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.

State University of New York at Binghamton

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

Patient Authenticity Management: How patients construct credible disability claims

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

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

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

Reference For: Discursive Psychology and Disability

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

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

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.

Agency-Accountability Link

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.

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