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301 Secondary Handicap and Learning Disability : A Component Analysis

The term ‘secondary handicap’ is frequently encountered in services for people with disabilities. The term has its origins in Freud’s original description of secondary gain (Freud, 1901), and Winnicott’s description of the ‘false self’ (Winnicott, 1965). Since the late 1980s, however, the term has largely been associated with the psychoanalytic writings of Valerie Sinason at the Tavistock Centre in London. This article examines the evidence base for secondary handicap and concludes that although no empirical evidence exists for the concept as a whole, evidence can be found for individual components that make up the phenomenon. It is concluded that sufficient evidence exists to infer the existence of secondary handicap. Therapy provided to people with learning disabilities must not, however, proceed in a formulaic or manualised manner as the stripping of individual defence mechanisms may cause more harm than good unless carefully considered.