Secondary gains

It s a dangerous illness, politically, because it demands so much change. It s different enough that it s easy for some people to move it from the body to the mind. I hope my book is a corrective to some of the critics that are too ready to write this illness off as neurotic somatization. They re too ready to move it from the body to the mind. Environmental illness doesn t fit any of the hysterical contagion models that are out there, and there aren t any real secondary gains associated with this illness. 

Simulations of reality, whether realistic or not, can also trigger emotions that in turn affect the brain s pleasure centers. We can become conditioned to distort our simulations of reality in ways that make us feel good. Since apparent unpleasant feelings often have a hidden secondary gain of feeling good underneath, as was discovered in studies of psychopathology, simulations of reality that seem to make us suffer may have a hidden payoff, a point we shall explore later. 

Psychotherapists have studied a phenomenon known as secondary gain, which arises when a feeling or behavior that is obviously unhappy on the overt level has a hidden, usually unconscious payoff. The hidden payoff often makes the apparently unpleasant or maladaptive experience quite worthwhile. Secondary gains can have very powerful influences on experience and behavior. 

We usually have a number of socially defined roles with which we identify, such as parent, educated person, good listener, political activist, or pillar of the community. We also commonly identify with other people an insult to my spouse is an insult to me, and the like. Identifying with people we think of as role models, heroes and heroines, is also quite common. These heroes and heroines can be losers in the conventional social sense also recall our discussion of secondary gains in the previous chapter. 

Desires General pleasure, specific user-accepted goals Aimlessness, (repressed) desires to harm or degrade self for secondary gains... 

The basic techniques of treating gas mask phobia are similar to those of treating other phobias, modified for the military culture and environment. They are desensitization, relaxation, and flooding. To avoid malingering, any secondary gain (ie, other benefits accrued by not being able to wear the mask, such as evacuation from the field environment) should be avoided. 

Perhaps one of the valuable, yet to be fully appreciated political lessons of Lacanian psychoanalysis is the understanding that, in certain cases, the narcissistic secondary gain (to resort to Freud s language) of... 

The standard of care in evaluation and treatment of these patients must include nutritional, electrolyte, hormone, and structural considerations that should be properly balanced, while social and family history, familial support structures, and secondary gain issues should be investigated. Nutritional supplements, replacement hormone therapy, and surgical interventions should be considered as a matter of course in an appropriate sequence dictated by standard of care. 

Is there secondary gain, i.e. a conscious/unconscious reason to stay ill Broaching this directly will lose rapport Denise may feel disbelieved or accused of malingering. But these issues are iii5)ortant to your formulation, so ask... 

Secondary gain tends to be associated with external advantage, e.g. financial support, housing avoiding work or criminal charges... 

Unlike malingering, the gain here is usually formulated as an unconscious need to adopt the sick role. In reality, there s usually a mix of primary and secondary gain. Again, you need proof of deliberate feigning or production of symptoms. Specifically assess risks from iatrogenic/self-inflicted medical problems or suicide. Support the medical team to raise their concerns with the patient, explaining ... 

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