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Anti-Black Medical Gaslighting in Healthcare: Experiences of Black Women in Canada
Abstract
Background
Stereotype about Black people contribute to nurses and healthcare providers gaslighting and dismissing of their health concerns. Despite the popularity of the term medical gaslighting in mainstream literature, few studies have explored the experiences of Black women during pregnancy and childbirth.
Purpose
This paper aims to provide an in-depth insight into Black women's experiences of anti-Black medical gaslighting when accessing care during pregnancy and childbirth.
Methods
Utilizing qualitative methods, we conducted 24 semi-structured interviews with Black women in the Greater Toronto Area. We used thematic analysis to ground the data analysis and to generate insight into Black women's experiences.
Results
Three overarching themes: 1) Not Being Understood: Privileging of Medical Knowledge Contributing to the Downplaying of Health Concerns, 2) Not Being Believed: Stereotypes Contributing to Dismissive Healthcare Encounters and 3) Listen to Us: Turning off the Cycle of Medical Gaslighting. These themes highlight ways anti-Black medical gaslighting manifests in Black women's healthcare encounters to create differential access to treatment and care.
Conclusions
Anti-Black medical gaslighting contributes to differential access to treatment and care. Improving equitable access to treatment and care must involve addressing structural and epistemic biases in healthcare and fostering a culture of listening to humanize the experience of illness.
Background
The coronavirus disease 2019 (COVID-19) pandemic exposed long-standing connections between health inequity and social injustice. With Millennials and Gen Z at the forefront of protests against racial injustices, the disconnect between students and educators is increasing. Students expect educators to trouble the comfort zone of the classroom and clinical settings to address the complex dynamics of anti-Black racism and oppressive practices. Educators are challenged to be critical allies for transformative learning to occur.
Method
The innovative co-creation of a teaching and learning model involving educators and students is introduced.
Results
Centering educators as critical allies, the model demonstrates how, using the three P components of people, place, and program, educators can integrate the principles of equity, diversity, and inclusion for a transformative experience that will bolster the student-educator relationship.
Conclusion
Educators as critical allies are central to dismantling anti-Black racism and other forms of oppression through teaching and learning. [ J Nurs Educ . 2025;64(X):XXX-XXX.]
The prevalence of gender and race-based sexual stereotypes contributes to the sexual health disparities that young Black girls and women in the US experience. This systematic review examined young Black girls’ and women’s experiences of sexual stereotypes and its impact on their sexual behaviors. A qualitative evidence synthesis of 26 studies using a meta-ethnographic synthesis approach was utilized. Black Feminist Thought (BFT) was applied as a conceptual framework to center Black girls’ and women’s experiences. The review generated several constructs that highlighted the impact of stereotypes on sexual decision-making and behaviors: reclaiming versus rejecting stereotypes; loss of control; confront and challenge; health professional distrust and intergenerational trauma; and internalized misogynoir. A line of argument synthesis was also generated, which highlighted how this demographic sought sexual autonomy away from race-based sexual stereotypes: this was coined flipping the sexual script. The findings highlight the need for policy changes concerning sexual health and education in the US, to include policies specifically tailored to Black girls and women.
A form of indentured labour, Canada’s Seasonal Agricultural Worker Program (SAWP) hires thousands of Jamaican farm workers each year on temporary contracts that bind their employment and immigration status to a single Canadian employer. Hazardous working and living conditions in Canada render SAWP workers vulnerable to poor health outcomes, and injured workers are often repatriated before they can access health care or workers’ compensation. In this context, SAWP workers are typically reluctant to refuse unsafe work, report injuries, or seek health care for fear of losing present or future employment in Canada. This research conceptualizes the SAWP as a necropolitical system of unfree labour wherein Jamaican workers are racialized, dehumanized, and refigured as disposable instruments of labour through mechanisms commensurable with those employed in the plantation slavery system. Drawing on 18 months of ethnographic fieldwork with Jamaican SAWP workers, this paper focuses on the experiences of workers who are physically injured in Canada and explores the challenges they encounter attempting to recover their health and income. To discuss these experiences, I present what I call the triple violence of injury under the SAWP: (1) the pain and debility caused by physical injury; (2) the structural violence that injury both exposes and makes workers vulnerable to; and (3) the necropolitical legacy of slavery and ongoing dehumanization through which Jamaican workers experience their bodies as racialized and vulnerable. In foregrounding the experiences of Jamaican workers, this study addresses the dearth of research on the experiences of migrant farm workers from the Caribbean.
Background
Obstetric racism in healthcare encounters impact on access to quality maternal healthcare for Black childbearing women yet remains underexplored in Canada. Understanding the experiences of Black Canadian women is critical to inform policy and create targeted interventions to address obstetric racism and advanced maternal health equity.
Objective
The aim of this study was to explore the experiences of obstetric racism and its influence on perceived quality of maternity care among Black women in Toronto, Canada.
Design
Qualitative research was conducted using a critical qualitative inquiry approach.
Methods
We conducted a semi-structured interviews with 24 Black women who were pregnant and/or have given birth in the last 3 years. The interviews explored their experiences seeking care during pregnancy/childbirth and perceived quality of care.
Results
Two themes were generated through the process of thematic analysis: (1) Manifestations and Impacts of Obstetric Racism and (2) Strategies for Addressing Obstetric Racism. Narratives of being dismissed, objectified, dehumanized, trauma and paternalism were reflected in the accounts of the participants. These experiences undermined the quality of care, hindered therapeutic relationships and contributed to mistrust.
Conclusion
Black women understood the nature and impact of obstetric racism as it relates to the quality of maternal health care, their safety, and well-being. Participants recommended the need for anti-Black racism training specific to caring of Black childbearing women and increasing Black healthcare provider representation in perinatal settings as strategies to address obstetric racism. Investment in Black maternal health research is urgently needed to generate meaningful evidence to inform policy and interventions to advanced maternal health equity.
Introduction: Growing evidence suggests disparities in the prevalence, management, progression, and outcomes of chronic, nonmalignant pain-related conditions, especially for African American patients.
Objective: The purpose of this review is to explore studied causative factors that influence the management of chronic pain among African Americans, including factors that result in disparate care that may contribute to unfavorable outcomes.
Methods: This narrative review is based on available literature published on this topic published within the last 10 years.
Results: Assessment of chronic pain is multifaceted, often complicated by patient medical comorbidities and a complex set of biopsychosocial/spiritual/financial and legal determinants. These complexities are further exacerbated by a patient's race, by provider bias, and by structural barriers—all intersecting and culminating in disparate outcomes.
Conclusions: A comprehensive analysis is needed to identify quality improvement interventions and to mitigate major barriers contributing to disparities in the management of chronic pain in the African American population.
While there is a steadily growing literature on epistemic injustice in healthcare, there are few discussions of the role that biomedical technologies play in harming patients in their capacity as knowers. Through an analysis of newborn and pediatric genetic and genomic sequencing technologies (GSTs), I argue that biomedical technologies can lead to epistemic injustice through two primary pathways: epistemic capture and value partitioning. I close by discussing the larger ethical and political context of critical analyses of GSTs and their broader implications for just and equitable healthcare delivery.
A large slice of contemporary phenomenology of medicine has been devoted to developing an account of health and illness that proceeds from the first-person perspective when attempting to understand the ill person in contrast and connection to the third-person perspective on his/her diseased body. A proof that this phenomenological account of health and illness, represented by philosophers, such as Drew Leder, Kay Toombs, Havi Carel, Hans-Georg Gadamer, Kevin Aho, and Fredrik Svenaeus, is becoming increasingly influential in philosophy of medicine and medical ethics is the criticism of it that has been voiced in some recent studies. In this article, two such critical contributions, proceeding from radically different premises and backgrounds, are discussed: Jonathan Sholl's naturalistic critique and Talia Welsh's Nietzschean critique. The aim is to defend the phenomenological account and clear up misunderstandings about what it amounts to and what we should be able to expect from it.
A qualitative description design is particularly relevant where information is required directly from those experiencing the phenomenon under investigation and where time and resources are limited. Nurses and midwives often have clinical questions suitable to a qualitative approach but little time to develop an exhaustive comprehension of qualitative methodological approaches. Qualitative description research is sometimes considered a less sophisticated approach for epistemological reasons. Another challenge when considering qualitative description design is differentiating qualitative description from other qualitative approaches. This article provides a systematic and robust journey through the philosophical, ontological, and epistemological perspectives, which evidences the purpose of qualitative description research. Methods and rigor issues underpinning qualitative description research are also appraised to provide the researcher with a systematic approach to conduct research utilizing this approach. The key attributes and value of qualitative description research in the health care professions will be highlighted with the aim of extending its usage.
This article analyses the phenomenon of epistemic injustice within contemporary healthcare. We begin by detailing the persistent complaints patients make about their testimonial frustration and hermeneutical marginalization, and the negative impact this has on their care. We offer an epistemic analysis of this problem using Miranda Fricker's account of epistemic injustice. We detail two types of epistemic injustice, testimonial and hermeneutical, and identify the negative stereotypes and structural features of modern healthcare practices that generate them. We claim that these stereotypes and structural features render ill persons especially vulnerable to these two types of epistemic injustice. We end by proposing five avenues for further work on epistemic injustice in healthcare.
Criteria for determining the trustworthiness of qualitative research were introduced by Guba and Lincoln in the 1980s when they replaced terminology for achieving rigor, reliability, validity, and generalizability with dependability, credibility, and transferability. Strategies for achieving trustworthiness were also introduced. This landmark contribution to qualitative research remains in use today, with only minor modifications in format. Despite the significance of this contribution over the past four decades, the strategies recommended to achieve trustworthiness have not been critically examined. Recommendations for where, why, and how to use these strategies have not been developed, and how well they achieve their intended goal has not been examined. We do not know, for example, what impact these strategies have on the completed research. In this article, I critique these strategies. I recommend that qualitative researchers return to the terminology of social sciences, using rigor, reliability, validity, and generalizability. I then make recommendations for the appropriate use of the strategies recommended to achieve rigor: prolonged engagement, persistent observation, and thick, rich description; inter-rater reliability, negative case analysis; peer review or debriefing; clarifying researcher bias; member checking; external audits; and triangulation.
This paper explores how a medicalized view of pregnancy shapes the process of pregnant embodiment and women's experiences postpartum. Analyzing interviews with 42 pregnant women and new mothers, I show that while women's experiences of pregnant embodiment are shaped by biomedical notions of pregnancy, women also bring new meaning to the biomedical guidelines. Women view pregnancy as a process of sharing their bodies with their children, and they continue to share their bodies with their newborns during the postpartum period. I conclude the paper by reflecting on the role of the body in shaping our understanding of medicalized phenomena.
In this paper we argue that ill persons are particularly vulnerable to epistemic injustice in the sense articulated by Fricker (Epistemic injustice. Power and the ethics of knowing. Oxford University Press, Oxford, 2007). Ill persons are vulnerable to testimonial injustice through the presumptive attribution of characteristics like cognitive unreliability and emotional instability that downgrade the credibility of their testimonies. Ill persons are also vulnerable to hermeneutical injustice because many aspects of the experience of illness are difficult to understand and communicate and this often owes to gaps in collective hermeneutical resources. We then argue that epistemic injustice arises in part owing to the epistemic privilege enjoyed by the practitioners and institutions of contemporary healthcare services-the former owing to their training, expertise, and third-person psychology, and the latter owing to their implicit privileging of certain styles of articulating and evidencing testimonies in ways that marginalise ill persons. We suggest that a phenomenological toolkit may be part of an effort to ameliorate epistemic injustice.
Like the nation as a whole, organized medicine in the United States carries a legacy of racial bias and segregation that should be understood and acknowledged. For more than 100 years, many state and local medical societies openly discriminated against black physicians, barring them from membership and from professional support and advancement. The American Medical Association was early and persistent in countenancing this racial segregation. Several key historical episodes demonstrate that many of the decisions and practices that established and maintained medical professional segregation were challenged by black and white physicians, both within and outside organized medicine. The effects of this history have been far reaching for the medical profession and, in particular, the legacy of segregation, bias, and exclusion continues to adversely affect African American physicians and the patients they serve.
Published online July 10, 2008 (doi:10.1001/jama.300.3.306).
Gaslighting has become a popular term to describe experiences of doubt and manipulation that make individuals or groups feel like their lived realities are not valid. Much of the theoretical work utilizing gaslighting as an analytic can be found in psychology literature or feminist domestic violence discussions. More recently, political scientists, philosophers, and sociologists have noted the structural, political, economic, and social processes that enable gaslighting to move beyond an interpersonal dynamic between women and their abusers. This essay extends these arguments through a Black feminist anthropological lens to examine how anti‐Black medical gaslighting functions structurally within medical systems, individually through implicit biases held by healthcare workers, and collectively through cultural norms. Despite Black patients’ learned mistrust of the medical system and often after multiple failed attempts to receive care or answers, ethnographic vignettes reveal that Black people with amyotrophic lateral sclerosis (ALS) and their caregivers continue to fight to be heard by the medical establishment despite being gaslit.
Gaslighting is a type of abuse aimed at making victims question their sanity as well as the veracity and legitimacy of their own perspectives and feelings. In this article, we show how gaslighting can operate as a key, yet underexamined, strategy of obstetric violence, or the institutional and interpersonal violation of women's rights during pregnancy, childbirth, and postpartum. We draw on forty-six in-depth, semi-structured interviews with mothers who experienced a traumatic childbirth to examine how obstetric providers gaslight mothers before, during and after childbirth when they deny – and thereby destabilize – mothers' realities. We identify and examine four core types of denials: denials of 1) mothers' humanity, 2) mothers' knowledge as valid, 3) mothers' judgements as rational and 4) mothers' feelings as legitimate. All four denials work to render mothers noncredible and their claims illegible within clinical encounters. In explicitly naming, theorizing, and examining obstetric gaslighting, our aims are threefold: 1) to uncover and theorize an underexamined mechanism of obstetric violence through a sociological lens, 2) to offer a typology of obstetric gaslighting's manifestations to aid scholars and practitioners in recognizing when obstetric gaslighting is occurring and 3) to advance a growing research program on gaslighting in medicine.
In recent years, the term ‘medical gaslighting’ and accompanying accounts of self‐identified women experiencing invalidation, dismissal and inadequate care have proliferated in the media. Gaslighting has primarily been conceptualized in the field of psychology as a phenomenon within interpersonal relationships. Following the work of Paige Sweet (American Sociological Review, 84, 2019, 851), I argue that a sociological explanation is necessary. Such an explanation illustrates how medical gaslighting is not simply an interpersonal exchange, but the result of deeply embedded and largely unchallenged ideologies underpinning health‐care services. Through an intersectional feminist and Foucauldian analysis, I illuminate the ideological structures of western medicine that allow for medical gaslighting to be commonplace in the lives of women, transgender, intersex, queer and racialized individuals seeking health care. Importantly, these are not mutually exclusive groups, and I use the term bio‐Others to highlight and connect how those with embodied differences are treated in medicine. This article indicates the importance of opening a robust discussion about the sociology of medical gaslighting, so that we might better understand what structural barriers people of marginalized social locations face in accessing quality health care and develop creative solutions to challenge health‐care inequities.
Gaslighting—a type of psychological abuse aimed at making victims seem or feel “crazy,” creating a “surreal” interpersonal environment—has captured public attention. Despite the popularity of the term, sociologists have ignored gaslighting, leaving it to be theorized by psychologists. However, this article argues that gaslighting is primarily a sociological rather than a psychological phenomenon. Gaslighting should be understood as rooted in social inequalities, including gender, and executed in power-laden intimate relationships. The theory developed here argues that gaslighting is consequential when perpetrators mobilize gender-based stereotypes and structural and institutional inequalities against victims to manipulate their realities. Using domestic violence as a strategic case study to identify the mechanisms via which gaslighting operates, I reveal how abusers mobilize gendered stereotypes; structural vulnerabilities related to race, nationality, and sexuality; and institutional inequalities against victims to erode their realities. These tactics are gendered in that they rely on the association of femininity with irrationality. Gaslighting offers an opportunity for sociologists to theorize under-recognized, gendered forms of power and their mobilization in interpersonal relationships.
What are the key issues confronting the call for a new critical inquiry? How to create a new family of terms for a new critical inquiry, terms slip and slide, fall over one another: critical embodied, transformative, dialogic, reflexive, participatory, emancipatory, narratives of resistance, plateaus, planes of composition, Deleuze, Guattari, assemblages, affect, nomadic inquiry, rhizomatic, love, loss, praxis writing as a way of being in the world. Writing framed around acts of activism and resistance. How do we move forward?
Significance
The present work examines beliefs associated with racial bias in pain management, a critical health care domain with well-documented racial disparities. Specifically, this work reveals that a substantial number of white laypeople and medical students and residents hold false beliefs about biological differences between blacks and whites and demonstrates that these beliefs predict racial bias in pain perception and treatment recommendation accuracy. It also provides the first evidence that racial bias in pain perception is associated with racial bias in pain treatment recommendations. Taken together, this work provides evidence that false beliefs about biological differences between blacks and whites continue to shape the way we perceive and treat black people—they are associated with racial disparities in pain assessment and treatment recommendations.
Justice is one of the oldest and most central themes of philosophy, but sometimes we would do well to focus instead on injustice. In epistemology, the very idea that there is a first-order ethical dimension to our epistemic practices - the idea that there is such a thing as epistemic justice - remains obscure until we adjust the philosophical lens so that we see through to the negative space that is epistemic injustice. This book argues that there is a distinctively epistemic genus of injustice, in which someone is wronged specifically in their capacity as a knower, wronged therefore in a capacity essential to human value. The book identifies two forms of epistemic injustice: testimonial injustice and hermeneutical injustice. In doing so, it charts the ethical dimension of two fundamental epistemic practices: gaining knowledge by being told and making sense of our social experiences. As the account unfolds, the book travels through a range of philosophical problems. Thus, the book finds an analysis of social power; an account of prejudicial stereotypes; a characterization of two hybrid intellectual-ethical virtues; a revised account of the State of Nature used in genealogical explanations of the concept of knowledge; a discussion of objectification and 'silencing'; and a framework for a virtue epistemological account of testimony. The book reveals epistemic injustice as a potent yet largely silent dimension of discrimination, analyses the wrong it perpetrates, and constructs two hybrid ethical-intellectual virtues of epistemic justice which aim to forestall it.
This paper demonstrates how the problematic kinds of epistemic power that physicians have can diminish the epistemic privilege that pregnant women have over their bodies and can put them in a state of epistemic powerlessness. This result, I argue, constitutes an epistemic injustice for many pregnant women. A reconsideration of how we understand and care for pregnant women and of the physician-patient relationship can provide us with a valuable context and starting point for helping to alleviate the knowledge/power problems that are symptomatic of the current system and structure of medicine. I suggest that we can begin to confront this kind of injustice if medicine adopts a more phenomenological understanding of bodies and if physicians and patients-in this case, pregnant women-become what I call "epistemic peers."
© The Author 2014. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Epistemic oppression refers to persistent epistemic exclusion that hinders one’s contribution to knowledge production. The tendency to shy away from using the term “epistemic oppression” may follow from an assumption that epistemic forms of oppression are generally reducible to social and political forms of oppression. While I agree that many exclusions that compromise one’s ability to contribute to the production of knowledge can be reducible to social and political forms of oppression, there still exists distinctly irreducible forms of epistemic oppression. In this paper, I claim that a major point of distinction between reducible and irreducible epistemic oppression is the major source of difficulty one faces in addressing each kind of oppression, i.e. epistemic power or features of epistemological systems. Distinguishing between reducible and irreducible forms of epistemic oppression can offer a better understanding of what is at stake in deploying the term and when such deployment is apt.
This paper identifies and examines the social context and social interactions that facilitate the process of pregnant embodiment. It views the embodiment of pregnancy as a performance of “doing pregnancy” that involves learning, adapting, and performing. By using qualitative analysis of 42 interviews with women of diverse age groups, and social and cultural backgrounds, it is demonstrated that the embodiment of pregnancy as a process of doing includes: (1) learning to be pregnant through reassessment and reevaluation of bodily sensations; (2) adapting new routines of care for the body; and (3) performing normalized cues and routines of pregnancy. This paper demonstrates the social regulation of pregnancy through the analysis of pregnancy as a performance.
Studies of reality television often overlook a first-hand, first person account of the implications that representations of race have on individuals. This autoethnographic essay discusses the multiple consciousness of a Black female scholar. Layering storied excerpts and theoretical framing the author proposes the use of an “oppositional gaze” and “oppositional reading” to interrogate and engage images and representations of Black women on reality television shows. Given the historical legacy of Black female representation and the destructive images that result, a critical awareness could ultimately alter or inform the images of Black women we see on reality television. The author urges Black women to become critical consumers of how their experiences are depicted on reality television.
- Drwecki B. B.