Case 2, Episode 1: The Story So Far – Listening Beyond the Symptoms
“I’ve been depressed most of my life.
I’ve tried everything.
Therapy. Meds. Meditation. Journaling.
They help for a while, and then… nothing.
So maybe this is just who I am now.”
— Marcus, 48
Marcus is not in crisis.
He’s in something deeper, quieter, and harder to treat: the collapse of hope.
He walks into your office not asking to be fixed—but asking if he’s even worth the effort anymore.
This isn’t his first episode of depression[1]. It’s his seventh.
And somewhere between the fourth and fifth, he stopped believing anything would really change.
Now, your task is not just to assess.
It’s to bear witness to someone who feels like he’s been forgotten by recovery.
The Presentation: Not Acute, But Enduring
Marcus is 48. He’s single. He works in IT. He hasn’t taken a vacation in five years.
He describes himself as “functional” but says life feels like “moving through fog.”
No suicidal ideation. No psychosis.
Just a numbness that has become normal.[2]
And an invisible weight he carries so long, he no longer notices how heavy it is.
He’s been on:
Sertraline
Bupropion
Venlafaxine
Mirtazapine
Duloxetine
Lithium (briefly, couldn’t tolerate)
Aripiprazole (gained 20 pounds, felt flat)
Each trial brought minor relief, then faded or introduced side effects.
His therapist “retired.” He never got around to finding another.
He meditates, kind of. He journals, sometimes.
He shows up for work, but he doesn’t feel alive.
This Is Not “Noncompliance.” This Is Burnout.
We often mislabel patients like Marcus as “treatment-resistant.”[3]
But what if what they’re resisting isn’t treatment—it’s disappointment?
What if they’re not “unmotivated,” but exhausted by the cycle of hope and failure?[4]
Marcus says, “I used to think something would help. Now I’m not even sure I deserve help.”
This is a symptom.
This is a belief.
And it’s also a clue.
Because beliefs like this are rarely born in adulthood.
They are echoes of something earlier.
How to Begin with Someone Who’s “Done It All”
Don’t rush to fix. Slow down to see.
Ask: “Can you tell me the story of your depression—not just the symptoms, but how it’s shaped your life?”
Name the fatigue. Validate the effort.
“It sounds like you’ve fought hard for a long time. That alone tells me something about your strength.”
Look for patterns in the past.
“Was there ever a time when it started to lift? Even for a little while? What was happening then?”
Use curiosity, not protocol.
Instead of: “Have you tried CBT?”
Try: “When have you felt even slightly more connected to yourself? What helps you remember who you are?”
Why This Case Matters
Marcus represents a common but under-discussed population in psychiatry:
Patients who are not in acute crisis, but live in chronic, low-grade suffering
People who have tried multiple treatments and now feel like failures
Individuals who may be carrying trauma, grief, or shame underneath the diagnosis of “depression”
Clients who no longer believe in the therapeutic process
They challenge us not with chaos—but with quiet despair.
And they call us to offer something deeper than medication: relationship, insight, and radical presence.
Coming Up Next: Episode 2 – Constructing a Life Timeline
Next, we’ll explore Marcus’s life not as a checklist of episodes, but as a timeline of meaning.[5]
We’ll ask:
What shaped his beliefs about suffering, effort, and worth?
Where are the inflection points that brought him closer—or further—from himself?
And what’s been missed in the rush to prescribe and move on?
Reflective Prompt for You
Have you ever worked with someone like Marcus—functional on paper, but fading inside?
What helped them start to feel again?
What helped you stay with them in the stillness?
Your experience may be the bridge someone else needs.
References
[1] Hirschfeld, R. M. A., et al. "Psycho-social predictors of chronicity in depressed patients." The British Journal of Psychiatry 148.6 (1986): 648-654.
[2] Scott, Jan. "Chronic depression." The British Journal of Psychiatry 153.3 (1988): 287-297.
[3] Souery, Daniel, George I. Papakostas, and Madhukar H. Trivedi. "Treatment-resistant depression." Journal of Clinical Psychiatry 67 (2006): 16.
[4] Putman III, H. Paul. "Clinical reasoning, medical error, and treatment failure." Current Research in Psychiatry 5.1 (2025): 9-16.
[5] McKenna, Patricia, and David Todd. "Longitudinal utilization of mental health services: A timeline method, nine retrospective accounts, and a preliminary conceptualization." Psychotherapy Research 7.4 (1997): 383-395.