Medical Gaslighting

In 1996, I was trained to treat chronic fatigue syndrome as a psychiatric illness.

That’s not a criticism of my professors. That’s what the field believed.

Women came in exhausted, in pain, unable to function, and we gave them antidepressants. Prozac. Cymbalta. And here’s the thing… some of them got better. Which, at the time, felt like confirmation: Of course it’s a psychiatric problem. They responded to psychiatric medications.

What it actually confirmed was that we didn’t understand the mechanism. We’d found something that moved the numbers and called it understanding. And so we gaslit them. “It’s all in your head” was the clinical conclusion, delivered with the full authority of a physician who believed it.

In the previous article, I wrote about blind spots: beliefs the system holds as correct, defends as correct, and sometimes punishes people for contradicting. Those are failures at the level of knowledge. What I want to talk about here is more troubling. It’s what happens when medicine encounters a condition it can’t explain and instead of holding that uncertainty, redirects it onto the patient.

There’s a name for that pattern. And if you’ve spent enough time in the healthcare system, you’ve probably experienced it firsthand.

---

What Medical Gaslighting Actually Is

The word “gaslighting” gets used loosely. It means making someone doubt their own perception of reality. In the context of medicine, it doesn’t usually look like manipulation. It looks like care.

It looks like a doctor who orders the standard tests, finds nothing remarkable, and tells a patient their symptoms are probably stress-related. It looks like a prescription for an antidepressant when the presenting complaint was physical. It looks like being referred to a psychiatrist when you came in with fatigue, pain, or neurological symptoms you can’t explain.

The problem is: “we don’t know what’s causing this” and “this is psychological” are not the same statement. But in practice, one tends to slide into the other without much friction. And once a condition gets labeled as psychiatric or stress-related, the investigation often stops. The patient has a category now. The system can move on.

But the patient? They came in with symptoms. They’re now leaving with a diagnosis that’s essentially a statement that the symptoms aren’t real (or aren’t worth pursuing). And they often internalize that. They start doubting themselves. They wonder if they really are overreacting. They stop pushing.

That’s the consequence that doesn’t show up in the chart.

---

Chronic Fatigue & Fibromyalgia: A Case Study in Doubt

When I trained in the 90s, chronic fatigue syndrome and fibromyalgia were understood, by the mainstream, as psychiatric conditions. They affected women far more than men. They didn’t show up on standard labs. They didn’t map cleanly onto anything we could image or measure. So we reached for the explanation that was always available: it’s psychological. Patients were told, in various ways, that it was all in their head. Many of them were given antidepressants. Some improved. The improvement was taken as confirmation of the diagnosis.

What nobody was asking was whether those medications might be doing something else entirely. Whether the patients had something real and biological that we just didn’t have the tools or framework to see yet.

Now we know that many of these patients had a condition the UK formally classifies as Myalgic Encephalomyelitis. That name matters because of what it describes: inflammation in the brain. Specifically, activation of the microglia, the immune cells of the central nervous system. The result is a cluster of symptoms that makes complete sense once you understand the mechanism: disordered sleep, profound fatigue, immune dysregulation, and systemic inflammation. These are downstream effects of a brain on fire.

We also know now that chronic fatigue and fibromyalgia can have infectious triggers. Lyme disease is one of them. I have a patient in her seventies who had fibromyalgia and chronic fatigue for forty years. Forty years of being told, in one way or another, that nothing was definitively wrong. After treating her underlying Lyme disease, she has been in remission for roughly two years.

Forty years … two years.

That gap is what medical gaslighting costs. Not in the abstract, but in a specific person’s life, a woman who spent four decades with real, biological, measurable disease being categorized as a psychological problem.

The condition didn’t change. Our ability to see it changed. And in the years between “we don’t know what this is” and “here is the mechanism” … patients paid the difference.

Unfortunately, fibromyalgia and chronic fatigue are still contested in parts of the medical world today. There are still physicians who consider them primarily psychiatric. The functional medicine world is doing real work with low-dose naltrexone, gut restoration, treatment of chronic infections. But the mainstream hasn’t fully caught up. Which means the same dynamic is still running, just more quietly than before.

---

Refrigerator Moms & the Blame Default

In the 1950s–1970s, the prevailing theory for why some children had what we now recognize as autism was that their mothers were emotionally cold. Distant. Withholding. The term that got used was “refrigerator mother.” A child with sensory integration issues, speech delays, or social difficulties had a mother who, in the view of the experts, had failed to bond with them properly.

There was no biological model. The presentation was real and visible, but medicine had no framework to explain it. So the explanation defaulted to the patient’s environment, and specifically to the closest available target: the mother. The expert told her it was her fault. And that was the clinical conclusion.

I heard the term for the first time from an older physician I worked with early in my career. He used it in a way that acknowledged how far we’d come from it. “Can you believe we used to do that?” And he was right. We can shake our heads at it now with the benefit of foresight. But think about what that actually meant for the mother sitting in the office. We’d literally blame moms for their kids being autistic. How’s that make a mom feel? The expert is telling her it’s her fault that her kid has sensory issues, integration issues, speech issues. That’s not ancient cruelty. That was standard clinical practice within living memory.

We now understand that neurodivergence is largely heritable. A neurodivergent parent is statistically more likely to have a neurodivergent child. The mechanism is genetic and neurological, not relational. A mother being cold wasn’t causing anything. But the system needed an explanation, and in the absence of a biological one, it blamed the person sitting across the desk.

The refrigerator mother theory is easy to dismiss now because we can see it clearly from a distance. What’s harder is recognizing when the same logic is operating in the present tense. Lyme disease and Long COVID are both recent examples of the same pattern: real conditions dismissed as psychological, patients told nothing was wrong, recognition arriving years later without meaningful acknowledgment of the harm done in between. I covered both in detail in the previous article. The mechanism is identical. Only the disease name changes.

---

Why This Keeps Happening

It would be easier if this were a story about bad actors. A corrupt institution, a specific failure of character. But that’s not what the pattern shows.

Medicine is built around diagnosable categories. The training, the billing, the legal system, the standard of care: all of it runs on the assumption that conditions can be classified and that classification can be defended. Clinicians aren’t trained to sit with uncertainty. They’re trained to resolve it. That’s the job. A patient comes in with symptoms. The physician’s role is to find the explanation and treat it.

When the biological explanation isn’t available, something else fills the gap. Psychological explanations are always available. They don’t require a positive test. They don’t require imaging findings. They can be applied to almost any presentation and cannot be definitively disproven. They provide closure, and closure is what the system is designed to produce.

There’s also the authority problem. Admitting uncertainty is structurally costly for clinicians. It undermines the expertise the therapeutic relationship depends on. A physician who says “I don’t know what this is” is in a different position than one who provides a diagnosis, a name, a treatment plan. The system understandably rewards the doctor with a quick and confident response.

None of this requires malice or a conspiracy. It just needs the incentives to be tilted in a particular direction. The result is a cycle of explanatory shortcuts … medical gaslighting.

What breaks the cycle isn’t any single physician or any single patient. It’s the accumulation of people who refuse to accept the reframing. Who keep coming back. Who find the practitioners willing to hold uncertainty rather than paper over it. Who document, advocate, persist. The conditions that eventually get recognized are the ones where enough people refused to accept “it’s all in your head” as a final answer.

That’s not a small thing to ask of someone who is already sick.

---

What This Means If You’re the Patient

If you’ve gone through the healthcare system with symptoms that don’t resolve, and the explanations you’ve received consistently point to stress, anxiety, depression (or some variant of “we can’t find anything wrong”) … that’s worth taking seriously as information. Not as proof that your physicians were negligent or acting in bad faith. Most of them were doing exactly what they were trained to do. But the system they were trained in has a documented history of reaching for psychological explanations when biological ones aren’t immediately available, and of being wrong about that for years or decades at a stretch.

The absence of a diagnosis is not the same as the absence of disease. That’s not a new idea. But it gets lost in the authority of the clinical encounter, in the weight of someone with decades of training telling you the tests came back normal.

A few things I’ve seen make a real difference for patients navigating this:

Finding a physician who is willing to say “I don’t know yet” without immediately converting that uncertainty into a psychological label. That’s harder to find than it should be, but it exists.

Not abandoning your own account of your symptoms. The history a patient gives is still one of the most diagnostically valuable things in medicine. When that history gets dismissed or reframed, the loss isn’t just emotional. It’s clinical.

Understanding that the conditions being contested today are often the conditions that will be recognized tomorrow. Lyme. Long COVID. Conditions we haven’t named yet. The patients who eventually get answers are frequently the ones who kept asking the question after they were told to stop.

None of this is easy. It requires energy that people who are already sick often don’t have. Which is exactly why understanding the pattern matters before you’re in the middle of it.

---

A Note on Where This Series Is Going

The next article in this series turns to a specific population: women.

The blind spots and gaslighting patterns described in these first two articles don’t fall evenly across all patients. Women are disproportionately affected, and not by coincidence.

The conditions most likely to be labeled psychiatric are the ones that predominantly affect women. The research gaps are largest in areas of women’s health. The corrections, when they come, often come late.

Chronic fatigue and fibromyalgia. Heart attacks presenting atypically and going unrecognized. Hormone replacement therapy withheld for twenty-three years based on a flawed study. These examples are part of a pattern with a specific shape.

If you want to understand that pattern, and what it means for how you engage with your own care or the care of someone you love, that’s what Article 3 is about.