Medical gaslighting: conceptual and theoretical foundations, 2026, Noble

[Hutan]

You can't truly help an Ill person until you understand what they need from their perspective, and in their terms,

I don't think that is true. If you have a good understanding of disease and treatments, a lot of the time you will be able to provide very useful help without knowing for sure exactly what the patient 'needs from their perspective and in their terms'. The proof of that is that doctors in an Emergency Room can often provide substantial help to an unconscious patient who is unable to inform their medical team of their perspective.

Frankly, give me any day competent ethical 'biological reductionism' and 'chauvinism derived from [an accurate understanding of the] relationship between pathogenic causes to symptoms' over an incompetent doctor who wants to spend time trying to understand what I need from my perspective and in my terms.

My perspective about what I need could easily be wrong - lots of people's perspectives have been that they need homeopathy or to suspend themselves by a rope around their neck in order to cure CCI or drink bleach or jump on a paper circle and shout 'Stop!'.

Sure, patients with capacity should always be able to refuse medical care and to make informed choices, for example, in end of life care. But it seems to me that the further away medicine gets from biology and good quality evidence, the higher the chance of medical gaslighting, patient exploitation, deceit and charlatanism.

 

[Jonathan Edwards]

Frankly, give me any day competent ethical 'biological reductionism' and 'chauvinism derived from [an accurate understanding of the] relationship between pathogenic causes to symptoms' over an incompetent doctor who wants to spend time trying to understand what I need from my perspective and in my terms.

Absolutely.
And it has nothing to do with 'materialism' which is a bogey invented by philosophers to justify their preference for talking about everything from a position of ignorant intuition. I am not a materialist.

 

[JellyBabyKid]

By definition, denying a patients lived experience and reality must cause some kind of harm

Epistemic injustice = denying someone is a reliable narrator of their own experience

Traumatic invalidation = repeated invalidation of someone's experience or reality

Potentially leading to moral injury = profound psychological distress from actions (or inactions) that violate one's deeply held moral or ethical beliefs, leading to intense guilt, shame, anger, and loss of trust, often stemming from betrayals by authority

I have been giving this area of psychology a lot of thought, when able.

 

[JellyBabyKid]

Does anyone know how to access the full article free? Ty.

No, but I would also be interested to read it if anyone gets hold of a copy. Thanks

 

[hallmarkOvME]

Absolutely.
And it has nothing to do with 'materialism' which is a bogey invented by philosophers to justify their preference for talking about everything from a position of ignorant intuition. I am not a materialist.

Thank you for disclosing that.

 

[hallmarkOvME]

My perspective about what I need could easily be wrong - lots of people's perspectives have been that they need homeopathy or to suspend themselves by a rope around their neck in order to cure CCI or drink bleach or jump on a paper circle and shout 'Stop!' It seems to me that the further away medicine gets from biology and good quality evidence, the higher the chance of medical gaslighting, patient exploitation, deceit and charlatanism.

We all have the self determined right to be wrong, and it ethically (deontically) precedes anyone else's notion of the good. The only time limiting that right is justified is when it interferes with, or clearly amd presently portends to interfere with, another's same right.

But it seems to me that the further away medicine gets from biology and good quality evidence, the higher the chance of medical gaslighting, patient exploitation, deceit and charlatanism.

Biology and good evidence are necessary but insufficient conditions to protect and enforce that right; they can neither guarantee nor enforce it. And it isn't medicine that moves away or makes ethical choices; it's other agents with their own self determination. Are you saying that the presence of or intervention of the doctor protects patients from medical gaslighting, patient exploitation, deceit and charlatanism from others? And if so, isn't that itself paternalistic?

 

[Utsikt]

We all have the self determined right to be wrong, and it ethically (deontically) precedes anyone else's notion of the good. The only time limiting that right is justified is when it interferes with, or clearly amd presently portends to interfere with, another's same right.

Biology and good evidence are necessary but insufficient conditions to protect and enforce that right; they can neither guarantee nor enforce it. And it isn't medicine that moves away or makes ethical choices; it's other agents with their own self determination. Are you saying that the presence of or intervention of the doctor protects patients from medical gaslighting, patient exploitation, deceit and charlatanism from others? And if so, isn't that itself paternalistic?

The patient’s right to refuse any medical treatment without it negatively impacting the other medical care they receive, effectively protects their agency. That mechanism sometimes doesn’t work, but that’s a different question entirely.

It is the doctor’s duty to make the best recommendations they can based on their knowledge and experience. That is the social contract we’ve entered into with them - they have to act in our best interest from a medical perspective. That will to some extent include disagreeing with the patient about what they think they need.

If you want to drink bleach you are usually allowed to drink bleach. But a doctor should not recommend or approve of you doing it just because that is what you want.

 

[Jonathan Edwards]

I still find the use of the term 'gaslighting' in the context of ME/CFS too vague, polysemic and confusing to be of any use. Why not stick to plain English such as 'the doctor doesn't believe the patient'. All the stuff about having to understand the patient's reality seems to me in practice an even worse paternalism than we already have - based on a mish-mash of ivory tower academic philosophising and debased Freudian psychodynamics.

The one thing we do know about ME/CFS care is that the people who go in for this sort of psychodynamic approach have failed totally to provide any benefit yet still insist on treating people. The more down to earth lot at least admit they have nothing to offer.

 

[rvallee]

I don't think that is true. If you have a good understanding of disease and treatments, a lot of the time you will be able to provide very useful help without knowing for sure exactly what the patient 'needs from their perspective and in their terms'. The proof of that is that doctors in an Emergency Room can often provide substantial help to an unconscious patient who is unable to inform their medical team of their perspective.

Frankly, give me any day competent ethical 'biological reductionism' and 'chauvinism derived from [an accurate understanding of the] relationship between pathogenic causes to symptoms' over an incompetent doctor who wants to spend time trying to understand what I need from my perspective and in my terms.

That's definitely true, but it only applies to issues where that biology is known. All medical gaslighting occurs when it's unknown, and it's a common thing. If it were rare things may work out on balance, but it's far from that. And in some ways the success of this approach is a major reason why there is no plan B, no one ever thought of having a plan B before precisely because it's not needed in all the cases where it makes no difference.

But of course almost no one can actually do that reliably, but the problem is that a lot do seem to believe they not only can do that, but do so reliably. It all depends on what the words mean. For me it's strictly about symptoms, their patterns, differences, functional limitations, and so on. But somehow that's considered useless, largely because in cases where the biology is well-understood, none of this is actually needed.

I don't see how illnesses like ME/CFS get fully solved without that. Not our feelings, or beliefs, or what we think, or any of this psychosocial mumbo jumbo. That's entirely useless. I could not care less for someone to smile at me reassuringly, holding my hand telling me it's all going to be OK, especially when it's false, which is the case here. I would be perfectly fine with a disembodied AI doing the whole work without ever faking any of this.

But to solve illnesses where the biology is unknown does require working with the patients and our perspective. It's just that this means none of the usual biopsychosocial/psychosomatic garbage, but rather a whole different branch of medicine that doesn't even exist, and would have meaningful, reliable, accurate and replicable skills doing that. Something that has never been done before, and therefore means no one can teach it, while it appears that millions of physicians believe they already have those skills, and would gladly teach their peers wrong about it.

So it's definitely true that our perspective is critical. When we compare what patients bring unprompted about what needs to be done, it's massively superior to what medical professionals bring when they do the same exercise, or when they work in highly-prompted discussions where they inject their own priorities and pass them as the patients'. They are literally worlds apart. On one side everything that needs to be done to solve this, research, expertise, and so on, and on the other is the multidisciplinary fake-sincerity psychosocial garbage that has zero chance of ever achieving anything.

The problem is always with the professionals. They don't just bring nothing here, they make everything worse because they can't help inject their own perspectives, which is only valid and useful when it involves biology and physiology, as they are trained to do. Just the same when it comes to medical gaslighting, the problem is explicitly that the professionals are wrong, a perspective that they can't even imagine.

Biopsychosocial/psychosomatic is plan F, failure by design. That doesn't change that there is a need for a real plan B that involves working with patients, as opposed to working the patients, because medicine is still very far from knowing half of everything there is to know. Having ruined everything by working with a failing approach doesn't change that, and that it absolutely requires working with the patients and our perspectives, it just has to be completely different from everything that's been done, all the way down to the motivations and intentions. Good intentions don't count when they have zero chance of achieving what they set out to do.

 

[MrMagoo]

I still find the use of the term 'gaslighting' in the context of ME/CFS too vague, polysemic and confusing to be of any use. Why not stick to plain English such as 'the doctor doesn't believe the patient'. All the stuff about having to understand the patient's reality seems to me in practice an even worse paternalism than we already have - based on a mish-mash of ivory tower academic philosophising and debased Freudian psychodynamics.

The one thing we do know about ME/CFS care is that the people who go in for this sort of psychodynamic approach have failed totally to provide any benefit yet still insist on treating people. The more down to earth lot at least admit they have nothing to offer.

Gaslighting is specific in that it denies what the patient says and further it convinces them the situation is different.
Telling a patient to find their baseline is gaslighting as there’s no such thing as a baseline
Telling a patient they will improve when they do x,y,z is gaslighting because they probably can’t do x y z and even if they do they aren’t guaranteed any improvement.

 

[Jonathan Edwards]

Gaslighting is specific in that it denies what the patient says and further it convinces them the situation is different.
Telling a patient to find their baseline is gaslighting as there’s no such thing as a baseline
Telling a patient they will improve when they do x,y,z is gaslighting because they probably can’t do x y z and even if they do they aren’t guaranteed any improvement.

But why do we need the word gaslighting for these - which are clear enough in their own right.
The original example of gaslighting in the film seems to have precious little to do with any of this.

 

[Eleanor]

The problem with the phrase 'medical gaslighting' is that 'gaslighting' has a specific meaning: the gaslighter is trying to persuade the other person to believe something they themselves know to be untrue. In the film, the perpetrator was trying to make the victim believe she was going mad so that he could achieve his own ends, not because he himself believed she was mad. If you're trying to convince a person to come around to what you yourself believe to be the correct and realistic understanding of a situation, that isn't gaslighting, it's just persuasion.

 

[MrMagoo]

But why do we need the word gaslighting for these - which are clear enough in their own right.
The original example of gaslighting in the film seems to have precious little to do with any of this.

Gaslighting is clear in the general vernacular, it’s a cultural touchstone, a meme.
We don’t need to say something is “67” but we do.

 

[Eleanor]

I think it's an important distinction because "gaslighting" is a dead-end accusation. "Doctors should stop gaslighting patients!" - doctors reply: "We aren't doing that, we're trying to help." Whereas "Doctors need to keep their professional knowledge up to date so that they don't inadvertently harm patients by promoting out-of-date beliefs" is a criticism that contains an achievable goal of improvement and might at least prod a few of them to think, hmmm, perhaps I should just check whether I am completely up to date.

 

[V.R.T.]

If you're trying to convince a person to come around to what you yourself believe to be the correct and realistic understanding of a situation, that isn't gaslighting, it's just persuasion.

I understand this hesitance, but I feel that in many cases of medical gaslighting the doctor is either saying whatever will get them out of the office quick enough, or convincing them in a framework like functional or mind body that is not the framework they use in their interactions with colleagues, where they are much more dualist. They gaslight you into accepting a framework of your symptoms that will make you do what they want. It isn't necessarily what they believe.

 

[MrMagoo]

I think it's an important distinction because "gaslighting" is a dead-end accusation. "Doctors should stop gaslighting patients!" - doctors reply: "We aren't doing that, we're trying to help." Whereas "Doctors need to keep their professional knowledge up to date so that they don't inadvertently harm patients by promoting out-of-date beliefs" is a criticism that contains an achievable goal of improvement and might at least prod a few of them to think, hmmm, perhaps I should just check whether I am completely up to date.

The wording used won’t affect the outcome.

And patients have a right to describe the abuse in any words they wish.

And patients already do a lot of bending and twisting themselves, their words, their presentation, so as not to upset the Dr and maybe be treated.

If you don’t like the term, don’t use it. But other people will.

 

[Nightsong]

Not sure this framing is particularly helpful:

The term “contested condition” is typically used to refer to diseases like fibromyalgia, postural orthostatic tachycardia syndrome (POTS), chronic fatigue syndrome (CFS), or multiple chemical sensitivity (MCS), for example, which predominantly affect women. Historically, physicians have perceived women to have more emotional lability, more complaints due to emotional factors, and more psychosomatic illnesses than men (Unruh 1996).

Women with POTS, for example, are more likely to be told that their symptoms are “all in their head” (Waterman et al 2023) and 77% of patients with POTS report a physician suggesting their symptoms were due to a psychiatric disorder despite only 28% of patients having a legitimate psychiatric disorder that preceded their diagnosis of POTS (Shaw et. al, 2019).

And then there's this:

There is also the proverbial elephant in the room: the provider, the other half of the interaction. Primarily, patients’ perspectives are presented in literature about medical gaslighting. There is some input from healthcare professionals, but many of them have familiarity with the concept and speak about it in the context of patient advocacy.

Perhaps there is a lack of provider input due to the risk of appearing overly defensive - moreover, reflecting on the experience requires admitting that you have “done” it, which many providers may avoid out of shame or outright denial. However, it is important to note that across literature, medical gaslighting is largely described as an unintentional act (Brennan 2020; Bhatia 2021; Thune-Boyle 2021).

So close, yet so far.

 

[hallmarkOvME]

The patient’s right to refuse any medical treatment without it negatively impacting the other medical care they receive...,

I agree as long was we stipulate that is the patient who ultimately decides when impact is negative.

It is the doctor’s duty to make the best recommendations they can based on their knowledge and experience. That is the social contract we’ve entered into with them - they have to act in our best interest from a medical perspective. That will to some extent include disagreeing with the patient about what they think they need.

I agree as long we stipulate that (1) the patient agrees and understands the social contract had been entered and what it constitutes, and (2) the patient's knowledge, experience and decision, supersede any interpretation of what the "medical" perspective in interpreted to be.

If you want to drink bleach you are usually allowed to drink bleach. But a doctor should not recommend or approve of you doing it just because that is what you want.

Yes. The doctor has a right to protest, and would of course be malfeasant to recommend drinking anything known to be harmful.

 

[hallmarkOvME]

I still find the use of the term 'gaslighting' in the context of ME/CFS too vague, polysemic and confusing to be of any use. Why not stick to plain English such as 'the doctor doesn't believe the patient'. All the stuff about having to understand the patient's reality seems to me in practice an even worse paternalism than we already have - based on a mish-mash of ivory tower academic philosophising and debased Freudian psychodynamics.

The one thing we do know about ME/CFS care is that the people who go in for this sort of psychodynamic approach have failed totally to provide any benefit yet still insist on treating people. The more down to earth lot at least admit they have nothing to offer.

I agree with every word of that. But I've never been gaslit for ME/CFS. I've only been gaslit for chronic pain, hEDS, and MCAS.

However, the topic of the the OP (if I've understood it accurately), as the title of the publication it's about, involves the use of gaslighting n the gray (as opposed to formal) literature.

Moreover, the gaslighting I'm most familiar with comes from my sick cohorts' descriptions, not ivory towers or neo-Freudians (per se).

 

[V.R.T.]

I still find the use of the term 'gaslighting' in the context of ME/CFS too vague, polysemic and confusing to be of any use. Why not stick to plain English such as 'the doctor doesn't believe the patient'.

Because that doesn't encapsulate the experience of having your doctor use underhanded and manipulative language and techniques in order to trick you into accepting a bogus psychobehavioural/biopsychosocial framework of your illness, one that they don't necessarily believe themselves (doctors being more bluntly like 'this is a mental illness' about ME/CFS when they talk to each other).

They do this in order to convince you to behave in a certain way - do GET or stop coming to see them or whatever. It is manipulative in the extreme and goes far beyond simple disbelief.