There was a long article in the New York Times earlier this year about terminal anorexia. It can be terminal. The stories described in the article were harrowing. Absolutely dreadful. The one I remember the most was of woman whose illness was accepted as terminal by her provider and by her and no more attempts were made to prolong her life and she knew she was dying and even during those last days she would go on incredibly long walks to prevent her body from gaining weight. The grasp her disease had on her mind could not be released. I posted this article in the eating disorders forum and can find it for you if you are interested, with a warning that simply reading the article through the end was very hard for me.

Anorexia in this deadliest form is an exception among mental illnesses, though, as most can be managed with the arsenal at our disposal today. You have posted about your story and we know you are at that point that for 30 years everything has been tried and failed and you feel out of options and understandably pessimistic. And it seems that the constraints of the VA system do not allow doctors to experiment with some medications. But I offer from my friend who lives quite well with treatment resistant bipolar II and who is a software engineer says: mathematically, we have so many drugs available today that if you combine them in different constellations and at different dosages, the sheer number of possible combos is staggering and something there will work if you have a doctor willing to try unusual combinations. He has such a doctor at McLean hospital and thanks to that doctor, my friend stopped trying to kill himself when his life seemed pointless to him and managed to build a life with employment (even though he did not graduate as he was too sick in college, but he took enough classes) and a family. Actually his wife never worked and they raised two daughters and he now has two grandchildren, his elder daughter's children. And he has a loyal dog who helps him work from home. He has depressive waves during which he mostly sleeps and does not attempt to work, but they are infrequent. He has moved to PNW and his doctor there is a woman willing to adjust dosages a lot and experiment and that is still needed from time to time. He is very sedentary and that is not something that he is willing to change. I am sure his life would have been even more manageable had he walked and lifted weights, but... This is a rather long story to say that he, as a math nerd who went to a top technical school, makes a combinatorics argument for the possibility of finding a winning combo out there.

To DocJohn's point: I have hypothyroidism caused by prior intake of Lithium which was diagnosed by a lab test and my presentation with symptoms in urgent care but also have a chronic intractable migraine and now also vestibular migraine for which there are no lab tests. The absence of lab tests does not make these diseases any less real, or painful if untreated. But I have ultimately found treatment for all the symptoms with pharmaceuticals. One of them is not approved in the US but widely in use in Europe and UK and I will have it shipped by a Canadian pharmacy at a reasonable cost but that is OK. I am very thankful for these drugs. And with bipolar, I am on an unusual combo and doing relatively well. It took years to get here but that is the story of iterating and trying many things that do not work until you find the thing that does.