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= D.: primärer und sekundärer Krankheitsgewinn.–Es.: beneficio primario y secundario de la enfermedad.–Fr.: bénéfice primaire et secondaire de la maladie.–I.: utile primario e secondario della malattia.–P.: Iucro primário e secundário da doença.
In a general sense, ‘’ covers all direct or indirect satisfaction that a patient draws from his condition.
The primary gain has a hand in the actual motivation of a neurosis: satisfaction obtained from the symptom, *, beneficial change in the subject's relationship with the environment.
Secondary gain may be distinguished from the primary kind by:
a. Its appearance after the fact, in the shape of an extra advantage derived from an already established illness, or a new use to which such an illness is put.
b. Its extraneous character relative to the illness's original determinants and to the meaning of the symptoms.
c. The fact that the satisfactions involved are narcissistic or associated with self-preservation rather than directly libidinal.
From its beginnings the Freudian theory of neurosis is inseparable from the notion that the illness is brought on and maintained by virtue of the satisfaction it affords the subject. The neurotic process complies with the *: it seeks to reap an * benefit, to achieve a reduction in tension. The
existence of this gain is shown up by the subject's resistance to cure, which counters the conscious will to get better.
The distinction between primary and secondary gain, however, was not drawn by Freud till a late date–and then only in a rough and ready fashion. Thus to begin with, in his study of the ‘Dora’ case (1905e [1901]), Freud seems to take the view that the motives for the illness are always secondary to the formation of symptoms. The symptoms are said to have no economic function at first, and might enjoy but a transient existence if they did not become fixed as the result of a new development: ‘Some psychical current or other finds it convenient to ma