So, a bit of background. I apologize ahead of time as this is a two-parter raised from one instance.

I was reading a case study of a psychologist who had treated a woman for decades for severe depression that was unresponsive to all forms of treatment. Everything from ECT to anti-psychotics that would take out Mr. Ed. The woman had no family or support network other than this psychologist, and he was the closest thing she had to a friend.

Two issues were raised:

One, is it okay to bridge the line between patient and doctor by being a friend so long as both are sober about staying friends and not putting the other in a position where that trust is compromised? Are we not first and foremost humans sharing the same miserable petri dish? Why shouldn't there be a friendship bond between doctor and patient? Wouldn't that friendship strengthen the trust so long as it's not compromised?

Two, where is the line between continuing treatment for depression and acknowledging that the depression is terminal? How many times does a person have to switch meds and therapies before the professionals finally conclude that this person suffers from terminal depression?

Yes, I believe in terminal depression because sometimes, there really is no way out. It's not common, but there are times when we have put ourselves so far into the black of madness that there is no more light to be had. There seem to be cases where the depression will never get better because of external variables that are outside the patient's control. Yes, the patient may have had control over some of those variables at one point in time, but has lost the ability to influence the external instances that their life is controlled by rigidly.

When the entirety of your life is focused on mere survival, the externals that make living tolerable (vacations, friends, etc) tend to be out of reach and/or no longer desireable. If all I am doing is living to survive, am I really living at all? And when all indicators hint that the future is more of the same, what is the point? Where is the cut off where we are allowed as humans to say enough?

Sorry for being morbid/negative, but the masochistic part of me wants to know. Something new to obsess over/torment myself with.