I have some primary care providers in the family and I've asked them since I often have differing opinions. I've asked if some people with bipolar and schizophrenia refuse specific medical treatment and just go on with their life. I've gotten the answer that many of them have learned to recognize what is happening and ride it out well enough that they can live with it. I'm sure it's highly dependent on the severity and the person.

I've noticed something similar with people on say heavy doses if hallucinogens. Some people just ride it out knowing it's the mind playing tricks on them, others hopelessly panic or make irreversible decisions.