nursing care. The internal social advantages come from the medical and nursing staff, and from
other patients. After the patient's discharge the external social advantages are gained by provoking
sympathy and awe. In its extreme form this game is played professionally by fraudulent or
determined liability and malpractice claimants, who may earn a living by deliberately or
opportunistically incurring disabilities. They then demand not only sympathy,
as amateur players
do, but indemnification. "Ain't It Awful" becomes a game, then, when the player overtly expresses
distress, but is covertly gratified at the prospect of the satisfactions he can wring from his
misfortune.
In general, people who suffer misfortunes may be divided into three classes.
1. Those in whom the suffering is inadvertent and unwanted. These may or may not exploit the
sympathy which is so readily offered to them. Some exploitation is natural enough, and may be
treated with common courtesy.
2. Those in whom the suffering is inadvertent, but is gratefully
received because of the
opportunities for exploitation it offers. Here the game is an afterthought, a "secondary gain" in
Freud's sense.
3. Those who seek suffering, like polysurgery addicts who go from one surgeon to another until
they find one willing to operate. Here the game is the primary consideration.
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