Vignette 2

Vignette 1.

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.

Alice was a bit overweight, had periodic eating binges. She’d sneak to the McDonald’s drive –through and order cheeseburgers and milkshakes. Afterward, she’d hate herself for it. She had tried for years to control her eating binges but with little success.

After an eating binge, I asked her to notice any thoughts that occurred to her, whether or not they seemed related to the eating binge. Her thoughts ran to her husband. She said he was self-centered and controlling and disregarded her needs. She said he treated her as a trophy to display, not as a human being with feelings of her own. Her additional associations were that her husband was happy when she was thin because she was a better trophy, that she felt deprived and unloved, and that she felt dependent on her husband and trapped. My patient’s eating binge was embedded in complex web of associations and meanings. As it turned out, her behaviour served simultaneously to punish her husband, to compensate for her emotional deprivation (because she associated food with love), to reassure herself that she was not under his control, to help suppress fantasies about leaving him (because being overweight would make her less desirable to other men), and to punish herself for her vengeful thoughts (because she hated being overweight).

Дата добавления: 2014-11-08