Medical Gaslighting: It’s NOT ‘In Your Head’

Aaron Hartman, MD explains medical gaslighting: when doctors dismiss real symptoms like dizziness and heart palpitations as anxiety. Dysautonomia and POTS have measurable signs like blood pressure changes and pupil dilation. Your gut produces neurotransmitters that affect mood, so physical causes matter.
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Have you ever heard the following? It's all in your head. You're just anxious. It was just a panic attack. You need to calm down, do some breath work, you need to relax. But ultimately it's all in your head. There's nothing serious. Your anxiety, general anxiety disorder, your depression, your panic attack, your lightheadedness, your dizziness, all these things, these are just, you know, nothing we can do for. It's all in your head. I want to talk about medical gaslighting today, using this, talking about the symptoms that I just mentioned, and talk about all the things that really could be. I think this is important because many times when we don't find an exact diagnosis easy, it's not, you know, actual heart arrhythmia, it's not actually a lung thing. It's not actually a stomach ulcer or blood pressure irregularity or whatever that the easy diagnosis is. It's psychological stress and to blow it off. But there are many, many diagnoses that can have all those symptoms I just mentioned, and they're real diagnoses that have real treatments and really need to be addressed. And unfortunately, this happens a lot in women who are more to their bodies, who've been paying attention to their bodies from the time they're 11, 12, 13 from their first cycle for decades, many times. And what happens is when you have hormones changing throughout the month, estrogen being more prominent, the first part of your cycle having a. The little luteal phase, when you feel that, it's called the middle schmertz. It's when you ovulate, feel that little, that little pelvic twinge or pain, sometimes, sometimes it can be quite severe. And then the last part of your cycle, having your progesterone going up with estrogen kind of coming down, and then everything goes down when you have your cycle, like going through that month after month, year after year, women become super attuned to the body's physiology and knowing, hey, I know my body better than anybody else. And unfortunately, in our current system, we ignore a lot of that and we get these diagnoses of anxiety, et cetera, et cetera. So what could it be in this medical gaslighting situation? And one thing I see a lot of is a thing called dysautonomia, which is an irregularity or dysregulation in your autonomic nervous system. And there's like five part. I literally just learned this reading a textbook of autonomic medicine a couple, a couple weeks ago, finishing it, that there's actually Five parts to your nervous system. Not just the traditional, you know, sympathetic parasympathetic nervous system. And when you get an irregularity in these parts of nervous system, you can have things with blood pressure fluctuations. So like for example, if you feel really bad in the heat in the summertime, you go outside, you feel dizzy, lightheaded, barometric pressure changes kind of knock you out. And I think most of us at this stage know individuals that have problems like that. That's actually related to dilation of your vessels. And so you actually get some pulling of your blood. And because there's an irregularity between your noradrenergic nervous system called the SNS and your adrenergic system called the sas, it's basically epinephrine and norepinephrine. You get the dilation of the norepinephrine effect, which causes more blood flow to the muscles, but you don't get the epinephrine effect, which actually keeps your blood pressure up. And in situations where you get dilation, for example, heat staining quickly, if you go, you go from sitting to staining the nervous system irregular will result in blood pressure dropping a little bit. And that can make you feel dizzy, lightheaded. Anxiety is a real low level Anxiety is a very common symptom of this low level, low blood pressure, inability to get blood going to your brain. And your brain senses it and feels a little anxious, a little on edge, a little like when compared to next thing drop. And it's a pretty easy thing to evaluate and diagnose by a physical exam. Looking at individuals pupils, you'll see them, they kind of open and close. It's called an adrenal pupil. When you do a blood pressure and someone goes from sitting just standing, you'll see the blood pressure kind of go down, the pulse kind of go up. And you can see a shift in their systolic, which is the upper blood pressure number and diastolic. These are typical standard things medical students learn to look at, but you can look at to get a window into someone's nervous system. Do they have problems sweating, pointing is that there's symptoms of anxiety. Could be an issue with dysautonomia. A more common one is known as pots. POTS is a type of dysautonomia. When you stand up, you're more prone to get. It's called postural orthostatic tachycardia syndrome. These individuals, if you're relaxing, might have a pulse of like 90. Walked in the office with new patients before, hey, how you Doing. Nice to meet you. I look at the chart and like, huh, you're just sitting here and your pulse is 90. It's 92. Like that's not normal. So let's talk for five, six minutes, recheck it. Hmm. It's still up. A lot of people will have a low level of this POTS thing. It gives them a low level. Anxiety. You have more palpitations. And actually, strangely enough, sometimes things like caffeine will make you feel better, because caffeine actually can lower your, I mean, increase your blood pressure just, just a smidgen. Drinking lots of water, electrolytes. Some people realize, hey, I feel better when it's a little colder, you know, because you get constriction of your, your arteries or you feel a little better, less anxious, less dizzy, less lightheaded. When you wear tight Spanx or tight biking shorts or something that puts pressure not just on your legs, but also on your internal organs. These are basic things that can be looked at. But the point is like this. Anxiety could just be like these. How about your gut? We've now learned that 90% of serotonin, which is your calms in neurotransmitter, 50% of dopamine, and 75% of all neurotransmitters are made in your GI tract. So all of a sudden, if you're not making adequate neurotransmitters because you have a gut issue, gas, bloating, constipation, diarrhea, maybe you belch a lot, maybe you pass undigested food in your stool, maybe your gut as part of your anxiety, stuff you're dealing with that's really interesting. Or even imbalances and fatty acids. There's actually an FDA approved drug called Viaren used to treat kids with ADHD who have low DHA levels. And this prescription medication actually will treat their adhd. Point is, like anxiety, something as basic as anxiety, as mood and mobility could be a whole host of things. And unfortunately, if you don't have a traditional diagnosis, you're not, you know, you don't have bipolar, or you don't have severe depression or severe panic. You get in these little categories and you get medically gaslit. You get minimized. You say, go home, take your drug, and you'll feel better. And the reality is you do have something going on. Listen to your body. I'll talk about a couple other examples of medical gaslighting, but just anxiety alone is one of the ones I see the most. I want to talk about obesity as another form of medical gaslighting here next, because I actually was recently asked to write a article for a big national magazine in regards to this topic. It's something that's really important because as obesity increases in our country, is it a primary thing or a secondary thing? Is it resulting from just eating too much, or is there inflammation in our environment? Is there toxins in the environment? Are there toxins? Do we have issues with our mitochondria, our metabolism, or even trauma and stress affecting our weight? So all of a sudden, now there can be more under that hood as well. So that's another topic we'll talk about here, about medical gaslighting, knowing about your body, paying attention to it, and how you can take charge of health. Take care, and we'll talk to you soon.
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