In an opinion essay for STAT, pharmacist and journalist Marcela Gottschald describes how her clinical experience changed her understanding of why patients stop taking long-term medications. The usual explanations—forgetting, side effects, or poor understanding—were only part of the story. After longer conversations, patients revealed that needing daily treatment felt like losing control over their bodies, or that stopping it was a way to prove they could still function without it.
Gottschald points to cases across psychiatry, cardiology, and transplant care. One young kidney transplant recipient stopped his immunosuppressants after learning his girlfriend was pregnant, saying he needed to "become a man." For him, the medication had become a symbol of dependence that conflicted with his image of strength and adulthood. She notes that similar patterns appeared in mental health care, where some patients felt medication changed who they were, not just through side effects but through a deeper sense of disconnection from themselves.
The essay draws on research showing that beliefs about medicines and illness identity influence adherence, and that these beliefs can form before the first prescription. Gottschald argues that clinicians should ask harder questions—what a medication means to a patient, how they feel about needing it daily, and whether part of them resists that dependence. Explaining how a drug works is essential, she writes, but understanding what it represents may be just as important.