Medical gaslighting as a mechanism for medical trauma: case studies and analysis, 2024, Shapiro & Hayburn

https://link.springer.com/article/10.1007/s12144-024-06935-0#citeas

Shapiro, D., Hayburn, A. Medical gaslighting as a mechanism for medical trauma: case studies and analysis. Curr Psychol (2024). https://doi.org/10.1007/s12144-024-06935-0

Medical gaslighting as a mechanism for medical trauma: case studies and analysis

Published: 19 November 2024


Abstract

Being dismissed or disparaged by medical professionals can be shocking and demoralizing for patients, leading to unnecessary harms (e.g., avoidance of medical treatment; depression; shame).

This difficulty is further compounded when patients are also the target of wide-ranging stigmatization due to the nature of the medical and behavioral diagnoses they carry, and/or the social identities attributed to them by medical providers.

Incorporating both clinical psychology and medical ethics perspectives, two clinical cases are presented demonstrating the insidious nature of the harms incurred to patients from traumatic medical experiences like those described above.

Both cases are shown to illustrate the role that a particular form of gaslighting– medical gaslighting– plays in creating the conditions that result in a form of medical trauma.

The term “medical gaslighting” currently lacks a clear and stable definition in the larger literature; the authors develop and establish a definition here.

The case of Alex is offered, illustrating a standard form of medical trauma recognized in the literature, and the significance of epistemic injustice in preparing the grounds for medical gaslighting.

Next, the case of Kiara is considered, in order to demonstrate how medical gaslighting becomes the vehicle for a more subtle form of medical trauma, not currently captured in standard diagnostic criteria.

The claims presented here are testable, and the authors suggest that further work expanding the conceptual reach of medical trauma, and incorporating the concept of medical gaslighting into standard practice, is warranted.

 

Totally agree that medical gaslighting does a lot of harm. But I am worried about the ever-increasing loose use of the term "trauma" to add power to an argument, to the point where it does nothing but serve as a form of rhetorical device.

Making people feel as though they're crazy when they're not is a terrible thing to do to anyone - it is deeply harmful and it causes great suffering, pain and misery, sometimes prolonged. Why can't that be enough? Why do we have to bring f-ing psychiatric terminology into it?

 

Agree. Bps have twisted that term in other areas too in order to sort of make it something the victim is responsible for sorting out rather than a justice issue an injury and importantly something that is both avoidable and utterly immoral and something someone should not do to another without consequences to them for having done it.

I think it’s a very dodgy word and territory to use therefore as I’m shocked at how it’s been billed as such a throwaway term when the most important thing is to stop it happening. I half expected decades ago that injury whether psychological or situational as well as the classical physical injury would be something people would be held culpable for by now

and will be honest when I read the bps stuff I do think that using sophism to try and fuzzy the line between perpetrator and responsibility for consequences caused to the victim was indeed one of the aims/parts of it whether that was just their beliefs and attitudes to ‘victims’ showing through unconsciously from them ir indeed part of the sales pitch

 

There was the Netflix series Dead to me that had the classic line to her son when he treated his girlfriend badly then said she was crazy:

“she’s not crazy, YOU DROVE her crazy”

different things

 

From the PDF version of the paper, in the text describing case 2 - my emphasis :

I was a bit surprised by the above quote. The patient gave up on trying to get help for her medical problems for 2+ years , but appears to have eventually been diagnosed with, amongst other things, health anxiety, which I thought in modern times was a euphemism for hypochondria. The poor woman is going to continue to have problems with the medical profession throughout the rest of her life because she has now been diagnosed as a hypochondriac.

 

And the reason she didn’t trust wasn’t trauma but experience of having seen what they can be like

the idea that advocating better stops the harmful system and bad players from harming is untrue

the concern is because the health profession won’t fix itself and so become safe and trustworthy

the author is aware are they not ?

and yes giving that label shows whoever that psychologist was completely did not understand and that the poor woman didn’t have health anxiety but concerns that turned out to be right as she’s now got that stuck on her record which will further impact care

when will they take responsibility should be the question

 

The thing is the way they seem to try and phrase it more towards something people need to work on to get past rather than underlining the role of justice and fixing the problem ie stopping the damaging thing from still being unsafe before they call it ‘anxiety’ rather than ‘justified suspicion of safety issues’

trauma has been used for some awful things that happened to others in other areas and I’m not sure what making it into a non-specific rather than ‘this was done’ really does other than switch the focus and responsibility away from the doer to almost reframe it as if it’s an illness implicit in people that could have been ‘triggered by anything’

and that’s not accurate and I’m not even sure helpful for the treatment model to infer a transdiagnostic type approach is fine and let’s just gloss over it being a normal human being coping bith with something abnormal having happened to them and that dark view into the world of realising there are people who do that and the level of protection and sorting society does to make it less likely to happen again

fir example it’s easier to treat ptsd if not still in the war zone with bombs and gunfire that you do have to react to - particularly if the reaction or over reaction to that or hyper alertness to such dangers is the issue.

the separation of situation out of the psychology of it - and the need for that bad situation to be addressed and fixed as a first step - to me makes it non psychology and is trying to make it something else

 

Speaking of 'trauma'....

A 'neighbour' has sent me this on 'trauma and cfs', to look at, thinking it might be of interest.....

I have searched Carolyn, who is a sexual abuse surviver....who claims she has/has CFS etc bedbound......?

https://www.carolynspring.com/shop/trauma-and-the-body-online-training/?
Neighbour thought the website 3 min. Video worth watching.

All comments welcome to pass back.....

The damage that well meaning folk can engender, knows no bounds...?

What worries me is she is a physiotherapist working currently in a hospice......formerly privately and NHS.

 

Yeah. The only issue I have of the use trauma in our case is it seems to come with the connotation that it leads to irrational behaviour.

I believe pwME being absused by the medical system, then avoiding this system, is perfectly rational. And the only way for the system to make up an excuse for this avoidance not being rational is to label it as a psychiatric problem.

 

Sorry to hear that. It seems to really be a trend these days to say trauma causes physical illness.

My partner was reading a book she told me about, which touched on trauma, and it seemed really interesting, then we got to an ME/CFS chapter, and the book basically said trauma causes ME/CFS (without any evidence mind you)…

 

Find a suitably passive aggressive leaflet on a different topic related to her which has insinuations she might find inaccurate to send to her kindly in return?

I’m now imagining a skit where one that could be invented (like there have been fake journals to prove points eg on peer review in the past) on certain professions and suggesting common ailments to those professions might actually be due to the mind in order to see what comments come back when the shoe is on the other foot to ‘it being intended as helpful etc’

I think sometimes that’s the only way to attempt to communicate empathy

then perhaps a link to physios for me and the cdc website?

 

This reminds me of the term ‘moral injury’ that is perhaps worth a thread one day (like epistemic injustice)

I saw the term used in a paper whose authors included the gent who was a CBT therapist that wrote a letter in reply to monbiots article (but wasn’t the normal bps lot) , ironically. But the subjects/context were soldiers.

I wonder if this term stretches to our situation and if not there is a similar one that can cover this.

 

Very concerning.

From the website:

The most worrying things are the way this stuff targets just about every illness - RA, heart disease, cancer, diabetes. Its seductive and alluring, because of course everyone wants to cure their illness, and the narrative espoused gives people permission to blame it all on something someone else did that injured them emotionally.

 

I have medically induced PTSD thanks to being medically gaslit and nearly dying after being dismissed as "overweight" when I had pneumonia and double pleurisy that I have never entirely recovered from, and led to needing major lung surgery after two lung collapses, and led to my diagnosis of ME after 6 years of trying to get anyone to answer the question "why aren't I getting better?"

This was compounded by continued failings and blunders that almost cost me my life on two further occasions as well as multiple dismissals big and small during the whole process and since.

I have lived with flashbacks to varying degrees since and experience panic attacks on going anywhere near any sort of medical facility or personnel, which means I am constantly dismissed as anxious and not heard with resultant significant impacts (asthma going undiagnosed for over 6 months thet led to multiple trips to hospital) so personally, I think trauma is an accurate word to use here.

Thank you for sharing, I look forward to reading the paper.

 

Appropriately for this thread: traumatic invalidation

Traumatic invalidation occurs when an individual's environment repeatedly or intensely communicates that the individual's experiences, characteristics, or emotional reactions are unreasonable and/or unacceptable.

Often experienced by the LGBTQ community

 

To find a way of hiding / ‘taking the actual injuror’ out of it

I’m not impressed by the quick google suggesting things like people leading a healthy lifestyle is ‘the cure’ with no mention of justice anc apology which to me and I expect to anyone who was in that situation is the logical bare minimum starting point along with making the situation safe

it’s the classic bs of the renegade side of psych who are just trying to push and rewrite the world to any reaction is the issue that needs to be treated and nothing to do with the actions that were the direct cause ie seem to be all about those who want to act without responsibility, liability or even want to rewrite the natural laws if action-consequences

the best way to reduce trauma is to reduce situations and people doing harmful things. Once something awful has been done those harmed need proper sympathetic help and not the bs of biopsychosocisl and I’m very concerned at how quickly some schools seem to want to try and rewrite everything into just focus on the person as if their reaction is abnormal and what happened didn’t matter because that’s utter nonsense bith in science law and common sense.

the idea for example that those who have a moral injury is fascinating - be it soldiers who had to kill or medics who had to choose who they couldn’t treat etc

it seems obvious basic tosh that expecting them to eat healthy, exercise and ‘become more psychologically flexible’ is the cure is old brainwashing wash your hands of what you’ve done to others nonsense that only those who don’t have that strong conscience so don’t value it as something good would try to push. And try to invert the usual cat before horse lifestyle stuff to infer people are ill because of not living right. I’d well imagine someone in that situation would need to go through some sort of phase to deal with that. So it doesn’t sound like psychology at all. More like nonsense made up stuff.

I also mention moral injury because we are at that fun place where sophists who are responsible have somewhat tried to twist the situation to make it as if our injury and what has been done to us is validated then WE are the cause of the moral injury to those on the ground who did it to us … rather than themselves and those giving them bum steers that it didn’t harm. Nothing could be further from the truth but it shows how unpleasant tactics or maybe the real thinking of some can be , but also how strong that wish to avoid ‘being wrong’ is - we have to keep having sustained injuries levelled at us so others can keep thinking they didn’t harm us etc

 

@JellyBabyKid, you mentioned you have been diagnosed with PTSD. I'm so sorry to hear that. I hope you are getting the treatment you need!

Above, I was talking above about whether its helpful to PwMEs to use the looser term "trauma" in their advocacy. I wasn't talking about actual PTSD Which is awful. I did not mean to minimise your experience in any way.

In case anyone isn't sure, here is the DSM-5 diagnosis for PTSD (in adults).

 

I agree strongly with the main premises of the article. Medical trauma is widespread and causes severe harms, and is disproportionately likely to hurt those who are already vulnerable, such as people with developmental disabilities, with pre-existing trauma, or living in poverty. It caused me a lot of harm. For the first three years I had ME/CFS, I didn't know I had an illness, and for the next two, I was scared that I was just lazy. It destroyed my trust in the medical profession, and it influenced my overall care decisions. I got an advance directive and POLST form ordering comfort care only. My poor quality of life was the main motivation, but minimizing medical intervention, including invasive medical procedures and encounters with doctors and hospitals was another.