This has less worth

A pseudo-random sequence of events led to me re-reading my most recent posts, so I might as well do an update, I guess.  To keep it as brief and non-redundant as possible, this makes no attempt to make sense as a stand-alone post, but rather presumes one has read at least the most recent posts, which are themselves largely redundant.

Upon revisiting my psychiatrist and discussing my ever-narrowing treatment options, I acquired a referral to a provider of TMS (Trans-Cranial Magnetic Stimulation).  Due to insurance issues and some very non-satisfactory discussions with the staff, this was a dead end.  The next logical step was to identify an alternate provider compatible with my insurance and then get a referral to said provider.

It seemed prudent to combine my search for a provider with some additional online research into TMS.  I had expected to wade through an evaluation of a broad spectrum of competing hardware and treatment protocols, comparing each to the most solid science I could find on the subject.  I was surprised to discover three things:

1. There is essentially only one hardware system from one manufacturer, and only slight variations in treatment protocols, since all providers are directly trained by the manufacturer.  Providers are numerous, but there appears to have been a bubble of growth in this industry which is in the early stages of bursting, with a number of bad links already.

2. There is no solid science to support the efficacy or prudence of TMS.  There are many articles discussing the difficulty in designing experiments which would provide more definitive results.  Ok, this part wasn't really surprising.  The most reputable sources were the most skeptical about TMS, not the least of which, the APA (Americal Psychological Association) itself.  The only good news is that, effective or not, it is largely benign with very rare incidence of serious negative effects.

3. Seemingly trustworthy and well-known large medical universities have vaguely positive things to say about TMS and claim to be engaged in TMS research.  Suspiciously, all photography of experimental apparatus appears to depict the very same equipment sold to the individual practice providers.  My wife spent a lot of time following up in detail with OHSU (Oregon Health and Sciences University) about their TMS research.   Their story, as it turns out, appears to be typical of the other universities as well.  They had some initial enthusiasm and limited experimentation, ran into the same difficulties in designing experiments and producing solid results that everyone else has had, and are not currently actively engaged in any research on the subject.

So... probably another form of electric snake oil, but just enough of a hope/doubt mix to maybe give it a try, with very low expectations.

It appears that my next step will most likely be just that, give it a try so long as it is covered by insurance, but invest no hope.

This ultimately brings me back to my obsession with threes, in this case, three choices:

1. Go ahead and pursue ECT (Electroconvulsive Therapy).  A treatment much maligned in popular culture, but which has a fairly good rate of initial efficacy, although a higher than hoped-for rate of relapse and diminishing returns with subsequent re-treatment (a profile it shares with success stories claimed for TMS).

2. Abandon all physical or pharmacological approaches to treatment, and do my best to live out what remain of my days as tolerably as possible, with or without a return to the endlessly disappointing talk therapy.  My concern is not as much with what I can tolerate, but more with what is reasonable to expect others to tolerate in terms of my behavior.

3. Ummm...  So far, I only have extremely brief moments of psychic discomfort so intense that I contemplate the final solution.   These moments have passed and not led to a very loaded word I am loathe to invoke in this context: planning.  In calmer times, I have dispassionately gone through the intellectual exercise of finding the inevitably unacceptable consequences or risks of consequences that come with any methodology I can imagine for implementing a final solution.  I understand that a person can reach a point where the final solution is coveted as the last and only thing within individual control, but even that sense of control is false as there are too many variables that can lead to unintended results.  This is a strongly discouraging situation before moral philosophy is even considered, which tends to cast even more doubt on the prudence of the final solution.

So much for my obsession with threes.  There is a fourth, very unlikely, course of action:

4. Engage in experimentation with legal and non-legal pharmaceutical treatments.  I have done some online investigation into this and it is not very promising.  The best I can hope for is a temporarily altered state of consciousness which occludes one set of mental dysfunctions with another.  The most promising substance, MDMA, is far too difficult to synthesize properly and I would trust no amateur manufacturer.   It is a substance that has been, in pharmaceutical-grade form, tested by scientists, with some hopeful results for some extreme conditions, but FDA approval seems very far away, if it ever comes, and even then, there is much that is not known about appropriate dosing or long-term efficacy.

Once again, as always, way too much, and no hopeful conclusion.  I expect that I will never tire of complaining until the day I die.