Attributing agency makes past actions accountable. If you choose to lie down, why did you choose inactivity? This provokes defensive responses from patients. Conversations spiral into frustrating circular patterns.

State University of New York at Binghamton

- Doctorability Dilemma
- Agency-Accountability Link
- Chronic Pain Context
- Interactional Fix

Interactional Tensions: Conflicts and dilemmas arising in pain consultations

- Willing But Unable Identity
- Agency Attribution
- Agency-Accountability Link
- Mind-Body Contrast Management

Agency Management: How agency is attributed, resisted, and negotiated

- Script Formulations
- Breach Narratives
- Insufficient Explanation Framing
- Agency-Accountability Link

Accountability Work: Managing responsibility and moral identity

Lester, J. N. (Ed.). (2021). Discursive Psychology and Disability. Palgrave Studies in Discursive Psychology. Springer Nature Switzerland AG.

Reference For: Discursive Psychology and Disability

Patients must prove both problem authenticity and change motivation. Too much inability questions treatment potential. Too much ability questions need for specialist care. This creates a precarious balancing act in self-presentation.

Doctorability Dilemma in Chronic Pain Treatment Eligibility

Chronic pain lacks clear biomedical causes, lasting 3+ months. Treatment uses biopsychosocial approaches targeting functioning despite pain. Patients seek biomedical explanations while practitioners target psychosocial factors. This mismatch creates interactional tension.

Chronic Pain Context

Agency-Accountability Link

Negotiations get stuck in repetitive patterns. Patient asserts inability, practitioner suggests agency, patient defends harder. Neither party achieves their communicative goals. Understanding these patterns helps explain consultation frustrations.

Interactional Fix

Separating mental willingness from bodily capacity is key strategy. Patients position mind as willing agent, body as limiting force. This preserves moral identity while claiming physical limitation. Practitioners challenge this separation to encourage behavior change.

Mind-Body Contrast Management

Patients contrast mental willingness with physical limitations. They present wanting to function but being prevented by their body. This construction manages moral identity and accountability. It establishes pain as authentic and burdensome.

Willing But Unable Identity

Using "you lie down" versus "you have to lie down" matters. Active voice positions patient as choosing their actions. This makes accountability and responsibility relevant to the interaction. It opens possibility for different choices in future.

Agency Attribution

Practitioners mark behavior as inadequately accounted for. "It's still not quite clear to me" implies pain alone doesn't explain inactivity. This subtly challenges the inevitability of patient's limitations. It creates space for alternative explanations.

Insufficient Explanation Framing

Patients use "if-then" structures to present actions as inevitable. "If pain is bad, then I must lie down" frames behavior as forced. This minimizes personal accountability for decreased activity. The pain, not the patient, determines the action.

Script Formulations

Calling in sick described as exception to normal conduct. Establishes baseline of good work ethic and responsibility. Prevents inference of malingering or lack of motivation. Positions patient as reluctantly disabled, not willingly inactive.

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