Mental Difference and Medical Gaslighting

Two years ago, I collapsed and was taken by ambulance to the hospital, for the first time in my life. My throat had closed. I crashed onto the floor of my bedroom, barely able to speak and unable to move.

My husband called 911. I took that surreal flashing-lights-and-hands-all-over-you ride to the emergency room. And I got gaslighted.

I’d had two previous but milder episodes of my throat closing. The first happened the night after Thanksgiving. As we head into the holidays, a time when medical problems flare, it’s a good time to think about managing health care, especially in acute settings.

Two excellent columns here in Psychology Today describe medical gaslighting—when doctors ignore patients’ reports of their symptoms, dismissing and even disparaging them. As when doctors write off serious symptoms as just “psychological.”

Patients who actually have a psychiatric diagnosis—especially a “major” one like mine, bipolar—are even likelier to be dismissed. Such a diagnosis can be all doctors see, especially in acute care. As the diagnosis “overshadows” all other health concerns, the problem is called diagnostic overshadowing. It’s a pernicious form of gaslighting.

That night I had a weak pulse and poor vital signs. A doctor appeared at my ER cubby and asked me to lift a finger up to his. I couldn’t. He held his finger a few feet above my chest. In my mind, I told my finger to move, but it just fluttered and dropped. The doctor was masked but I could see his brows meet in irritation. He huffed out of the room.

I found out later the doctor left to chase down my husband, saying, “Your wife is refusing to cooperate.” Bruce told the doctor that I couldn’t move. The doctor just repeated that I could move if I wanted to. I’m not sure what shocks me the most: that the doctor thought I would fake paralysis or that he felt my husband needed to hear this. As if my spouse were my nanny, and the doctor felt I needed a good scolding.

You don’t drink enough water, a nurse said as she pinched my skin and diagnosed dehydration.

I answered that I drink about one to two quarts a day. She insisted I must not realize I don’t drink water. When I got home, I was still so dehydrated I had to plaster huge bandages across my cheeks. The thinned skin flamed when my cheeks touched the pillow. I still don’t know why.

Gaslighting often refers to personal relationships. But medical responses are personal, in some ways as personal as it gets. When they’re biased, they damage—emotionally and physically. Doctors and nurses are at least as biased about psychiatric diagnoses as the general population. Some studies say more.

That doctor and nurse filled me with shame and guilt. Had I turned into a person who could think herself into collapse? Had I put my spouse through the trauma of seeing me sink to the floor because I’m delusional? In this case, the person closest to me got gaslighted, too.

My bipolar diagnosis may not be why I was treated this way. It’s just very probable that it is. My medical records include the facts that I’ve never been in an ambulance before and am hardly a hypochondriac—more someone who walks around, as I once did, on a badly injured knee without paying attention. These aspects of my medical history indeed seemed to get overshadowed.

Medical studies find diagnostic overshadowing affects treatment in a range of issues, from cardiac care to diabetes to pain management. One factor is suspicion that patients are inventing symptoms or are too unreliable to understand what is happening in their bodies.

Some doctors also buy into the myth that patients like me won’t be compliant. So they write fewer prescriptions and schedule fewer follow-up tests. People who have a serious mental diagnosis die on average one to three decades earlier than those who don’t have one. These can be deadly choices.

Gaslighting Essential Reads

A New Questionnaire Measures Gaslighting Victimization

Surviving Gaslighting Relationships: 6 Core Themes

I’ve talked to Patrick Corrigan, who runs national programs to help fight psychiatric bias in medicine, about the problem of overshadowing. As he puts it, doctors are “trained to talk to the diagnosis and not the person." And they over-rely on the “pigeon-holing” diagnostic system of psychiatry’s guidebook, the Diagnostic and Statistical Manual of Mental Disorders. Peer advocates, Patrick tells me, can be very helpful in guiding patients with diagnoses through medical treatment.

I’d suggest alerting family members, who might have to speak for you, that overshadowing is a very real problem. Get doctors to explain why they’re coming to the conclusions they are—make sure these conclusions are based on facts, not assumptions. If you’re the one with a diagnosis, never accept a result that doesn’t clearly acknowledge all your symptoms. Ask to see someone else. I was finally stabilized by a different, very kind doctor.

Stigma means to be pierced, a metaphor for being marked in the eyes of others by a condition of your life. It’s harder to do when the point is not so sharp. Stigma reduction in medicine is good work. But appreciation of neurodiversity, of different mindways, is essential too. I balk at the common antistigma talking points that the diagnosed are “people like you” or “could be your loved one.”

I don’t need to be like anyone or their loved ones to have value. The truth is I’m statistically unlikely to be like most people I meet or their family members. That doesn’t matter. I’m still a human being in a body, a body I know. A person who doesn’t get this harbors distortions more profound than any they might imagine in me.