When Your Illness Doesn't Count

overdiagnosis and medical gaslighting are both trending this year

Medical gaslighting is the top patient safety concern of 2025, according to the healthcare research non-profit ECRI.

It’s a term that originated with patients, and it’s popular on social media, where people share their experiences of doctors’ ‘justs’ — you just have anxiety, you just need to lose weight, you just need to exercise — despite later discovering a serious condition that was missed.

In a study of Long Covid patients who were dismissed by their doctors, Au et al argue that the term gaslighting is ‘political language’ — a deliberate challenging of the doctor’s authority to define the patient’s reality:

Not only do patients demand that their reality be taken seriously by experts who wield the power and resources to dispense potentially life-saving medical care, but they also level the accusation of “abuse” at them. By framing the clinical encounter as gaslighting, Long Covid patients contest the objectivity accorded to judgments and tests that come at the end, presenting them as just one version of reality, or worse, as a willful distortion of reality.

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Meanwhile, three NHS doctors published books this year about an alleged epidemic of overdiagnosis. Two were by psychiatrists (whose publishers apparently had very little imagination) — No More Normal by Alastair Santhouse, and Searching For Normal by Sami Timimi.

The third, The Age of Diagnosis, was by the neurologist Suzanne O’Sullivan, which I critiqued last month and haven’t been able to stop thinking about.

The Age of Overdiagnosis Panic

Lately, I’ve been watching O’Sullivan give interviews. A few months ago, she made an appearance on Good Morning Britain, where the hosts brought up that she was mentioned in a BBC interview with Wes Streeting, the current Secretary of Health in the UK.

The interview in question was a grilling Streeting got from host Laura Kuenssberg about rumored welfare cuts. Here’s their exchange:

HOST: One of the areas where you are, we understand, going to try and claw back money is people who've been signed off because of mental health problems. Now, in the last few days, it's interesting, the prominent neurologist Susan O’Sullivan has said there's overdiagnosis of mental health problems. Your colleague, Liz Kendall, when she was here, talked about the problems of self-diagnosis, when people feel that they might have a condition. Do you believe, as a health secretary, that too many people are being treated as sick and incapable of work for essentially struggling with what are quite normal feelings?

HEALTH SECRETARY: Well, I want to follow the evidence, and I agree with that point about overdiagnosis, but here's the other thing. I mean, mental well-being, illness, it's a spectrum, right?

HOST: But you do think there’s overdiagnosis?

HEALTH SECRETARY: I think too many— I think there's definitely an overdiagnosis, but also, there are too many people being written off. And to your point about treatment, there's too many people who just aren't getting the support they need. So if you can get that support to people much earlier, then you can help people to either stay in work, or to get back to work. And that's why we're recruiting eight-and-a-half-thousand more mental health staff, to make sure we can get the waiting list down and also starting early, so making sure we've got mental health support in every primary and secondary school in the country so we can give people that resilience and those coping skills they'll need for life.

HOST: But you do believe there's a problem with overdiagnosis.

The NHS has seen a rise in disability benefits claims since 2020, with a little over half due to mental illness, and there has been talk in the press of ‘spiraling’ spending. Disabled activists, however, have dug up official budget data and argued that spending proportional to GDP has not increased, and is actually set to remain stable for the next four years.

Currently, the government is trying to tighten requirements for claiming Personal Independence Payments, a benefit that people receive regardless of work status to help with tasks of daily living. Since this score is based on a doctor judging how hard it is for a person to perform specific tasks around the house, people with mental illnesses are more likely to score lower than people with physical disabilities.

In light of these cuts, books that delegitimize mental illness are spreading dangerous rhetoric. The Age of Diagnosis, however, expands the bounds of the conversation beyond psychiatry to contested chronic illnesses like Long Covid.

O’Sullivan’s book argues that Long Covid is psychosomatic, continuing in a tradition of medical gaslighting that has been going on since the early days of the pandemic. I don’t want to misrepresent her position — I think she genuinely believes that she is challenging the stigma against psychological conditions with her work.

In her previous book, It’s All In Your Head, she writes:

“Maybe it is time to stop changing the labels and start changing the attitudes to psychological illness instead.”

And on Good Morning Britain, she was careful to clarify that ‘overdiagnosis’ doesn’t mean ‘these people have nothing wrong with them, they’re a bunch of layabouts’:

“What overdiagnosis means is that someone may well be suffering, but does it benefit them to label that suffering as medical?”

This shows a naivete about ableism. The word psychosomatic has an entrenched cultural meaning that isn’t likely to be changed by including careful disclaimers — it implies agency and responsibility, and decades of rhetoric from policymakers pitting disabled people against workers in the UK have reinforced this stigma.

You can see a subtle nod in Streeting’s description of how they want to help the mentally ill — training children to have ‘resilience’, which implies that people who claim benefits for mental illness aren’t really ill, but rather, morally weak.

Disabled journalist John Pring spent ten years researching the UK’s Department of Work and Pensions, and he found that baseless accusations of mass fraud and ‘scrounging’ in the press have been used to prop up the department’s cuts for 30 years now.

Pring quotes prime minister John Major, who spread suspicion about malingering when he told Parliament in the early 90’s that the disability rolls had exploded, saying that it ‘beggars belief that so many more people have suddenly become invalids, especially at a time when the health of the population has improved.’

According to his research, US insurance companies actually helped design the assessments that the Department of Work and Pensions uses to decide whether or not a person should receive benefits — assessments which were then outsourced to private companies. Hundreds of people died because of it:

"A study funded by the National Institute for Health Research – which itself was funded by the Department of Health – concluded that the programme to reassess people on incapacity benefit using the work capability assessment was linked to nearly 600 suicides in just three years."

Stateside, the US government is also arguing over welfare cuts in Trump’s Big Beautiful Bill. Disabled activists were arrested last week for protesting in the Senate Rotunda; doctors are telling the press that cuts will kill their patients, and hospitals in rural areas will be the hardest hit. 7.8 million people are set to lose their healthcare if the Medicaid cuts pass the Senate.

Meanwhile, RFK Jr is telling a House committee he has a vision that ‘every American is wearing a wearable in four years’ to ‘take control of their health’.

It’s a contradiction that makes me think of how Good Morning Britain closed out their interview with O’Sullivan. Referring to the years-long waiting lists at the NHS, one of the hosts said:

"Already people [are] getting in touch saying, how on earth can people be diagnosed when you can't even get an appointment?"

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For paid subscribers, a deeper dive on contested illness: the differences between disease, illness, and sickness, a few interesting films about medicine’s most controversial conditions, and two good books on fibromyalgia.