Under what conditions should we expect states to do things radically differently all of a sudden? In this book, David Welch seeks to answer this question, constructing a theory of foreign policy change inspired by organization theory, cognitive and motivational psychology, and prospect theory. He then "test drives" the theory in a series of comparative case studies in the security and trade domains: Argentina's decision to go to war over the Falklands/Malvinas vs. Japan's endless patience with diplomacy in its conflict with Russia over the Northern Territories; America's decision to commit large-scale military force to Vietnam vs. its ultimate decision to withdraw; and Canada's two abortive flirtations with free trade with the United States in 1911 and 1948 vs. its embrace of free trade in the late 1980s.

Painful Choices has three main objectives: to determine whether the general theory project in the field of international relations can be redeemed, given disappointment with previous attempts; to reflect on what this reveals about the possibilities and limits of general theory; and to inform policy. Welch argues that earlier efforts at general theory erred by aiming to explain state behavior , which is an intractable problem. Instead, since inertia is the default expectation in international politics, all we need do is to explain changes in behavior. Painful Choices shows that this is a tractable problem with clear implications for intelligence analysts and negotiators.