DOI: 10.1097/JPN.0000000000000306
Continuing Education
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J Perinat Neonat Nurs r Volume 32 Number 1, 59–65 r Copyright
Institutional Betrayal and Gaslighting
Why Whistle-Blowers Are So Traumatized
Kathy Ahern, PhD, RN
ABSTRACT
Despite whistle-blower protection legislation and
healthcare codes of conduct, retaliation against nurses
who report misconduct is common, as are outcomes
of sadness, anxiety, and a pervasive loss of sense
of worth in the whistle-blower. Literature in the field
of institutional betrayal and intimate partner violence
describes processes of abuse strikingly similar to those
experienced by whistle-blowers. The literature supports the
argument that although whistle-blowers suffer reprisals,
they are traumatized by the emotional manipulation many
employers routinely use to discredit and punish employees
who report misconduct. “Whistle-blower gaslighting”
creates a situation where the whistle-blower doubts
her perceptions, competence, and mental state. These
outcomes are accomplished when the institution enables
reprisals, explains them away, and then pronounces that
the whistle-blower is irrationally overreacting to normal
everyday interactions. Over time, these strategies trap the
whistle-blower in a maze of enforced helplessness. Ways
to avoid being a victim of whistle-blower gaslighting, and
possible sources of support for victims of whistle-blower
gaslighting are provided.
Key Words: gaslighting, institutional betrayal, reprisals,
whistle-blower
N
urses who report concerns about illegal
or unethical behavior are often subjected
to reprisals that include denigration and
Author Affiliation: Visitor, University of New South Wales,
Kensington, New South Wales, Australia.
Disclosure: The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining
to this article.
Corresponding Author: Kathy Ahern, PhD, RN, Visitor, University of New South Wales, Kensington, NSW 2052, Australia
K.Ahern@unsw.edu.au.
Submitted for publication: July 4, 2017; accepted for publication:
November 1, 2017.
The Journal of Perinatal & Neonatal Nursing
marginalization. As a result of these reprisals, whistleblowers often experience severe emotional trauma that
seems out of proportion to “normal” reactions to workplace bullying. The purpose of this article is to apply the research literature to explain the psychological
processes involved in whistle-blower reprisals, which
result in severe emotional trauma to whistle-blowers.
“Whistle-blower gaslighting” is the term that most accurately describes the processes mirroring the psychological abuse that commonly occurs in intimate partner
violence.
BACKGROUND
On a YouTube clip,1 a game is described in which a
woman is given a map of house to memorize. She
is then blindfolded and given 30 seconds to find the
kitchen door or she will get slapped. According to her
mental map, the individual finds herself where the door
should be, but it is not there. As the woman frantically searches for the missing door, she gets slapped.
Then she is ordered to find the bedroom or get another
slap. After several rounds of the “blind-maze game,” the
woman becomes disheartened, confused, exhausted,
anxious, and paranoid. Then a new rule is added. The
woman is not allowed to say that the map she was given
is false, or she will receive an even harsher punishment.
The blindfolded individual is trapped. She was given a
faulty map, set up to fail, was punished for failing, and
forced to keep using a faulty map.
The video clip describes the situation of people
who have been caught up in abusive “love fraud”–type
situations with sociopathic individuals. However, the
blind-maze metaphor reflects many of the experiences
of individuals who report misconduct at work. The
thesis of this article is that the “blind-maze game” that
traumatizes romantic partners in abusive “gaslighting”
relationships is the same process by which whistleblowers are inordinately traumatized when they report
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59
misconduct. Traumatized whistle-blowers are using a
faulty “mental map” in which they erroneously believe
their allegations will be investigated and that they will
be protected.
WHISTLE-BLOWING
The term “whistle-blowing” has several definitions.
Peters2(p2908) defines it as “a situation where a party
or parties take matters that would normally be held
as confidential to an organisation outside that organisation.” Other definitions do not specify that an individual reports concerns to an external body. McDonald
and Ahern3(p16) define whistle-blowing as a person “who
identifies an incompetent, unethical, or illegal situation
in the workplace and reports it to someone who may
have the power to stop the wrong,” indicating that internal reporting of concerns constitutes whistle-blowing.
Rehg and colleagues4 suggest that it is not necessarily
the reporting of concerns that create a whistle-blower;
rather, reporting opens the door to reprisals, which are
the defining characteristic of whistle-blowing. In practice this means that a nurse who reports suspected
malfeasance to her employer is simply being a good
employee who is adhering to her professional code of
conduct. It is only when the nurse experiences subsequent punitive reprisals that the she belatedly realizes that she has been morphed from “good employee”
to despicable whistle-blower. Rothschild describes how
whistle-blowers in their study were:
. . . almost to a person, extremely devoted to the
organization’s purpose, and they worried that the
misconduct they observed would undermine that
purpose, and potentially, bring down the whole
organization. Typically, they saw their boss as the
perpetrator of the problem, and they believed that if
senior management knew what was going on, they
would surely correct the situation. Thus, they tend to
go, first, to their boss’s boss with the information. Only
when they see that the boss is either complicit or inert
do they consider going outside the organization, to
either the media or to a legal authority. At this stage,
they see themselves as being without a real choice:
Indeed, in 79% of our cases, the individual whistleblower values the purposes of the organization and
their own integrity so highly, that they see no
alternative to disclosure. In very few cases in our
sample did the whistle-blower anticipate or prepare for
the retaliation that was about to come their way.5(p891)
Retaliation against whistle-blowers is common and
severe and includes negative job performance evaluations, micromanagement, isolation, loss of job, and
blacklisting.3,5 Whistle-blowers are framed as deviant
and stripped of their respectability.6
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According to Peters et al,2 the effects of whistleblower reprisals on nurses include overwhelming sadness and distress, akin to the grief associated with the
death of a loved one. Anxiety is felt for years, to the
extent that it interferes with normal enjoyment of life.
Other outcomes include intrusive thoughts and nightmares, and constant hypervigilance—looking for and
anticipating possible danger in previously unproblematic activities. All nurse whistle-blowers in the Peters
et al study reported experiencing a level of emotional
distress that negatively influenced their health, ability
to work, and their private lives. These disabling posttraumatic stress disorder (PTSD) symptoms first started
with self-doubt and then escalated in a spiral to a loss
of sense of coherence, dignity, and self-worth.2
GASLIGHTING
The “blind-maze game” phenomenon is reported in diverse areas of environmental disasters,7 sexual harassment and assault,8 and intimate partner violence.9 The
common threads in these reports are the way in which
trauma is created and exacerbated through the betrayal
of trust. When what should happen is the opposite
of what is happening, cognitive dissonance is created,
which undermines the individual’s sense of reality, confidence, and their mental health. When a romantic partner uses these strategies, it is called “gaslighting.” When
institutions apply these strategies, it is a sign of institutional betrayal.10
There is mounting evidence that the trauma experienced by whistle-blowers is exacerbated by the cognitive dissonance resulting from a real-life version of
the blind-maze game. Prior to their disclosures, whistleblowers are generally high-achieving, respected, exceptionally committed members of their employing
organization.5 They have no reason to believe that their
organization will not be as troubled at the reported
malfeasance as they are.
The mental map that the majority of whistle-blowers
are working from is that the organization will investigate allegations of misconduct. Codes of conduct and
mission statements all acclaim the organization’s integrity and foremost concern for patients. Nurse whistleblowers only discover that their mental map is faulty
when they experience reprisals, which is the real-world
equivalent of the blind-maze slap. Basing one’s sincere
actions on false assurances,11 and being ambushed by
the ferocity of unexpected reprisals, explains a great
deal about why whistle-blowers experience long-term
PTSD symptoms.2
Repeated false reassurances given by apparently
genuinely concerned managers severely undermine
the whistle-blower, as experienced by British nurse
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Rodriquez-Noza, who made allegations about the “third
world treatment” of patients.12 The hospital’s acting Director of Nursing met with Rodriquez-Noza twice to
discuss her concerns, where Rodriquez-Noza was informed her allegations were “taken very seriously but
no evidence was found.” Then Rodriquez-Nova was
fired from her job. A subsequent review following complaints by patients’ families resulted in 3 nurses from the
hospital being charged with willful neglect and falsification of records, indicating (too late) that RodriquezNoza had indeed reported events accurately and that
the Director of Nursing had indeed not investigated her
allegations. However, by that time, Rodriquez-Noza had
already experienced a mental breakdown and become
suicidal.12
When the whistle-blower believes what she is told
that she is a valued staff member and her concerns
are taken seriously, while she experiences actions that
portray her as incompetent or mentally unstable, cognitive dissonance is created. Cognitive dissonance leads
to confusion and self-doubt. It is a major factor in
trauma from intimate partner violence where victims
feel trapped in an abusive relationship because of
economic dependence; potential judgment from others, beliefs regarding social roles, and the time, effort, and resources they have already committed to the
relationship.13
Cognitive dissonance discussed in the intimate partner violence literature highlights the insidious means
by which repeated denials of reality undermine a target’s well-being. Such a form of emotional manipulation
known as “gaslighting” occurs when the gaslighter tries
to induce in her partner the sense that reactions, perceptions, memories, and beliefs are not just mistaken but
utterly without grounds. Gaslighting almost always involves multiple incidents that take place over time, frequently involves isolating the target, and often involves
multiple parties cooperating with the gaslighter.14
The same gaslighting constellation of isolation
and denial of allegations and reprisals is consistently reported in whistle-blower literature.2–4,6,12,15–23
Abramson14 explains that the aim of perpetrating institutions is to destroy the possibility of disagreement
by so radically undermining the person that she has
nowhere left to stand from which to disagree and no
standpoint from which her words might constitute genuine disagreement. Abramson provides the following
hypothetical scenario:
[Whistle-blower] Liz starts to notice that she’s being left
out of important decisions and not invited to major
meetings. She hears rumors that clients are being told
she doesn’t want to work with them anymore and has
recommended that they speak to her new boss
The Journal of Perinatal & Neonatal Nursing
instead . . . . Finally, Liz confronts her boss, who has a
plausible explanation for every incident. “Look,” he says
kindly at the end of the meeting. “I think you’re being
way too sensitive about all this—maybe even a little
paranoid. Would you like a few days off to destress?”
Liz feels completely disabled. She knows she’s being
sabotaged—but why is she the only one who thinks
so?” . . . Also the manipulative threat is clear to the
whistle-blower that her job is on the line.14(p4)
In whistle-blower gaslighting, the gaslighter creates
cognitive dissonance in the whistle-blower by pronouncing that her distress at reprisals and stonewalling
are merely irrational responses to minor, isolated bureaucratic irritations. Often, the finding is couched in
terms of concern and respect. McDonald and Ahern3
describe an example in which a whistle-blowing nurse
received official commendation for reporting misconduct and was simultaneously threatened with legal
action. Because whistle-blower gaslighting consists of
false reassurances coupled with incongruent actions
(see Table 1 for examples), it often takes the whistleblower quite a while to realize that her employer is
actually trying to discredit her before she can discredit
her employer.5
When intimate partner or whistle-blower gaslighting works well, the target ends up feeling a worthless
“nobody” in a major depression. Factors contributing
to such an outcome include grief at the loss of many
intangible but significant things: the loss of an independent perspective, the loss of the ability to form and
maintain one’s own perceptions, and the loss of trusted
relationships.14 In whistle-blower gaslighting, there is
also grief at the knowledge that the whistle-blower has
brought the situation upon herself by reporting misconduct in the first place.
INSTITUTIONAL BETRAYAL
The trust individuals have in institutions is based on
expectations that the institution will fulfill an important
role in their lives. Examples include a religious institution providing a place of worship and community, an
educational institution providing an environment conducive to learning, and a healthcare institution providing safe and effective care. There is an implicit expectation of support by members of many institutions,
including between employees and their organization,
church members and their clergy, and soldiers and the
Department of Defense. When individuals trust or depend on an institution, there is potential for betrayal.
When these expectations are violated, institutional betrayal has occurred.29
The concept of institutional betrayal arises from Betrayal Trauma Theory (BTT), expanding the scope of
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61
Table 1. Red flags of whistle-blower gaslighting
1. The workplace environment makes misconduct/reprisals seem normal.24 – 26
2. Proactive steps to prevent misconduct/reprisals are not undertaken.24,25,27
3. The response to allegations of misconduct/reprisals is inadequate.27 Examples include stonewalling, willful
blindness, and deliberate ignorance of events, evidence, and policies.25
4. Misconduct/reprisals are covered up.25,27
5. Your case is mishandled.27 For example, mediation is not an appropriate strategy to deal with alleged reprisals, as it
does not address the imbalance of power central to bullying, nor does it redress wrongs.28
6. Delaying tactics.25 For example, lack of time/resources is provided as an explanation for not properly investigating
your allegations; lengthy processes inevitably mean that the case becomes “too old” to merit investigation.
7. Organizational action is inconsistent.27 The organization is inexplicably incompetent in investigating your allegations
but is extraordinary meticulous in holding you accountable.
8. It is unnecessarily difficult to report misconduct/reprisals.29
9. Your experience is denied in some way,8,25 such as calling unfair treatment a “personality clash,” or allegations of
reprisals a “gray area” or “miscommunication.” You are advised by an apparently supportive person in the
institution to “put this behind you” and “get on with your life.”
10. An environment is created where you no longer feel like a valued member of the team.27
11. You are reprimanded after you made allegations of misconduct/reprisals24 when there were no problems with your
work prior to your allegations.
12. Your supervisor approves, acquiesces, or fails to intervene in retaliatory actions.4
13. You are referred for psychiatric evaluation or advised to take stress leave following destabilizing reprisals and
denials.3,5,14
14. Hypocrisy: You are praised for reporting misconduct but no steps are taken to protect you from reprisals.3
personal betrayal to acknowledge that institutions are
often trusted or depended on in much the same way
as individuals. According to BTT, traumas that are perpetrated in the context of a relationship in which the
victim trusts and/or depends on the perpetrator will
be remembered and processed differently than other
traumas. Familial rape, childhood physical abuse perpetrated by a caregiver, and domestic violence are examples of betrayal traumas.29 So are reprisals against
employees who report misconduct that harms members
or clients of the institution.
Institutional betrayal can happen through acts of
commission in which the institution takes action that
harms its members. This occurred for 2 Texas nurses
who were criminally indicted for misuse of official information when they reported a physician to the Texas
Medical Board after the hospital administration failed
to take action on their concerns.22 Institutional betrayal
can also occur through acts of omission, in which the
organization fails to take actions that could protect
members, as in Rodriquez-Noza’s case,12 where an investigation of her allegations was claimed to have occurred, when it fact it had not.
Institutional betrayal can be systemic but made to
appear to be isolated incidents. For example, one
employee might receive a curt e-mail in response to
the reporting of a concern, and this appears to be
an isolated incident of a concern being summarily
dismissed. However, if all complaints receive the same
curt response,29 this indicates that the institution’s
deliberate but unspoken policy is to routinely ignore
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employee concerns. The person who has made the
complaint is left wondering how the manager could be
so incompetent in handling the allegations, when in
fact the manager is simply enacting the institution’s unspoken policy of ignoring and minimizing complaints.
Every time the whistle-blower takes the matter up the
chain of command to a higher manager, she is met with
similar inexplicable incompetence, which is, in reality,
a well-choreographed systemic institutional betrayal.
Institutional betrayal often occurs when the reputation of the institution is valued over the well-being of
members or clients. For example, during the investigation into child abuse at Penn State, it was determined
that allegations had been buried for a period spanning
14 years.25 During this period, the University’s leaders
had made a series of decisions that prioritized Penn
State’s good name over all else.8
Institutional betrayal is associated with complex outcomes similar to those associated with interpersonal betrayal. Empirical evidence of the impact of institutional
betrayal includes psychological distress, anxiety, dissociation, and suicide attempts.29 When measured directly,
the exacerbating effects of institutional betrayal on psychological well-being are clear and consistent with BTT:
higher rates of dissociation, anxiety, and other traumarelated outcomes.8
Wright et al30 used BTT to explain how betrayal of
trust by an institution exacerbates posttraumatic symptoms. Using an augmented version of the Institution Betrayal Questionnaire, they sampled undergraduate students at a Northwest university who had participated in
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study-abroad program. Of the students who reported
a traumatic experience, more than one-third (35.44%)
also reported experiencing at least one form of institutional betrayal, such as minimization or cover-up of
the traumatic event. In 4 of 6 subtypes of study-abroad
traumatic events, institutional betrayal contributed to
posttraumatic distress.
Another study of institutional betrayal of female
university students who reported unwanted sexual
advances10 found that almost half (46%) of victims reported experiencing at least one form of institutional
betrayal, including 21.5% of participants who reported
that the institution responded as if their experience was
no big deal. A further 9% reported that the institution
made it difficult to report the experience, 12.5% of participants said the experience was covered up, and 2.1%
reported they were punished in some way. The authors concluded that the added institutional betrayal
surrounding sexual assault exacerbated what was already a traumatic experience.10 Likewise, the institutional betrayal of whistle-blowers would exacerbate the
trauma of reprisals.
Institutional betrayal can even occur at a community level. Beamish7 presents a case analysis of the
Guadalupe Dunes oil spill in California. Community
members not only reacted to the immediate event but
also experienced a more encompassing breach of trust
by corporate and governmental regulators. Community
members felt betrayed and angry because they believed
the spill was not “accidental” but was the outcome of
systemic disregard. Once the spill was “discovered,” local Unocal mangers denied it and state and federal regulators were slow to push for resolution. The pattern
of a unified front of denial in the face of objective evidence is typical of systemic institutional betrayal, and
trauma is exacerbated when regulatory watchdogs play
a part in the betrayal, as occurred with the Bernie Madoff Ponzi scheme,31 for example.
SUMMARY
The similarity of gaslighting behaviors of sociopathic
individuals who abuse romantic partners, institutions
that betray their members, and workplaces that systematically undermine the credibility and mental health
of whistle-blowers is striking. For whistle-blowers, the
processes and effects of gaslighting have not been
specifically identified in the research literature, although
complex PTSD outcomes related to whistle-blowing
have been described.2,5
CONCLUSIONS
Along with the recommendations for research that
focuses on the means, processes, and outcomes of
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whistle-blower gaslighting, the following recommendations emerge as having promise in helping nurses who
report misconduct to minimize the effects of whistleblower gaslighting.
It is important that whistle-blowers who suffer
reprisals recognize the reality of their experience.13
First, Miller19 suggests that people who report misconduct should not see themselves as “whistle-blowers”
but as “truth tellers.” Second, whistle-blowers who experience reprisals are victims of bullying reprisals and
need to be supported as such. Third, depending on the
jurisdiction, whistle-blowers could also be victims of a
crime when whistle-blower protection legislation is violated. Fourth, whistle-blowers are victims of institutional
betrayal when their organization fails to take their allegations of misconduct and reprisals seriously. Finally,
organizations that stonewall investigations and deliberately avoid evidence of reprisals to label the whistleblower mistaken, overreacting, or paranoid are perpetrators of whistle-blower gaslighting and need to be
held accountable for this psychological abuse as well
as the commonly identified workplace bullying acts of
reprisal.
Research is required on the links between
stonewalling investigations of alleged misconduct,
reprisals, and adverse outcomes in whistle-blowers
that are eerily similar to those reported by victims of
domestic violence9 and even torture victims.32 There
is a dearth of specialist support geared toward the
phenomenon of whistle-blower trauma related to
institutional betrayal and whistle-blower gaslighting.
Until THE diagnostic and Statistical Manual of Mental
Disorders and International Classification of Diseases
classification systems, workplace policies, and legislation catch up, it appears that one of the most helpful
sources of validation for whistle-blower gaslighting victims might very well be Web sites that support victims of
abuse.
Ways in which long-term whistle-blower trauma can
be mitigated include having the individual who witnesses misconduct asking herself about whether her
mental map of how the organization will react is accurate. Before reporting misconduct, all employees should
take a step back to observe whether there is any evidence that the organization might not be as true to its
ideals as it professes. For example, a vaguely formulated
code of conduct might suggest that it has merely been
established under the pretense of meeting legal and social requirements.33 Clues include the use of “should”
or “shall” (instead of “must”) and “guidelines” rather
than “procedures.” Words such as “should” mean that
policies can be interpreted as suggestions rather than
requirements. Also, perhaps there have been examples
of other employees being denigrated for reasons that
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63
are difficult to understand with a current mental map
that sees the organization as fundamentally ethical and
well-meaning.
Even if the nurse truly believes the organization will
act with integrity, before reporting concerns, she should
consider that there is always a possibility that she will
be punished, denigrated, and portrayed as mentally ill if
she reports misconduct. There are a few alternatives to
making a formal allegation of patient-harming misconduct. McDonald and Ahern3 provide a list of alternative
activities by nurses who witnessed misconduct but did
not report it. These alternatives include speaking directly with the wrongdoer, telling the next shift, quietly
doing the right thing, telling a “higher up” in confidence, and using humor or manipulation to change the
situation. However, even using these tactics to protect
patients from harm, 32% of nurses who used 1 or more
of these non–whistle-blowing strategies were ignored
or told to “forget” their concerns and one or two others
experienced active reprisals.
When a whistle-blower experiences reprisals, institutional betrayal, and whistle-blower gaslighting, she
has experienced a profound injustice that most other
people, including counsellors, might not understand.
If required, the most effective mental health intervention is likely to be found with a clinician who has
expertise in working with complex trauma survivors.
Clinicians who have experience in working with patients with complex PTSD are able to make sense
of perplexing emotional reactions and validate the
experience of institutional betrayal.8 Other potential
sources of validation of trauma resulting from institutional betrayal and whistle-blower gaslighting can potentially be found in Web sites devoted to survivors
of abuse (see, for example, https://lovefraud.com/ and
https://www.psychopathfree.com/).
People who report misconduct or fraud are often following the policies and procedures required by their
job description or code of conduct. Since by some
definitions4 whistle-blowing is defined by the occurrence of reprisals, any unusual negative event following the reporting of suspected malfeasance should be
viewed as a red flag for the start of reprisals. At this
point, the employee should undertake self-protection
measures. Such measures include seeking legal advice
and mental health support and engaging in emotional
hygiene activities such as getting enough sleep and
exercise.34,35 It is also recommended that any employee
who reports a concern and subsequently experiences
an unusual negative workplace event seemingly out of
the blue should consider looking for a new job rather
than naively trusting that her current employer will do
the right thing.
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