My sense is that they have lost their emotional connection to the real world, and can't get it back. It is like faulty wiring. And I am sure that fear also plays a part
Sad to say it doesn't really affect any of us any more whether my xh gets his act together or not. We would rather he did than not, but for his sake rather than ours. We all hoped for it for so long, but life moved on, and now he is just a somewhat shadowy figure in our memories. Less than if he had died. My mother who died around the same time is more 'real' to me than my xh, and I really loved that guy.
It doesn't come right, for most of us, the way we hoped and longed for, but it comes out right in some way, for most, if we persevere.