31 Jan Secondary Gain

“Secondary gain” is a loaded term, because it can easily sound as though illness isn’t “real”—as if someone is making it up, being dramatic, or as if you ought to blame yourself. But that isn’t what it has to mean. Illness is real, and yet it can happen that being unwell, alongside pain, limitation and loss, also brings something with it: attention, rest, recognition, connection, relief from pressure, a sense of structure, and sometimes even status. That’s not a moral judgement; it’s a description of how systems—human and societal—sometimes operate.

In psychology, this is often linked to the idea of secondary gain: benefits that arise from the way those around us respond to symptoms, and which can unintentionally slow recovery. It is rarely about conscious manipulation; more often it is an old, intelligent survival route within the system. When asking directly is, or once was, unsafe, the body or the mind finds a detour. Not because someone is weak, but because the system is loyal to what was once necessary in order to keep functioning.

On a societal level, you see secondary gain when, structurally, more money, attention and power flow towards symptom management than towards reducing root causes. Then illness becomes not only a human experience, but also a market. In that arena people speak, for instance, of disease mongering: stretching the boundaries of what counts as a disorder so that more people become patients and the market for treatments expands. There is also genuine debate about the influence of lobbying on policy, and about how a “sick-making” environment and commercial solutions can reinforce one another. This isn’t a simplistic story of “everything is malicious”; it’s an invitation to look honestly at what we reward as a society: prevention and wholeness, or primarily products and protocols that keep us trapped in the loop of problem–reaction–solution.

On a personal level, secondary gain is often the most recognisable—and the most painful—to face, because it touches our most basic needs: to be seen, to be held, to belong, to be allowed to stop, to be safe. Illness can unconsciously become an entry ticket to care and closeness—precisely what someone never learned to ask for directly, receive, or find within themselves. If you never felt you had the space to set boundaries, a body that “runs out” can end up enforcing them for you. If you never learned to rest without guilt, burnout can suddenly become the only “legitimate” pause. And if you don’t dare to say “I need you”, a symptom can still make those words manifest—only without you having to speak them.

This mechanism is not indifferent or weak; it is often ingenious and subtle. At the same time, especially in a culture where visibility and narratives acquire economic value, it can slide into something increasingly stagnant: an identity, status, or income that begins to rely on holding on to the illness story. It doesn’t have to be fake to become limiting. Illness remains real, but the reward around it can take the system in a stranglehold and keep it there—precisely because, at a deep level, it fulfils something that has been missing for a long time.

Spiritually, things become tense, because words like “manifesting” and “creating” can quickly tip into blame: “so you did this to yourself.” A more conscious, mature approach is softer and more precise: not the question “who is at fault?”, but “what is it in me that I’m not aware of that is co-creating this?” If we see ourselves as creative beings in relationship with life, then illness can be an invitation to move out of powerlessness and victimhood—not by denying what is happening, but by looking and listening to what it makes visible. What truth only becomes audible when the body says “no”? What old loyalty, fear, grief, anger, or boundary is asking for integration? Sometimes illness invites action and choice; sometimes surrender and slowing down; often both. And sometimes the lesson isn’t that you can “fix” it, but that you can learn to carry it: to endure life with dignity, clarity and love, without narrowing yourself down to control alone.

Where secondary gain is at play, there is almost always inner conflict. On the one hand, there is the false safety of the familiar pattern: you know what it yields—care, rest, structure, a place in the system, a story in which you don’t have to risk. On the other hand, there is the natural movement towards balance, inviting you to heal. But healing sometimes means relinquishing something you unconsciously believed you needed in order to survive, and that is exactly why change can feel unsafe, even when the old pattern limits you.

That is why the key so often lies in a shift in perspective from mind to heart: from conflict, polarisation and stress towards a starting point of unity, creation and natural order. It is no coincidence that “to heal” is etymologically linked to the Old English hælan, meaning “to restore wholeness”. In that light, healing is not the absence of symptoms, but the absence of inner resistance, judgement, fear and denial—the moment you stop fighting what is here now, and therefore finally can hear what is actually needed. Sometimes that is treatment and action. Sometimes it is softening and surrender. Sometimes it is the courage to ask directly for what you have always tried to obtain by detour: love, rest, support, recognition, truth.

This way of seeing is not a replacement for medical care, diagnosis or therapy. It is an additional lens—one that invites you to be honest about the hidden rewards around illness, so that the underlying need no longer has to be met through pain, but through awareness, choice and wholeness.