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He's in his late 30's, if that changes things. The "young Denzel" line might have given a different impression, but there's a high degree of "black don't crack" going on. He has excellent skin condition.
I don't have any clues from things he's told me, but as we've covered his is pretty functional. Is it possible he's already on medication? I don't have a good sense of what modern anti-psychotics do. Would you expect a notable improvement on the delusions?
It's also worth noting that there's a small chance that he was previously on medication, but desisted. The drugs don't always work, and an unfortunate number of patients quit them either due to a lack of efficacy or the side effects becoming unbearable.
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That's good context to have, but his situation will still likely decline with time.
Antipsychotics are modestly effective in schizophrenia. They're not... pleasant drugs to be on, but they do meet the bar of being better for you than going untreated. The most significant benefit they provide is a roughly 50% reduction in mortality rate, which is a pretty big deal. Even so, they're very unlikely to restore normalcy, but they have decent odds of at least helping improve his QOL. It's complicated, and I find it hard to translate things like improvements in PANSS scores to actual tangible benefits.
I would strongly bet against him being on meds. The profile just doesn't fit, he lacks insight into his condition, and he hasn't complained about medical professionals messing with him, which is the usual presentation for people who are coaxed or coerced into treatment. The US medical system is awful about such things.
Of course, you could just ask him next time you see him. If he doesn't know he has a diagnosis or doesn't remember taking pills or getting shots, then he's almost certainly not on medication.
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