Toward the end of my third year of medical school, I was 25, newly married, and overwhelmed by responsibility. I hadn’t enjoyed the clinical rotations. The hours and the degree of human suffering were just too much. My husband and I fought about how unavailable I was. I had to complete my 6-week psychiatry rotation 3 hours away from home. I wasn’t sleeping well, so I went to student health and was prescribed hydroxyzine, an antihistamine with heavily sedating properties now primarily used to treat anxiety and tension. Unbeknownst to me then, it also has a half-life of 14 to 25 hours.
The psychiatry rotation was harder than I had expected. I went to a women’s prison, where the incarcerated shared their heartbreak about being away from their children or were screaming and violent. Later, long trips into the country led to a remote institution where severely handicapped children wore helmets and drooled, so drugged they couldn’t walk unassisted. I spent another two weeks at a long-term care facility for schizophrenic patients who had been on long-term antipsychotics and were catatonic. Some had tardive dyskinesia with uncontrollable facial tics like lip-smacking, tongue thrusting, and rapid blinking.
The psychiatrists’ role was to monitor their meds; they weren’t able to converse. It was hard to sleep at night in a strange place with a roommate I didn’t know from another program. The patients haunted me. The hydroxyzine knocked me out but made it difficult to rally in the morning.
In the last two weeks, I followed a psychiatrist in an outpatient clinic. I wasn’t allowed to interact, only to listen. In stale rooms, observing him speak to his patients in a monotone, sterile way, I could hardly keep my eyes open. I’d occasionally nod off. At the end of the rotation, his feedback was blunt: “You’re smart, and I wish you the best. But you have a sleeping disorder.”
None of the mental health professionals I shadowed made any effort to see how I was processing my surroundings. Before asking if I was getting enough sleep or if I was feeling well, or even offering me a cup of coffee, this psychiatrist diagnosed me with narcolepsy.
I didn’t sleep the entire following week. By now, I was brainwashed to believe medical professionals over myself. My mental health deteriorated as I plodded through the OB/GYN rotation, often lying about my whereabouts to take power naps in the call room. Ironically, I made my own appointment with a psychiatrist. This was the beginning of a career of lived experiences in medicine that made me feel like I was crazy. Since then, I’ve collected similar stories from many in the field. Medical life is fraught with intense emotional experiences for all who enter its doors, but the impacts are scarcely discussed. American medical culture has perpetuated the debilitating notion that if you’re struggling, physically or emotionally, something is wrong with you. This is gaslighting.
We hear about gaslighting in romantic or familial relationships, but it can happen anywhere, even in medical culture. It’s a form of psychological manipulation wherein abusers seek control over others by making them question their own judgment or intuition, like they’re making things up or they’re too sensitive. It’s not always traumatic, but even small instances are disorienting and destabilizing, coagulating into a profoundly psychologically unsafe experience.
Medical gaslighting occurs when a medical professional dismisses a patient’s physical symptoms or attributes them to something extraneous, like a psychological condition. It’s something many of us have experienced as patients whenever we felt that a clinician didn’t believe us, called us “hysterical,” or minimized our symptoms. Since COVID, medical workers have left their jobs in droves, with the quality of care suffering from a rapidly diminishing workforce. Unsurprisingly, patients describe feeling like the medical system doesn’t take them seriously or care about their well-being.
Another form of gaslighting happens to medical practitioners themselves: When the physician is the patient, between physicians, between physicians and other members of the health care system, and between physicians and themselves. Such medical professional gaslighting has received little attention to date. Beyond one-off interactions, medical professionals are gaslit throughout their careers and transfer learned behavior to patients directly and indirectly. They’re indoctrinated with time-honored beliefs:
- Never show weakness.
- Never make a mistake, and smother it if you do.
- Respect the hierarchy.
Deviation from these tenets puts practitioners in the crosshairs of scrutiny. It can be career-threatening at a minimum and even life-threatening, as evidenced by the high suicide rate among and violence against medical professionals.
Gaslighting a patient or medical professional is easy to do: simply plant a seed of doubt by making them feel wrong, weak, or crazy. The result is deep shame (“not enough-ness”), which manifests as constant survival mode behavior: Am I OK? What’s right? Who’s right? Am I doing enough? Am I doing it wrong? Is someone judging me? Is my doctor wrong? Will the patient find out? Will I lose my job? Am I safe? Gaslighting is especially likely to happen to women and people of color.
Medical centers are highly emotional environments; they are the sum of people’s experiences within them. Amidst other systemic issues in American health care, the permeation of shame in medical culture, in combination with a lack of formal training around how to cope with it, has far-reaching deleterious implications for practitioners and patient care. Until skills of emotional intelligence and shame resilience are adopted, prioritized, taught, practiced, and modeled in the medical establishment, the cycle of gaslighting will continue. Struggle needs to be normalized, not pathologized.
Since all of us will encounter the health care system in our lifetime, it’s critical to understand and combat gaslighting within it. We need to examine why it happens, who’s susceptible, who’s likely to gaslight others, how it affects the sustainability of the health care system, and ultimately, what it looks like when we get rid of it. Answering questions like these will allow us to define a new American medical culture, where patients and practitioners alike feel seen, respected, and cared for.