If I Confide the Whole Truth to a Professional, Will They Force Me Into Treatment?

Reader’s Question

I would like to see a physician for a check-up and even to begin therapy, but I’m afraid that because of scars I have from when I was much younger, I might end up being forced into drug treatment or some other type of psychiatric care I don’t want.

During my late teens to very early 20s, I went through a period of deep depression and went so far as to injure myself and make several half-hearted suicide attempts (although they felt very real at the time). I did not advertise any of this to others in my life, outside of asking my family to allow me to go into counseling when I was still ‘together’ enough to recognize that I was departing from my normal emotional state. But I’m sure the change in me was obvious to most. I have not cut or otherwise hurt myself in more than a decade and feel that it was an expression of a phase of my life. I still go through cycles of depression, followed by elevated or normal moods, and I still have an aversion to social interaction that renders me mute and anxious when in the company of groups larger than a few people. Even though I’m obviously not trained to diagnose myself, I fear I still suffer from some significant mental illness. I just don’t want to be shoehorned into drug treatment or have my input ignored because my old self-mutilation scars are still with me, and their striking appearance might cause someone evaluating me to overestimate the seriousness of my problems.

I’m almost 30 now, and although my mood swings have had a negative impact on my life, they are manageable — unlike during the period of my life when I hurt myself. I’d like to get them under control before too much more of my life is past, and would like to see a physician, to make sure I’m physically healthy — I haven’t seen a doctor since I started high school. But I’m too frightened that they’ll see the scars on me and put me on heavy-duty medication based on a hasty diagnosis. Am I being paranoid or just ignorant of how things work? Will a doctor listen if I explain all of this to them?

Our Clinical Psychologist’s Reply

You are a legal adult, and no one can force treatment upon you that you do not want unless you pose a clear and imminent danger to yourself or others. There are some fairly tough legal guidelines in place to protect your rights. That said, you seem to be quite aware that it would be in your best interest to get some help. More than likely, your concern about your situation arises neither out of true paranoia or ignorance but rather the damage done to your self-esteem over the years. On the one hand, you have to admit you still have some serious problems. On the other hand, you want others to know that you’ve managed to learn how to cope much better than you did in your younger years. In short, you want others to respect that you may be ill, but not as ill as you once were. Your sense of trust also appears quite tenuous, and understandably so. You want help, but you are unsure you’ll be treated correctly if you entrust yourself to someone’s care.

You can take heart in knowing that you are the person ultimately responsible for your mental health. You should seek out a professional who is well-versed in the treatment of individuals who have struggled with serious mood disorders as well as an impaired sense of self. Tell them the whole story. They should listen. Be prepared to be apprehensive, possibly mistrusting, and to struggle with your self-image in the whole process. But stick with it, even when it gets dicey. An inner voice is telling you that you still need guidance, support, and a forum for working through some serious issues. Listen to it. And remember, you always have the right to ask questions about your diagnosis and recommendations for your treatment.