[Michael2Wolves]

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.

[jaynedough]

You raise some interesting questions.

As far as "professional distance" goes, I think that there are a lot of variables that can affect that. Where I grew up, doctors were very distant. When I moved one state over, into a more rural setting, the healthcare professionals were totally different. Some of my docs are very involved in the community. And I've seen my PDoc in church and Costco and another doc in WalMart. The way they interact with me is totally different from what I grew up with and that's made a huge difference in my life. I had some truly great years that I never would've experienced with my old docs.

As far as terminal depression goes, I agree that it can reach that point. For me, it's become a question because of some serious health problems that are making it impossible to do much of anything. That being said, I'm not ready to give up. Depression tends to ebb and flow, and I try to remember that I'll feel better in a bit. I'm not saying that the depression is going to completely go away; it never does. But it does let up enough to let me live a little.
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[Michael2Wolves]

This is a complex bit, isn't it? I'm going to chew on this some more because I really think there's not much left for me, either, and I have only lower back issues that are responding fairly well to treatment. I want to keep this in my feed, though.

[eskielover]

As for professionals being friendly outside of work, one of my best friends is also my GP, PA. She has helped me get a med I needed that another MD refused to prescribe because they wanted me to come into the office for a treatment with the med I could do at home.

My other good friend is my now retired pharmacist. Both these people have farms down the road from mine. Rural areas are so much different than living in a huge city.

My awesome psycholigist had listened to me talk about a ballroom dance performance I was doing. She asked where & when & actually came to the performance to support me. She knew many other people there because she has lived in that small town for a very long time.

I love the small town atmosphere because so many people know each other when involved in the community & they care.

As for treatment resistent depression.....ugh, 13 years of it & not a med in the world helped & neither did any of the therapy during that time. Went through pdocs because I wouldn't stop attempting sui & they hated the close calls. Basically gave up on me.

Everyone just thought I was overreacting to the loss of my computer engineering career & convinced me that was all there was to my depression that had become permanent disability because it looked & seemed like NO RECOVERY.

THEN.......I got fed up with my bad marriage I was financially trapped in after my mom died. I took my inheritance & left....like moved 2100 miles away to my rural farm I bought. Honestly, the depression & anxiety started to lift almost immediately even with his financial irresposnibility still effecting me with IRS & mortgage companies making divorce still impossible. Finding my awesome psycholigist & 2 years of intense DBT group work, the past came into a very clear picture of just how & why my depression had been so bad it seemed to everyone including myself there was no hope to feel better until I moved.

Thatvdidn't make sense to me at first because everyone had told me you can't run away from your problems because they follow along with you. Not in my case.....& I had to process & understand why I had improved so much wuth the move. 11 years later & my depression is gone. My anxiety level is almost non-existent until I have to deal with my almost ex.....which just validates what the root cause for my mental health issues actually were. It was triggered buy my loss of career but constantly grew worse being trapped in the bad marriage after that.

The freedom & the peace I finally felt after leaving & the fact that healing came after leaving all helped me understand thst past & I learned what behaviors had been bothering me so badly when I finally found the words to express what I had been feeling all along. Giving it words & a voice & freedom from the situation that no one even had the slightest thought it was creating the serious mental health isdues I was experiencing.

We never know what knowledge tomorrow may come regarding the past & present that can open that door to treatment resistent mental health issues especially if they are sutuational in nature.

[Michael2Wolves]

I almost hesitated at including the link for the case study in this thread because it is not easy to read and is very likely triggering for some people. Readers beware:

When Is Depression a Terminal Illness? Deliberative Suicide in Chronic Mental Illness, June 16 - AMA Journal of Ethics

The entire reason I asked about this is because I constantly wonder where I am on that spectrum...yeah, I may be able to take meds to ameliorate some of my symptoms, but the root, external cause inducing the symptoms will never change short of humans evolving overnight and learning sudden compassion and understanding.

I am locked into this life by legal restraints stronger than steel. My external variables will always be negative, and there's nothing I can do about that to change it. Yes, I can make small changes here and there about myself, but due to the externals, those changes amount to nought.

I had one psychologist I've trusted in the last twenty years, and now she's not in private practice (she went from working in a prison to working for the county crisis center) so I cannot rely upon her for any meaningful palliative treatment, and the idea of trusting another rando psych who has no background in criminality or treating severely abnormal psychology (I'm half-convinced that everyone who comes out of the joint has some form of PTSD, deserved or not) makes me shake and get panicky.

I am stuck. And there absolutely is no way out. I fear that all I am doing is numbing myself to the reality of my situation because the reality is that it will never get better.