A patient recovering from a heart attack kept “forgetting” to take his medication. The patient (Steve) was an intelligent person and his memory for other things was just fine. Steve’s doctors responded with “patient education”, explaining why the medication was necessary. Steve wanted to take care of his health and tried to follow his doctors’ treatment plan. Still, he kept forgetting.
I suggested to Steve that there might be more to his forgetting than meets the eye, and asked if he had any ideas about this. Steve eventually said that something about the medication gave him a bad feeling but he could not say what. He genuinely did not know. I asked him to tell me any thoughts or feelings that occurred to him, whether or not they seemed relevant or made any sense. Steve said he did not know why it came to mind just then, but found himself thinking about his younger brother. As a child, Steve had been popular, athletic, and a good student. In contrast, his little brother had been sickly and weak. He was always taking pill for one thing or another. He did poorly in school and was no good at sports. He was disappointment to his parents. E associated taking medications with his sickly younger brother. In Steve’s mind, taking pills is equated with being like his younger brother – weak, sickly, and less loved. In fact, Steve stopped forgetting his medication only after we were able to discuss his fear of being weak and a failure, and his related fear of losing the love of the people who mattered to him. Steve recognized that taking the medication would not turn him into his brother. That was an irrational fantasy.