Secondary gain, what do we get by being wrong?

We think that being unwell is negative and feeling well is positive. There is no middle ground. However, in life very few things are black or white. And although we resist believing that being ill can have any advantage, the truth is that it does provide some benefits for those who feel unwell. In psychology, this phenomenon is known as secondary gain.

A UK study into patients’ “hidden agendas” found that up to 42% of them had hidden motives. Doctors found that they hoped to gain secondary gains associated with their status as patients, such as receiving financial support, help or care from others, being prescribed stimulant medication, avoiding certain responsibilities or even gaining privileges at work or school.

Of course, this does not mean that these people are not sick or do not suffer from a disorder, it only means that more or less consciously they try to take advantage of their discomfort, so some may cross the line and develop chronic victimhood.

What is secondary gain in a disease?

The term “secondary gain” refers to the indirect benefit we obtain from a physical illness or a psychological disorder or problem, although in general it could be expanded to any apparently negative situation that generates suffering and discomfort but that, precisely because of that adverse condition, also produces certain benefits or favors.

As a result, secondary gains often lead to intense resistance to change. Whether consciously or unconsciously, people do not want to lose these benefits, so they may cling to their sick role or reject solutions, which prevents them from improving and keeps them trapped in a vicious circle.

The Top 7 side profits we hold on to

Often, people are not fully aware that this psychological mechanism is slowing down their recovery process or reducing the possibility of solving their problem. For this reason, it is important to identify secondary gains and get rid of them in order to move towards the path of true healing.

1. Greater emotional closeness with someone significant. Illness acts as a catalyst that strengthens bonds with important people in our lives. In these moments of vulnerability, it is normal to experience greater emotional closeness or even to rekindle broken relationships. For some people, the fear of losing that level of connection once the disorder is over acts as a brake on healing. Basically, we fear that when we get better, that person will move away or not pay as much attention to us and we will feel alone again, so we prefer to maintain the status quo.
2. Gaining power by assuming the role of victim. Many people have not developed the ability to ask for help or affection directly. Therefore, they resort to more subtle strategies of emotional manipulation, such as pity. Often, an illness, disorder or adversity becomes the ideal occasion to assume the role of victim and demand all the love, compassion, attention and support that they do not dare to ask for. Feeling emotionally comfortable, these people refuse to give up their role as victim and use it to control those who are part of their support network. In this way, the secondary gain gives them greater power over others.
3. Letting go of responsibilities. We live in an extremely demanding world, so it is not strange that sometimes the weight of responsibilities crushes us. Illness can exempt us from many commitments and tasks because others take them on for us so that we can recover. This “protective shield” is a respite that frees us from having to make decisions or face the pressure of day-to-day life. It is an opportunity to not have to meet external expectations and to be able to delegate to others, so it is not strange that we can end up unconsciously becoming fond of this secondary gain from illness.
4. Time for yourself, at last! In the age of productivity, when we feel guilty if we take a break from our obligations, illness can seem like the only legitimate justification for pausing the hustle and bustle of daily life. For those who care for others, illness also offers a kind of implicit permission to pay attention to themselves. The mind finds, in the midst of illness, an opportunity to take a break from its daily obligations, to disconnect, to stop thinking about others, and finally to focus on itself and its needs. Obviously, resuming the routine after such a break can generate a great deal of unconscious resistance.
5. Avoiding conflict. For people who are afraid to deal with conflict, a secondary benefit of illness is the ability to avoid such disagreements. Their condition becomes a valid reason for not having to make difficult decisions and, at the same time, creates a protective halo around them, so that others do not pressure them either. In this way, it becomes a strategy to postpone dealing with problems in relationships with their partner or with their children, for example, since they will avoid disagreements so as not to upset the sick person.
6. Breaking free from external expectations. There are those who feel trapped by the expectations of others, but are unable to break those bonds. So they take advantage of the illness to make decisions that, otherwise, they would never have dared to make. A young person, for example, might leave a career imposed by family expectations, and a father might finally quit a job that does not satisfy him. In these cases, illness becomes a legitimate way to make difficult decisions and escape the weight of the disappointment of others. It is an opportunity to find a new narrative that others will be more understanding of.
7. Disregarding our needs. Illness creates a situation of vulnerability, so that other people have to help us meet some of our needs. This can become a perfect excuse to not have to continue struggling and to assume a passive role. For example, someone with a fear of public speaking could feel bad every time they have to give a talk or present a project, a perfect excuse to cancel them or have someone else take their place. This secondary gain would allow us to disregard our obligation to take care of meeting our needs and transfer it onto the shoulders of others, without being judged for it or considered lazy.

The trap of secondary gains

There is no doubt that secondary gains offer emotional relief and temporary protection, but in the long term they often generate adverse effects that would be better avoided.

• If we refuse to confront problems and conflicts, they will not disappear, but will continue to grow.
• If we refuse to take responsibility for our decisions, we do not mature emotionally, but instead become eternal children.
• If we always let others satisfy our needs, we become extremely dependent on others, creating an increasingly difficult burden for them to bear.
• If we use illness to escape expectations, we lose the opportunity to build a life based on our own authentic decisions.
• If we tie ourselves to the role of victims, we hinder our development and deny ourselves the possibility of transforming pain into power.
• If we take refuge in illness, we abandon other dreams and aspirations, so in the long run we will only experience a bitter feeling of frustration.

How to get out of this loop?

Behind every problem, whether interpersonal, psychological or physical, there is usually an indirect benefit that can slow down our evolution and prevent us from overcoming that situation. Holding on to these secondary gains is obviously not the best solution.

The first step: becoming aware

If we become aware of what is happening to us, it will be easier to give up the benefits that are tying us to harmful behaviors. To do this, it is necessary to perform an act of introspection with complete honesty.

Symptoms can give us some answers: Do they appear cyclically? How long do they last? What usually happens when they appear? What happens when they ease? The secret is to understand the context and emotions that revolve around that discomfort.

The second step: detect the secondary gain

At this point, it is about finding the secondary gain that prevents us from moving forward. In this case, the key question would be: What positive feelings surround the illness?

These may be feelings of relief, but also of satisfaction, support, understanding, closeness… We must be alert to detect where these positive emotions come from, since their origin will reveal the secondary gain.

We can also ask ourselves: What have we dared to do? What have we gained since we became ill? At first, no answer may come to mind because we refuse to acknowledge that illness can bring anything positive.

In that case, we can imagine that we are free from that illness or discomfort. What would change in our lives? What would we have to take responsibility for? And, above all, what would we miss?

The third step: find a more assertive way to satisfy that need

If we have fallen into the loop of secondary gain, it is because we are satisfying an important need for us. Therefore, we have to look for a more mature and healthy way to satisfy it without staying hooked on the symptom.

It’s about accepting that we have to confront the underlying problem. We may have to learn to express our needs and desires directly, or we may have to set boundaries. We may have to confront our fears and insecurities or even refuse to meet other people’s expectations.

In many cases, when the illness is long-standing, we have incorporated it into our personality, so we will be forced to reconstruct a new identity without that condition. At first, this can be scary and generate resistance because we have identified with our problems, so if they disappear, they will leave a feeling of emptiness.

However, it is the only way if we want to lead a fuller and more authentic life, while freeing others from the burden of taking care of us emotionally. We must remember that behind every adversity there is a learning experience. It is up to us to use it to grow or remain stuck at that point.

References:

Wise J. (2022) The Importance of Secondary Gain – a Missing Story. Eur Psychiatry; 65(1): S46.

Fishbain, D.A. et. Al. (1995) Secondary gain concept: a review of the scientific evidence. Clin J Pain; 11(1): 6-21.

Fishbain, D. A. (1994) Secondary gain concept: Definition problems and its abuse in medical practice. APS Journal; 3(4): 264-273.