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No, not everyone is saveable. And not everyone I see is actually mentally ill. When a person is irreclaimable because of their own stupidity (drug users and criminals, for instance) I don't feel much for them. They did this, and they have to face the consequences of their actions, which are sometimes quite dire.
On the other hand, there are folks who are very, very crazy. They just are. Multiple attempts to stabilize these folks on medications have failed ... and often these are fairly bright people, folks that when they can grasp reality are pretty cool ... those are the ones who hurt.
These groups are usually separate from each other, but every now and then someone from group II will be an alcoholic or something.
There was a guy, Ross. Ross was someone that I saw if not every month, every other month. He was pretty mild mannered, drank like a fish, and became very suicidal every time he missed getting his testosterone shot (he had a condition called Klinefelter's Syndrome). It took us a while to figure out the suicidal/lack of testosterone link, but one we got it, it was one of those smack yourself in the forehead moments.
So anyway, poor Ross was not terribly functional. He was on welfare and SSD, hadn't worked productively in 30 or more years, and divided his time between the bar, his apartment, and the nuthouse. He had a few friends in the community, but was essentially a loner.
We knew Ross wasn't worth a whole lot to the world in the general scheme of things, but it's important to understand that we never treated him that way. And he let us know that he appreciated that care, and especially that respect that we gave him.
On one of his last admissions I was working with him and had let him out of seclusion to use the restroom. He emerged and I asked him to go back to the exam room, where I was going to lock him back up to wait for nursing to escort him to the unit.
He drew himself up to his full height (he was about 6'2") and said "no."
"Ross, whaddaya mean "no." You can't say no. You have to go back to the room."
"No, I'm not going in the room."
"Ross, if you go back to the room, I'll give you a cigarette." (bribery is an effective therapeutic tool."
"No, I'm not going!" (Ross, who was very soft spoken, actually shouted.)
"Ross, you're going to make me put on the gloves. You know I don't want to put on the gloves ..." (repeat patients know that prior to entering ass-kicking mode I put on a pair of black leather gloves)
He looked at me as I very deliberately and seriously reached into my back pocket for the takedown gloves. His shoulders drooped, his posture relaxed, and he truly looked defeated as he walked back to the exam room.
I went with him and sat with him a while, as he cried, telling me that he knew that he was a worthless piece of shit. I told him I didn't agree with him, and tried to help him regain what shreds of his dignity remained. And I gave him the cigarette. He cried at the thought that somebody gave a damn. Which I truly did. (I don't incidentally, get this way with all of my patients. some of them are one and done, some of the frequent flyers much less compelling. I couldn't survive if I did. You need to step away to keep doing this.
It was a month or two after that discharge that he was found dead, of an overdose that was believed to be accidental. He didn't leave much behind him in the way of a legacy ... few friends, no children, hadn't had contact with his parents in 30 or so year.
But I will always remember Ross.
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