Expressive priority and somatic testimonial injustice: a framework for women's embodied distress

Research on women's mental health increasingly frames female distress as embodied, presenting this as a move beyond mind-body dualism. This paper asks whether the move is complete.

Conceptual analysis of the literature on epistemic injustice, somatisation, functional disorders, predictive processing, and gender bias in diagnosis.

A residual assumption, termed here expressive priority, treats bodily distress as the expression of a prior psychological state that holds explanatory priority over the patient's own account. It concerns explanatory practice, not metaphysics, and is compatible with physicalism. Building on Fricker, Carel and Kidd, Dotson, and Pohlhaus, the paper develops somatic testimonial injustice: a sequence in which a bodily account is deflated in credibility, translated into a psychological idiom presented as the patient's own, and redirected so that it counts as evidence about her psychology rather than her body. The mechanism is general, but its burden is gendered, as endometriosis, systemic autoimmune disease, premenstrual dysphoric disorder, and polycystic ovary syndrome illustrate.

Taking predictive-processing accounts of miscalibrated symptom report, the paper argues for the parity of bodily testimony as evidence, not its primacy, and states three discriminating, falsifiable predictions. Its empirical anchors are illustrative, and the framework awaits testing.