Medical gaslighting

Medical gaslighting is term used to describe doctors or medical practitioners who wrongly 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. Gaslighting refers to a type of manipulation where the intent is to lead someone to question their own experiences, memory, or perceptions. Gaslighting is viewed as a form of emotional abuse.

Effects
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. Gaslighting almost always involves multiple incidents and is particularly effective if several different people gaslight the same person. 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.

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.

ME/CFS
People with ME/CFS typically experience healthcare professionals who dismiss or ignore their health problems, 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. 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.

Long COVID
Some Long COVID patients have experienced gaslighting, particularly when a doctor or healthcare professional does not find a clear biological (organic) causes for their long COVID symptoms. Perkins and Jason give as example:

Blaming patients and carers
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". 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. 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.

Forced treatment
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. 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, and Karina Hansen, who was later found to have been illegally detained. 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. 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.

Call for apologies to patients
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.

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,  and research has shown that health professionals routinely suggest or provide inappropriate and harmful treatments,  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.

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

Notable studies and publications

 * 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 - (Full text)


 * 2008, Obstructions for quality care experienced by patients with chronic fatigue syndrome (CFS)—A case study - (Abstract)


 * 2015, THIRTY YEARS OF DISDAIN: How HHS and A Group of Psychiatrists Buried Myalgic Encephalomyelitis] - (Full text)


 * 2016, Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent - (Full text)


 * 2016, Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm? - (Full text)
 * 2017, Epistemic injustice in healthcare encounters: evidence from chronic fatigue syndrome - (Full text)


 * 2019, Legitimizing myalgic encephalomyelitis/chronic fatigue syndrome: indications of change over a decade  - (Abstract)


 * 2019, Dismissing chronic illness: A qualitative analysis of negative health care experiences - (Full text)

Articles and blogs

 * 2022, The great gaslighting: how Covid longhaulers are still fighting for recognition - The Guardian
 * 2022, Long COVID and gaslighting - Vernita Perkins and Leonard A. Jason
 * 2020, Trial By Error: Some Thoughts on Long-Covid, ME/CFS and MUS - David Tuller
 * If you spend 20 years gaslighting your patients, perhaps you should think twice before accusing *them* of trolling *you* - psychologist Brian Hughes
 * 2019, How doctors gaslight women into doubting their own pain - VICE
 * 2019, Have You Been A Victim Of Medical Gaslighting? - Jo Moss
 * 2018, Memoirs of Disease and Disbelief Porochista Khakpour’s deliberately unheroic “Sick” raises questions about what we expect of female patients with chronic illness - The New Yorker
 * 2015, It's time for doctors to apologise to their ME patients - The Telegraph

Learn more

 * EXPERT Q&A When Medical Symptoms Are Dismissed as 'All in Your Head' - David Tuller
 * A Narrative Review of the Impact of Disbelief in Chronic Pain (2013)