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Agency, Chronic Pain, and Medical Gaslighting

'Pain is often accompanied by suffering. Philosophers often explain this suffering in terms of pain's detrimental impact on an individual's agency. A reduced sense of agency correlates with a decreased quality of life, and chronic pain is often experienced as severely disruptive, limiting, and/or disabling (Walker et al. 2006). Although current scientific understanding suggests that somatic pain is a complex phenomenon resulting from the complex interplay of multiple factors (including activity in the nociceptive, endocrine, immune, and limbic systems, as well as beliefs and expectations), many clinicians still adhere to an outdated biomedical model of pain: “normal” pain is caused by actual or potential tissue damage, and when a person’s pain report does not clearly correspond to observable tissue damage, the pain is deemed "medically unexplained." For many clinicians, medically unexplained pain is inherently suspicious, plausibly stemming by psychological pathologies or faked. As a result, clinicians might devalue, dismiss, or distrust their patients’ pain testimonies, unfairly excluding the patients from the epistemic practices related to their diagnosis and treatment. My goal is to investigate how such attacks on chronic pain patients’ epistemic agency might contribute to their overall illness experience. Questioning or doubting one’s own credibility or general capacity for sense-making can be disorienting, frightening, and isolating, even if individuals actively resist these attacks. Understanding these dynamics can provide insight into how chronic pain patients' experiences are shaped not only by their physical symptoms but also by the epistemic challenges they face in medical settings.

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