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“It’s All in Your Head”: A Meta-Synthesis of Qualitative Research About Disenfranchising Talk Experienced by Female Patients with Chronic Overlapping Pain Conditions

Hintz, Elizabeth A.·2023·Health Communication

DOI 10.1080/10410236.2022.2081046

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Abstract

Interactions between female patients with chronic pain and their medical providers in which providers question or contest the "realness" or nature of their illness experience (e.g. "It's all in your head") have been reported extensively in the extant qualitative literature, particularly for poorly understood ("contested") chronic pain syndromes. Many terms have been offered to describe this talk (e.g. invalidating, dismissive), resulting in conceptual fragmentation and isolated silos of research which together report about one communicative phenomenon. To rectify this fragmentation, the present study offers a meta-synthesis which explores, analyzes, and integrates the findings of 82 qualitative interview studies representing the patient-provider communication experiences of 2,434 female patients living with one or more of 10 chronic overlapping pain conditions (COPCs). COPCs are costly, gendered, and poorly understood. From the meta-synthesis, three key concepts are identified: (1) Functions of disenfranchising talk: Discrediting, silencing, and stereotyping; (2) Effects of disenfranchising talk: Harmed agency, credibility; access to care, support, and resources; and perception of patient-provider relationship; and (3) Responses to disenfranchising talk: Submission, critique, and resistance. Findings confirm the centrality of gender in the experience of disenfranchising talk, underscore the need to adopt an intersectional approach to the study of this talk along additional axes of race and class, and offer heuristic value toward conceptually unifying research about female COPC patients' experiences of disenfranchising talk from providers.

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Grieving “The Death of Possibility”: Memorable Messages of (Dis)Enfranchised Loss in Invisible, Physical Illness
Gunning, J. N., & Taladay-Carter, C. (2023) · Health Communication · doi:10.1080/10410236.2023.2257942 · Cited by 33

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Authors: Hintz, E. A.
Affiliations: University of Connecticut (US)
Corresponding author: Hintz, Elizabeth A.
ORCID: Hintz, Elizabeth A.
Venue: Health Communication
Publisher: Informa UK Limited
Published: 2022-06-12
Volume: 38
Issue: 11
Pages: 2501-2515
ISSN: 1041-0236 (ISSN-L)
1532-7027
DOI: 10.1080/10410236.2022.2081046
OpenAlex: W4282590574
Cited by: 106
References: 97
Citations by year: 2026: 36 · 2025: 30 · 2024: 22 · 2023: 15 · 2022: 3
FWCI: 20.09
Type: journal article
Language: en
Open access: closed
Locations: Health Communication (publishedVersion)
PubMed (publishedVersion)
Funders: associated
Topics: Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Social Sciences › Arts and Humanities › History and Philosophy of Science › Medicine, History, and Philosophy
Keywords: chronic overlapping pain conditions, female patients, patient-provider communication, gender, silencing, stereotyping, patient agency, health care access, patient-provider relationship, intersectionality, race and class
MeSH terms: Chronic Disease, Communication, Female, Humans, Professional-Patient Relations, Qualitative Research, Chronic Pain

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“It’s All in Your Head”: A Meta-Synthesis of Qualitative Research About Disenfranchising Talk Experienced by Female Patients with Chronic Overlapping Pain Conditions

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