Abstract
Persistent pain is a prevalent and debilitating global health issue. Although women are disproportionately affected by persistent pain, they are routinely denied recognition as credible knowers of their pain experiences in the persistent pain clinic. Whilst feminist and bioethical scholarship has examined how clinicians contribute to this credibility gap, less attention has been given to how women themselves may help sustain the systems that constrain their credibility. In this thesis, I address this underexamined dimension by introducing the conceptual framework of panoptic pain, which refers to the deliberate behaviours women adopt to appear credible to clinicians, such as avoiding conflict, downplaying emotions, or describing their symptoms using medical language. These strategies are effective because they align with institutional expectations of what ‘real’ pain should look like and how ‘good’ patients should behave. Unfortunately, whilst panoptic pain can help women achieve short-term credibility, it also perpetuates the unjust systems that cast doubt on their pain accounts in the first place.
This thesis uses Foucauldian theory and feminist ethics to examine the moral significance of panoptic pain. Foucauldian theory is useful because it centers power as something that circulates through social norms, shaping how people come to see and govern themselves. For example, Foucault’s account of disciplinary power – an internalised form of control that leads people to self-regulate their behaviour – helps explain how and why women engage in panoptic pain, both knowingly and without conscious awareness. Feminist ethics brings moral urgency to this analysis, foregrounding the gendered harm of credibility gaps and the ethical significance of complicity in one’s own marginalisation. Feminist insights help develop a normative account of why complicity in oppressive systems is not morally neutral, and under what conditions resistance becomes an obligation.
I argue that when a woman understands the harm that panoptic pain can cause, and when she has the ability to act differently without facing serious personal risk or consequences, then she has a moral obligation to resist. Resistance takes the form of authentic pain representation: expressing one’s pain honestly and in a way that challenges institutional norms and expectations regarding medically appropriate and acceptable expressions of pain. Authentic pain representation allows women to establish some credibility without reinforcing harmful institutional norms. However, this shift from panoptic pain to authentic pain representation involves a trade-off: whilst panoptic pain tends to maximise women’s immediate credibility, authentic pain representation may lead to a slight reduction in credibility in the moment. This short-term cost is justified because authentic pain representation helps shift institutional norms over time toward more just and inclusive understandings of pain.
The normative requirements to transition from panoptic pain to authentic pain representation applies only to women who meet the conditions for moral responsibility for their complicity. My model does not offer a framework for evaluating the moral responsibilities of women whose agency is more constrained – a limitation that points to an opportunity for future research into how to support women most vulnerable to systemic exclusion and credibility-based harm within the persistent pain clinic.
This thesis makes several original contributions: it offers a new account of how disciplinary power shapes women’s experiences of health care; it introduces panoptic pain as a conceptual tool for analysing both the pressures women face and the behaviours they adopt to be believed; it expands on existing work about how patients navigate credibility in unjust systems; and it presents authentic pain representation as a practical and ethical alternative to panoptic pain. Ultimately, this thesis shows that even within healthcare environments that limit women’s choices, small but deliberate acts of honest self-expression are necessary moral responses to resist the systems that deny women credibility and agency. Even in spaces designed to silence them, women’s voices can unsettle power, disrupt injustice, and redefine what counts as truth.