I know someone with bipolar 1 who is a physician and a very successful one. She sees a psychiatrist regularly, exercises regularly, eats in a healthy manner and goes to therapy when she needs to. And she takes her medications regularly. So, she seems to be doing all she can to keep her illness well controlled. No doubt this has helped her succeed in life. However, she has also been married five times. And periodically, if in a bad mood, she will scream at her staff and they sometimes quit because of it causing difficulties in the office.
So, things are NOT ideal, but she seems to have made a decision to do her best to do what she personally can do to keep herself well.
The comparison to dieting sort of makes sense to me. I have done WW many times. Why? Because it works for me. I need the accountability, etc. recently, I'm doing MyFitnessPal. This also works well. When I don't use it, I don't lose weight. It is a conscious choice whether I use it or not. Geez, I wish I didn't have to. Geez, I wish I was one of those gals that just magically know when to stop eating. But I'm freakin NOT. So, I can use the MFP, a tool that works or I can cry in my milk and be overweight. The choice is mine.
Now, with the difficult child that we adopted. Dios mio. There are times, I'm fairly sure she doesn't have a clue. I don't know if it is a refusal to accept personal responsibility, a futilitic attitude, learned helplessness, depression, brain damage, etc. She has said the only reason she takes her medications is she won't sleep without them. She has made better decisions with a therapist in the past, but finds them taxing and sometimes aggravating and doesn't like having to remember appointments.
She makes many peculiar mistakes, but very often repeats them. No cause and affect reasoning.
Very generally speaking, I think she can do better to a certain extent. So, I think she has some control over her actions...but I think it requires an enormous amount of her will, energy, concentration etc. I don't think it is something I fully "get." It seems to be like her brain is stuck in muck and something what would be common sense and simple to a smart ten year old, would take tremendous effort and every last ounce of her energy and strength to make a good decision for my Difficult Child. Soooo...it would be like lifting a three pound weight for us and a 50 pound weight for them ???? So, they can do it , but much more difficult.
Still processing this age old question.