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Defiance of Medical Compliance



Has your doctor told you that you are making yourself sick, that your pain or disability will continue to get worse until you change your lifestyle?  Perhaps you have had trouble complying with doctor’s orders about alcohol, cigarettes, street drugs, prescription pills, physical therapy, losing weight, getting exercise, eating a balanced diet, or changing your high-stress lifestyle.

If you read the rest of this article and get turned off, I hope you will at least have the courage and wisdom to ask yourself the question at the end of this article.  Meanwhile, if you have tried over and over without success to change your ways, if your loved ones have asked you repeatedly to stop what’s making you sick, if you know deep down inside now that you are your own worst medical enemy (and perhaps also your family’s), these insights and suggestions are for you.



  1. Ask your doctor to predict your medical future, both if you do and if you don’t shape up.  Ask for specifics, about months and years, about the predicted dates of losing this or that ability or freedom, and about how the doctor believes it will affect your friends and family one way or the other.

  1. Ask the doctor if there are any cost-effective ways to encourage or measure your compliance:  nicotine substitutions, weighing daily on a digital scale, blood or urine tests, physical therapy reports, new medications for alcohol abuse, etc.  Does the doctor know any other people who have made similar lifestyle changes, and would be willing to support you in this change of lifestyle?

  1. Share this information (every single detail) with your family and friends, and ask them to tell you how they will be affected over time by your choosing medical compliance, or on the other hand, your choosing continued unhealthy behavior. Give this article to them, so they know what you can do, and what they can do.  Another article is coming next week or soon, to guide them in how to help you.

  1. Make a written analysis of why this is so hard for you. Start by listing and then rank-ordering the situations that tempt you to unhealthy behavior. Consider the following – A.  Mental triggers:  dread, boredom, lack of hopes or goals, or unhealthy or unrealistic beliefs about God, your family, friends, work, health, control, revenge, entitlement, unconditional love, euphoria, nirvana, etc.  (You might need a friend or counselor to draw your thoughts out, and help you identify the sick ones.)  B.  Physical triggers:  being hungry, tired, on a caffeine or junk food high or low, etc.  C.  Emotional triggers:  feeling unattractive, scared, insecure, angry, hurt, shameful, discouraged, elated, embarrassed, jealous, craving something or someone, dreading or craving sex, etc.  D.  Situational triggers: the setting is too lonely, boring, structured, chaotic, stimulating, tempting, or you have failure, money in hand (or none), a tempting friend or group, etc.  E.  Relational triggers: being rejected, ignored, refused, criticized, patronized, suckered, ordered around, etc.   A and B arise within you, and D and E are external situations you run up against, but you also seek and provoke.  C comes from both inside and outside of you, but everyone is fully responsible for coping with their own emotions.



  1. List constructive alternative responses that will reduce your frustration and temptation in these situations.  For example, some people benefit from buying time (“I’ll think about this and get back to you”), prayer (the Lord’s prayer, the serenity prayer, Google St. Francis’ “make me an instrument” prayer, write out your favorites), inspiring thoughts (Google AA slogans, list your favorite sayings and Bible passages, see the tab here for “New Proverbs”), calming behaviors (cardio or yoga exercises, deep breathing, muscle relaxation, visual imagery, visual and auditory relaxations and distractions), reviewing consequences (next section below).  Keep a list of these coping strategies on your person at all times.



  1. Plan and imagine rewards and punishments.  Set up short, medium, and long-term goals for your behavior (the number of pounds lost, miles walked, weeks clean and sober, etc.).  Plan to reward yourself at each of these points in time, and plan with others how they can best reward these accomplishments.  (You may want to do this all by yourself, but this would be as foolish as a physician who tries to treat himself:  both of you would have a fool for a patient.)  So agree with two or three people on how they can react to you in ways that will help you stay on the right track, and report to them at regular intervals.  (You might want to ask if there is anything in their lives that they want to be accountable to you about in return.)  When you have had a bad day or time, remember that self-administered punishments (e.g., giving up TV shows, or doing household chores without being asked) work way better for stopping your unhealthy behavior than other people criticizing or punishing it.

  1. Ask your loved ones to follow your leadTell them as much of this as you can:  “When I’ve treated myself well, you treat me good too.  When I’ve been bad, just leave me alone, and don’t help me with anything. Wait till I have shown a change of heart by admitting my mistake, punishing myself in some way, and asking you to help me start over. Meanwhile, just walk off– no lecture, no further interaction, no hanging out in the same room together, and especially, NO EMOTION FROM YOU.  Let me feel all the emotional pain.  Seeing yours just gives me a temptation and excuse to mess up some more, and distracts me from my own painful emotions. I need my painful emotions to motivate my healthier behavior, not yours.  Whatever you need me for, find someone else for now.”

  1. Ask your loved ones to speak your love language strategicallyYou might have a different one, but the five most common love languages are:  words of affirmation, quality time, physical touch, receiving gifts, and acts of service.   Know what your favorite love languages are, and ask your significant other to speak them to you only when you have been taking good care of your health.  Otherwise, those parts of your loved ones go on strike.

            For the public good, an evolving copy of this article has been posted on my website given above, under the homepage tab of “Doctor’s Orders”.  I invite readers to send any suggested improvements for this piece to my email (drpaul@mynewlife.com), because any help you can give may add years to someone’s life, and peace to someone’s home.  The same will go for my next column written for the friends and family members of people who are defying doctor’s orders for their health.

            One last question for you:  if you think you can still enjoy and manage your life successfully without following these suggestions, how would you ever know if you were wrong—what would it take to convince you?





This article is for readers who have a loved one who refuses to follow doctor’s orders for recovery from a medical problem.  It assumes you have read first the article I wrote for your loved one, “Are You in Defiance of Medical Compliance?”  And like the first piece, if you read the rest of this article and get turned off, I hope you will at least have the courage and wisdom to ask yourself the two questions in the last paragraph.

Anyway, let’s call your loved one “Pat” (short for patient, and for standing pat).  You can initiate solution number one in the first article, by asking Pat to read it, and answer for you the questions it poses.  With or without Pat’s help, you can learn a lot, and find some new peace of mind in both these articles.

If your efforts to help Pat have been going on for years, you are probably doing Pat more harm than good.  If you are starting most of the conversations with Pat about unhealthy behavior, if you seem to be trying harder than Pat to produce healthy behavior in Pat, or if you are showing stronger feelings about Pat’s unhealthy behavior then Pat is, these are clear signs that you are actually doing more harm than good. Your efforts to help encourage Pat’s healthy behavior are backfiring, because without your knowing it, Pat is likely to be using them to excuse or even provoke unhealthy behavior.

If your helping behavior is backfiring, and if you are a part of the problem and instead of the solution, the most accurate way to describe your help is to say that it is enabling Pat’s unhealthy habitsHere are twelve of the most common enabling behaviors to avoid:

  • Co-indulging: colluding, joining in with or excusing the unhealthy behavior to stay connected to Pat

  • Denying/minimizing: making believe Pat’s medical or family problem isn’t very real or large

  • Moral compromise: dulling or defying your conscience to appease Pat, to stay connected

  • Covering up: concealing or outright lying to relieve Pat of the natural social consequences of unhealthy choices

  • Detective work: your obsessions and compulsions from doing Pat’s thinking, monitoring or research

  • Taking responsibility: over-protection by taking over Pat’s duties, especially responsibility for Pat’s health and compliance, but also things like parenting and budgeting

  • Manipulating: using logic or persuasion, offering deals or bribes, sending others to brain-wash Pat

  • Getting on stage: creating or entering into emotional turmoil (rather than walking out when you can, and when you can’t, just pulling up a chair and watching the show, without showing emotion)

  • Blame and punishment: playing cop or judge by shaming, hurting or getting even with Pat

  • Guilt-tripping: playing parent/martyr (“after all I’ve done for you,” “after all you’ve put me thru,” “how could you?” etc.)

  • Playing therapist: trying to predict, explain or figure out Pat’s behavior (this is your illusion of control)

  • Playing anti-therapist: saying or thinking Pat can’t change.

Just imagine the time and energy you will be saving by not doing these things anymore!  So what would work to help Pat learn to stop unhealthy behavior and start making healthier choices?

  • Telling the truth. Consistently but briefly, say that Pat’s unhealthy behavior, and the lies and excuses behind them, disgusts you, and make you want to leave Pat alone. Tell others the truth about Pat too – stop covering up

  • Leaving Pat alone. When patients don’t take care of themselves, stop paying attention to them. Don’t spend time with them. Don’t let them see that they tick you off, just that their unhealthy behavior turns you off.

  • Taking better care of yourself. Most enablers don’t know how to do this, and so they benefit from counseling, or from talking with others who have learned different ways to respond to similar behaviors in their loved ones.  Just do the next right thing. Do something nice for yourself, or for someone else.

  • Work together with Pat’s other friends and family. Agree to share information about Pat, and help each other abide by the guidelines of this article.  It might help for you all to sign some kind of pledge, and give Pat a copy as well.

  • Expect Pat to get help. Pat will connect with new people, places, practices, principles, and prayers that will strengthen his new habits, or else you won’t be connecting with much with Pat.  If Pat doesn’t know where to find those new resources, you know Pat will benefit from the help of professionals like the physician, a pastor, or a counselor or life coach like me.


What if Pat doesn’t do anything, or worse still, gets worse?  Remember that like surgery or remodeling, things often have to get worse before they get better.  Give it time.  Tell Pat that by treating Pat as someone who could change, you are showing that you respect and care about Pat more now.  Pat can use this same approach with the unhealthy friends in Pat’s life, by telling them, “I am giving you more of myself, now that I am taking better care of myself and inviting you to do the same.”

No matter what happens between you and Pat, one thing will be the same for both of your experiences.  If you change and make healthier choices, you will find that your social circles shift.  Imagine those who care about you as sitting in circular rows of seats around you, with the rows closest to you giving you the most time, communication and respect.  You will soon notice that people will start standing up and shuffling around to find more comfortable seats.  Some close supporters won’t like your new choices and will take seats further away from you.  But others will move in closer and take those seats, and your circle of closest friends and family will have some new faces before long.  They will help you see very soon that all of your efforts are worthwhile.

Two last questions for you:  if you have trouble making any of these changes, if you are scared to risk rejection by Pat, perhaps you have some unhealthy habits in your own life, and you need to read the first article.  If not, perhaps you have an unhealthy dependency on Pat.  If so, admit to your other family and friends that before creating a better life for Pat, you first need to get one for yourself.

About Paul Schmidt

Dr. Paul Schmidt, PhD is a psychologist life coach with offices in Louisville and Lexington, KY, 502 633 2860.