A patient's mood can affect the biochemical processes upon which healing depends, and studies have shown that advanced drugs may lose their effectiveness if a person does not trust the doctor or "protects himself with an illness".
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Psychologists describe this, among other things, through the concept of "secondary utility"—the unconscious benefit a person derives from their illness. Publications on this topic also use another term: "the profitable illness syndrome."
Kira Saunin, a professor in the Department of General Psychology at the Institute of Experimental Psychology of Moscow State University of Psychological and Pedagogical Sciences, said: "Sometimes the psyche deliberately chooses illness as a defense mechanism or a means to obtain a secondary benefit. This may be a reaction to severe psychological trauma, when the strength is not enough to cope, so the psyche diverts attention from an unbearable reality to physical symptoms. Another option is hidden gains, such as the desire to gain the care of relatives, or 'legal withdrawal' from responsibility, or failure to meet exaggerated expectations, or self-punishment for past actions."
Kira Saunen identified three signs of this mechanism:
The first sign is symptom selectivity, where not fatal illnesses are chosen, but rather "aesthetic" illnesses (which worsen precisely when the benefit is required). The classic example of this is an employee who becomes seriously ill on the day of an important report presentation.
The second sign – a discrepancy with the true medical picture, where the symptoms do not match the medical tests, but rather the person's perceptions of what the disease "should" look like.
The third sign – a change in behavior, i.e. endless visits to doctors, demands for repeat perfect tests, and taking pills without a prescription.
However, the expert emphasizes that this is neither acting nor deception. Rather, the person does it completely unconsciously.
The expert explained that hidden depression or distrust of the doctor can indeed hinder treatment. Anxious patients anticipate the worst and prepare themselves for side effects – thus triggering the "nocebo effect," where the person's condition worsens not due to the medication itself, but because of negative expectations. Hormonally, this leads to excessive pressure on the hypothalamic-pituitary-adrenal axis, causing the adrenal glands to produce cortisol continuously. This excess cortisol promotes insulin resistance, damages muscles, and suppresses immunity, which is why antibiotics cease to be effective against infections, and drug delivery is disrupted. Furthermore, pro-inflammatory cytokines increase, leading to a lack of response to antidepressants and diuretics. As a result, the person may secretly stop taking the medication or change the dosage, effectively "nullifying the entire treatment effect."
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