Secondary Gain.

Secondary gain is one of the main reasons why people refuse to action change in their lives, it’s a medical term that is applied to a person who benefits from not overcoming their condition. Secondary gain can also be a component in a disease, an example would be a patient with an illness who gets sympathy from those around them, and due to this sympathy their illness behaviour is reinforced, in the extreme even when an illness has actually gone illness behaviour can remain.

In secondary gain the benefit the person receives is said to be external (from others) and shouldn’t be confused with primary gain, which is where any benefit is internal.

Simply put primary gain is when you don’t do something because you just don’t like it or when you do it you get rewarded generally by feeling good, whereas secondary gain is where you get reward from those around you, commonly secondary gain happens hand in hand with primary gain.

Secondary gain is not a new concept, over a hundred hears ago the psychiatrist Sigmund Freud described patients who were ‘clinging on’ to their disease, the other thing about secondary gain is that it’s not that people are ‘doing this behaviour consciously it tends to just happen because human nature pushes people to move towards something that gives them benefit and makes them feels good.

Secondary gain is important because it can start to get out of hand, when this happens people become resistant to change and people just don’t get better, and what then happens is that the initial problem becomes reinforced by the secondary benefit, behaviour can drift into being attention seeking, abnormal illness behaviour can develop and any symptoms can be perceived to be greater than they really are.

At the extreme of secondary gain behaviour fictitious symptoms and Münchausen syndrome can develop where medical conditions are feigned for the purpose of gaining attention, sympathy and reassurance from others.

It’s difficult to put a finger on what actually causes the condition or to see at which point secondary gain starts to become a problem in people’s lives, before the behaviour is entrenched the individually is usually unaware that they are doing it and for a therapist or doctor it can be difficult to spot because a lot of illnesses have a subjective component, and when secondary gain becomes a problem the person can be unwilling to accept it is happening and can be very resistant to change.

Some people with secondary gain cling on to their disease, their sickness, their problem or their diagnosis,  it gives them an identity, it gives them leverage over others and in turn this re-enforces their behaviour even more.

To understand how commonplace secondary gain is there are a range of medical conditions where their is no physiological evidence that they exist, it’s either that doctors don’t yet understand the pathophysiology of the condition, or perhaps secondary gain consciously or unconsciously is a factor in their illness. This in turn might explain why some people within a few days of talking therapy ‘just get better’ and leave their illness behind.

I see people continuously ‘self sabotage’ their lives to the extent that they just can’t seem to get past their problem, here secondary gain is happening because moving on in life can be difficult, getting back to work is hard, rehabilitation hurts, and sometimes those around you don’t want to see you in pain and their sympathy and attention can make it easier for you to stay where you are.

The answer is to look at whether there is a behavioural element to what’s holding you back, it only takes a second to change, change can happen almost instantly but only when you are ready.

This article on ‘Secondary gain’ was written in reflection of the illness behaviour in some patients who just seemed to ‘get stuck’ in their illness and in those who were particularly resistant to making the changes they needed to make.