Didn’t he wake up everyday thinking he was a marvelous person?
I have no idea. Maybe he is a sociopath that doesn’t even try to understand how others perceive him. Or maybe he has other mental conditions. I will note a recent study showed that extra income beyond a certain level doesn’t result in increased happiness. Nor are rich people immune from mental conditions like depression, bipolar, schizophrenia, etc.
I have a family member that works in mental health. When they do therapy with a patient they don’t automatically use a cookie-cutter, touchy feely, feel good about yourself type plan. The trajectory through therapy is tailored specifically for the individual. Now I can’t speak to the competency of the psychiatrists handling Jerkface Bernie, but if they are any good they would do something similar.