COMMENTARY

Gaslighting Syndrome: A True Story of Abuse

Georges Otte, MD

Disclosures

July 09, 2020

This transcript has been edited for clarity.

It is sometimes said that the practice of psychiatry is a bit like peeling an onion. The more you peel, the more tears come to your eyes. This story, adapted with respect for anonymity and privacy, could have been the scenario of a horror film if it hadn't been a rather bitter reality. Sometimes we wonder how often psychiatry fails to detect an underlying reality. Unless our intuition never fails...?

We see it in detectives, customs officers, inspectors, doctors, and all those who work intensely with individuals in various situations. Some people call it a "visceral" instinct, an expression not so strange now that we better understand the connection between the brain and intestine. Others call it intuition, the System 1 of Tversky and Kahnemann. Whatever we call it, we are talking about a kind of feeling that "something is wrong." Sometimes we can't clearly indicate where this feeling comes from, but it encourages us to dig deeper.

The Case

The case involved a 57-year-old woman who had been admitted to a psychiatric clinic because of blatant psychosis. The history from the psychiatric center indicated recurrent paranoid psychosis. The woman was convinced that she was in danger and that her "charming husband" was a kind of wolf in sheep's clothing who wanted to get rid of her in order to have an affair with the cleaning lady.

A plot had been hatched against her, she was watched everywhere, her food tasted suspicious (she didn't want to eat anymore), her thoughts were being read, and she could smell radiation through the walls of the house. Sometimes strange characters would pass her in the living room and would not react when she spoke to them.

The Characters

The woman came from a wealthy family with much property and many estates. Likewise, her husband, a businessman, could hardly be described as poor. The couple had no children and lived outside the city in a luxurious villa with an indoor swimming pool. Everything was perfectly taken care of by two maids, one of whom also cooked every day, and a gardener and handyman. These people had been serving the couple for years. One year earlier, the patient had suffered her first psychotic attack (paranoid psychosis), which was quickly brought under control thanks to a new atypical neuroleptic.

At the age of 25, she had experienced severe depression following the breakup of a long-standing relationship, but a few years later she met her current husband and entered a phase of stability. She was married at the age of 32. The patient was described as a kind and sensitive woman who had a great love for nature, art, and music. She was able to fully devote herself to her garden, which she and her gardener had transformed into a flourishing jewel. It had even been the subject of a photo shoot for a well-known gardening magazine. She was also a member of a women's cultural association, whose activities she faithfully followed. Apart from that, she had few other close friends or acquaintances, and most of the social gatherings held at the villa were for business relations or important clients of her husband's company.

The husband was a friendly, educated man who was very concerned about his wife's situation but also very annoyed by her bizarre behavior, invective, and accusations against him, including in the presence of third parties, some of them his clients. He had already asked his family for help in looking after and supervising her, but without much success. Moreover, relations with her in-laws were not cordial. The husband had finally brought in the general practitioner, who deemed it desirable to have her admitted to a psychiatric ward.

The standard forced admission protocol was followed, with a home visit by the justice of the peace, and the woman found herself in the clinic where the first therapy session would take place after a week. The woman's psychotic picture was pronounced; she had no awareness of the disorder and no willingness to take antipsychotics, although her appetite had returned and the sense of danger to herself seemed to have subsided somewhat. However, she continued to blame and threaten her husband, and thus it seemed clear that the involuntary admission would be supported.

The Background

From conversations with the woman's family, husband, and staff, we learned that her family had a significant mental health history. An uncle had been hospitalized several times for alcoholism and had died in the clinic after alcohol withdrawal; a nephew had autism spectrum disorder; and a brother had obsessive-compulsive disorder. Her parents were described as cultured and gentile, but with a strong desire for perfectionism, order, and cleanliness, which she inherited. One of her brothers told us, "Everything must always be clean and orderly," and sighed.

Her family had never noticed any tensions with her husband. The man was a busy and responsible businessman and was not often at home, they said. The picture of recurrent psychosis seemed clear, and there was no reason to look any further.

A Strange Phone Call

On the second day after her admission, I received a phone call at my home, quite late in the evening, from a man who identified himself as the local justice of the peace — the one who had visited the woman at her home. He was calling because he had a strange feeling that something "wasn't right." He apologized for the vagueness of his wording and only asked that the entire case be examined carefully. He could not or would not give more concrete indications.

It was a strange phone call. Regardless, I was motivated to consider this case very carefully. If not for that phone call, I probably would have overlooked one small but telling clue. The fact that I see it now (the whole thing would have been a great plot for a crime novel or Hollywood movie) was only possible because I double-checked each clue, and checked them again. Unfortunately, I can't go into details because of privacy concerns.

The culprit was indeed the "good husband"; money played a role in the plot, and there was another young woman involved, but not one of the cleaning ladies. I received confirmation of the plot from the husband himself. The wife never filed a complaint. The couple divorced shortly afterward, and I later learned that the patient was doing relatively well.

The Truth Revealed

This was a good example of the gaslighting syndrome, a known but rare psychiatric "syndrome" in which the offender causes his victim to have psychological doubts resulting from all sorts of well-directed plotting. Because of the subterfuge, the person (especially if she or he is sensitive to such deceptions) is driven into a psychotic state in which it is no longer possible to distinguish between reality and imagination. This is literally an induced psychogenic psychosis. It was named after the 1944 movie, Gaslight, starring Ingrid Bergman and Charles Boyer.

Conclusion

The winding path that marks the border between neurology and psychiatry is lined with various wonderful plants, flowers, and shrubs. The neuroscientist who walks the path will discover unique syndromes. But one must always keep one's eyes open so as not to stumble over the rubbish that some shadowy characters dare to put there.

Dr Georges Otte has been a neuropsychiatrist since 1978 with a subspecialty in EMG and EEG. He is former head doctor of the Psychiatric Center Dr Guislain and of the neurophysiology laboratory in Ghent, Belgium, and co-founder of the multidisciplinary group NeuroTope, which aims to translate modern neuroscientific knowledge into practical applications in the field of clinical psychiatry. Since 1983, he has been involved in computer science, neural networks, signal analysis, statistics, machine learning, AI, nonlinear dynamics, and therapeutic applications of virtual reality in psychiatry.

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