has mostly been illustrated depicting an elderly gray-haired white man clutching his chest, reinforcing that heart disease is a white male problem or even Parkinson disease for that matter has been described as a disease of a white, elderly man. So, a woman’s similar symptoms may be wrongly ascribed to stress or depression. Another reason is that physicians are trained to look for the most common rather than the most “exotic” diagnosis for a patient’s condition. But sometimes that approach might unintentionally lead to downplaying a patient’s symptoms.

Although the term “medical gaslighting” has been recently coined the issue has disproportionately affected women for centuries. The misogynist stereotype and prejudice of labeling women irrational and “hysterical” if they complained of an illness that wasn’t immediately visible shows the deep entrenchment of this issue. Even Hippocrates believed that the womb traveled throughout the body of a woman causing “hysteria” (Greek for uterus), a psychological diagnosis that was removed years later from DSM-3 onwards. But such stereotypes are still pervasive in today’s times; a simple example includes casually asking an angry, anxious, or depressed woman if she is on her period or experiencing PMS!

The issue of gaslighting is common even in the medical community, stemming from the deep-rooted factors of egoism, narcissism hierarchy, and power. The most striking and easily identifiable target for gaslighting could be a younger woman of color working as a non-specialized healthcare professional. The same inequalities that make her a target also render her powerless to report this issue, perpetuating a vicious cycle of unjust scrutiny, criticism, and invalidation. Another example could be a preceptor or consultant constantly gaslighting medical students and residents by insulting or belittling their medical knowledge leading to detrimental effects on their self-esteem and mental health, or a specialist colleague gaslighting general practitioners by aggressively questioning their medical abilities. Such behavior is questionable and unacceptable as residents and general practitioners rely on their seniors and colleagues for support and not to be treated with manipulative tactics to act as subordinates.

Medicine and management plans should be a careful and respectful exchange of dialogue between the physician and the patient. Women and patients of color might consider bringing a friend or relative with them to their medical appointments as an advocate and support. As a patient, if you’ve exhausted all your options or do not want to deal with a gaslighting physician, ask for a second opinion or referral. A healthcare professional should seek to empower marginalized patients to speak up for their health and wellness as well as understand their perspective instead of snubbing or dismissing them. The need of the hour is a gender-sensitized and culturally-competent approach to disease management.

References:

  1. Fraser S. The toxic power dynamics of gaslighting in medicine. Can Fam Physician. 2021 May;67(5):367-368. doi: 10.46747/cfp.6705367. PMID: 33980633; PMCID: PMC8115954.
  2. https://www.webmd.com/mental-health/news/20230120/medical-gaslighting-what-to-know 
  3. https://ajourneythroughthefog.co.uk/2019/11/have-you-been-a-victim-of-medical-gaslighting/ 
  4. https://www.northwell.edu/katz-institute-for-womens-health/articles/gaslighting-in-womens-health 
  5. https://www.nytimes.com/2022/03/28/well/live/gaslighting-doctors-patients-health.html 

Images credits:

  1. https://www.newsbytesapp.com/news/india/understanding-gaslighting-the-movie-the-abuse-the-signs/story 
  2. Photo credit: Marta Monteiro

Available from: https://www.nytimes.com/2022/03/28/well/live/gaslighting-doctors-patients-health.html

  1. https://www.wnycstudios.org/podcasts/takeaway/segments/medical-gaslighting-women-and-people-color 

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