Research Spotlight: A Narrative Review of Medical Gaslighting

Alexandra Fuss, PhD, Director of Behavioral Medicine in Inflammatory Bowel Disease at Massachusetts General Hospital’s Crohn’s Colitis Center, and an Instructor in Psychology in the Department of Psychiatry at Harvard Medical School, is lead author of a new review in Translational Gastroenterology and Hepatology, We Didn’t Start the Fire…Or Did We? A Narrative Review of Medical Gaslighting and Introduction to Medical Invalidation.

What Question Were You Investigating?

Our review aimed to open discussion around the concept of medical gaslighting within the practice of gastroenterology. We aimed to provide a starting point for future research into how gaslighting may present itself, what contributes to its occurrence and how to mitigate its impacts while considering the perspectives of both patients and providers.

What Were Your Findings?

Through our review of the literature, we found overall that medical gaslighting can be defined as instances of gaslighting behavior taking place between providers/professionals, patients, medical organizations or groups, and healthcare entities such as hospitals.

Although medical gaslighting is often the most talked about among patients to describe experiences with providers, we point out that this phenomenon can also occur at the systemic level, where it impacts providers.

Within the gaslighting literature the role of intent is hotly contested, with some authors maintaining that gaslighting is truly defined by the impact on the recipient, while others maintain that intent must be present for gaslighting to occur.

Alexandra Fuss, PhD

We proposed the use of a new term, medical invalidation, for instances in which gaslighting behaviors take place without the intent to gaslight or even with well-meaning intentions.

By distinguishing between the presence of intent there are then opportunities to hold accountability, act towards prevention, and engage in relationship repair.

Based on the literature we created a model that helps to illustrate the breakdown of contributors to medical gaslighting and medical invalidation.

At the top of the system are the insurance coverage organizations, administration and the organization the patients and providers fall within. These place pressures on patients that may influence their behaviors such as needing specific diagnoses to attain coverage, barriers to care and a lack of timely care.

Additionally, these place pressures on providers which contribute to provider burnout such as increased time spent in the electronic medical record, lack of autonomy, and lack of support. Between the patients and providers within the system there is an inherent power differential in which providers are in the position of power.

Within the patient-provider relationship providers hold the expertise and competence in the etiology of suffering, patients hold the expertise and competence in the experience of suffering and the seriousness of suffering is shared by both.

When a patient or provider attempts to take ownership of the expertise and competence held by the other; for example when patients make demands for specific diagnoses or treatments or when providers discount patients’ subjective reports that is when medical gaslighting or medical invalidation can occur.

Because medical gaslighting/invalidation can involve numerous factors involving patients, providers, the medical system and broader culture there may be no way to completely prevent these experiences entirely, however there are strategies that can reduce the risk of their occurrence.

These include believing patients, using thoughtful communication about the brain-gut axis, building trust, collaborating with the treatment team, providing patients with opportunities ask questions and clarify concerns and reducing the burden on providers through advocacy and systemic change.

What are the Implications and Next Steps?

Through defining the term medical gaslighting and proposing the term medical invalidation opportunities for prevention and repair become apparent. By looking at the contributors to medical gaslighting and medical invalidation from a systemic persective we can see opportunities for prevention, and repair which ultimately have a positive impact for all who are operating within the medical system.

Studies assessing medical gaslighting in gastroenterology care are non-existant and thus future studies are critically needed.

Funding:

None.

Paper Cited

Fuss, A., Jagielski, C. H., & Taft, T. (2024). We didn't start the fire…or did we?-a narrative review of medical gaslighting and introduction to medical invalidation. Translational gastroenterology and hepatology, 9, 73. https://doi.org/10.21037/tgh-24-26