Abstract
Research suggests that a conscious desire for external illness gain can have internal unconscious effects, in that subjective symptoms can be heightened by external reward. This mechanism can be explained on the basis of Freud’s later work, in which he mentions two types of resistance, which resemble each other — the need to be punished and the need to be ill. The concept of the need to be ill can explain why in modern society, with its established systems of support, regulations, and procedures that are conducive to illness behavior, patients who consciously strive for external gain can experience strengthening feelings of being ill and even deterioration without being aware of this process.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
F. Alexander (1948.) Fundamentals of psychoanalysis Norton New York
A. J. Barksy G. L. Klerman (1983) ArticleTitleOverview: Hypochondriasis, bodily complaints, and somatic styles American Journal of Psychiatry 140, 273–283
J. D. Cassidy L. J. Carroll P. Cote M. Lemstra A. Berglund A. Nygren (2000) ArticleTitleEffect of eliminating compensation for pain and suffering on the outcome of insurance claims for whiplash injury New England Journal of Medicine 342, 1179–1186
R. A. Emsley S. Soraya D. J. Stein (2003) ArticleTitlePosttraumatic stress disorder and occupational disability in South African Security Force members Journal of Nervous and Mental Disorders 191, 237–241
S. Freud (1940.) An outline of psychoanalysis Standard edition EditionNumber(Vol. 23, pp. 39–207). Hogarth Press London
Freud, S. (1961). The economic problem of masochism. Standard edition (Vol. 19, pp. 155–170). London: Hogarth Press. (Original work published in 1924)
Freud, S. (1963). Introductory lectures on psychoanalysis. Standard edition (Vol. 16, pp. 358–391). London: Hogarth Press. (Original work published in 1917)
B. C Frueh J. D. Elhai P. B. Gold J. Monnier K. M. Magruder T. M. Keane G. W. Arana (2003) ArticleTitleDisability compensation seeking among veterans evaluated for posttraumatic stress disorder Psychiatric Service 54, 84–91
B. Hofmann (2002.) ArticleTitleOn the triad disease, illness and sickness Journal pf Medical Philosophy 27, 651–673
F. Kennedy (1946.) ArticleTitleThe mind of the injured worker. Its effect on the disability periods Comprehensive Medicine 1, 19–24
J. M. Pearce (2002.) ArticleTitlePsychosocial factors in chronic disability Medical Science Monitor 8, 275–281
M. A. Stout (1984.) ArticleTitleA cognitive-behavioural study of self-reported factors in migraine Psychopathology 17, 290–296
J. J. Egmond Particlevan (2003.) ArticleTitleMultiple meanings of secondary gain American Journal of Psychoanaysis 6 135–145
J. J. Egmond Particlevan I. Kummeling Particlevan (2002) ArticleTitleA blind spot for secondary gain affecting therapy outcomes European Psychiatry 17 46–54 Occurrence Handle10.1016/S0924-9338(02)00622-3 Occurrence Handle11918993
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Egmond, J.J.v. Beyond Secondary Gain. Am J Psychoanal 65, 167–177 (2005). https://doi.org/10.1007/s11231-005-3624-2
Issue Date:
DOI: https://doi.org/10.1007/s11231-005-3624-2