Why are nurses indifferent to the phenomenon of gaslighting of patients in medical systems?

Abstract

Gaslighting in medical systems refers to the mistreatment patients experience when their concerns are minimized, doubted, questioned, second-guessed, or outright denied by clinicians (Agarwal, 2023). A common example is when clinicians dismiss a patient's symptoms by attributing them solely to stress, poor nutrition, mental health, obesity, or lack of exercise. Such patients may feel that their health concerns have been unjustifiably dismissed and that the clinician, appearing unable to hear their claims, denies them the status of a patient, categorizing them as "just plain crazy" (Sebring, 2021).Despite frequent references to gaslighting of patients in the media, there are few scholarly articles on this topic in academic journals (Caron, 2022;Rubin, 2020). | GASLIGHTING IN MEDICAL SYSTEMSDiseases in which gaslighting has been described include inflammatory bowel disease (Actis et al., 2019), endometriosis (Hudson, 2022), peptic ulcers (Radomski et al., 2021), long COVID (Au et al., 2022, chronic liver disease, and Lyme disease (Baarsma et al., 2022;Dumes, 2020). Refusal to order imaging or lab work, or dismissing the results of blood tests, may contribute to the gaslighting of patients (Durbhakula & Fortin, 2023;Fagen et al., 2023).Being forced to doubt things over which one ought to have firstperson authority can disempower the patient and give rise to selfdoubt and self-distrust (Barnes, 2023;Sweet, 2019). Epistemic gaslighting, as opposed to manipulative gaslighting, can occur when the gaslit are weaker than the perpetrator, causing them to doubt their own epistemic capacity in a way that belittles and degrades them (Sweet, 2019). Importantly, gaslighting of patients by clinicians may occur without intentionality from the clinicians, if the patient is driven to doubt their interpretive abilities in a way that is causally related to systematic epistemic injustice, a process that increases vulnerability to such doubts (Sebring, 2021). | WHAT ARE THE RAMIFICATIONS OF GASLIGHTING OF PATIENTS?Long-term effects of gaslighting include anxiety, depression, PTSD symptoms, and trauma (Merone et al., 2022). This creates a vicious cycle as psychological symptoms can exacerbate physical symptoms.Clinicians who suggest, either directly or indirectly, that patients' physical pain is attributable to psychological issues (e.g., somatic symptom disorder or anxiety) may cause or exacerbate those very issues. In addition to diagnostic difficulties and feelings of being dismissed, gaslighting causes patients to feel stigma, prejudice, shame, and blame, and to develop a fear of seeking clinical help due to concerns about reactions to their past and present medical issues (Merone et al., 2022). Gaslighting occurs following communication in dyadic interactions connecting ethical, psychological, and sociological perspectives. | THE STATE OF THE ARTResearch on gaslighting in medical systems has primarily adopted psychological and sociological perspectives. Approximately 15 academic articles have examined gaslighting in the context o...