Women’s Health and Gaslighting: How to Cope and Avoid Gaslighting Yourself
A recent experience of mine got me thinking about all the ways in which women are gaslit (behaving in such a way that causes the person to doubt their own perceptions of reality) about their own bodies when trying to seek healthcare. Worse, the experience of being gaslit and not taken seriously over and over again teaches women to gaslight themselves. As if we needed more people doubting our own experiences!
I thought I had caught my baby’s cold, which was not a surprise given the petri dish that is daycare. But instead of staying mild but miserable and gradually improving, I got worse and worse. On a Saturday night I started having a lot of trouble breathing, which was scary. I couldn’t catch my breath. I thought I probably had RSV or Covid and begrudgingly decided to head to the local South Bay ER in Torrance. Despite being scared about my breathing, on the drive over there I found myself thinking, “this is silly, this is just a bad cold or respiratory virus, I’m probably being dramatic.”
As a women’s health psychologist, I hear story after story of women not being believed about their own bodies by their doctors, other healthcare providers, partners, and often their parents when they were kids. Women are told over and over again it’s “in our heads” and our physical symptoms are dismissed, such as is the case with hysteria. Or our pain is diminished and dismissed. For example, the utter lack of pain relief offered during IUD insertion or removal. These are sadly just a few examples. There are major disparities in the frequency with which women get dismissed compared to men, and this is even more of a problem for women with additional marginalized identities, such as BIPOC women, disabled women, or trans women. And heaven help you if you are a fat woman (I use the word fat as a neutral descriptor such as short, tall, blonde, or brunette).
Get dismissed enough times, and it’s no wonder women start to question and dismiss themselves, as I was doing on my drive to the ER.
However, I have learned valuable lessons from previous times in which healthcare providers have dismissed my symptoms (and I unfortunately believed them) and so I was determined to listen to my gut. And it was a good thing I did, as I ended up having pneumonia of all things! Thankfully nothing that antibiotics and lots of rest couldn’t fix, but I am very glad I went in when I did. I think I caught it just in the nick of time before it got much more serious. I shudder to think of how much worse it would have become had I not listened to my gut and delayed seeking care.
So how did I manage to override the self-gaslighting and listen to my gut afterall? Between my own experiences and working within healthcare systems for years and years, I have picked up a few tools to cope with gaslighting in healthcare. Here are my best tips.
Listen To Your Gut No Matter What: There is NOBODY out there who knows your body better than you. Doctors and other healthcare providers may be experts on bodies and treatment, but YOU are the expert on your body. You know what feels normal for you and when something is off. When your gut is telling you that something is off, listen to it. Trust that. This is body trust and it is vitally important.
In my experience, women’s gut feelings are never wrong. Where we go wrong is when we do not listen to them or gaslight ourselves or allow ourselves to be gaslit.
Center Yourself: When you are being dismissed or questioned, it can create a lot of noise that can make it hard to listen to your own voice. It can also be a fine line between anxiety (“something is wrong!”) and self-gaslighting (“this just my anxiety, it’s all in my head”) and difficult to tell the difference between the voice of anxiety vs a gut instinct, so I recommend a simple test. Give yourself a moment and take ten slow, steady breaths, grounding yourself and quieting your mind. Do some grounding exercises or self-soothing if needed. Then check in with yourself again once you are calmer. This will help you discern if it was your anxiety talking or your gut.
Evaluate Pros and Cons of Seeking Help: If you still aren’t sure if your symptoms are worth seeking help for, consider the pros and cons of seeking the help vs not seeking the help. For example, if the worst outcome of seeking care is feeling a bit silly and a wasted copay and time, that seems less bad then your medical issue potentially getting much more serious which could lead to more misery, more missed work, more invasive and costly treatment, and a longer recovery period. You can also consider watching and waiting for a little bit OR call a telephone advice nurse to consult (most health insurance companies and larger medical systems offer this). Also consider, what would you tell a friend in the same situation? Some symptoms warrant immediate evolution such as suicidal thoughts, hallucinations, difficulty breathing, stroke symptoms, chest pain, etc.
Seek Women Doctors When Possible: Study after study confirms what we have all experienced: women doctors listen better, are less dismissive, and less biased than men who are doctors. As a result, patients, and especially women, receive better care when treated by a woman doctor, which leads to better health outcomes across the board.
Now, this isn’t always possible and there are some truly excellent male doctors out there. Additionally, women doctors can also be terrible and gaslighting. I always choose a women doctor if possible and I also try to vet doctors ahead of time if I can (via asking for referrals, reading reviews, etc.), especially if they are men. I recently found a wonderful male specialist this way and was happy to make an exception to my usual rule. This isn’t possible in an emergency situation of course, or in cases where care options are limited due to geography or specialty. In these cases, I use the tips below.
Use The DEAR MAN Skill: This skill is from Dialectical Behavior Therapy and is a skill to help ask for what you need. It is particularly useful when the party you are trying to communicate is being difficult in some way and/or when you don’t feel confident in speaking up. I think it’s really helpful (and is one of my very favorite skills) in part beacuse communication is difficult generally and if you are seeking healthcare, you don’t feel well and the person treating you is probably working in an underresourced system and has many competing prioritites. Miscommunication can happen even between two people trying their best.
DEAR MAN is an acronym that stands for Describe, Express, Assert, Reinforce, Mindful, Appearance, Negotiate. Describe means to state what is happening in objective terms (“I have shared that I am having difficulty breathing in a way that is very different from my baseline”). In Express, you share your feelings and opinions, rather than assuming the other person knows or can read your mind (“I know in my gut that something is very wrong and I do not feel like you are hearing me”). Assert refers to asking for what you need or saying no, making it very clear and not assuming the other person knows (“I need you to take this symptom seriously and evaluate it in an evidence-based way”). Reinforce is the secret sauce of this whole skill - the fact of the matter is people are more likely to comply with your request if they understand how it will benefit them. This doesn’t necessarily make them selfish, it’s just human nature. Explain the benefits to the other party (“If you can evaluate these symptoms, I will really feel heard [AKA I will be satisfied and not make a complaint, but not making an overt threat], we can get clarity one way or another and I can avoid a return visit”). The MAN part of the acronym is more how to say it than what to say. M is for staying mindful by staying on message, not getting distracted, and repeating yourself if necessary. A stands for Appear Confident by speaking in a calm, confident manner while making eye contact. Lastly, N stands for negotiate. If this person can’t help you, is there someone else who can? From whom can you get a second opinion? If they don’t want to run a whole battery of tests, is there one they would be willing to start with and then do more testing after getting the results? Stand your ground, but be flexible and creative.
Bring An Advocate: It can be challenging to speak up for yourself when you have not been historically empowered to do so, and that is even more true when you aren’t feeling well or are in pain. Feeling awful makes it hard to think straight and communicate. It’s a vulnerable time. For all these reasons, and especially if you tend to freeze in difficult interactions, I really recommend bringing a trusted loved one with you if at all possible. Tell this person on your way to the healthcare visit what you are experiencing and tell them, “I know that something is off.” Have them write down what you are saying if need be. That way, if you aren’t able to communicate yourself, are struggling to convey what you want to convey, or are being dismissed by the doctor, your loved one can advocate for you and help communicate on your behalf. If you have multiple marginalized identities, I think this is an especially important tip. Have your ally use their privilege to help advocate for you or find an ally amongst the staff to try to connect with.
Bring In Reinforcements: If you are still not being taken seriously, ask for a second opinion or to be connected with the patient advocate (most hospitals and healthcare systems have one). If all else fails and you can, go somewhere else. Your health and safety come first.
Push Back on Medical Anti-Fat Bias: If you are being dismissed and you have the feeling it’s due to your size, or if you are being told just to lose weight as a solution to your healthcare need, do not be afraid to push back on this. Ask how your issue is treated for thin people. Tell them you only want to discuss solutions that are not concerning weight. Ask them to show you a single study showing evidence of a weight loss intervention maintaining weight loss for five years (spoiler - there isn’t one!). There are so many stories of women being told to just lose weight for problems not remotely connected to weight or for providers focusing exclusively on weight to the exclusion of other issues or treatment, which results in fat (I use this as a neutral descriptor) women receiving delayed treatment and diagnosis, resulting in their problems becoming more severe by the time they are treated. This harms women more than perceived extra weight. Check out Ragen Chastain’s excellent workshops about how to deal with fatphobia at the doctor’s office for more.
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About the Author, A Los Angeles Women’s Health Therapist:
Dr. Linda Baggett is a Licensed Psychologist at Well Woman Psychology, serving clients online in California, Illinois, Colorado, New York, and Washington. She received her PhD in Counseling Psychology from the University of Memphis in 2012. As a women’s health psychologist in Los Angeles she specializes in supporting women through their own unique experiences. While she focuses on women’s issues and women’s health broadly, she also has expertise in relationship issues, sexuality, pregnancy loss and miscarriage, birth trauma and postpartum issues, pregnancy and perinatal mental health, infertility, trauma and PTSD, EMDR, and body image and size-based oppression.
Disclaimer:
This blog is for educational and informational purposes only, is not a substitute for individual medical or mental health advice, and does not constitute a client-therapist relationship.