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

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). Diseases 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 first-person authority can disempower the patient and give rise to self-doubt 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). 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. Research on gaslighting in medical systems has primarily adopted psychological and sociological perspectives. Approximately 15 academic articles have examined gaslighting in the context of structural racism and gender discrimination, concluding that women and people of color are the most likely targets of gaslighting (Sebring, 2021). Research on gaslighting in medical systems from an ethics perspective is scarce. The scarcity of research on gaslighting from an ethical perspective suggests that this area has not been a focus for medical ethicists and researchers. This gap in the literature means that ethical discussions about gaslighting in practice are limited. How is it that there is no scholarly research on the topic of gaslighting and nursing ethics? Are nurses indifferent to the ethical faults encapsulated in the phenomenon of gaslighting of patients? This indifference could stem from several factors. (a). Nurses may not be adequately trained to recognize gaslighting or its ethical implications. Without proper education on this issue, they might not identify their actions or those of their colleagues as gaslighting. (b). Medical systems may prioritize efficiency over patient-centered care, leading to an environment where gaslighting is more likely to occur. (c). Nurses, often overworked and under-resourced, might unintentionally contribute to this problem. (d). Cultural norms and biases within the medical profession can influence how patients are perceived and treated. Nurses, like other healthcare professionals, can be influenced by these biases, leading to unintentional gaslighting. Nursing ethics has been discussed in the literature since the 1880s and predates the rise of the field of biomedical ethics (Fowler, 2017, 2020, 2024). Nursing ethics focuses on the individual ethical dilemmas that arise from the therapeutic alliance between a nurse and a patient (Doane et al., 2009; Pilkington & Giuliante, 2023). Given the proliferation of interest in gaslighting over the last 5 years in other disciplines, it is surprising that there are no ethical inquiries that relate to the gaslighting of patients in the dyadic nurse–patient communication (Shane et al., 2022). In an optimal nurse–patient dyad, the relationship is characterized by values of care such as compassion, empathy, and active listening, facilitating relational autonomy. Compassion and respect for the dignity of every patient are guiding principles based on which nurse–patient relationships are established. Nurses practice with compassion and respect for the inherent dignity, self-worth, and unique attributes of every person (Gallagher, 2007). Consequently, they must maintain a high level of respect and preserve dignity in patient–nurse communication as well (Haddad & Geiger, 2018). Furthermore, the patient-centered care approach places an increasing emphasis on the relationships nurses have with patients (Pilkington & Giuliante, 2023). The capacity of nurses to convey patients' concerns, values, and preferences sharply and accurately is at the core of implementing patient-centeredness in practice, acting as patient advocates (Byrne et al., 2024). Since core tenets of nursing practice involve the ability of nurses to establish enduring therapeutic relationships with patients and their families through respect and dignity, it is surprising that nurses appear unconcerned about patient experiences of gaslighting. Nurses often operate in a mode of “Doing,” focused on completing tasks and achieving goals in a chaotic work environment. Shifting to a mode of “Being,” which involves reflecting on their attitudes and seeing each patient as an individual, can be challenging (Segal, 2022). This shift is crucial for addressing gaslighting but may be difficult for busy nurses (Fink, 2020). Nursing ethics emphasizes relationships and requires shifting between modes. Nurses provide care at the patient's bedside and advocate for patients while establishing meaningful, trustworthy connections. Ignoring or gaslighting patients breaches the core professional values of nursing, jeopardizing relational autonomy and invalidating the fundamental role of nursing advocacy (Ibrahim, 2024). While nurses have clinical expertise, patients possess their own expertise as authorities of their own bodies. When nurses disregard patient experiences or question their sense of reality, they undermine the patient's power, a fundamental feature of gaslighting (Barnes, 2023). Speaking out to safeguard patients is a crucial ethical and moral obligation for nurses (Laari & Duma, 2023). Gaslighting patients may be an unacknowledged barrier to fulfilling this moral obligation, constituting a moral wrongdoing. Therefore, nurses must actively participate in formal ethical decisions, mediation, and interventions. Gaslighting of patients contradicts the ethics of care and expropriates relational autonomy. It poses a public health threat, as it may go underrealized, underreported, and underaddressed. Gaslighting also damages patient trust in nurses, which is essential for higher adherence, self-management of illness, and utilization of health services. Invalidating nursing advocacy by gaslighting patients may breach public trust in the nursing profession. As patients' advocates, nurses must be aware of the potential occurrence of gaslighting by nurses, physicians, and other providers. They must listen attentively to patients' concerns and complaints and protect them from the hazards of gaslighting. This integral connection between nursing challenges, ethical dilemmas, obligations, and actions (Doane et al., 2009) may facilitate the shift between the tracks of “doing” and “being” and reduce the gaslighting of patients. Gaslighting of patients by nurses can be eradicated if nurses observe the ethical complexity of their practice and are inspired by nurse ethicists who apply ethical theories and concepts in practice (Doane et al., 2009; Morley et al., 2023). Patients need to feel heard, understood, and cared for, so they do not feel gaslit. Moving to a ‘being’ mode and carrying out proper dialogue will more likely enable nurses to listen and provide compassionate and responsible care. We encourage nurses to cultivate their sensitivity to situations indicative of gaslighting, treating patients as authorities of their own experiences and self-governing agents. Nurses should foster an environment that enables patients to express their experiences without fear of disbelief. By going back to basics and practicing constructive listening, empathy, compassion, and accountability, nurses can validate patients' experiences and reclaim their trust. Take your blindfolds off and speak up! There is no funding for this commentary. The authors declare no conflicts of interest. There is no data for this commentary.