Enjoying ill Health: The Seduction of Secondary Gains

The Seduction of Secondary Gains

You probably don't think about the seductive benefits that come from being sick, since the prevailing cultural belief is that the sick are innocent sufferers, incapable of the kind of manipulation that would make their unpleasant situation advantageous. In fact, this belief may be the central benefit of illness: you’re assumed to be innocent because illness is something that "just happens," which means you can’t help being the way you are. Helpless and suffering because of an act of fate, you must be catered to and accommodated, no matter how much trouble it makes for everyone around you.

But we all use illness for secondary gains—consciously and unconsciously. When you call in sick to work and escape the whole onerous day without being accused of deliberately shirking your duties, you are enjoying a secondary gain of illness. When you cut short or avoid unwanted social engagements because you’re sick, you are enjoying a benefit of illness. When someone waits on you tenderly and takes care of all the chores as you languish in bed, you are enjoying a secondary gain. When a child escapes a day at school by claiming a stomachache or sore throat, this is a secondary gain—and often escalates to blatant manipulation when paired with an overly protective parent.

We assume no one would wish to be ill, but it's clear that many of us want the benefits of illness. Some are so driven that they cannot allow themselves time off or rest from work or family duties unless illness strikes them down. But chronic illness is where benefit of secondary gains can become truly disabling for the patient and exhausting for the caregiver.
Emergency room "frequent flyer"

An extreme true-life example of a chronic condition used for secondary gains illustrates clearly how rewarding illness can be. Gregory Goins, is a "frequent flyer" at the emergency room of Highland Hospital in Oakland, California, having racked up over 1200 visits since 1996. Goins, who lives in a group home for developmentally disabled men, flagrantly milks the medical system in the name of chronic illness—he has dangerously high blood pressure—dialing 911 at least once and sometimes twice a day for a dose of attention, concern, and socializing.

Making himself into a daily emergency provides Goins with what his life lacks. His concerns are taken seriously—medical ethics require that people come running to help him whenever he dials 911. He is familiar to those who "rescue" him time and time again, which provides him with a pleasant sense of community absent from his lonely life as an low status, unemployed, disabled person. His visits to the emergency room give him a sense of command and control over people of education, power, and status—something that could never happen under any other circumstance. He gets to bask in being the center of attention as his symptoms—chest pain—are checked day after day after day. While he is in the emergency room, he is as significant as anyone else—after all, it is indisputable that his medical condition is serious.

Unless he is in jail, Gregory Goins is in the emergency room every day. His weight is dangerously high for a man with barely controllable high blood pressure, yet he tosses his new medication in the trash on the way out of the emergency room. He is effectively holding the health care system hostage to a daily threat of suicide. However, because he is not actually announcing that he’s threatening suicide to keep getting attention, his case continues to be treated as a physical problem

Because this case is so blatant, the secondary gains are transparent. Most of us take a more subtle approach to getting our needs met through illness. Nonetheless, in this outrageous example, we get a clear picture of how useful illness can be, and some clues for anyone with chronic illness who really wants to get well.
Blaming or empowering the victim?

Any suggestion that you might be taking advantage of others as a result of your suffering is usually labeled "blaming the victim." Unfortunately, allowing yourself to be labeled and treated as a victim strips you of any reason—or power—to change your circumstances. How can you take any kind of healing action when you are assumed to be unable to help yourself?

But if you are not getting well despite attempts to heal, you ought to consider how your symptoms benefit you. Remember, we all use illness to get what we believe we can't get comfortably by direct means. Acknowledging your fears, needs, and insecurities opens the way to learning to get what you need without having to use illness to get it.

Developing awareness of the benefits of illness

How can you notice you’re benefiting from being sick if the whole point of secondary gains is having illness be a cloaking device that conceals your needs and insecurities from everyone, including yourself? One way to uncover secondary gains is to notice what you complain you can’t do as a result of illness. If you substitute "I don’t have to" for "I can’t," you may uncover a benefit of illness. For example, "I can’t work," becomes, "I don’t have to work." "I can’t take care of anything anymore—even myself," translates to, "I don’t have to take care of anything anymore—even myself." "I can’t go anywhere" becomes "I don’t have to go anywhere."

Chronic illness often frees you of adult responsibilities while leaving you with the grown-up prerogative to demand what you want and expect to be heeded. No one can expect anything of you, but you can expect others to attend to your needs as though you were a child. Notice how others have to accommodate you, and pay attention to areas where you "can’t" accommodate others, and you’ll discover other benefits of illness.

Although it may be obvious that emergency room "frequent flyer" Gregory Goins’s problems reflect mental health needs at least as much as physical ones, few medical systems would think to treat chronic disease by referring patients to mental health workers. Patients contribute to the problem by strenuously resisting referral to mental health professionals, clinging to their secondary gains by indignantly insisting their problems are purely physical. But anyone with chronic health problems who truly intends to heal must assume that mental health is the key to wellness. Making that single assumption is the first step away from the seduction of secondary gains and toward health.
Common secondary gains are:

* Expectation of financial compensation for pain and suffering
* Expectation of disability leave from work
* Special treatment and solicitous attention from others
* Exemption from work, chores, family responsibilities, and unpleasant duties
* Permission to act out irresponsibly or treat others badly because you "can’t control yourself"
* Power to get others to conform to your special needs
* Getting to take without having to give
* Significance—feeling special because of your unusual condition
* Inclusion and intimacy—becoming part of a family of loving and supportive fellow sufferers and caregivers
* Avoidance of the discomfort of self-examination and the challenge of working to change

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