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

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

Patients emphasize pushing limits to maximum extent. Phrases like "I try to anyhow push the limit" show willingness. This reinforces experiential knowledge of their body's boundaries. It defends against accusations of not trying hard enough.

Extreme Case Formulations: In Chronic Pain Treatment Eligibility Negotiations

Declarative statements present disability as objective reality. "I cannot walk" versus "I feel I can't walk" differs significantly. Factual framing removes subjectivity and choice from the equation. It positions limitations as "out there" in the world.

Factual Language

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.

Breach Narratives

- Willing But Unable Identity
- Script Formulations
- Extreme Case Formulations
- Factual Language
- Breach Narratives

State University of New York at Binghamton

- Patient Authenticity Management: How patients construct credible disability claims
- Practitioner Challenge Strategies: Techniques for encouraging behavioral change without direct confrontation
- Interactional Tensions: Conflicts and dilemmas arising in pain consultations

Patient-Practitioner Dynamics: The interactional dance between competing goals and perspectives

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

Reference For: Discursive Psychology and Disability

Patient Authenticity Management: How patients construct credible disability claims

- Normalization Devices
- Hypothetical Treatment Directions
- Insufficient Explanation Framing
- Agency Attribution
- Hedging and Distancing

Practitioner Challenge Strategies: Techniques for encouraging behavioral change without direct confrontation

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

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