Supporting Clients Through Medical Gaslighting

Supporting Clients Through Medical Gaslighting

Since the post-pandemic explosion in post-viral and related diseases, the burden of this crisis has expanded far beyond patients and their immediate family members, many of whom are forced to operate as full-time, hospital-level caregivers. The failure to medically treat millions of sufferers, alongside the active harm done to untold numbers due to contraindicated treatments, has pushed the responsibility onto those outside the institutions designed to care for them. This of course includes the many mental health professionals, therapists and counsellors who are now tasked with managing the psychological fallout of this phenomenon.

1. The Mechanics of Medical Gaslighting

Despite the latest scientific research confirming the biomedical reality of conditions such as long COVID, ME and post-viral dysautonomia, the NHS and policymakers are lagging far behind the data. Whilst some oversubscribed private healthcare providers are starting to roll out experimental, research-based treatment programmes, public health bodies are still frequently adopting behavioural and psychiatric explanations (Action for ME released a report on this in 2025 – link opens a PDF). This is despite diseases like ME having claimed the lives of young women such as Maeve Boothby O’Neill and Sophia Mirza, the latter of whom was even sectioned before her death, which significantly aggravated her disease.

With female-to-male ratios of between 3:1 and 5:1 where these illnesses are concerned, many patients report serious and repeated instances of medical gaslighting. The gender-based predisposition and historical stigmatisation, combined with a lack of established biomarkers, make this cohort a tinderbox to the flame of disbelief.

Systemic issue: not an individual patient problem

It is crucial for those working with patients to understand that this gaslighting is not limited to individual, poorly informed, or dismissive clinicians; rather, it is systemic. Many patients will present with very real and frightening symptoms, such as post-exertional malaise (PEM), in which the body goes into a flu-like, energy-depleted state that many describe as feeling poisoned. Over time, this can leave some patients so severely unwell that they are no longer able to tolerate oral hydration and nutrition, requiring an ICU-style setup for basic function.

Furthermore, there will be those presenting with debilitating cardiovascular abnormalities, such as sudden and unexplained tachycardia, palpitations, adrenaline surges, blood pooling in their extremities and even loss of consciousness.

However, because these patients will often receive normal routine test results, they are frequently told they are simply anxious, unfit, or overly health-conscious. It is important to understand that objective physiological abnormalities—such as small-fiber neuropathy, low blood volume, hyperadrenergic surges, neuroinflammation, profound metabolic and mitochondrial dysfunction and the failure of blood vessels to constrict—do not show up in basic screening panels. This is not because they are absent, but because standard resting tests are simply not designed to detect these issues.

In an ideal world, these patients would then be sent to specialists to get tests that do detect these abnormalities. However, no such specialists, nor cost-effective and reliable diagnostic tests, yet exist on the NHS for these conditions. For the few who do manage to get a referral, they will likely be discharged or have their referrals rejected before they ever step foot in a clinic.

Personal example of medical gaslighting

In my own experience, a critical, two-month-long blood volume crisis was dismissed as ‘panic’ by NHS cardiology within five minutes of a remote phone call, despite me being so severely unwell I couldn’t even sit up long enough to travel to the hospital. I was forced to withdraw from further referrals due to the genuine danger of the NHS further psychologising my condition, a systemic failure that directly contributed to my catastrophic physical collapse in the summer of 2025.

Many patients referred to neurology are given functional or psychosomatic diagnoses, leaving these vulnerable, severely unwell individuals carrying the crushing guilt that they have somehow brought this on themselves. Not only is this psychologically damaging, it is physically dangerous.

For those who never get that far, 10-minute, one-symptom primary care appointments will likely see the patient discharged without any diagnosis, validation, or meaningful plan. I can only imagine the intense self-doubt patients must experience now that ‘COVID fatigue’ has seemingly infiltrated the whole of our society.

For many, simply giving up on getting medical help is not an option. Employers require information regarding absences and any sickness-related welfare payments require NHS support. Sufferers therefore find themselves repeatedly psychologised, behaviouralised and sometimes outright neglected, until their nervous systems naturally adapt to seeing healthcare professionals as a threat – particularly if disbelief has directly worsened their condition through poor, behavioural advice.

Forced to research for oneself

Many of us end up needing to conduct our own research for safe disease management in the absence of medical treatment. I maintain that an AI search performed by my partner during my acute crisis saved my life, as it resulted in me obtaining a drug privately that eventually restored bodily function. This was refused by the NHS, but a search helped guide my private care. However, this “Google doctor” behaviour is very much frowned upon, with those having the audacity to research a condition their GP may not even have heard of finding that it reinforces health anxiety explanations. The fact they had no other choice is rarely taken into consideration.

Finally, it is imperative for anyone involved in patient care within our community to understand that certain physical symptoms and presentations can resemble panic or avoidance to the untrained eye. Severe, unrelenting tachycardia with some attending A&E with heart rates of over 200 that will not alleviate can look like anxiety in a 5-minute appointment. The fact this may have been going on for 12 hours and is accompanied by other severe symptoms is often overlooked.

Anyone in that level of cardiac distress would be presenting as anxious; however, this is secondary to the physical cause, which is the underlying disease. Similarly, those who may be accused of participating in “avoidance” are likely learning to stave off disease progression as much as possible by avoiding repeated states of severe PEM, which over time lower baseline function.

2. Psychological Themes & Systemic Trauma

Aside from the obvious psychological impact of decreased or absent independence, an unrecognisable life, crushed dreams and guilt surrounding becoming a burden, the systemic gaslighting faced by patients in this community brings additional complexities to the forefront.

Power imbalance during medical interactions

One of the primary drivers of this harm is the sheer power imbalance between doctor and patient. We live in a culture that reveres NHS staff as heroes. When those same doctors dismiss, mistreat, or harm patients, it is deeply isolating. The patient has little to no power, whilst the individual doctor in front of them holds complete control over their life, safety and physical survival. Challenging them or acting in a way the doctor deems unfavourable, such as by researching their own illness in the absence of care, risks total medical abandonment or even dangerous advice.

This leaves severely ill patients at the complete mercy of one powerful person, who far too often within our community does not validate or correctly diagnose the patient. Others internalise the mistreatment, blaming themselves for coming across as “anxious” or somehow causing their own misdiagnosis and dismissal. Both suffer a total lack of control, often over many years, leading to the associated psychological damage you would expect in similar dynamics.

Impact of gaslighting on multiple fronts

Then, of course, there are the psychological repercussions of relentless institutional gaslighting. From the DWP ignoring the reality of PEM during assessments, to doctors dismissing life-threatening presentations as mere panic, the mental damage inflicted on patients cannot be underestimated.

Many of the symptoms experienced are objectively frightening and debilitating and attempting to ignore them is a guaranteed recipe for their aggravation. Rather than being encouraged to “listen to our bodies”—as we are so often told to do—patients are actively pushed to do the exact opposite. Inevitably, this makes things worse, trapping the patient in a cycle of fear and self-blame.

Grief and the burden of extreme self-reliance

Beyond the direct psychological harm of clinical gaslighting lies the profound weight of grief and the burden of extreme self-reliance. Denied the validation, accommodations and societal support granted to other severe conditions, patients mourn their lost futures in isolation. This isolation is often compounded by friends and family who lack understanding of post-viral syndromes, placing the added burden of constant education on the patient. At the same time, when safety-net institutions fail, patients are left to navigate a complex medical landscape entirely on their own, carrying the exhausting responsibility of managing their own survival despite crippling disability.

Ultimately, the culmination of this systemic abandonment and psychologisation can lead to severe medical trauma and PTSD-adjacent symptoms. However, patients are seldom comfortable seeking help for this trauma, fearing it will give the clinicians who initially labelled them as hysterical a reason to validate that theory.

Personal insight into PTSD as a result of medical gaslighting

In the interests of providing a case study, I will use my own personal experience to illustrate how this type of PTSD can manifest. During the crisis I mentioned earlier, standard pulse oximeter readings showed normal oxygen levels, completely failing to capture the severe blood pooling and drastically low blood volume that prevented oxygenated blood from reaching my major organs. Because of this, my resulting spasms, seizure-like convulsions and the shutdown of major bodily functions were dismissed as panic and care was refused. This refusal was repeated, with increasing hostility towards me with every attempt to access help.

This experience has forced me to accept that emergency services are effectively inaccessible to me. Should another acute episode strike, there is a reasonable chance that I could die in my home. Having nearly lost my life during that last collapse, I was left with severe functional decline, meaning I am deeply ill-equipped to survive a repeat. Now, during severe episodes, traumatic flashbacks compound the physical distress, while the realisation that I cannot call for emergency help escalates autonomic cascades. This is almost always followed by a mournful period of grieving, questioning why I am not deemed worthy of being saved.

Understanding by therapists

A therapist does not need to understand the medical mechanics of every client’s physical illness; that’s not their job. However, understanding the additional burdens that they carry trying to access basic medical care is essential.

The next article in this two-part series will look at legal rights that patients have. It will explore how they can be used for the best chance of obtaining meaningful care within the current system.

Thank you to Daniel Dalea on Unsplash for the photo at the top of this page.