By Kirsten Ballard
“It’s all in your head.” “You’re just looking for attention.” “There’s no way you’re in that much pain; you would be screaming all the time.”
Almost all people with chronic medical conditions or serious long-term injuries have experienced their pain being dismissed or trivialized. “Medical gaslighting” is when medical professionals manipulate patients into questioning their own experiences.
“It’s a feeling your concerns are not being validated,” says Stacey Rosen, MD, a cardiologist and leading expert in heart disease in women in New York City. “It’s a feeling you’re being talked down to and trivialized.”
She says medical gaslighting, which predominantly occurs to women and minorities, is epitomized by a patient not feeling heard: “Their concerns are minimized or ignored, attributed to anxiety or stress.”
This is in part because of systemic sexism and racism that has long affected everything from who has been able to practice medicine to who has been included in medical trials. It often manifests in delayed diagnoses, which can cause worsening health. Even though some chronic pain conditions affect women more predominantly, it often can take them years to get a correct diagnosis. Individuals of color experience similar disparities.
“We used to tell women they don’t get heart attacks,” Rosen says. “If you weren’t having crushing chest pain, it was all in your head. We told women they should take antacids or maybe anti-anxiety medication. And then from 1985 to 2014, more women in the United States died of heart disease every year than men.”
Turning a lifetime of medical gaslighting into a teaching opportunity
Melissa Geraghty, PsyD—a licensed clinical health psychologist and CEO of Phoenix Rising with Dr. G—has experienced medical gaslighting her entire life as she navigated disabilities and pain.
“I was born with a rare neural tube defect that was not discovered until 2019 when I started to become paralyzed,” she shares. “Even then, medical professionals first thought it was anxiety.”
It’s happened so often, she can’t remember the first time she was gaslit in medical settings, though several instances stick out.
When she visited a neurologist because of intense episodes of head pain, the neurologist told Geraghty that her husband should re-marry someone “fat and ugly” who wouldn’t pretend to be sick for attention.
“This incident was medical gaslighting, because he downplayed all my symptoms as just me being an overdramatic thin woman who wanted attention,” Geraghty says. “Even though I knew what he said was horrific and wrong, I then second-guessed myself, thinking that maybe I had verbalized my symptoms in a way that came off as over-dramatic, when in reality I was just listing the symptoms.”
She left the appointment and returned to her pain team in tears, saying she did not want to see another neurologist. Her pain management doctors performed additional testing and discovered that she was experiencing cluster headaches.
“This encounter impacted me significantly; it caused medical trauma,” Geraghty shares. “Many, many years later, when my doctors said it was time to see another neurologist for new symptoms, it brought a lot of trauma from my past medical gaslighting experiences. I had significant anxiety.”
Fed up with how often her concerning symptoms were dismissed and how frequently she was told it was all in her head, and hearing from her own patients and friends that they were having similar experiences, Geraghty decided to do something about it.
She now speaks at conferences and develops webinars and materials as a “medical gaslighting sensitivity trainer” to help the medical world become aware of this phenomenon.
“I teach both patients and medical professionals how to respond to medical gaslighting from a place of assertiveness and not anger,” she explains.
The harmful consequences of being dismissed
Medical gaslighting can have serious effects on patients’ clinical outcomes.
“When an individual is gaslit, their symptoms aren’t taken seriously, they aren’t evaluated, they aren’t heard and respected,” says Rosen. As a result, symptoms can worsen, diagnoses can be delayed, and mortality rates can rise.
Geraghty says gaslighting also frequently results in medical trauma. In some cases, this means patients may feel the need to plan extensively for medical appointments and don’t feel safe going to an appointment alone.
“Before a medical appointment, [someone who has been gaslit] may mentally go through all of the worst things the doctor, nurse, or staff may say or do, and think a lot about how to respond,” she explains. Gaslighting can make “you question yourself and the validity of your pain. You wonder if your symptoms are really ‘bad enough’ to get treatment.”
A red flag Rosen says to look out for is physicians who immediately attribute symptoms to stress, anxiety, depression, or weight, particularly for women who are overweight or obese. “Alarm bells should ring any time you hear a dismissal of your symptoms—‘Everything is fine,’ or ‘I’m sure it’s nothing, you’ll get over it,’ or if they attribute it to things like work pressures or weight,” she says. “Your clinician is not listening to you and not optimally partnering with you.”
Her advice? Fire your doctor.
Rosen says that when searching for a doctor, it’s not about finding one with the most certifications or prestige, but rather, finding the doctor who makes you feel heard. It’s about finding the partnership that works for you.
Approaching appointments effectively
When the right provider is found, individuals living with pain can continue to take steps to ensure appointments go well. Rosen recommends bringing a second person to medical appointments if you’re able, allowing you to better focus on what’s being said. If you’re unable to bring a second person, bring a way to take notes or record the visit (check your local laws first).
In order to really optimize the visit, she says, people with complex conditions have to step up and “be a better patient.” That means coming prepared.
“I like to remind folks that you’d never go to an accountant during tax season without all your paperwork,” Rosen says. “Don’t go in assuming that it’ll all be in your hospital chart or your doctor’s office.”
She adds, “It’s your health. I mean, think about how much work we put into choosing a car, a job, a pair of shoes, or buying a computer. This is your health.”
In order to avoid being caught off guard by medical gaslighting, Geraghty recommends that patients prepare simple statements for when they feel as though they are being dismissed. That can be as simple as:
“My experience is valid.”
HOW TO RESPOND TO MEDICAL GASLIGHTING
Patients should practice what they want to say in the event that medical gaslighting occurs to them. Geraghty recommends pre-preparing statements such as:
—“I understand you were intending to make a joke. I did not take it as such, because it felt hurtful.”
—“I see that you have a different perspective than me. I’m not imagining things.”
—“Name-calling or making light of my situation is hurtful. It’s hard to hear you when you speak to me like that.”
—“I feel like I am not being heard.”
—“I feel like my symptoms are being dismissed.”
—“I know the symptoms I am experiencing are not typical for my body, and I am here reaching out for help.”