He’s always been this person, the wealth just amplified it. Sometimes the wrong people fall into power. Sometimes we trust the wrong people. Most of life is luck.
Take the ketamine, wealth, and sycophants away, he will still be this person. But without the power. Human condition is tricky.
I often think of Tony Hsieh (Zappos founder/CEO), who was a much more grounded and humble person before he became extremely wealthy. Perhaps he had the tendencies/propensities (that ended his life) dormant all along, and his wealth suddenly boosted those deadly habits.
His story really is a tragedy. We have a long way to go to properly treat mental health issues as a health issue (no different than allergies, cancer, etc), and to eradicate the stigma of acknowledging, accepting, and ultimately addressing them.
You can't be a billionaire without pathology. The power, unlimited access to every resource, the inherent isolation, security implications, factual immunity to most consequences, morbidly twisted self-efficacy, the ethical dissonance of having it all while others starve... the human brain evolved adapted to scarcity and existential group boundaries to check on social pathology. These guys are holistically unchecked, inherently dysregulated on every axis. Their brain is constantly in an extraordinary, extreme state, trying to reach homeostasis for a life that couldn't be more distant, trying to find a model of reality which explains the abnormal signals it is getting.
Unfortunately, the rich and billionaire class are convinced they got where they did just because of sheer personal effort. This of course is delusional. Effort is important, but luck is essential.
We here are all guilty of this. Nobody is really aware of or grateful for all the things that enabled us to make a living.
Even if you are unloved, digging for gold with your bare hands, you were spared by people stronger, had people grow your food, teach you, build the streets,
make your meds, literally deal with your shit all your life. And let's not forget the people who endured cruelty, suffered and died for your jeans and coffee...
(There are some great scenes in Pluribus, which illustrate this ignorance very well.)
I also think of him as a ten-year-old boy with access to infinite amounts of other people's money. Embarrassing stunts like "let that sink in" is the sort of thing my friends and I would have done at age ten thinking we were being awfully clever and witty, but no-one past the age of about fourteen or fifteen would still think that. And stuff like the Cybertruck is what you'd expect if you gave a ten-year-old (or Homer Simpson) some pencils and paper and said "draw your dream vehicle".