Dr. Robin Stern (00:06): Welcome to The Gaslight Effect podcast. I'm Robin Stern, co-founder and associate director of the Yale Center for Emotional Intelligence, and author of the bestselling book, The Gaslight Effect. I'm an educator and a psychoanalyst, but first and foremost, I'm a wife, a mother, a sister, aunt, and healer. And just like many of you, I was a victim of gaslighting. Please join me for each episode as I interview fascinating guests and explore the concept of gaslighting. You'll learn what it truly means to be gaslighted, how it feels, how to recognize it, and how to understand it, and ultimately how to get out of it.
Dr. Robin Stern (00:55): Before we begin, I want you to know that talking about gaslighting can bring up challenging and painful emotions. Give yourself permission to feel them. Some of you may wanna go more deeply with your emotions. While some of you may hold them more lightly, no matter what you're feeling, know that your emotions are a guide to your inner life. Your emotions are sacred and uniquely you respect and embrace them for they have information to give you. If you want to listen to other episodes of The Gaslight Effect Podcast, you can find email@example.com or wherever you listen to podcasts. Thank you for being here with me. Welcome everyone to this episode of The Gaslight Effect podcast. I am really thrilled to have my friend and colleague, Tracy O'Connell, uh, Dr. Tracy with us today. And Tracy, please tell us what you want us to know about you.
Tracey O'Connell (01:56): Well, thanks so much for having me, Robin. And, uh, you know, like you, I am a mother, a daughter, a sister, a spouse, and a friend. Um, I'm also a physician. I'm trained in radiology. I am specifically in musculoskeletal imaging. And because of some fundamental dissatisfaction I had with that career, I left what was for me, um, psychologically unsafe private practice job about six years ago. And now I do teleradiology part-time, but I spend most of my time, energy, and resources, um, going toward helping others in medical careers who have also felt unsafe or unsatisfied in their careers.
Dr. Robin Stern (02:42): Well, that sounds like an invitation for me to ask you. So tell us what you mean about, um, being unsafe and how did you get from being a doctor to focusing on, um, things that are happening to doctors rather than just the clinical work, uh, that you were doing in the past.
Tracey O'Connell (03:03): Right. Well, most recently I received probably the best compliment I've ever gotten, which was that someone called me a compassionate observer. And I think, you know, in radiology we're all day long using our eyes to look at images, um, you know, inside of people. Um, and I was always kind of distracted by what was happening on outside of the person. I originally went to med school to be a psychiatrist, and I had a weird couple of rotations in psychiatry, and I just thought, you know, I mean, I was only 23, 24 at the time, and the notion of some of the, you know, I was just happened to be placed in some really, like the most severe of the severe, um, on the mentally ill spectrum with regard to people who were institutionalized or chronically, uh, medicated. And it was, it was quite traumatizing for me, actually.
Tracey O'Connell (04:01): And I've written some about this because, uh, you know, you're young. I mean, I have kids now that are in their twenties and to the notion of how they would handle some of the exposure to some of the, the things that we see ordinarily in, in medical life that are quite traumatizing, and yet it's just the way it is. I also early on wanna make a distinction in our conversation today between medical gaslighting and medical professional gaslighting and medical gaslighting. If you, if you look that up, and I know you've, you've done interviews around this before, um, personally and on the podcast, Robin, but, you know, medical gas lighting is what we hear about in newspaper articles and standing on the corner talking to a friend, uh, that's really all too common. Where we have felt while being a patient that someone didn't believe us or minimized or dismissed our medical experience, symptoms we're having things that don't add up and feeling like the medical system, the healthcare, um, practitioner didn't take us seriously or believe that it was all in our heads, that type of thing.
Tracey O'Connell (05:16): And that happens all too common. And I will reassure all listeners that it happens to doctors too,
Dr. Robin Stern (07:03): Well, maybe it is, unfortunately, the way it is. And, um, thank you for shining a light on it today with us before, though you go into it because there's so much to say. I know we've spoken about this before you go into detail about this that you are so interested in and, and interviewing people about right now. Um, how did you even come to think about gaslighting in the first place?
Tracey O'Connell (07:29): Right. Well, I will say that for the, for years, I mean, as a child and as a teen and as a college student, I was someone who worked hard and played hard and had a really balanced, wonderful life. And I felt pretty good about myself. Sure, there were insecurities and things that came up, but it wasn't until, it wasn't until I started studying for the mcat, which is the medical college admissions test, that I really started to feel this pervasive sense of not enoughness and otherwise known as shame. Um, and it was kind of, you know, at ever just this kind of constant evaluation, constant need to measure up
Dr. Robin Stern (08:17): Feeling shame that you felt like you didn't measure up. Was that where the shame came in or the shame that you had to go through that process to begin with?
Tracey O'Connell (08:25): Yeah, I think that it was just this subtle sense that there's a right way and a wrong way, and I don't know what that is and I'm gonna be really hustling to get the right answer. Uh, and until, you know, prior to that, my academic success had just been part of my identity. It was not all consuming. And I think then once starting medical school, not doing well on my first test, realizing I am not special. I'm mediocre. I'm just another fish in the sea, and how am I gonna distinguish myself here? Um, it just, it kind of, I always kept thinking, this is temporary. This feeling is temporary. I'll get used to it, I'll get better at it. It'll get easier when I'm on the clinical wards and not in the classroom. It will be, it will be easier when I'm done being a resident. It will be, I will feel at ease and competent and confident when I'm out in private practice, and I'm calling my own final word. Uh, but it kind of
Dr. Robin Stern (10:04): Um, I'll say now, just because I don't wanna interrupt your flow, but, uh, I do wanna to speak about shame that one of the reasons that I think people are stuck in gaslighting relationships so long is that they are ashamed to talk about it. Not only are they ashamed to find themselves in it, but um, since we know social support is a key factor in helping people to move past and even identify gaslighting, if they're not talking about it, then they're only listening to information and reality coming from one channel. They're gaslight and they're not able to really talk about, um, uh, the relationship because of the shame. So I'll say that for now, and then we can talk about that later today or in part two of us. And, um, so I invite you to just continue now in your own flow.
Tracey O'Connell (10:56): Yeah, and I, I do wanna say that since all of us will encounter the healthcare system in our lifetime, that, that's why I feel like this conversation is so important. 'cause there's a lot to unpack for both practitioners and for patients. I also want to emphasize that what I'm sharing today is an ex the experiences that have been my own, but it's also a combination of experiences that many of my colleagues and clients that I've worked with have shared. Um, and some of this is gonna be kind of bold. It's gonna make people angry. There's going to be a real defensiveness, um, around any critique of the system. And I'm at liberty to say some of the things that we're gonna be talking about because I am a free agent now, and I'm not held hostage by, by the healthcare system that would employ me. Um, because I'm, I'm working now as an independent contractor,
Dr. Robin Stern (11:57): How wonderful for our audience
Tracey O'Connell (11:59):
Dr. Robin Stern (12:59): Might wanna translate that for the audience. Serotonin reserves,
Tracey O'Connell (13:04): Well, serotonin is the, is the neurochemical. Uh, it's a neurotransmitter that helps us to, to regulate our mood. And, um, when, when we're feeling, when we, we literally do run out of these things. I mean, the relationship between your adrenal glands and stress and the brain, it takes an enormous toll on the body. And that's what's so ironic. And that's a whole other conversation about stress and the impact on our thinking and what we allow ourselves to believe and what happens when we're sleep deprived, chronically sleep deprived when we're not taking care of basic needs like food, water, um, you know, rest light being exposed to the elements, like not even knowing what season it is. It's, um, it kind of suspends normal reality. And again, there's so many things that make that medical culture makes gaslighting. It's such a fertile ground for being, for questioning your own reality and questioning what you think.
Tracey O'Connell (14:15): It can be really hard to stay. The other reason I think it's gonna be hard for anyone in the medical profession to hear this is because people have blinders on. Uh, they've believed that what they're doing is right. Um, there's so much social capital and respect for the medical profession, um, that's just historical and also well earned. Um, and it's also, you know, it used to be that you could just, doctors would just make house calls and sit with people in their troubles and maybe they could offer a tincture or a, some, some advice or some kind of herbal remedy. And then everyone accepted, patient included patient's, family included, physician included, that they were doing everything they could do. And now the expectation is that doing everything you could do and all the oppor, you know, all the pharmaceutical advances and technological advances and medical ingenuity that has really exceeded human evolution,
Tracey O'Connell (15:35): Am I doing enough? Am I doing it wrong? Is someone going to be judging me? Because that medical hierarchy I talked about, someone's always above you and whoever's above you has power over you. And the only people I now interact with who are really happy in their medical careers are people who are either in positions of power, who can, who have autonomy and can call the shots and how they spend their day and time. Or they are people who have designed their own practice, who have left a group and are now operating independently. People who work part-time, people who have left the medical profession altogether. And this is really a crisis.
Dr. Robin Stern (16:22): It's so fascinating and, and devastating, um, in that you are right, people aren't talking about it. People are talking about medical gaslighting. Like, you know, when I went to the doctor years ago because I was very tired after having a child, and, um, really my thyroid was off, but what he told me was, don't worry about it. You're just stressed out. You just had a child just sleep more. And it wasn't until I went back for repeated visits that he was able to determine, actually it wasn't even my, my GYN person, it was my, um, regular doctor who said, wait a minute, you know, your levels are off here. I think that you need more thyroid. And that happened as a result of your pregnancy. I mean, this was like many years ago, but, um, but you're not talking about that. You're talking about what's actually happening systemically institutional gaslighting in, in the medical field. And I would imagine that, um, well first, that you're not alone in seeing this. Maybe you're, you're alone in naming it for a profession, which would be such a gift is such a gift for our listeners, but also that, um, it's, uh, exhausting to have to, to live it and to be worried about it all the time,
Tracey O'Connell (17:44): All the time. And I think what is interesting is a lot of people that I know that are unhappy in, in medicine right now are people who, there's a lot of overhead, like the electronic medical record or dealing with insurance companies, Medicare, Medicaid, their education debt, how much they owe from what it cost them to go to medical school. Um, a shortage of workers, massive exodus of people from medical practice, nurses, doctors, all all levels of practitioners. And then there's so many other systemic issues that that plague medical culture. Um, and but what's interesting is that people are not talking about this underlying psychological mindset that happens in medical culture about what I should be able to manage and how I should be able to handle this. And also who am I if I'm not a doctor and I feel powerless to make a difference.
Tracey O'Connell (18:45): And also I enjoy the social capital and the, you know, being out in, in whatever people have used to justify how they've made it through. You know, I know you always ask why do people stay
Dr. Robin Stern (20:25): But you can handle it all. And that if you are complaining there's something wrong with you.
Tracey O'Connell (20:29): Yes. If you can't handle it, something's wrong with you. And that is where there's this overhead of, of gaslighting in the ether. It's in the air we breathe and, and nobody, people sort of recognize it, but there's too many other factors that contribute to believing that that's where we should be. And obviously we, you know, there's an element, most people enter medicine because they care and they wanna make a difference
Dr. Robin Stern (21:04): So that when they hear the patient comes first, that speaks to their calling to begin with. And anything that, that challenges that from their own, like, no, I'm exhausted. I can't, it's not okay because the patient comes first. But, um, what's interesting about that is the patient comes first, but then the expectations of how many patients have to come first at the same time in the world we live in is quite extraordinary.
Tracey O'Connell (21:33): Absolutely. Everyone is double booked. Um, you know, people believe that how you perform at work, how many patients you see, how much, how productive you are, how efficient you are determines, you know, what kind of evaluation you'll get, whether you'll get promoted. And, and this whole belief system really begins at the very, very beginning of medical training. So I know you had Steven Hassan on your program talking about cults, and I asked myself after that episode, like, wow, I, I'd often wondered, is medicine a cult? And the best distinction I can make between what he said and what my understanding was, 'cause I see so much overlap between cult experiences and medical culture. The distinction he would make between the two is that a cult is something that you don't enter by choice and you don't leave by choice. Um, and I don't know, it's tricky. I, I think there's so many reasons people enter medicine that aren't always the noble pursuit of patient care and wanting to be compassionate. I think there's a lot of people who do. And what we're finding is the people who enter and really care, have compassion fatigue and aren't having their needs met. And it's not sustainable, like on a human level, it's impossible to sustain. But then the gaslighting message is, I'm not enough. The problem is with me because the patient comes first and I can't show weakness.
Dr. Robin Stern (23:18): Um, so during Covid, and actually for years before, and still now, I have the privilege of working with nurses and, and doctors, um, at, uh, the Yale New Haven Hospitals and, and also have worked with people at St. Jude's, um, in Memphis and working, uh, just with people in my practice who are medical professionals. I hear that in some way during Covid, while everybody was stressed and stretched and, um, just anxious. And, um, life was unpredictable and outta control. And so we all were feeling what doctors were feeling in multiples and, um, and yet doctors and nurses were having to hold it together and show up at work every day. And they were on the front lines and deserved all the people hanging out of windows, applauding them every night at seven o'clock. They deserved that and more. And during that time though, they felt something, well, I, I'm hearing from people that they felt something that made a difference.
Dr. Robin Stern (24:26): They felt like they mattered and that they, people were grateful for them. Whereas now, post covid some of that immediate gratitude, and I, I'm speaking in generalities now 'cause I'm just imagining there are people who were listening to this who express their gratitude towards their physicians and physicians who don't feel this way. But as general rule people, I've worked with Yale and my practice and other places, um, say that the, there's one of the things that kept them from going into this rabbit hole of sadness and exhaustion was feeling during that time that even though things were crazy, that gratitude lifted them up and feeling like they mattered and that people knew they mattered, really lifted them up. And I wonder whether or not, um, you notice that or you would agree or think differently perhaps about, uh, gratitude and mattering as being antidotes for that feeling of complete exhaustion with those expressions of care and compassion and, and gratitude help someone to, uh, stand up internally to that feeling of not being not enough.
Tracey O'Connell (25:51): Yeah, well, sure. I think temporarily, and I also think kind of rarely, I will confess that the conversations that we're having behind the scenes during Covid with, with people I was communing with in all different medical specialties was one of really deep despair. Because again, this, the thing that's so funny is doctors are not secret service and they're not military professionals. So this whole kind of implicit message that was being given to doctors during this health crisis was that you will show up and you will take a bullet for someone else. And the thing was, that was never part of the deal. Yeah. You know, Hippocratic oaths and other pledges and things that, that are taken the, you know, the tenant of first do no harm of course, but, but doctors and nurses and all healthcare practitioners were having to show up every day with, again, this belief, the patient comes first and never show weakness.
Tracey O'Connell (27:06): So it wasn't, it's so ironic to me actually that people did keep showing up because they were making decisions between their own lives and someone else's life. They were making decisions between their own families, children, spouses, um, you know, massive risks. And so, sure, I think it helps to be told that you're appreciated. And I think a lot of, again, this gaslighting experience of is this right? And, and is this reality, like there was so much uncertainty at that time globally, and people get frustrated by, it's so easy now through the retrospective scope to be able to say, oh, it was all gonna be fine. You know, people that were reluctant of that, the vaccine or people who were, we, people can't remember those days when we didn't know anything. And so doctors were just as scared as everybody else.
Dr. Robin Stern (28:06): Yes. I I wonder in this conversation whether the gratitude that was shown to doctors and nurses reinforced their feeling that they were doing the right thing by showing up every single day, and they were for their patients, but what about for their families? To your point, and I, I know that a lot of people, um, who have left the profession since then have reported that they just were never prepared to put people themselves at risk. And teachers are the same in that way.
Tracey O'Connell (28:40): Absolutely. Teachers and, and grocery store owners, I mean, everyone that had to show up anyway. Right. And I think that that is also really, if we go by your definition of gaslighting, like well in medical practice, we're now calling that moral injury. Um, and it's really can be the same for the, the grocery store owner or anyone who is having to show up anyway where moral injury goes back to the military, where it, it, it's a, um, I'm not gonna get the definition exactly right, but it's a phenomenon that happens where you are doing something that goes against your values, like something that you really believe in and who, it's not just a matter of guilt, it's, it's a deep fundamental sense of self betrayal that you are doing something that is against your moral compass. And even against, in this case, your intellect, everything, you know, to be true and you're doing it anyway.
Tracey O'Connell (29:41): And how confusing to be applauded and lauded, um, by, by the public. And so you think, okay, I am doing the right thing. And then also the system telling you, I mean, I know so many horror stories about really reputable institutions who were putting very underqualified people like first year interns in, in, say, who came in to do a psychiatry residency, right? Who are now told you're gonna work in this covid unit end of life, right. End of life. And, and they don't have, these are young people with no medical training who are going to be harmed forever by that kind of, that kind of psychological manipulation. And I just think that there's so much positive attention for people who go into medicine as it being a calling. And I think most people now are even really irritated by the term burnout because it, it implies that there's something deficient in the individual.
Tracey O'Connell (30:45): I've reached my limit as opposed to exploitation
Tracey O'Connell (31:49): And so, again, another form of gaslighting where you believe I should have done this better, how could I possibly do this better? I must not be enough. I am not enough. I am never enough, and I will keep the, the thing that selects people who go into medicine are perfectionistic, hyper achieving, hypervigilant, controlling, you know, people who are used to being in charge or want to be successful. And so all you have to do is take those kind of people and fe you know, put them on a Petri dish that is full of deprivation of resources, but have them just be in the dark together and they will feed on each other and outgrow the resources that are available. And people forget, including doctors themselves, that doctors are humans. And so this model we have is not sustainable. And yet the methods that people are going about managing it are completely bypassing your areas of expertise, emotional intelligence, how can we help people process the trauma that they've seen and also give them a chance to, um, express that they feel like they're being taken for granted or advantage of. And also to address this deep, deep, deep belief of not enoughness,
Dr. Robin Stern (33:21): I, you are giving us so much to think about. I really appreciate what you're saying and and I, and the complexity of it. So it's not just that the doctors worked hard and we were grateful and that was good for them. There's a whole other dimension of moral, we, what we call moral distress, where they are doing things that they know or don't align, and yet they have to do them anyway, or they think they have to do them, or the job requires that they do them, and then at the same time, they're never enough. So it's very complicated and, and deeply disturbing. Um, when we think about, or when I think now about what that, what does that mean for the wellbeing of the people we look to, to take care of us? How do you stay well, what are you doing now to, um, for your wellbeing that you were not able to do when part of a larger institution?
Tracey O'Connell (34:17): Well, I mean, to be honest, like I, I left, and this is where
Tracey O'Connell (35:56): It happens all the time in medical training. You know, if you're, if you're a medical student, then you have to get the approval of the resident, um, the the attending and, and everyone above them. And what happens is everyone's afraid of the person ahead of them
Dr. Robin Stern (37:07): Tracy, this is, this is so interesting and important for, for our listeners, and I know we have a lot more to go into. And, um, for today I'd like to leave our audience with where they can find you if they wanna learn more about the work you're doing now, which, um, um, just privileged to know about, um, by knowing you and, and I'm so awed by your, um, persistence and determination and passion in collecting stories, um, reaching out to people who have experienced this kind of gaslighting. And, uh, I thank you for that on just behalf of the gift you're going to give the world when you finally write your book. Um, but in the meantime, uh, if people who are listening have stories they want to tell about that relate to medical institutional gaslighting, please contact Tracy and Tracy. Please tell people where they can find you and if that's the way, the right way to introduce what you're doing.
Tracey O'Connell (38:18): Sure. Um, I am collecting stories of people who work in the medical profession, who have experienced, well, they've experienced shame. And I think shame is a, is a flag sort of a, a waving telling you that maybe there's something not wrong with you, maybe there's something wrong with what's happening around you. And that is a pivotal shift right there because it's so easy to believe that this problem is within you. And even if you complain about the system, you're still showing up for a reason which is causing you some, some dissonance between what you believe and what, how things really seem to be in your day-to-day existence there. And so I'm collecting stories, all sorts of stories from all different types of medical practitioners that are confessing and confiding about narcissistic relationships with the boss. Um, inability to get promoted despite many qualifications, lots of issues around race and discrimination and injustices that occur at every level in the the hierarchy.
Tracey O'Connell (39:25): Um, and so people can reach me by emailing me. Um, and my website is my name Tracy, with an e, uh, www dot tracy O'Connell md.com, and I'm on social media, those same, um, that's those same extensions. And I think what I wanna leave people with though today is that I'd like to discuss with you more, Robin, is about the need for emotional intelligence education in medicine. Um, when people are sick, what they really wanna be is to be cared for. And you've got a population of people caring for people who are not being cared for themselves and also don't have any idea what that even means.
Dr. Robin Stern (40:58): Well, I thank you for that wrap up because I think, um, I certainly agree that the, uh, medical training does not include emotion, skill development and, um, more and more, uh, people are asking for it. We're called for consultation at the Yale Center for Emotional Intelligence, where my day job, and, um, and yet it's not, uh, institutionalized in the way that needs to be. That people, physicians need this, we all need this training, but physicians in particular because they're on the line as you're saying every day, caring for patients when they don't have the skills to care for themselves and aren't feeling cared about by their superiors, as you're saying to the contrary, or feeling most of the time or at least a lot of the time, not good enough. So we have to stop here for today, and I thank you for being my guest today and for, um, for our many conversations that led up to today happening. I look forward to part two and, uh, I can't wait really to get into some of the deeper dynamics of what keeps doctors in these relationships and what leads to, um, vulnerabilities in, uh, accepting relationships like this and the commitment to the profession that feeds to all of that acceptance and tolerance of things that are not okay. Thank you very much, and I know it's been a meaningful hour for people listening. And you can find Tracy at Say it again, your website,
Tracey O'Connell (42:36): At my website, which is uh, tracy O'Connell md.com.
Dr. Robin Stern (42:41): Thank you. See you next time. Thanks for joining me for today's episode. I hope you found it helpful and meaningful. If you want to listen to other episodes of the Gaslight Effect podcast, you can find firstname.lastname@example.org or wherever you listen to podcasts. And please leave a rating and a review. I also invite you to follow me on Facebook, LinkedIn, Instagram, and Twitter. This podcast is produced by Mel Yellen, Ryan Chang, Coco, Mike Lens, and me. The podcast is supported by Gabby Coga and Sala Kangi, all of my work and my upcoming book is supported by Susan Petit Marcus Estevez and Imaginarium, also by Sally McCarton and Jackie Daniels. I'm so grateful to have many people supporting me and especially grateful for all of you, my listeners.