This is an excellent and complicated thread on a subject I have struggled with for years. How do you help someone who doesn't want help, or who wants to change but isn't "capable" of doing it? A person apparently not able to make the choices necessary?
Well, change does require choices and commitment and follow through and sometimes tough decisions, as well as patience with therapy and meds etc...It would be nice to think that everyone can do this if they just "wanted" to , but the truth is that there are millions of people who are stuck and cannot or have not yet been able to push through to the other side.
As I read through these threads, and think about my own life, I keep coming back to this: It is obviously not enough for some people just to want to change. It's really complicated with our biochemical makeups, our histories etc.. But an essential part of what we are leaving out is the support system surrounding this person. People who are flailing in life need grounding, they need support, and follow-up, acceptance and persistence.

For example, say there are 2 people who are both struggling with all of this- lifelong issues which are affecting their lives in negative ways. One of these people is alone with all of this, going from one doctor to the next, getting discouraged with meds, full of negative self talk which feeds into their isolation and frustration. Perhaps the only family "support" they have is from unhealthy relationships who are actually part of the problem.
And then there is another person with similar issues, but he/she has friends or family or someone in their lives who is continuously checking in on them, helping them with appts and follow-through, not letting them just give up. It seems likely that this second person will have a better chance getting out of the circle of pain and frustration.

Obviously this is not a given, and there are plenty of people who, no matter how much support and help they have been given, still cannot change their lives for the better. But certainly it is a variable which makes a big difference. When you hate and don't value yourself enough to get help, having another person care enough to push you is so very powerful. That's why it's essential that the care givers and doctors we go to need to be excellent. For many of us it is difficult to see whether our treatment is healthy or more hurtful. I am sorry if I am rambling.. basically what I am saying is that having an advocate can make a HUGE difference on whether or not a person can indeed make positive life changes. It is unfortunate that so many of us are surrounded by just the sort of dysfunction we need to get away from!