Betty J. is a 74-year-old retired school teacher. She became widowed 20 years ago when her husband died unexpectedly in a car accident, after 30 years of marriage.
Following that tragedy, Betty went on to raise her two children and continue in her career until retiring at age 67. She prided herself on her independence and the success of her children-Tom, a high school principal, and Sally, an accountant. Although she lived alone, Betty was very close to Sally, who still lived in the same town.
One night during a rainstorm, Betty slipped and fell as she got out of her car. Later that night, she underwent surgery to replace a broken hip. Through this crisis, Betty showed great resilience and recovered quickly-progressing to physical therapy and then living at home with assistance from her daughter. Then, three months following the accident, Sally married Mark, her fiancé of two years.
Betty was the star of the wedding, as many marveled at her rapid recovery. Soon after the wedding, Mark reported that he was to be transferred by his company to North Carolina in five months. Sally was to join him three months later.
Betty was saddened by news of the move. She gradually began to lose weight as her appetite decreased. She no longer attended her water aerobics classes at the physical rehabilitation center. Her golf friends complained that she made numerous excuses not join them.
Sally noted that her mother became very negative in her comments and her outlook, often referring to herself as a “burden on my children” and “a useless old woman.” She neglected her household and grocery shopping to the extent that she moved to an assisted living facility. Betty began to complain about pain from her hip and walked less and less.
Betty insisted that she needed assistance to walk and developed a fear of falling. Mark moved to North Carolina as planned. Sally remained to assist in the care of her mother, who was becoming increasingly more dependent. Sally was particularly alarmed at the continued weight loss and the increasing fragility of her mother.
Although Betty’s family physician attempted to treat the depression, Betty could not tolerate the side effects of the medications she tried. Her doctor referred her to a geriatric psychiatrist who recommended a hospitalization for electroconvulsive therapy (ECT).
Betty and Sally agreed to this plan. Following a three-week hospitalization and nine ECT treatments, Betty was discharged to a rehabilitation unit and subsequently back to her assisted living apartment at the retirement village. She continued with medication and supportive therapy.
Sally moved to North Carolina one month after her mother’s return home. With family therapy sessions including Sally, Betty was able to cope with her feelings of loss and abandonment and accept the move of her daughter.
Betty eventually stopped therapy, but continued on the antidepressant medication. She gradually regained her independent spirit and became involved in redeveloping her community and social life. Within a year of her hospitalization for depression, Betty was living in her own home again and leading an active life filled with volunteer activity, friends and visits from her children and grandchildren.