This may not sound like what you want and need to hear James, but from what I`ve read on this thread and others of yours, one thing struck me most: all the things you describe, what you feel and think, how you feel and judge, I`ve heard before, almost exactly with the same words, from another person (and other persons but without so many details). Over and over again I heard the same things. Which led me to only one conclusion: this is a mental health problem, out of your control, quite serious, that has to be treated. Point.
This is the disease speaking and identifying with the disease is a mistake many in your situation make. Don`t! It would be best if you had the support of someone reliable to go with you see a dr. A combination a psychotherapy and meds works best. After so many years, it has become a chronic state, and only councelling is not enough. It saddens me to see that not a single person of those I know who suffer from the same symptoms like you, have had the courage and determination to do whatever necessary to get well. It isn`t easy, it is unpleasant, hurts like hell, but it is necessary and often it is called inner restructuring. After a few appointments and maybe a month of medication they gave up. Years passed and they feel worse and worse, repeating the same old complaints but doing nothing.
James, when you feel determined to do something for yourself, you will succeed; this may be when the situation becomes unbearable or when you decide to not let your inner demons and thoughts rule over your mind, soul, body. You are not a coward, so forget about the suicidal play of thoughts. Seriously.
Another excuse I hear often is: "I have no money". Give me a break. There are solutions even for such people (pro bono therapy, free meds, activity at volunteers centers etc.).
So, James, while I understand your point and sympathize with what you`re going through, I cannot encourage self-pity and victimization. Simply because it`s of no use. Taking action and doing something for your own benefit instead, yes. Just make up your mind and persevere. Don`t expect others to do your part, simply because you are ill, helpless, etc. You are in charge of your life, so think prospectively not retrospectively.
I know you understand what I`m saying, but if you`ll react in a negative manner, I`ll also know that it is the disease, not the real James reacting.