Medical gaslighting

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Medical gaslighting is term used to describe doctors or medical practitioners who blame a patient's illness or symptoms on psychological factors, or deny a patient's illness entirely, for example wrongly telling patients that they are not sick.[1][2][3][4]

Gaslight

Gaslighting is a form of emotional abuse which involves persistently denying or refusing to accept facts, and frequently leads to the other person doubting their own experiences.[5]

Effects[edit | edit source]

Psychological effects of gaslighting

People experiencing gaslighting often begin to question their own reality or may feel "crazy", particularly if the person gaslighting them has greater authority or personal power.[6] Gaslighting almost always involves multiple incidents and is particularly effective if several different people gaslight the same person.[7] Victims of gaslighting may become anxious, develop depression or mental illness, or become increasingly emotional as a result, which makes them more likely to be seen having unreliable or questionable judgement, both by others and themselves, discrediting them further. Gaslighting may result in a loss of trust, and isolation.[6]

Gaslighting by medics is more commonly experienced by certain patient groups, particularly women, and in illnesses which do not yet have a clear diagnostic tests, for example ME/CFS, chronic pain, and endometriosis. This form of gaslighting may be done either consciously or unconsciously.[7]

ME/CFS[edit | edit source]

ME/CFS patients who have experienced a dismissive attitude from a health care professional.
Source: Health Care Women Int. 2019 Mar; 40(3): 241–258.[8]

People with ME/CFS typically experience healthcare professionals who dismiss or ignore their health problems,[9] or attribute their ME/CFS symptoms as coming from a psychological rather than physical cause, leading to inappropriate treatments, such as focusing patients'"beliefs about the illness" rather than medical treatment of the symptoms.[10][8][11][12] Some doctors have also made claims that patients are not really sick, or have tried to discredit them by suggesting they are exaggerating the extent of their illness.[13]

Blaming patients and carers[edit | edit source]

Some health professionals, including doctors, have stated that they believe ME/CFS is a behavioral disorder, and in one unsuccessful clinical trial of psychological therapy for severely ill patients, some nurses blamed patients when the treatment involving behavioral change failed, claiming they were "bastards" who just "don't want to get better".[14][12] Some nurses had become totally convinced that the psychological and behavioral treatment would work, and that patients were well enough to be able to follow it, that they appeared to lose sight of the fact they were part of a clinical trial to determine if the treatments worked.

Some carers of severely ill ME/CFS patients have been blamed for "encouraging" patients to remain sick by providing essential care, and told to stop essential care.[15] Some parents of severely ill children with ME/CFS found themselves accused of medical neglect or Munchausen’s Syndrome by Proxy when they declined potentially harmful medical treatment, or the children were labelled as having school phobia rather than a genuine illness when doctors or social workers denied the reality of their illness.[16]

Forced treatment[edit | edit source]

The belief of some health professionals that ME/CFS is entirely or partly psychological/behavioral in nature has led to some patients, including children, being forcibly admitted to locked psychiatric units in order to force them to participate in treatment that had had previously declined. Concerns over forced treatment of severely ill ME patients has led to some charities to produce advise for patients and carers about how to avoid unnecessary and harmful forced psychiatric admission.[17] Patients known to have been subjected to inappropriate forced treatments in psychiatric units include Sophia Mirza, who died of M.E. just a few months after being released,[15][18] and Karina Hansen, who was later found to have been illegally detained.[19] ME/CFS is not classified as a psychological disorder, so patients typically have this diagnosis removed and are misdiagnosed with a psychiatric diagnosis that includes physical symptoms instead, e.g., bodily distress disorder, functional somatic syndrome, somitization or conversion disorder, or in the case of children, the unrecognised diagnosis of pervasive refusal syndrome.[17] The mental illness diagnosis can be used to claim patients are unable to make their own healthcare decisions or are not able to make decisions in their own best interests, which allows doctors to determine their treatment for them. Forced treatments may include exercise, cognitive behavioral therapy (if patients can still speak), or behavioral approaches like removing disability aids and leaving food out of reach to "motivate" patients to over-exert in order to eat.[17]

Call for apologies to patients[edit | edit source]

In 2015, several doctors publicly called for the medical community to apologize to ME/CFS patients for their decades of poor treatment, including José Montoya, who was then a specialist doctor and researcher at Stanford University, and Charles Shepherd, medical director of the ME Association, who is also a doctor with ME.

Dr Sarah Myhill has a long-standing petition calling on the UK government to carry out an inquiry into the medical abuse of M.E. patients.[20]


A number of researchers who promote the biopsychosocial model of ME/CFS have been described as gaslighting ME/CFS patients and intimidating ME/CFS advocates,[12][21][13][22] and research has shown that health professionals routinely suggest or provide inappropriate and harmful treatments,[10][8] wrongly suggest that a patient's ME/CFS symptoms result only from psychological factors or from a mental health condition such as depression, anxiety, or somatization, or treat patients as if their symptoms are in some way "all in their head"—regardless of the symptoms or history that the patient has.[8][23][24][25]

Chronic illnesses[edit | edit source]

Medical gaslighting behavior by health professionals is experienced by patients with certain chronic illnesses, particularly those that also disproportionately affect women, such as endometriosis,[3]chronic pain,[23]fibromyalgia, irritable bowel syndrome, and medically unexplained symptoms (sometimes called persistent physical symptoms).[21] People with long COVID are also reporting gaslighting by medics.[26][27]

Notable studies and publications[edit | edit source]

  • 2008, Obstructions for quality care experienced by patients with chronic fatigue syndrome (CFS)—A case study[28](Abstract)
  • 2017, Epistemic injustice in healthcare encounters: evidence from chronic fatigue syndrome[30](Full text)
  • 2019, Legitimizing myalgic encephalomyelitis/chronic fatigue syndrome: indications of change over a decade[31] - (Abstract)
  • 2019, Dismissing chronic illness: A qualitative analysis of negative health care experiences[8] - (Full text)

News and articles[edit | edit source]

Articles and blogs[edit | edit source]

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. Mitchell, Natasha (Oct 22, 2020). "Doctors warn of lasting effects of COVID-19 after struggling to recover from virus". www.abc.net.au. Retrieved Oct 24, 2020. 
  2. Nelson, Hilde Lindemann (2001). "Narrative Repair: Reclaiming Moral Agency". Damaged Identities, Narrative Repair. Cornell University Press. pp. 29–30. ISBN 978-0-8014-8740-8. 
  3. 3.03.1 Weiss, Suzannah (Mar 6, 2018). "How Doctors Gaslight Women into Doubting Their Own Pain". www.vice.com. Retrieved Oct 24, 2020. 
  4. VanElzakker, Michael [@MBVanElzakker] (Aug 16, 2016). "What #PACEtrial called "CBT" is not normal CBT" (Tweet). Retrieved Oct 31, 2020 – via Twitter. 
  5. "gaslight, v". Oxford English Dictionary. Retrieved Oct 24, 2020. 
  6. 6.06.1 McKinnon, Rachel; Kidd, Ian James; Medina, José; Pohlhaus, Gaile (2017). "Gaslighting as epistemic injustice". The Routledge Handbook of Epistemic Injustice. Taylor & Francis. pp. 167–174. ISBN 978-1-351-81450-8. 
  7. 7.07.1 Pickles, Camilla; Herring, Jonathan (2019). Childbirth, Vulnerability and Law: Exploring Issues of Violence and Control. Routledge. ISBN 978-0-429-81290-3. 
  8. 8.08.18.28.38.4 McManimen, Stephanie; McClellan, Damani; Stoothoff, Jamie; Gleason, Kristen; Jason, Leonard A. (Mar 4, 2019). "Dismissing chronic illness: A qualitative analysis of negative health care experiences". Health Care for Women International. 40 (3): 241–258. doi:10.1080/07399332.2018.1521811. ISSN 0739-9332. 
  9. Lapp, Charles W. (2019). "Initiating Care of a Patient With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)". Frontiers in Pediatrics. 6. doi:10.3389/fped.2018.00415. ISSN 2296-2360. 
  10. 10.010.110.2 Blease, Charlotte; Geraghty, Keith (Sep 15, 2016). "Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent" (Journal of Health Psychology). doi:10.1177/1359105316667798. 
  11. Agardy, Susanna (Aug 2017). "Chronic fatigue syndrome patients have no reason to accept the PACE trial results: Response to Keith J Petrie and John Weinman". Journal of Health Psychology. 22 (9): 1206–1208. doi:10.1177/1359105317715476. ISSN 1359-1053. 
  12. 12.012.112.2 Williams, Margaret (Mar 2017). "The Power of Propaganda?" (PDF). Retrieved Oct 31, 2020. 
  13. 13.013.1 Tuller, David (Nov 8, 2018). "Trial By Error: An Australian Exchange with Professor Sharpe". Virology blog. Retrieved Oct 31, 2020. 
  14. "Evidence submitted by Professor Malcolm Hooper (NICE 07)". publications.parliament.uk. March 2007. Retrieved Oct 31, 2020. 
  15. 15.015.1 "The Story of Sophia and M.E." www.investinme.org. Retrieved Aug 10, 2018. 
  16. Colby, J (Feb 2007). "Special problems of children with myalgic encephalomyelitis/chronic fatigue syndrome and the enteroviral link". Journal of Clinical Pathology. 60 (2): 125–128. doi:10.1136/jcp.2006.042606. ISSN 0021-9746. PMC 1860612Freely accessible. PMID 16935964. 
  17. 17.017.117.2 The Grace Charity for M.E.; 25% ME Group (Jan 2019). "KNOWLEDGE IN THE HOPE OF PROTECTING M.E. SUFFERERS FROM UNNECESSARY SECTIONING". Retrieved Jul 12, 2019. 
  18. "Neuropathological Report". www.sophiaandme.org.uk. Retrieved Aug 10, 2018. 
  19. https://www.dailykos.com/story/2016/10/26/1587112/-Karina-Hansen-is-Finally-Home-sort-of
  20. Myhill, Sarah. "Medical Abuse In ME Sufferers (MAIMES)". www.drmyhill.co.uk. Retrieved Oct 31, 2020. 
  21. 21.021.1 Tuller, David. "Trial By Error: Some Thoughts on Long-Covid, ME/CFS and MUS". Virology blog. Retrieved Oct 24, 2020. 
  22. Hughes, Brian (Mar 21, 2019). "If you spend 20 years gaslighting your patients, perhaps you should think twice before accusing *them* of trolling *you*". The Science Bit. Retrieved Oct 24, 2020. 
  23. 23.023.1 Benjamin J., Newton; Southall, Jane L.; Raphael, Jon H.; Ashford, Robert L.; LeMarchand, Karen (2013). "A Narrative Review of the Impact of Disbelief in Chronic Pain". Pain Manag Nurs. pp. 161–171. 
  24. 24.024.1 Hooper, Malcolm (2003). "THE MENTAL HEALTH MOVEMENT: PERSECUTION OF PATIENTS? A consideration of the role of Professor Simon Wessely and other members of the "Wessely School" in the perception of Myalgic Encephalomyelitis (ME) in the UK.
    Background Briefing for the House of Commons Select Health Committee"
    (PDF). Retrieved Oct 15, 2018.
     
  25. 25.025.1 Dimmock, Mary; Lazell-Fairman, Matthew (Dec 2015). "THIRTY YEARS OF DISDAIN: How HHS and a group of psychiatrists Buried Myalgic Encephalomyelitis" (PDF). Retrieved Nov 5, 2018. 
  26. Mitchell, Natasha (Oct 22, 2020). "Doctors warn of lasting effects of COVID-19 after struggling to recover from virus". ABC News | Health & Wellbeing. Retrieved Oct 24, 2020. 
  27. Prior, Ryan (Oct 12, 2020). "Kids struggle with Covid-19 and its months of aftermath". CNN. Retrieved Oct 24, 2020. 
  28. Gilje, Ann Marit; Söderlund, Atle; Malterud, Kirsti (Oct 2008). "Obstructions for quality care experienced by patients with chronic fatigue syndrome (CFS)—A case study". Patient Education and Counseling. 73 (1): 36–41. doi:10.1016/j.pec.2008.04.001. 
  29. Geraghty, Keith; Esmail, Aneez (Aug 1, 2016). "Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm?". British Journal of General Practice. 66 (649): 437-438. doi:10.3399/bjgp16X686473. 
  30. Blease, Charlotte; Carel, Havi; Geraghty, Keith (Aug 1, 2017). "Epistemic injustice in healthcare encounters: evidence from chronic fatigue syndrome". Journal of Medical Ethics. 43 (8): 549–557. doi:10.1136/medethics-2016-103691. ISSN 0306-6800. PMID 27920164. 
  31. Friedberg, Fred (Jan 2, 2020). "Legitimizing myalgic encephalomyelitis/chronic fatigue syndrome: indications of change over a decade". Fatigue: Biomedicine, Health & Behavior. 8 (1): 24–31. doi:10.1080/21641846.2020.1718292. ISSN 2164-1846. 
  32. Shepherd, Charles (Dec 7, 2015). "It's time for doctors to apologise to their ME patients"Paid subscription required. The Telegraph. Retrieved Oct 31, 2020. Lay summary. 

ME/CFS - An acronym that combines myalgic encephalomyelitis with chronic fatigue syndrome. Sometimes they are combined because people have trouble distinguishing one from the other. Sometimes they are combined because people see them as synonyms of each other.

myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

somatic symptom disorder - A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience. Although "Somatic Symptom Disorder" is the term used by DSM-5, the term "Bodily Distress Disorder" has been proposed for ICD-11. (Learn more: www.psychologytoday.com)

medically unexplained physical symptoms (MUPS) - Technically, this term means that no cause or explanation for the patient's symptoms has yet been found. However, patients diagnosed with "MUPS" are generally lumped into a psychosomatic, or psychologically-caused category by those in the medical profession, without any scientific basis for doing so.

chronic fatigue syndrome (CFS) - A fatigue-based illness. The term CFS was invented invented by the U.S. Centers for Disease Control as an replacement for myalgic encephalomyelitis (ME). Some view CFS as a neurological disease, others use the term for any unexplained long-term fatigue. Sometimes used as a the term as a synonym of myalgic encephalomyelitis, despite the different diagnostic criteria.

chronic fatigue syndrome (CFS) - A fatigue-based illness. The term CFS was invented invented by the U.S. Centers for Disease Control as an replacement for myalgic encephalomyelitis (ME). Some view CFS as a neurological disease, others use the term for any unexplained long-term fatigue. Sometimes used as a the term as a synonym of myalgic encephalomyelitis, despite the different diagnostic criteria.

myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

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From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history.