Sara Purinton

Healthcare providers often rely on the following sort of concerning reasoning when encountering patients with difficult-to-explain symptoms: in the absence of evidence for a physical cause, the symptoms are presumed to be psychological in origin. In this paper, we take up this concern in the context of chronic pain, with particular attention to how such reasoning disproportionately affects women and how it interacts with the many levels of gender bias in medicine. We first examine the unwarranted inference from diagnostic uncertainty to psychogenic diagnosis and explore how identity prejudice and diagnostic uncertainty interact in clinical practice. We then consider additional contributors to diagnostic uncertainty concerning women’s pain: gendered research gaps and male-centered diagnostic paradigms. After outlining the harms associated with psychogenic diagnoses, we consider the objection that such diagnoses might be pragmatically justified. We end by calling for a more nuanced approach to diagnosing and treating chronic pain.

Living with chronic illness can involve fluctuating between radically different bodily states depending on whether you are experiencing flareups of illness symptoms. What you can do in these bodily states can differ drastically from one another. Sometimes, these fluctuations in abilities lead to fluctuations in your values. That is, your evaluative perspective can shift when you are experiencing flareups of the illness. This can give rise to a puzzle for planning, since it is unclear what you should plan on doing when you do not have a stable set of preferences guiding your plans. This paper argues that one way to navigate this puzzle is for the agent to adopt an overarching plan that mediates the conflict between her differing perspectives.