I’m with you, if a person truly is sick and has no control they will act out their insanity regardless of circumstances.
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My point is a little different though. I believe that the person who “acts out their insanity regardless of circumstances” may have contributed to their own insanity. Picture a tiny stream. Over the years it gets deeper and deeper . . . that’s how I picture habits forming. So the person who reacts in an “insane” way just lets their mind run in that groove until it becomes so deep they can’t escape from it. Create their own prison, their own artificial reality so to speak. Something like that.
I couldn’t have said it better, I really believe you are right. Part of what you describe is what I call “willful ignorance”, the steadfast refusal to see what should be obvious. Carried to extremes it results in cultural insanity engulfing entire nations and manifesting in practices like the footbinding that used to be done in China. A person has to expend a great deal of energy in buying into that sort of insanity and once they do they cannot afford to ever face the truth. Ayn Rand explained it all very well but I don’t remember exactly where in her writings that she went into it.