It’s not a headache! It’s a migraine: Exploring women’s experiences of medical gaslighting in Ontario,Canada

Abstract

This study explores the experiences of women seeking diagnosis and treatment for migraine symptoms in Ontario, Canada, and contributes to the growing literature on the concept of medical gaslighting. Migraine patients, particularly women, often report feeling disempowered within medical settings, where their symptoms and concerns may be minimized or dismissed. In recent years, the term medical gaslighting has increasingly been used by patients and in the media to describe these types of experiences. Guided by a critical ethnographic approach, this study seeks to illuminate how gaslighting is experienced within clinical interactions and traces the connections between women’s lived experiences and the broader social, political, and cultural contexts that shape them. Qualitative interviews were conducted with 17 women in Ontario, Canada who had received a diagnosis and/or treatment for migraine. Analysis of participants’ narratives revealed three key themes: questioning realities, narratives of diminishment, and shifting responsibility. Participants’ accounts highlight how deeply embedded cultural norms and dominant discourses can shape healthcare experiences, reinforcing oppressive assumptions related to sex, ability, and what constitutes “good care.” By foregrounding these experiences, this study adds depth to emerging scholarship seeking to define what medical gaslighting is and identifies strategies to address these concerns within clinical environments.

Introduction

The term “gaslighting” is usually used to describe exchanges in which one person engages in an intentional act of reality manipulation to gain control of another. The term refers to the 1944 movie Gaslight that tells the story of Paula (Ingrid Bergman), whose new husband Gregory (Charles Boyer) engages in a series of acts to isolate her and convince her that she is mad (Sweet, 2019). Medical gaslighting is a term that has emerged post COVID-19 to describe behaviors in medical settings that, while not necessarily intentional, frame understandings of what is happening in ways that can have a profoundly harmful impact on patients (Klein and Bartz, 2023). According to Sebring (2021), medical gaslighting is “not simply an interpersonal exchange, but the result of deeply embedded and largely unchallenged ideologies underpinning health-care services” (p. 1). She asserts that gaslighting operates through biopower, sustaining and supporting a deeply entrenched “hysteria” discourse in Western medical settings (Foucault, 1978/2020; Sebring, 2021). “Hysteria” often refers to the state of excessive emotion: it is a description often associated with, and has a history of being attached to, women in a derogatory way. Historically, hysteria was a diagnosable illness exclusively assigned to women often by male counterparts (Wright, 2019). Jackson (2019) suggests that, even in the present, when health providers are unable to locate an explanation—or a solution—to a woman’s suffering they “fill knowledge gaps with hysteria narratives” to make sense of the situation. This strategy is facilitated by Western medicine’s androcentric focus and the fact that knowledge of women’s health has been largely generated by men. In a recent commentary in the American Journal of Medicine, Ng et al. (2024) suggest that medical gaslighting is “an act that invalidates a patient’s genuine clinical concern without proper medical evaluation, because of physician ignorance, implicit bias, or medical paternalism” (p. 920). Medical gaslighting is a significant concern for the migraine community—especially for those who identify as women—who tend to encounter this phenomenon often and who report feeling powerless during these interactions (Sebring, 2021).

Purpose

This study critically examines the accounts of 17 women living in Ontario, Canada who sought diagnosis and treatment for subjective symptoms later defined as migraine. Through their narratives, this study elevates and prioritizes their voices and brings attention to their experiences. It then situates those experiences—and the dynamics of gaslighting—within broader cultural conditions and adds to the emerging literature and debate on “medical gaslighting.”

Background

While traditionally understood as a headache disorder, migraine is a poorly understood and complex sensory processing disorder characterized by recurrent, debilitating symptoms that can profoundly impair an individual’s quality of life (Aguilar-Shea et al., 2022; Lipton et al., 2007). The pathophysiology of migraine involves a combination of genetic, environmental, and neurobiological factors, leading to altered brain activity and the abnormal release of neurotransmitters, particularly serotonin, however, much of what causes migraine is unknown (Shekhar et al., 2011; Tanaka et al., 2024). Migraine attacks can manifest as episodes of moderate to severe pain, often localized to one side of the head, and may be accompanied by a range of symptoms such as nausea, vomiting, vertigo, and sensitivity to light and sound (Walter, 2022). While pain is a common symptom of migraine disease, not everyone experiences this symptom (Stolte et al., 2015). Migraine attacks can be episodic or chronic (>15 days per month) and can present with an aura—transient neurological symptoms such as visual disturbances—that occurs before or during the headache phase (Aguilar-Shea et al., 2022). The interictal burden of migraine disease—how people are affected in between attacks—can also be onerous and include physical, emotional and cognitive challenges that affect daily living (Vincent et al., 2022).

Migraine is well documented as comorbid with anxiety, depression, and other mood disorders (McCracken et al., 2024). Within this clinical context, it is neither unusual nor inappropriate for practitioners to consider psychological distress during patient assessments in clinical spaces. Similarly, medications such as antidepressants and anti-epileptics are commonly prescribed to migraine patients due to their ability to modulate neurobiological pain, alleviate other migraine related symptoms and prevent future attacks (Medrea et al., 2025). Stress is also widely recognized as a precipitating factor, and migraine is often conceptualized as a threshold condition where multiple biological and environmental variables may converge to trigger an attack (Zhao et al., 2026). Lastly, for many women, hormonal fluctuations play a significant role in triggering their attacks and may be difficult to treat (Vetvik and MacGregor, 2017). Acknowledging these biomedical realities is important as the aim of this article is not to challenge clinicians who engage in clinical practices or assessments that may be helpful to this patient population. Rather, this study examines how, within what we consider legitimate or evidence based clinical practices, women’s experiential knowledge can be dismissed, minimized, or reframed in ways that undermine their credibility as knowers of their own bodies.

Migraine patients often report feeling disempowered by both their illness and their encounters in medical settings (Buse et al., 2019). This is no surprise given that there is a social stigma attached to migraine (Bemel, 2021; Shapiro et al., 2025). Previously recognized as a biological human ailment, the validity of migraine came into question in the 18th century around the time of the scientific revolution (Parikh and Young, 2019). During this time conditions that tended to be invisible, or where no known biomarkers existed, were discredited (Parikh and Young, 2019). Consequently, headache disorders such as migraine became associated with a person’s moral failings rather than a biological affliction. As migraine more commonly affected women “gendered” migraine narratives became more commonplace (Finkel, 2008; Kempner, 2014). Migraine continues to be underestimated in its severity with many healthcare workers still perceiving it as a normal “headache.” While awareness initiatives by patient groups and some medical practitioners with a special interest in this area have been helpful, these misunderstandings and biases continue to influence how migraine patients are treated in medical settings (Buse et al., 2019; Kempner, 2014).

Methods

Methodology

This research draws on critical ethnography which combines traditional ethnographic methods with a commitment to social justice, aiming to both understand and challenge power structures within specific cultural or social settings (Thomas, 1993). Unlike conventional ethnography, which primarily seeks to observe and describe cultures or communities, critical ethnography emphasizes the researcher’s active role in advocating for marginalized groups, addressing issues of inequality, oppression and contributing to social change (Carspecken, 1996; Madison, 2005; Thomas, 1993). This approach is rooted in critical theory, particularly in its critique of societal norms and structures that perpetuate injustice and focuses on power and control dynamics to reveal the hidden or overlooked systems at work in society. Ultimately, critical ethnography seeks not only to document social realities but to challenge the status quo, particularly where power imbalances negatively affect the lives of people, or in this case, women (Ashgar, 2013). Aligned with this methodology, the following theoretical framework guided this study and provides a lens through which I examined the cultural conditions that shaped informants’ experiences.

Theoretical framework

This study draws from feminist and critical theory and explores how power, knowledge, and authority are constructed and/or disputed in a particular medical context. Specifically, Harding’s (1991) “feminist standpoint theory” provides a key framework for understanding how knowledge is socially situated. She posits that marginalization provides an epistemological advantage and suggests that prioritizing women’s voices might provide “empirically more accurate. . .and theoretically richer descriptions” to guide our understandings in developing care practices research (Harding, 2001: 145). By centering the standpoint of women with migraine this study recognizes that their perspectives are not only valid, but essential for understanding the systemic and relational dynamics of healthcare encounters. This is especially important as we reflect on what we know, and how knowledge is produced about women’s bodies and overall health. Standpoint theory asks us to consider whose perspectives shape scientific inquiry, who is excluded, and whose interests are being served (Harding, 2001). By doing so, we might challenge those who hold power to be more accountable to those affected by their research. This study also draws on Fricker’s (2007) work on “epistemic injustice,” illustrating how individuals are denied authority as knowers within the context of their own lives. This lens helps us to understand how gendered stereotypes and cultural discourse on women’s narrative reliability and/or tendency toward emotionality contribute to experiences of marginalization (Fricker, 2007).

Lastly, Foucault’s (1973/2003, 1978/2020) concepts of “biopower” and the “clinical gaze” are central to understanding how medical institutions exert control through knowledge production and surveillance. Foucault is concerned with how norms are historically constructed, how they are organized and reproduced within societies and how they become embedded in institutional practices (Foucault, 1978/2020). Foucault’s concept “biopower” describes how power manages peoples lives by shaping how they behave and care for their bodies in line with their roles as productive citizens (Foucault, 1978/2020; Suijker, 2023). Foucault reconceptualizes power as relational rather than strictly hierarchal (Gilbert and Powell 2010). That is, power does not simply flow from institutions to individuals in a top-down matter, but instead it is diffused through relationships, social norms, and everyday practices (Gilbert and Powell, 2010). Individuals become passive yet cooperative agents within systems of governance where they comply with norms and expectations that appear neutral or natural (Suijker, 2023). A key mechanism through which this power operates in medicine is through the “clinical gaze” which refers to the detached and ostensibly objective way that medical professionals are trained to observe patients (Foucault, 1973/2003). This not only shapes how providers interpret symptoms, it helps reproduce medical authority by constructing patient experiences in ways that may overlook subjective or embodied knowledge (Armstrong, 1994). Through these processes, Foucault shows how patient subjectivity is both constrained and produced by institutional power, practice, and discourses.

Informants and data generation

Informants (n = 17) were recruited from a Facebook support group and through Migraine Canada with permission from their administrators. A recruitment poster and letter were used to inform participants of the study. Recruitment required informants to be over the age of 18, to identify as women, to have been diagnosed with migraine and to live in Ontario, Canada. The women who participated in this study were between the ages of 19–50+. Informants were invited to write out their “migraine story” before interviews took place (optional) and these stories helped guide what areas this researcher focused on during interviews. While informants were also provided with a list of example questions prior to interviews, they were informed beforehand that interviews would be geared toward understanding their experiences of care. Women were asked open ended questions about their symptoms, general experiences of care, how they secured a diagnosis and treatment for their migraine symptoms and the challenges they experienced doing so. Interviews were detailed and required participants to describe concretely their experiences of migraine care in Ontario, Canada. All interviews were conducted virtually and were approximately 60 minutes long. A $15 honorarium was provided to all participants.

This project—and its amendments—received approval by the McMaster University Research Ethics Board under the title: Exploring Women’s Experiences of Migraine Care in Ontario, Canada, Project ID: 4909. Participants provided informed written consent prior to enrollment in the study. The study was deemed low risk, and all participants were provided an extensive list of psycho-social supports available in Ontario should they be required. Pseudonyms have been used in place of participant names to protect their identities, and other identifying information has been removed (city names, physician names, job locations etc.).

Data analysis

Data analysis for this study follows the principles of critical ethnography—as outlined by Madison (2005), Thomas (1993), and Carspecken (1996). Interviews were transcribed and reviewed several times in full to ensure familiarity with their content. During this review, open codes were generated by annotating meaningful segments of data that captured key ideas and recurrent patterns highlighting women’s experiences of dismissal and the impacts of those experiences. While this coding framework was developed inductively, drawing on women’s own language and descriptions, a deductive approach was employed once themes were established to gain a better understanding of how those experiences arose. To do this, concepts of epistemic injustice and biopower, and key tenets of feminist standpoint theory, were brought to bear on these data and themes. This deductive approach allowed me to make visible how institutional ideologies and norms were implicated in participants’ experiences and reinforced systemic inequalities, paying particular attention to gender. Given this researcher’s background as a migraine patient, reflexivity was an important part of this process. While my positionality provided insight and direction for this study, interpretive bias was addressed through debriefing sessions with colleagues. Below I present women’s narratives organized into the following themes: Questioning realities; Narratives of diminishment; and Shifting responsibility. In the discussion, I explore how women’s experiences were shaped by the culture of Western medicine, its attitudes and practices as they relate to the concept of medical gaslighting. I then suggest how we might reimagine care for this population by drawing on Mol and Harden’s (2020) framework of “good care.”

Results

Questioning realities

Informants’ symptoms were often passed off as emotional distress—such as “anxiety” or stress—by their physicians. In these excerpts, both Pat and Mary reflect on their experience of having their family physician frame their physical symptoms as psychological.

I was finally seen by a doctor. After I described my symptoms, she explained that it sounded like I was having an anxiety attack. At that point, I had been experiencing migraine like symptoms for almost a month, so although in the moment it could’ve have very well been an anxiety attack, it still did not explain my throbbing head pain, tinnitus, brain fog, etc. (Pat)They did convince me that it was (anxiety) until probably grade 12 and then first year university; And now I definitely feel that it is often passed off as anxiety. (Mary)

Diane expressed that while she was at a clinic attempting to gain a diagnosis and treatment for her hemiplegic migraine symptoms a physician asked her if she had ever seen a psychiatrist “. . . because sometimes numbness, tingling etc. can happen if you are under a lot of stress.” In response Diane shared that she had to pause for a moment to gather herself before responding assertively that she was open to seeing a psychiatrist as she had seen one before but wanted this physician to clarify for her what specific symptoms were associated with what psychiatric issue. She stated:

I remind him that I was taking anti-depressants up until the ambulatory EEG and regularly speak to a social worker about my mental health. He doesn’t say anything right away, so I keep talking. I go through my symptoms again, how I have unilateral numbness, tingling, and weakness in my right side, that is followed by a headache. That I’d had these symptoms pre-concussion and that now they’re worse. No, he agrees; that does sound like a headache disorder. You should go back to a headache neurologist.

In these instances, women’s physical symptoms (severe headaches, numbness, tingling, etc.) are downplayed or attributed to emotional distress. This type of “testimonial injustice” can have significant consequences as it may block access to resources or care, forcing women to self advocate or concede (Fricker, 2007). In Diane’s excerpt, we see how she needs to assert her reality to the physician before her migraine symptoms are taken seriously. Her momentary pause to gather herself to speak seems linked to an intention to present “her case” as a well-formulated medical history, in a way that interrupted the physician’s discounting of her narrative. This example highlights those practical barriers created by testimonial injustice, the harm that comes from being denied one’s capacity as knower, and where women must continually shoulder the burden of proving the credibility of their own lived experience (Fricker, 2007).

From questioning to accusation

During interviews, participants frequently reported experiencing disbelief or the questioning of their integrity by healthcare providers, a theme that emerged prominently in discussions about how their migraine symptoms were perceived. Several informants described instances where their physicians accused them of malingering, which not only invalidated their symptoms but also left lasting emotional impacts. For example, Laura and Susan recounted experiences during their formative years where they were accused of feigning illness by their attending physicians.

I went to my first pediatric neurologist, and he was extremely dismissive and said ‘she’s probably just faking it’, or ‘it’s probably just anxiety’. Like he put me on an antidepressant, but it didn’t really do anything, and they continued getting worse (Susan)

This sentiment persisted beyond that medical assessment into other areas of her life where authority figures—such as parents and teachers—prioritized that physicians’ perceptions over hers doubting the severity of her condition. They often told her to “push through it” or to “take over-the-counter medication,” trivializing her pain and reinforcing the idea that her symptoms were either exaggerated or inconsequential. As Harding (1991) suggests, when family members and other important authority figures align themselves with the dominant standpoint of medicine, they reproduce its authority and silence alternative standpoints, leaving little room for the patients own knowledge to be recognized. On this Susan stated:

I didn’t feel like they understood the severity. I felt like they were all saying. . .’I get migraines, people get them and they just kind of have their life anyways’ and ‘it’ll be fine’. And they weren’t really understanding that, you know, it was a huge quality of life issue and it still is. It’s such a big part of my life.

This persistent assessment of her reality from perspectives other than her own contributed to her feeling isolated as those around her failed to acknowledge that her condition was, from her standpoint, a significant issue affecting all aspects of her quality of life.

Meanwhile, Laura was checked into hospital after struggling with symptoms connected to a viral infection. She identified that the attending neurologist also accused her of “faking” her symptoms and told her that there was nothing wrong with her. She described the experience as “frightening, mortifying, made me feel vulnerable and has stayed with me my whole life.”

At one point during my hospitalization, and prior to my final diagnosis, the neurology resident examined me on his own, behind closed curtains, and without my parents or any other staff member present. He told me that there was nothing wrong with me and that I was faking. . .

Both Laura and Susan suggested that these encounters had long lasting effects. In particular, Laura’s assertion that the experience stayed with her “whole life” suggested her interaction may have been traumatic for her. These stories emphasize how questioning a patient’s integrity has far reaching effects that move beyond that single encounter, influencing a patient’s identity, how others may perceive them and the course of their treatment. Their accounts also reflect how intersecting identities—in this case being both young and female—may intensify perceptions that they are unreliable narrators of their own symptoms (Harrilal-Maharaj, 2025). Feminist scholarship on medicine has long shown that women’s accounts of illness have historically been treated as subjective, exaggerated, or psychologically driven, especially in conditions lacking clear biomedical markers (Barker, 2005; Hoffmann and Tarzian, 2001). Within a broader context, young female patients may encounter heightened skepticism that further marginalizes their attempts to describe their experiences. As Fricker (2007) argues, testimonial injustice arises when prejudice causes a hearer to assign a speaker less credibility than they deserve, undermining the speaker’s status as a knower. In these cases, being cast as an unreliable narrator does not merely distort how others receive their testimony; it also erodes the speaker’s sense of epistemic agency and integrity, a point I take up in the discussion.

Physician authority

Some informants noted that healthcare providers only took their concerns seriously after witnessing their symptoms in person, demonstrating a tension between a patients’ knowledge of themself and clinical expertise. This complicates how we might care for those who have invisible conditions with little to no known hard diagnostic markers. For example, during her interview, Tanya expressed:

There always seems to be an undercurrent of disbelief when I tell them that my arm will stop working, or that I’ll stop being able to talk normally, that I’ll have trouble walking. When you start physio for a concussion and you’re like, “OK, this is going to aggravate my symptoms and trigger a migraine and it will look like a stroke, but it’s not a stroke, probably the OTs and PTs you’re working with nod along to your face, but you can tell they’re trying hard not to roll their eyes. ‘Sure, whatever you say. Headaches aren’t like that, but if you say so.’ It’s all over their expressions. And then you start to have attacks in front of them and you show them your arm dropping and your face drooping and your speech slurring and you manage to get out ‘migraine, this is what I was telling you about’ before they call an ambulance and they say ‘THIS is what you meant?’ And you wonder to yourself ‘yeah, what did you think I meant when I said ‘like a stroke’ but out loud you say ‘yeah, it can be pretty startling.’

In this excerpt we can see how systems of care can fail to acknowledge the full range of patient experiences, and how preconceived notions of what a condition is, or how it affects someone may cause healthcare providers to dismiss them as improbable unless an event—one that aligns with observable, apparently objective evidence—forces them to confront the reality of the situation. As Foucault (1973/2003) suggests, medical knowledge has historically privileged what can be visually or empirically verified, positioning subjective accounts as secondary or unreliable. This is further complicated by the fact that even during intense migraine attacks symptoms often remain invisible, leaving patients vulnerable to dismissal when their suffering cannot be “seen.”

Narratives of diminishment

Minimizing symptom severity

Informants described how their symptoms or condition was minimized during medical appointments and the effects those interactions had on them. Informants frequently described how physicians downplayed their conditions. For example, Rory’s neurologist suggested that his other patients handled their migraine symptoms more easily, which made her feel as though her condition was not taken seriously. On this she stated, “When I explained how much I was struggling living everyday life he remarked that he knows migraine patients who, ‘vomit and then go back to work’. I felt like he was minimizing how debilitating this disease is.” Similarly, Heather spent two decades seeking a diagnosis, only to have her symptoms dismissed as normal. She had begun experiencing daily headaches, that she treated with ibuprofen. Soon after a move to Calgary her physician was quick to diagnose her as having “Chinook” headaches and acid reflux (to explain her nausea) and sent her on her way without further investigation. “Because I was not puking and needing a dark room, maybe only a few times a year, and I was functioning I guess no one suspected migraine.”

Some informants encountered physicians who assumed their symptoms were the product of stress with little investigation. During a visit to her family doctor, Pat had expressed she was experiencing severe headaches that occurred during menstruation. Her family doctor initially explained to her that what she was experiencing was “purely stress related.” She went on to say “I don’t recall him doing much of an assessment other than the standard vital checks. He told me to try to relax by taking a bath or massaging my neck (where the pain began).”

Disparaging patient-initiated coping strategies

When a diagnosis is difficult to come by, and/or treatment options are not effective, informants discussed drawing on their own resources to help them manage their symptoms. Both Zara and Laura described situations where their use of mobility aids, such as a cane or walker, was questioned by their physicians.

I’m sure I’m an anomaly among those who have migraine in that I use a cane a lot of the time because of the risk that I have with vertigo and with losing feeling in my leg and I know that I’ve gotten a lot of kinda crappy treatment from Dr’s for that because like you’re having migraines, its not like that big of an issue, you don’t need to use an cane. . .But it is! I’ve fallen before and I’ve gotten stuck places. I’ve been unable to take care of myself in daily life. . .to go do grocery stuff or anything like that just because I can’t get around for fear of not being able to get up or falling or those kinds of things. And I think those things are also dismissed. It is a physical problem for a lot of people in that it affects a lot more than just your head, it affects a ton of other issues especially if you have vertigo and stuff with the migraines. You are at more risk and I think that mobility and stuff like that is something that doctors tend to, I don’t know, they get really worked up about it with me (laughter)

For Zara, the physician’s response to her use of a cane minimized the significance of her vertigo and its impact on her ability to function independently. This reaction demonstrates a broader trend in medical practice, where patients with conditions that are not immediately visible or easily understood—like vestibular migraine—may be unfairly judged (Cleghorn, 2021). As Gleghorn suggests, such judgments are shaped by dominant norms of bodily ability and legibility, where practices of care and adaptation are measured against standards of what a “healthy” or “normal” body should require. In these accounts we see how their practice and necessary adaptations—such as using mobility aids—are constructed as unnecessary and excessive overreactions, a form of credibility deficit that resonates with Fricker’s (2007) account of testimonial injustice. Laura shared a very similar story: during a visit with her neurologist, she was questioned about her use of a walker. “Why do you use a walker? Is it for your arthritis pain?” Laura told her that she did not have arthritis; “I use the walker because of my vertigo.” The neurologist responded by suggesting she should consider seeing a psychiatrist. Laura then described the shame that ensued after that conversation. Her experience demonstrates how stigma may be operating in patient–provider relationships, but more broadly how certain diagnoses, such as arthritis, are conferred greater legitimacy because they align with biomedical expectations of visible, measurable pathology. In contrast, vertigo— when associated with migraine—resists easy incorporation into this framework, rendering her self-report suspect. In this exchange, the neurologist not only refused to see from Laura’s standpoint but seemed affronted by her assertion of a reality in conflict with his own epistemic frame. As Fricker (2007) argues, such refusals can amount to testimonial injustice, where the patient’s credibility is actively undermined. Moreover, as Harding (1991) suggests, standpoint illuminates realities that dominant knowledge systems often refuse to acknowledge; here, Laura’s embodied experience disrupts the physician’s reliance on observable evidence. The psychiatrist referral functions, then, as a disciplinary move, pathologizing her insistence on her own lived reality and deepening the shame she described. I take this point up further in my discussion, where I consider how the legitimacy hierarchy of diagnoses intersects with epistemic injustice in shaping patient experiences.

Internalizing others’ narratives

Informants recognized that other people’s perceptions of their symptoms and/or how they were handling those symptoms influenced their own perceptions of reality. For example, during Carrie’s interview she highlighted how she was socialized to minimize her symptoms after reaching out to her family doctor between the ages of 11 and 14. Her physician diagnosed her as having migraine and let her know that it would subside once she hit puberty. She was told to take over-the-counter medication to treat her symptoms. When her symptoms did not subside, she was given preventative medication without success and recalls her doctor telling her it was “impossible” for her to have migraine attacks everyday and that she was simply “stressed.” This messaging led her to understand herself as “dramatic” that she was “overreacting” and that her symptoms were no big deal, or at least something she “should push through.”

I honestly never thought it was a big deal, I thought either everybody had headaches like this, or maybe I was overreacting. I just always had a tendency of kind of just minimizing what it was because it’s not a big deal. It’s fine. Everything’s fine. It’s not a big deal.

Like many informants, the symptoms Carrie experienced were perceived as just a headache and headaches were portrayed as a normal experience to be endured. This messaging led Carrie to question if she was overreacting whether she did in fact need medical attention for the bodily sensations that she was feeling. This resulted in Carrie delaying treatment well into her adult years where she continued to question the validity of her experiences and concerns.

Shifting responsibility

Informants discussed interactions with physicians that at times felt accusatory where they left appointments feeling like they were the problem, or that they were somehow causing their own condition. In Fiona’s case she was simply doing what many patients are told to do; take over-the-counter medication to treat their symptoms. When her family doctor declared that this behavior was causing her symptoms it was quite jarring.

I was a healthcare provider and knew that they were migraines but when I told my family doctor of my experience, he said these words to his medical student that I’ll never forget. . . ‘(She) has been taking too much Tylenol and Advil that she has induced these headaches.’ I was then asked to stop all over-the-counter medication and that was supposed to solve my problem. I was heartbroken because I didn’t cause my initial or subsequent migraines. I wanted relief, not to live through even more pain. I believe I did that for about a month and during that time I hardly slept or worked because of the pain. It was horrible.

Some informants spoke to how medical practices such as relying on medication to “fix” a patient’s condition can leave many patients wondering if they are the problem when that medication doesn’t work.

And then you start to feel that cycle of hopelessness again. . .why are these meds not working for me? And even with the migraine diagnosis, I’ve gone through those cycles of something works for a period of time and then it loses its charm or something changes and then I have to try something else. And you’re in that cycle constantly for quite a long time where I felt a lot of anxiety because nothing was working and then I felt like I was the problem. (Laura)

This belief is often reinforced when physicians provide few options for treatment or seem fixated on a particular treatment protocol.

I don’t think my interactions with a lot of health professionals helped that because I think some of the interactions made me feel like I was the problem. They seemed gung-ho that Topamax is the gold standard. ‘Why isn’t it working?’ ‘Well, I don’t know. My body doesn’t want it to.’ ‘What’s your problem?’ (Laura)

Diane shared that she was given a treatment protocol (nerve block) via injection at a clinic prescribed by her doctor. After the injection she experienced a reaction (possible allergy) to the medication. Despite her discomfort Diane felt compelled to try the injections again at another time until the medical secretary informed her that it was ok for her to reject a treatment, particularly if it is experienced as harmful.

They had sent me out of the exam room to sit quietly in the waiting area. I was sipping at a paper cup of water that the medical secretary had brought me. I still felt like I had to try the injections again. I remember sitting there, shivering, rubbing my throat because I wasn’t sure if I could swallow, and another patient asking if I could breathe. I had to stop and think before saying that yes, I could, my mouth was just numb and it felt weird swallowing. When the medical secretary asked me about what I wanted to do next, I said ’The doctor said we could try the blocks again in a week and see how I do.’ She waited until I looked up at her before she said that if I didn’t like the blocks, I didn’t have to do them. That I didn’t have to put stuff in my body that I didn’t want. I almost started crying and shook my head, and said I didn’t want to do the blocks again. When I was a little calmer, she took me down in the elevator and walked me out to where my dad was waiting in his car. She told me to call if I needed anything and encouraged me to follow-up with my family doctor.

While it is unclear if Diane’s interaction with her doctor made her feel that she had to try this treatment again, we can see from this vignette the responsibility this informant felt to adhere to the treatment her physician prescribed. Diane experienced a side effect from this treatment that left her feeling unsafe, yet she felt compelled to try it again at a later date until someone expressly let her know it was acceptable to decline. This dynamic also reflects Foucault (1973/2003) concept of the clinical gaze as the physician’s directive becomes the standard against which the patient measures her own judgment, leading Diane to override her lived experience of harm in order to conform to medical authority. While attempting to secure a diagnosis for their condition, some informants made note of comments that were made to them that made them feel as if they were the problem when not fitting easily into available diagnostic categories. Diane described a conversation where a specialist exclaimed “Maybe you’re an alien,” after they finished up their appointment where Diane was just told that they were unsure of what was wrong with her. “Ha, maybe,” she replied, unsure of how she was supposed to respond. “I’m glad you laughed,” the neurologist said, “most people don’t find it funny when I say stuff like that.” Diane reflected “it didn’t occur to me until later that maybe I didn’t find it funny either.”

Physicians hold significant influence over their patients and how they experience their treatments and their bodies. Communication style can inadvertently harm patients by reinforcing feelings of self-blame, inadequacy, and frustration. As a result, these interactions may not only fail to address patients’ needs but also contribute to emotional and psychological distress, further complicating their path to understanding and managing their conditions. Such communications also reflect a deeper epistemic gap: they emphasize the distance between medical realities—shaped by clinical categories and expectations of observable evidence—and women’s own embodied realities. Scholarship on contested conditions suggests patients’ experiences may be rendered unintelligible or “alien” within dominant biomedical frameworks. In such cases, the burden of resolving this mismatch often shifts back onto the patient, who is implicitly tasked with reconciling her embodied knowledge with biomedical authority (Barker, 2002, 2008; Conrad and Barker, 2010). The account described above reflects a similar dynamic.

Discussion

In this study, a critical ethnographic approach provided space to acknowledge the lived experiences of informants and facilitated an exploration into how healthcare providers’ words and actions can undermine women’s realities. Themes were initially developed by employing traditional ethnographic methods, and then analyzed through a critical, emancipatory lens. My analysis brings forward women’s experiences of having their realities questioned, their narratives diminished, and responsibility shifted back onto them. In this discussion, I argue that the term medical gaslighting captures central dimensions of these experiences, suggesting that gendered stereotyping and norms continue to influence women’s healthcare. To frame this, I draw on feminist standpoint theory (Harding, 1991), epistemological injustice (Fricker, 2007), and Foucault’s (1973/2003, 1978/2020) concepts of biopower and the clinical gaze, which together illuminate how power operates to discredit women’s embodied knowledge and reinscribe gendered hierarchies in clinical encounters.

Revisiting and defining medical gaslighting, drawing on standpoint theory

Patient accounts in this study are consistent with definitions of medical gaslighting that root it in multifaceted relational experiences. Revisiting our initial definition of medical gaslighting, it is an act of invalidation stemming from individual, structural and systemic sources. While often unintentional, this type of invalidation affects one’s perceptions of what is real or factual. Physicians rely heavily on diagnostic tools such as physical exams, blood work, imaging etc., to aid in their assessments. For conditions like migraine, where there are no known biomarkers, the process of diagnosis and assessment depends heavily on patient histories and the subjective interpretations of both patient and provider. Harding’s (1991) feminist standpoint theory reminds us that knowledge is socially situated: women’s everyday experiences of living with migraine provide them with forms of expertise that emerge through direct, embodied observation and, for many, careful attention to patterns, triggers, and symptoms over time. Informants’ accounts reveal that, in several instances, patients’ understandings of their symptoms were more accurate than those of their physicians, highlighting the limitations of conventional medical authority. Rather than assuming medical objectivity as the superior standard, standpoint theory emphasizes that all knowledge is partial and shaped by the position of the knower (Harding, 1991). Recognizing this makes it clear that patients’ perceptions and descriptions of their symptoms deserve more credence and curiosity. By centering the standpoint of women with migraine, we can both acknowledge the limits of the clinical gaze (Foucault, 1973/2003), which privileges what can be observed and measured, and open the door to more equitable, responsive forms of care.

The consequences of epistemic injustice

According to Australian philosopher Manne (2023), gaslighting is more than just changing one’s perspective on what happened. Manne posits that “gaslit people are made to feel defective in certain fundamental ways—either morally or rationally—for harbouring mental states to which they are entitled” (p. 137). This was evident in the stories shared during this study. Women described instances in which the way others interpreted their symptoms caused them to downplay or ignore their own pain, and they also discussed the profound effects these encounters had on their core being. Building on this, Fricker’s (2007) concept of “epistemic injustice,” specifically “testimonial injustice,” offers a powerful lens for understanding these experiences (Fricker, 2007; Fricker and Jenkins, 2017). Testimonial injustice occurs when someone’s word is given less credibility due to prejudice, often related to gender, race or other social locations (Fricker, 2007; Fricker and Jenkins, 2017). Here, informants’ concerns were frequently met with skepticism or outright dismissal by providers. Some informants shared feeling as though they were the problem after interactions with providers, particularly when medication prescribed did not work to lessen their symptoms. These feelings were exacerbated when their providers were accusatory or confrontational. This not only undermined their authority as knowers of their own bodies but also contributed to feelings of self doubt and defectiveness, echoing Manne’s (2023) observations. It follows, acknowledging the role testimonial injustice has in disrupting women’s perceptions of self is crucial, particularly for improving clinical practice in ways that work toward valuing their insights and contributions as partners in clinical spaces.

The clinical gaze, biopower, and gendered relations of care

Gender bias remains a pressing issue in medicine, where cis-gendered male bodies are frequently treated as the norm in research and education (Plevkova et al., 2020). This has consequences for conditions that disproportionately affect women, such as migraine, which remain poorly understood (Thompson and Blake, 2020). For example, although the majority of those diagnosed with autoimmune conditions are women, research has historically relied on male animal models and male cohorts, producing male-biased data that continue to shape what is considered “evidence-based” practice (Dodd and Menon, 2022; Holdcroft, 2007). Foucault’s concepts of the clinical gaze and biopower offer a useful lens for understanding how these gendered biases are enacted in everyday practice. The clinical gaze, calibrated to male bodies and normative expectations, renders women’s symptoms more likely to be overlooked, misinterpreted, or dismissed (Greenhalgh, 2001). Importantly, this gaze is not neutral but a mechanism of biopower—a form of power that, as Foucault (1978/2020) emphasizes, is always operating through the regulation, surveillance, and management of bodies and populations. In this sense, power is not only exercised in moments of overt conflict but embedded in the very ways medical knowledge is produced, legitimized, and applied. The women in this study described how these dynamics shaped their encounters with providers. Presenting with symptoms that did not align with dominant discourses, they sought recognition and a positive relational experience in clinical settings. Yet, their accounts reveal that these relational needs often went unmet: biomedical authority was repeatedly asserted over their lived realities, leaving them conflicted about the validity of their own experiences. As a result, informants reported feelings of despair, stress, anxiety, and depression, with some describing worsening health in the context of ongoing dismissals. Seen through the lens of the clinical gaze and biopower, these encounters illuminate how unequal distributions of power are continually maintained in provider–patient relationships. What is at stake is not simply individual miscommunication but the reproduction of medical authority as a political and social process. Recognizing this opens possibilities for reshaping healthcare policy and practice in ways that attend to the relational needs of marginalized groups—such as women with migraine—and foster more equitable forms of care.

Reimaging good care

As this study demonstrates, medical gaslighting can emerge at the intersection of diagnostic uncertainty and relational dynamics in which patients’ testimony is dismissed, minimized, or treated with suspicion. Reimagining what counts as “good care” therefore becomes central to addressing these experiences. Mol and Harden (2020) argue that modern healthcare systems have historically prioritized cure over care, treating relational forms of care as secondary. This orientation is particularly problematic for chronic conditions such as migraine, where diagnosis and management rely heavily on patient narratives and ongoing collaboration (Ashina et al., 2021).

In response, care must involve more than technical expertise. It requires relational practices that acknowledge patients as credible knowers of their own bodies. Mol and Harden (2020) describe this as an adaptive process of “tinkering,” in which clinicians and patients collaboratively experiment with treatments and strategies to improve quality of life (p. 194). When we reflect on participants stories, relational practices are not simply desirable but are crucial safeguards against the conditions under which medical gaslighting occurs. When clinicians engage in behaviors that result in patients feeling dismissed, they reinforce the epistemic hierarchies that this study has shown to undermine women’s credibility in clinical encounters.

Informants’ accounts also revealed what alternative forms of care can look like in practice. Several participants described positive encounters with providers who listened attentively, validated their experiences, and worked collaboratively to address their symptoms. Carrie, for example, described a nurse who advocated for her after a dismissive interaction with an emergency physician, ultimately helping her obtain medication to manage her pain. Quinn similarly emphasized that her family physician’s willingness to listen and take her concerns seriously made a significant difference in her care. These encounters illustrate how practices such as validation, empathy, and collaboration can mitigate the harms associated with medical gaslighting by affirming patients’ epistemic authority and fostering more equitable clinical relationships.

Limitations

Because this study draws exclusively on women’s accounts, it cannot definitively isolate gender as the sole axis shaping experiences of dismissal, responsibilities, or disbelief in clinical encounters. Experiences such as those described here may also be shaped by other intersecting forms of marginalization, including ableism, class, age, or broader dynamics surrounding contested or poorly understood illnesses. Rather than claiming that medical gaslighting is exclusively gendered, this analysis highlights how gendered assumptions appear to operate within these encounters and intersect with other structural dynamics that shape the credibility afforded to patients. Situating these narratives within feminist scholarship on gender bias in medicine allows us to see how longstanding patterns, such as the tendency to psychologize women’s symptoms or question their credibility, may help structure the experiences described by informants. At the same time, further research comparing diverse patient populations would be needed to more fully disentangle how gender interacts with other aspects of marginalization in producing these dynamics.

Conclusion

Medical gaslighting represents a form of misogyny embedded within a system that perceives women as unreliable narrators, often branding them as dramatic or excessively sensitive (Khan et al., 2024). Such stereotypes perpetuate the marginalization of women, whose value, knowledge and integrity are frequently questioned or dismissed in dominant discourses function to exploit or subjugate them. These social processes arguably contribute to social problems faced by women such as difficulty acquiring diagnosis and treatment for subjective or contested conditions

In this study, accounts from informants illustrate the various forms of discounting, dismissal and blame that women may encounter when presenting subjective symptoms during their interactions with healthcare professionals, social processes well captured by the concept of medical gaslighting. These narratives enrich the existing literature focused on defining medical gaslighting and make apparent how gaslighting unfolds in the context of specific illnesses and disabilities. It will take a paradigm shift for healthcare as an institution to critically assess and recognize its shortcomings as well as how it contributes to the continued oppression of populations. That said, through the sharing of these experiences and subsequent analysis, the researcher aspires for readers—particularly physicians—to contemplate how clinical practices may evolve to provide the kind of "good care”—envisioned by Mol and Harden (2020)—for women with migraine.