Clinical relevance of the sick role and secondary gain in the treatment of disability syndromes.

There are many controversial disability syndromes, representing medicolegal and social dilemmas for a variety of medical disciplines. Health care professionals are at a loss to cure these patients, and judges and disability review boards struggle to be fair while at the same time trying to understand the basis and appropriateness of the ever-growing claims of disability. Various models describe the illness behavior in these syndromes, and a recent model proposed that deals with the sick role, gain, and illness behavior in a social context is considered for its application to psychotherapy. One finds that despite the utility of such a model in describing the patient's behavior, using this knowledge to alter the behavior remains a difficult challenge for the psychotherapist.