Technically you covered this, but the narcissism rolled up with many of those other things, speaks to abuse, trauma, and how he has always been in an environment where getting professional help was never an option. So now he's everyone's problem. Passing the buck on abused people is far too normal around here. I'm not saying he's due a redemption arc (burned FAR too many bridges by now). Rather he's a symbol of mental health around the US too. He's a shambling husk made up of pure psychological damage, making every day an exercise in inflicting uncountable numbers of people with more of the same. And all of it was preventable if there weren't so many institutional and social failures to address it, at every step in their life.