A Brazilian pharmacist who treats patients in Argentina, Marcela Gottschald, has questioned why people stop taking long-term medication. Initially, she believed patients forgot, experienced side effects, or misunderstood their condition. However, her clinical experience across various specialties, including psychiatry, kidney transplants, and cardiology, revealed a more complex reality. Gottschald, also a journalist, shares her insights based on years of practice and research.
Across these specialties, Gottschald observed patients discontinuing vital medications. While initial explanations often cited forgetfulness, deeper conversations uncovered other reasons. For instance, in psychiatry, patients with schizophrenia experienced psychotic episodes after stopping antipsychotics, and those discontinuing antidepressants faced withdrawal symptoms. Similarly, in kidney transplant centers, patients stopping immunosuppressants developed acute rejection, mirroring challenges in cardiology and primary care.
Beyond Forgetfulness: The Emotional Weight of Medication
Some patients feared dependence, not just physically but emotionally, feeling a loss of control over their bodies. Others temporarily stopped medication to test their ability to function without it. Research suggests these concerns often arise before treatment even begins, as individuals grapple with what their illness and medication will mean in their lives. Gottschald notes that “I forgot” was sometimes an easier answer for both patients and healthcare professionals, masking deeper emotional struggles.
A Revealing Conversation: Medication and Masculinity
One case stood out: a young man who received a kidney transplant as a teenager. After years of adherence, he experienced acute rejection at 23. Initially, he attributed this to forgetfulness during a work trip. However, a casual conversation revealed a deeper reason. His girlfriend’s pregnancy triggered a desire to prove his masculinity, and relying on daily medication conflicted with his image of strength and autonomy associated with becoming a father.
Identity and Adherence: A Complex Relationship
Gottschald’s observations are supported by research. A 2024 systematic review on illness identity added another layer to this picture, showing that the way people integrate chronic illness into their sense of self was associated with whether they could manage their health problems and how they adapted to treatment. Studies also reveal that beliefs about medication and illness identity significantly impact adherence. The way individuals incorporate chronic illness into their self-image influences their ability to manage their health and adapt to treatment.
