Opinion: Here’s why #MedicalGaslighting has taken social media by storm

Editor’s note: Diane O’Leary is a philosopher of medicine and a 2023 Public Voices Fellow on Advancing the Rights of Women and Girls with the OpEd Project and Equality Now. The views expressed in this commentary are her own. View more opinion at CNN.

Frustration over medical gaslighting is heating up again, with more than 262 million views for #medicalgaslighting on TikTok. What we see in this stream of thousands of posts on social media are firsthand stories from patients, mostly women, who say doctors have ignored, minimized or dismissed their symptoms as stress or anxiety, often with severe consequences.

The metaphor of gaslighting arises from a 1944 film by that name, where a husband, Charles Boyer, sets out to convince his wife, Ingrid Bergman, that she can’t trust her own thoughts and experiences. In medicine, the term applies when doctors proceed as if patients’ reports of pain or disability are not credible enough to warrant action —but the stakes are far higher than they were for Bergman in the film. In the thousands of stories shared in the recent viral trend, patients report that their perspectives on the situation were indeed credible, and doctors’ failure to respect that led to medical harm.

We’ve been here before. In 2018, the “incendiary healthcare hashtag” of #doctorsaredickheads, gathered so many gaslighting stories so quickly on Twitter that an analysis of its data seemed to suggest that women patients were ready to storm the metaphorical gates of the medical profession. It seemed that we might actually be on the cusp of change, as a long list of new journalistic memoirs on the issue were then published — one, “The Invisible Kingdom,” a bestseller. But here we are, five years after that social media storm, measuring the size of public frustration once again, as if the idea of medical gaslighting is brand new.

Aside from likes, clicks and ad sales, these cycles of public frustration have had no systemic impact. We still don’t have a scientific study that determines how often women face this problem. In fact, according to the National Library of Health, a search for “medical gaslighting” yields only four articles related to patients’ health care experiences in the National Institutes of Health’s PubMed database.

Neither the American Medical Association nor the National Institutes of Health has a program to address, or even understand the nature of the problem, and neither do leading medical centers such as Johns Hopkins or the Mayo Clinic. And though gender equity is a common theme now in medical and governmental health organizations, it centers on women’s obstacles getting to the doctor, not the obstacles we face once we’re there.

What’s the problem here? Why has this intense public dissatisfaction with medicine failed to generate action?

The trouble is, first, the buzzword. Strictly speaking, gaslighting is a psychological issue — the emotional harm that occurs when a credible voice is discredited to the point of self-doubt. In an article in the Journal of General Internal Medicine, for example, two doctors respond to the recent social media storm by dismissing medical gaslighting as a mere “perception,” one that will disappear if physicians present their decision to ignore symptoms with an optimal tone of voice. This response is not surprising.

As long as we define medical gaslighting in purely psychological terms, it will be reasonable for medicine to respond with psychological remedies. In reality, though, psychological harms are the least of our worries. It’s damn unpleasant to be manipulated by your doctor in this uniquely demeaning way, but that’s nothing compared with the harm that comes from untreated disease.

The real takeaway from the massive stream of books, articles and stories that have emerged on this issue in the last five years should be this: Medical gaslighting can kill women and girls. Recent research suggests that when the ambulance arrives in a cardiac emergency, women are less likely to get appropriate care, and when we arrive at the hospital with chest pain, we’re less likely to be classified as an emergency, to be given an electrocardiogram or to be admitted. And though it’s well-known that heart disease is the No. 1 killer of women, studies suggest that we’re less likely to be prescribed key cardiac medications and twice as likely to have our cardiac symptoms attributed to mental illness.

Medical gaslighting is about women with strokes whose brain-saving emergency care is blocked or delayed more often than men’s, and the girls with acute appendicitis — such as Jake Tapper’s daughter, Alice —who face misdiagnosis, untreated pain, surgical delay and life-threatening risk more often than boys. It’s the 17% of women — 28 million of us, according to data from the US Census Bureau and the National Center for Health Statistics — who’ve suffered from long Covid, struggling with doctors’ preference for psychological explanation over scientific findings, and the 10 million women who bore the excruciating pain of endometriosis for an average of 10 years before diagnosis made relief possible.

Medical gaslighting obstructs women’s health care in every area of medicine. It is deadly. It destroys women’s quality of life, and it diminishes women’s ability to participate in the world.

Second, the consensus from all the public frustration seems to be that medical gaslighting is primarily the product of doctors’ personal gender bias, a manifestation of cultural bias against women that will not have specific medical solutions. Medical textbooks and recommendations, though, tell a very different story.

When it comes to the most common form of psychosomatic diagnosis, “somatic symptom disorders,” Medscape and American Family Physician tell doctors to expect that they’ll see 10 females with the disorder for every one male. The fact is that doctors attribute predominantly women’s symptoms to their psyches because they’re explicitly trained to do so and do so often.

Third, even the angriest follower of social media’s medical gaslighting movement will tell you that medicine rejected the idea of “female hysteria” decades ago, so at least doctors know better than to rely on that sexist, and dangerous, Victorian approach. But the construct of female hysteria was actually not abandoned. On the contrary, as one leading textbook puts it, “hysteria was renamed by committee, and now masquerades under such terms as somatoform disorder,” or, more recently, “somatic symptom disorder” or “functional neurological disorder.” As far as current leaders in psychiatry are concerned, “it was not hysteria that disappeared, but rather medical interest in hysteria.”

In short, the medical gaslighting movement has failed to have an impact because it draws our attention to psychological harm, downplaying the deadly, life-destroying reality of this problem. More than that, it proceeds as if medical training could not possibly encourage doctors to attribute women’s symptoms to their psyches as a matter of routine — but it does, unequivocally.

It’s not surprising that doctors have been led to believe that psychosomatic symptoms are predominantly a women’s health problem. There are probably thousands of studies that confirm a sharp gender imbalance in diagnosis of this kind. The trouble is, of course, that doctors have been trained since antiquity to diagnose far more women than men with psychosomatic symptoms, so studies of this kind only tell us that doctors do what they’re trained to do.

Scientifically speaking, there’s no reason at all to trust that this training has been wise — and the overwhelming statistics on women’s difficulty accessing medical care are more than enough to establish that it’s been a long, grave error.

It is certainly a good thing that with the term “medical gaslighting” we’ve finally named medicine’s gender problem — but it’s time to get clear about the seriousness of this form of gender bias. This is not about women’s hurt feelings. This is about gratuitous death and suffering on the basis of gender. There is more than enough evidence of the brutality of this problem, and more than enough evidence that it’s caused by explicit medical training. When we see medical gaslighting in this light, it is instantly obvious that medicine has an urgent duty to address it.