Gaslighting in the Medical Workplace & How to Recognize It
By Melissa Kaplowitch, Ph.D., Rick Rader, MD, Steve Perlman, DDS, Matt Holder, MD
“You are being abused if you find yourself apologizing when you didn't do anything.”
― Tracy A. Malone
Those of us—researchers, clinicians, advocates, educators, policy makers, academics and activists—who are committed to working and succeeding in the disability community are overwhelmed by a variety of significant and high level topics. Sure, gaslighting was 2022’s Word of the Year, but does that justify an article in HELEN?
The short answer is yes. The long answer is that the emotional abuse inherent in gaslighting is way too common, even in the medical community.
The field relies on a cadre of committed, dedicated and motivated leaders, both new to the field and seasoned veterans. They account for innovation, inspiration and the relentless pursuit of new approaches, beliefs and practices. Luckily, we have a pipeline of promising early career upstarts.
Too many of them will be exposed to educators, mentors, supervisors and advisors who for a variety of selfish and pathological reasons will attempt to derail them, intimidate them and curtail their careers. Of interest is the fact that the Joint Commission issued a Sentinel Event Alert requiring all accredited hospitals to develop a code of conduct and implement processes to manage staff bullying (Gillespie et al, 2017).
We must inform, alert and educate professionals to this ongoing and deleterious practice.
“Nurses eat their young.” It’s been over 30 years since we were introduced to this saying about supervisors and mentors bully young nurses. In a 2017 paper, Gillespie et at defines bullying as “work-related, personal-related, and physical-related negative behaviors such as withholding information, ignoring targets, spreading rumors, and intimidating others'' (p. 11). Recent estimates put bullying, and its close cousin, 'gaslighting,' at about 30% of the nursing workforce (Gillespie, 2017). This percentage reaches over 70% in nurses licensed for less than three years (Gillespie, 2017). Nursing is not the only health related profession that eats its young. We recognize it in medical education and training, academia, research circles, organized medicine and associations that are supposed to nourish, support, and encourage our most promising future leaders.
We have personally witnessed these practices in a variety of settings, committed by individuals who misused and dishonored their positions of authority and leadership.
What is gaslighting?
Theatrical release poster for Gaslight in 1944
Gaslighting is not a new term. It was coined in the 1938 play Gaslight and then used in the 1944 movie of the same name. In both, the gaslighter tries to convince his wife that she is insane after he carefully plots against her, making her question her own psychological health.
Gaslighting can happen in any setting but it is commonly found between intimate partners, parents and children, in the workplace, medical settings, academia, and the political arena. It’s a form of covert manipulation that results in self-doubt, low self-esteem, anxiety, and confusion (Sweet, 2019).
When a person experiences the repeated emotional abuse at the core of gaslighting, it can lead to a number of mental health issues such as anxiety or depression (Goldstein & Freyd, 2005). Often, because the victim is not aware of what is happening to them, they become a willing participant in their own subservient behavior to please their perpetrator, usually a person in a position of authority. Slowly the gaslighter gains the victim’s trust and dissects their inner psyche by questioning their ability and judgment—and blaming, shaming, lying, or confusing them. They rewrite history and exaggerate to discredit the victim and shake their confidence. Successful gaslighters deconstruct their victims to the point where they believe they have gone insane.
“Gaslighting of the soul: They do everything to dim your light, and then they ask you why you’re not shining.” - Unknown
From a psychological perspective, gaslighters, much like people with narcissistic or antisocial personality disorder are cunning, charismatic, dynamic liars who abuse power they have over others with no remorse. They hope to gain validation and increased positions of power. The gaslighter is motivated by their own ego deficits which translate into a conscious or unconscious intent to harm or discredit the victim. The act of itself, allows the gaslighter to project their own anxieties and insecurities onto another person which makes them feel better about their own existence while creating further division of the power structure within the relationship (Calef & Weinhsel, 1981). The increased power differential leaves the victim feeling as if they must comply with unreasonable, unethical, and manipulative demands out of fear of punishment or retribution. The goal of the gaslighter is to obtain complete submission over their victim. Doing so increases the gaslighter’s exaggerated levels of self-worth and self-esteem while decreasing the victim’s confidence or credibility. As a result, the victim questions their own skills, ability, sanity, or even ability to be independent from the gaslighter.
The goal of the gaslighter is to obtain complete submission over their victim. Doing so increases the gaslighter’s exaggerated levels of self-worth and self-esteem while decreasing the victim’s confidence or credibility.
In the Workforce
Gaslighting and its impact are coming to light in the workforce, especially when it comes to relationships among colleagues or the supervisor and supervisee. Even when a victim suspects gaslighting, they may feel powerless and scared addressing it with their supervisors, HR departments or others in positions of authority. More importantly, the implication of gaslighting on students, budding professionals or seasoned and accomplished professionals can have a significant impact on mental health and their ability to be successful or continue their career path.
You can encounter gaslighters in supervisory positions no matter what stage you are in your professional career or how many academic accolades you have.
You can encounter gaslighters in supervisory positions no matter what stage you are in your professional career or how many academic accolades you have. Failure to recognize key signs of gaslighting can result in disastrous consequences. Even if a victim is courageous enough go to human resources or others in the organization for help, they often get dismissed because gaslighters are experts at Kissing Up and Kicking Down (KUKD), a term used to describe supervisors who flood their superiors with flattery while putting down supervisees. "Research has shown that the most talented and decent employees are most often workplace bullying targets. They trigger a bully’s great fear of being exposed as an incompetent fraud. Due to their own ego and insecurity, bullying managers are willing to hurt their organization by demeaning and discarding its best talent” (Paknis, 2018). When someone is victimized they are not likely to take a stance against their bully (Freire, 1970). Rather, victims become so distressed that they become vulnerable to anxiety, loss of sleep, eating disorders, depression, and lack of confidence. The situation can become so acute it can lead to thoughts of suicide.
Another concern is that the present HR environment does not encourage or may not allow truthful, accurate references from former employers. For example, agency policy may only permit a reference to state how long an applicant was in their position and if they are eligible for being rehired. There is a reluctance to be truthful when writing a reference for a candidate for legal reasons. So a reference no longer produces an accurate picture of how a person conducts themselves and treats other people. Often, one agency may be so glad to be getting rid an employee that they sing their praises. As a result, a new company has then hired somebody they think is amazing. A common pattern becomes that the employee kisses up at every turn to their superior but then complaints are generated about how this person knocks down supervisees. Those complaints multiply but are not dealt with effectively so the knocking down continues because those in higher positions of authority have not witnessed such behaviors. The complaints simply don’t resonate.
What does it look like? Let’s see in these case studies.
Case 1
A new Chief Medical Officer at a corporation asks two dental professors to write a basic article on dentistry for her in a non-peer reviewed trade publication. The two professors, who between them have written over 400 articles in many highly regarded journals, complete their task and submit it well within the requested time frame. A day before the article is due, the CMO calls each one of them individually, tells them they did not do what they were told, that the article was inadequate, and that someone else would have to do it. She states, “This article was supposed to reflect our standing as a center of excellence. It clearly missed the mark. Not only do I have to reassign it to someone else but you delayed the submission and possibly made us miss the deadline. It is obvious I can’t count on you.” She then turns the request over to a recent dental graduate who had no publications and basically submitted what they had written.
As neither professor had ever experienced, nor had any knowledge of gaslighting, their initial response was diminished self-esteem, feeling badly about not being able to fulfill their new supervisor’s simple task, and anxiety about further requests. After similar requests by the CMO with the same scenarios, the situation continued until the CMO was eventually terminated.
Case 2
A pharmaceutical company makes a request of well-respected physician to assemble a group of experts in women’s health to address issues of importance for the development of a new medication. The physician does her due diligence and takes several months putting a team together with each member having a specific area of expertise and understanding of their deliverables and expectations.
A new Chief Medical Officer takes over the supervisory position in the company before the initial zoom meeting of the expert panel. Prior to the call she shows no interest in knowing who the members of the team were, why they were selected, or their qualifications.
When the initial meeting takes place, she shows up 30 minutes late in blatant disregard for the group. She starts the meeting by saying, “Sorry to keep you waiting but for some reason it was left up to me to restrategize our marketing launch, something I would have thought was well within the capabilities of this group. Maybe we need to revisit your involvement.” She does not acknowledge panel members but proceeds to talk about herself. It was the first and last meeting of the experts and the contract was terminated.
Case 3
A distinguished surgeon, Dr. S. has an outstanding reputation and has been providing services at a hospital for over 25 years. He heads a residency program, is a professor at an esteemed academic institution and although his patient population includes individuals with high comorbidities and secondary conditions, has an impeccable record with few post- op complications, readmissions or extended hospital stays. In addition, the operating room staff loves him and fully respects his compassion, patient care, and demeanor. His residents have the highest regard for him and his academic institution has recognized his career with numerous awards.
A new chief is appointed to his service. He randomly requests to observe Dr. S working. The case goes perfectly, yet the new chief finds minuscule faults, makes recommendations, and requests to observe another case. The next case has similar results. The procedure is flawless, yet nitpicking occurs and Dr. S. is not permitted to book any further cases without an observer. He states, "Dr. S, while I understand you have a loyal following, sometimes our past achievements have to be weighed against our current standards. Not everyone can transition to the new demands and expectations. Sometimes it's best to bow out when you still have a few polite admirers."
This situation continues for several months with proctors, some of whom have only been in practice for less than five years. Dr. S eventually becomes so disheartened and frustrated, he resigns from the hospital.
Case 4
An educator who has been recognized as a Distinguished Teaching Professor by his state has taught his entire career of over 50 years at a university in different departments. He is respected and admired by colleagues and students, and has mentored and helped guide the career of countless graduates over the years. A new Dean is appointed at the school who plans to replace existing faculty with friends and colleagues from his previous positions.
He constantly disparages the Distinguished Teaching Professor by verbally abusing him, continually minimizing his career accomplishments and that his contributions to the University were an embarrassment stating, "Professor, while I appreciate that you have earned the title of Distinguished Teaching Professor, the term distinguished could apply to the past tense. This school has an obligation and as Dean I have a commitment to pave the way for colleagues I trust will arrive with new ideas and approaches; things that will hopefully help redefine distinguished."
His repeated abuse causes acute depression to the professor who for reasons of mental health is forced into an early retirement.
Case 5
An elite medical organization is subcontracted to fulfill a multi -year research project. For the first few years, all deliverables are met and the contractor successfully submits their report and secures their funding. In the final year of the contract a new Chief Operating Officer, a physician, takes over and criticizes everything the subcontractor has done in the past despite the fact that everyone has been more than satisfied with the results.
She targets several of the contributors and begins to systematically degrade them individually and as a group. She tells the group "Research has to be a dynamic evolving endeavor. While your past results were accepted I felt they missed the mark. There were missed opportunities that you obviously shut your eyes to. My new goals, which hopefully you can implement, will save us from being regarded as an outdated, out of synch research center. You don't have to like it, you just have to execute it."
This behavior continues. She changes deliverables that were in the original contract and withholds funding to the subcontractors who in turn cannot pay the universities involved in the study. The project was unnecessarily delayed for many months and relationships were destroyed with all participants.
What happened in each of these cases?
In each case, the victim and witnesses began to understand they fell prey to gaslighting, yet they were powerless. In some instances, the gaslighter targeted not only individuals but also entire organizations. Victims were blamed, shamed, demoralized, and silenced. Victims, often subscribing to just world theory, hoped that fair, rational and competent practice would prevail (Haber, Podolski & Williams, 2015). Instead, in each case, the perpetrator, demonstrating narcissistic traits, pinned colleagues and even friends against one another asserting their power, diminishing others and causing emotional distress and self-doubt.
One of the hallmarks is the deep insecurity that often accompanies gaslighting. In each of the cases, the gaslighter sets their sites on embarrassing, degrading, and removing any competent person and seeks to replace them with fearful, lesser competent people who are less of a threat. The perpetrator, incapable of regulating internal emotions or feeling remorse, continues to engage in KUKD as a means of manipulation. This can be very damaging to the victim and the organization.
At the heart of both bullying and gaslighting is the authority gradient. The term was first defined in aviation when it was noted that pilots and copilots may not communicate effectively in stressful situations if there is a significant difference in their experience, perceived expertise, or authority
At the heart of both bullying and gaslighting is the authority gradient. The term was first defined in aviation when it was noted that pilots and copilots may not communicate effectively in stressful situations if there is a significant difference in their experience, perceived expertise, or authority (Cosby & Croskerry, 2003). In the cockpit the authority is defined by who occupies the left seat, also known as the captain. Hubbard & Chicca (2022) defined authority gradients as “perceived differences in status” (np).
Much like the pilot and copilot relationship, perceived expertise between a supervisor and a supervisee such as a medical resident and an attending physician, can prevent the less experienced of the two as being seen as an authority because in healthcare the authority gradient is based on an established or perceived command and decision-making power hierarchy. In surgery it’s the chief surgeon, followed by his/her assistant, and then the fellows, followed by the senior and junior residents, the medical students and then the surgical nurses and assistants.
Imagine a medical student observing the chief surgeon operating without a sterile prep. The authority gradient (and the prospect of seeing his/her career coming to an abrupt end) would prevent him/her from speaking up, questioning it or pointing it out. The supervisee is often intimidated, afraid of negative evaluation, feels inadequate or simply does not know how to handle incidents that may come up in the work place. Wachter (2005) reports that supervisees find it difficult to address predicaments because they are neither perceived as “an authority or in authority” which makes it difficult to challenge a supervisor (np).
In each of the presented cases we see gaslighting in the context of not being able, willing or capable of speaking up to the very people who are supposed to be guiding, supporting and teaching us. There is the unwritten rule to “suck it up,” “play by the rules,” and “don’t make waves” that allows the culprit to continue on his or her path of intimidation. In essence, the system provides the means and mechanisms to allow those in authority to conduct themselves in nefarious ways with impunity.
How can we combat gaslighting?
Combating gaslighting isn’t a simple process. It is not enough to recognize personality traits and behavior patterns of the gaslighter. Awareness that gaslighting is real and exists in every area of society is primary and is the first step in addressing a suspected case of gaslighting. Gaining awareness and skills to combat gaslighting should come early on in the education process and be included in onboarding programs for new employees. Educational programs developed for students or employees that teaches them to recognize and report bullying promotes active learning, allows participants to increase their knowledge about who can help, and has a positive influence in academic and work environments (Gillespie et al, 2017). However, even if awareness is present, if communication and advocacy skills needed to protect and defend against victimization are not, the gaslighter will continue to mistreat their victims.
Confronting a gaslighter can be challenging because the gaslighter will deny that they have done anything wrong. They turn the issue back on the victim, giving reasonable explanations or placing further blame on the victim. When a victim begins to suspect that someone is deceitful, lying, or is making them feel as if their sanity is in question, they should test their own reality by checking in with a trusted confidant or therapist. Finding a therapist who can be supportive and can help the victim learn to identify and challenge distorted thought patterns of the gaslighter and themselves will help preserve mental health and aid the victim in gaining coping skills such as mindfulness. Engaging in ongoing therapy will help restore self-esteem and restructure the thoughts, behaviors and emotions that the victim is experiencing. Victims will find that they have heightened emotions throughout this experience but remaining calm and reasonable will assist in formulating a plan of action.
When confronting a gaslighter, stick to facts and leave emotions out of the discussion. It may help to keep a detailed journal of facts, and develop a script that can be role played with a therapist or family member before confronting the gaslighter.
When confronting a gaslighter, stick to facts and leave emotions out of the discussion. It may help to keep a detailed journal of facts, and develop a script that can be role played with a therapist or family member before confronting the gaslighter. Griffen et al (2014) report that when trained to rehearse responses, nurses were effective at addressing bullying akin to gaslighting.
Boundary setting is another important step in addressing gaslighting. For example, a victim may say, “Stop manipulating this situation. I will not continue to remain in this role/relationship under these circumstances' '. In addition, it may be useful to join a support group with others who have experienced similar circumstances. Above all, victims should consider their personal safety while in the presence of the gaslighter. Developing a safety or exit plan ahead of time, attending to self-care to manage emotions, and building resilience are important to restoring health.
About the Authors
Melissa Kaplowitch, Ph.D., LMHC is an Assistant Professor in the Department of Psychology and the Program Coordinator of the M.S. in Counseling Program at Salem State University where she has trained students to become licensed mental health counselors for the past 22 years. She was named the 2017 Distinguished Teacher at Salem State University. Trained in Counseling Psychology, at Northeastern University, where she earned her Ph.D., Columbia University where she earned her M.A. and M.Ed. and Clark University where she earned her B.A., Dr. Kaplowitch has worked with children and adults in both inpatient and outpatient settings. Her clinical work has had an emphasis on effective treatment for people who suffer from chronic mental illness.
Rick Rader, MD, FAAIDD, FAADM, DHL (hon) is the Director of the Habilitation Center at Orange Grove Center, Chattanooga where he is responsible for the creation and implementation of innovative health delivery programs for individuals with IDDD. He is a former Presidential appointee to the National Council on Disability and is the current President of the American Association of Health and Disability. He is a co-founder of the American Academy of Developmental Medicine and Dentisty.
Steven Perlman DDS, M.ScD., DHL(hon) is a Clinical Professor of Pediatric Dentistry at The Boston University School of Dental Medicine and Adjunct Professor Division of Pediatric Dentistry at Penn Dental Medicine. He is the President of Project Accessible Oral Health and Co-Founder and Past President of the American Academy of Developmental Medicine and Dentistry.
Mathew Holder, MD, MBA, FAADM is a co-founder of the American Academy of Developmental Medicine and Dentistry. He co-established the Lee Specialty Clinic in Louisville, KY as the nation's foremost multi-disciplinary clinic exclusively dedicated to providing collaborative care to patients with intellectual and developmental disabilities. He has engineered Kramer Davis Healthcare an innovative healthcare delivery model with the intention of dotting the map with multiple clinic sites. He is the President of the American Board of Developmental Medicine and pioneered the credentialed specialty of adult developmental medicine. His life's work has been devoted to the creation of a standardized medical school curriculum to insure that the next generation of physicians has the knowledge, skills and experience to provide exemplary medical care to people with IDDD across the lifespan. Dr. Holder was distinguished as the Chair of the Global Medical Advisory Committee for Special Olympics International.
References
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