Medical gaslighting takes a toll on women’s health

Downplaying or dismissing women’s health concerns is a global bane with serious medical consequences. Greater awareness and a humane approach can help end medical gaslighting.

"One doctor or nurse can change the entire trajectory of your life,” says Kendall Soucie, a Canadian woman with polycystic ovary syndrome (PCOS)—an often poorly understood endocrine condition affecting 8-13% of women globally that can lead to chronic, lifelong complications if left unmanaged—whom healthcare workers initially dismissed as over-emotional and wrote off her health concerns as “part of being a woman”.

This is a classic case of ‘medical gaslighting’—an instance where a healthcare worker downplays a patient’s concerns or symptoms, or attributes them to something else. More women than men are likely to face medical gaslighting and, like with conventional gaslighting, it can leave the patient questioning her own reality or, worse, giving up on the healthcare system or any hope of treatment.

After six long years of continuous medical gaslighting, Soucie found a health practitioner who not only gave her an accurate diagnosis of PCOS and effective treatment, but also, importantly, validated her concerns and symptoms.

Soucie, an assistant professor of psychology at the University of Windsor, says "Finding that one person who understood was really a game changer—it changed my entire life.”

Now, with a wealth of first-hand experience, Soucie focuses on helping women who find themselves in similar situations. The topic of her research, in fact, is medical gaslighting in relation to PCOS and she credits this to the specialist nurse, saying "She was the only person who listened to me which led me to get the care that I needed, preventing a host of co-morbidities."

Indeed, medical gaslighting can be a double hit for victims, as not only are their realities denied, but they can also experience the long-term effects of treatment delays. For PCOS, long-term implications include increased risk of diabetes, cardiovascular disease (CVD) and endometrial cancer. In Canada, Soucie found that it takes an average of 4.5 years and at least four consultations with various healthcare workers for women to receive a conclusive diagnosis of PCOS. Similarly, in Australia, the average time to diagnosis is five years, preceded by visits to at least three different healthcare providers.

Soucie’s research shows that in Canada diagnostic delays or misdiagnoses are a key fallout of medical gaslighting, with the frequently reported reasons for delays including dismissal of adolescents’ early symptoms and negative diagnostic encounters.

Medical gaslighting is highly gendered

Medical gaslighting is disproportionately skewed against conditions commonly experienced by women and other marginalised groups. This is underpinned by wide gaps in research, diagnosis, and treatment of diseases most prevalent among women and reinforces the prevailing gender health gap.

Studies show that women with stomach pain wait longer than men to receive emergency care, are more likely to have symptoms of heart disease attributed to a mental health condition, wait longer for cancer diagnoses, and often do not receive pain relief during obstetric care.

Dr Priya Fielding-Singh, a sociologist at the University of Utah who focuses on gender, race, ethnicity, and health, has studied how gaslighting in obstetric care ends up invalidating the medical concerns of mothers. Her research shows gaslighting manifests as denying mothers' humanity, discrediting their knowledge, judgements, and feelings.

Medical gaslighting almost always surfaces in situations of power imbalance, Fielding-Singh explains. "For gaslighting to be effective, the gaslighter must hold power over the victim. Women rarely possess the cultural, economic, and political capital required to gaslight men.”

"The underlying dynamics of power, vulnerability, and dependence in the relationship between provider and patient make the clinical encounter an especially fertile arena for gaslighting to occur."

In medicine, the power imbalance is exacerbated by the nature of the doctor-patient relationship. "The underlying dynamics of power, vulnerability, and dependence in the relationship between provider and patient make the clinical encounter an especially fertile arena for gaslighting to occur,” Fielding-Singh says.

Gender stereotypes that characterise women as irrational, hysterical, or dramatic often play into this dynamic and female patients are likely to be seen as less rational, more emotional, and complaining more than men, she says. "This stems from gendered ideology within medical science itself, with theories of male superiority embedded in biological claims that men are whole and strong, while women are weak and incomplete."

In Iran, medical gaslighting is often woven into the fabric of healthcare practice, explains Dr Zahra Zeinali, an Iranian doctor who has worked internationally, most recently with gender equality advocacy organisation Global Health 50/50.

"Often, young women come to the emergency room with symptoms resembling those of a heart attack—cold sweats, palpitations, heart pounding, and so on," she says. "In Iran, it's known that the first differential diagnosis [for this] is hysteria or hysterical symptoms. It's considered psychiatric rather than necessarily physical. [Women] often just get a bag of IV [intravenous fluid], reassurance, and monitoring for a couple of hours.

“As a doctor, when you have this diagnosis at the top of the differential diagnosis list in your mind, it overshadows how you approach the patient.”

For women of colour, the risk of medical gaslighting is even higher, with Black, Hispanic, and Native American mothers reporting more stereotype-related gendered racism than white women in obstetric encounters, Fielding-Singh says. “Black and Latina women face historically rooted gendered and racist stereotypes related to reproductive health, such as associations with promiscuity, sexual availability, and having many children at a young age.”

Dismissing pain and other worrying symptoms

Gaslighting is a type of psychological manipulation that attempts to make people doubt their memories and experiences, says Dr Ian James Kidd from the Department of Philosophy at the University of Nottingham. "The gaslighter is hostile to the possibility of disagreement, so they undermine those who are, or could become rivals or challengers," he says.

Caroline, a 55-year-old woman from the UK, says that before she underwent a hysteroscopy—a procedure where a camera is inserted into the uterus to check for abnormalities—she wasn’t warned that it could be painful. “It was like an electric shock from my head to feet,” she says, and, despite her screams of agony, the male gynaecologist continued to probe her uterus, saying, “almost there, count down from five”.

After the procedure and the removal of a polyp, the doctor asked her to “rate him out of 10 on a so-called 'cutting scale'”. “I asked, 'do you mean the pain?'” Caroline says. “He said, 'no, I mean only the cutting'. I didn't remember the cutting part amid the agony, so I said 'two out of 10'. He wrote down 'one out of 10'."

Caroline's medical gaslighting continued when she made five subsequent visits to her local hospital, mostly the emergency room. "I couldn’t feel any sensation on or below my skin from the waist to the knees. I was terrified,” she says.

“The talking down, the standard script that tries to dupe women having the procedure. I felt completely worthless and on the verge of clinical depression. It was soul destroying, and still is."

After she explained her extreme numbness and incontinence, the emergency doctor cast aside her family doctor's referral letter and said, "You should be happy that the lesion was benign.” “He offered me painkillers,” she says. “I told him, 'I'm numb. I don't need pain relief!'"

Many women experience considerable agony both during and after a hysteroscopy, and they are increasingly speaking out against the fact that they had not been warned about the degree of pain, and that their suffering was dismissed and diminished. Caroline contacted the advocacy organisation Hysteroscopy Action and realised there were many women with similar stories like hers.

Nine months later, as she reflects on the experience, Caroline says the worst part was the language healthcare providers used to downplay her pain. “The talking down, the standard script that tries to dupe women having the procedure," she recalls. "I felt completely worthless and on the verge of clinical depression. It was soul destroying, and still is."

Perpetuating an age-old power imbalance

Professor Havi Carel, a researcher from the University of Bristol who investigates illness experiences, says patients regularly report that their testimonies and perspectives are ignored, dismissed, or explained away by the healthcare profession. "These experiences are injustices because they are unfair and harmful—and they jeopardise patient care, undermining trust in healthcare staff and systems."

The term 'gaslight' came into popular usage after a 1944 film of the same name, based on a 1938 play, showed a husband who dimmed the gaslights and manipulated his wife into believing she was imagining it and going insane. “Are you trying to tell me I’m insane?” the wife asks, to which he replies, “Now, perhaps, you will understand why I cannot let you meet people.”

"I don't think they are intentionally mean or manipulative. I think it's an unintentional consequence of a system that has been based on a power imbalance for a long time."

Soucie says that while medical gaslighting isn’t sinister and deliberate in the same way it was in the film, it stems from implicit biases nurtured by a healthcare system at fault. "Physicians often have limited time with patients. I don't think they are intentionally mean or manipulative. I think it's an unintentional consequence of a system that has been based on a power imbalance for a long time."

Zeinali concurs: "Practising in a rural area with a massive patient load, you get only a couple of minutes per patient to take their history and perform the physical examination. There’s very little time to treat the patient as much more than a collection of symptoms, despite best intentions." She adds, "unless the system improves the working conditions of health workers little will change."

In Iran, Zeinali says, the power imbalance that typically fuels medical gaslighting is also driven by the immense prestige and social respect attached to the title of physician. “Many doctors aren't necessarily very humble about it,” she says. “You see that lack of humility in most interactions, regardless of gender.”

It is also evident in the way doctors treat ethnic minorities, often with refugee status. "In Iran, we have a vast number of refugees from Afghanistan. There's a very visible, tangible difference in the way they are treated, especially if they have the appearance or demeanour of someone from a lower socioeconomic background," Zeinali says.

Ethnic minority and refugee status can compound the effects of medical gaslighting.

Photo: Katie Gee Salisbury

Together with Carel, Kidd is co-leading a new research project, Epistemic Injustice in Healthcare (EPIC), funded by Wellcome, that aims to prevent the silencing of patient voices and improve patient trust in the healthcare system. EPIC will look specifically at labour pain, child mental health, BCG vaccinations, neurodiversity, cancer and depression, and later-life care.

Kidd says addressing medical gaslighting is complicated, partly because people with some illnesses can be more vulnerable to certain kinds of gaslighting. "Many illnesses affect cognitive functioning, memory, and so on, while many medical treatments can badly affect one’s epistemic capacities—think of ‘brain fog' or ‘chemo brain’,” he says.

Among marginalised communities, the effects can compound. “Certain illnesses might tend to be more prevalent in social groups that are already marginalised. This is the predicament of patients—the whole set of obstacles, prejudices, and injustices that, sadly, often seem to go with being ill,” Kidd says.

Putting out the medical gaslight

Recognition is the first step towards challenging the medical gaslighting status quo. Zeinali says the problem is not yet widely acknowledged in low- and middle-income countries (LMICs). "I think conversations around medical gaslighting happen much more in high-income countries, especially in English-speaking countries that dominate global social media."

Next is reforming the approach and skillset of healthcare providers. Soucie says more needs to be done at a systemic level at medical school and throughout a healthcare professional's career.

"Among other changes to healthcare systems, there's a need for more reflection by physicians on their practice and on the type of physician they want to be,” she says. "Educating trainee clinicians on the injustices of medical gaslighting should also be integrated into medical education. The medical curriculum needs to address intersectionality and offer continuing education credits for participating in talks about women's health and implicit bias; for example; around weight, gender, race, or ethnicity."

Fielding-Singh says medical gaslighting during obstetric care can be minimised only through a broader shift within the field of reproductive health toward reproductive justice—the right of women to have true bodily autonomy and choices regarding their right to have or not have children.

Recognising that childbirth is an extremely meaningful and personal life event, for which women deserve agency, respect, and security, she stresses that "gaslighting occurs when providers treat birth as a purely medical event and women as 'bodies' rather than full people".

"The ingrained view of medical professionals as experts and the medicalisation of childbirth has led to a largely medical, rather than humanistic, view of childbirth," she says. “Providers need to practise with not only a medical model of birth, but also a humanistic one."

Tackling medical gaslighting will require changes on multiple levels, including a significant shift in wider socio-cultural determinants of gender inequity, which will take time to translate into improvements in women's healthcare experiences.

Despite the scale of the systemic change needed, Zeinali says truly effective solutions stem from focusing on the core physician-patient relationship at the heart of all healthcare interactions.

"For all the data, big and small, all the high-tech tests and drugs, sometimes we just need to look beyond that—we need to see the real person. A patient is more than a grab-bag of symptoms.

"As with most complex problems in the world, there are many factors in play, but lasting change comes with transforming our health systems in a way that allows healthcare professionals to connect with the art of the medical practice and their patients.”