Abusers are often victims first. You can't really look at Musk, or any billionaire, and think, "yeah, this person is totally fine." He's not. None of them are.

Patriarchy and capitalism reward the unhealthy coping mechanism he uses to protect his ego. Patriarchy specifically asserts that those coping mechanisms are not only normal but optimal.

He's absolutely a victim of this system and in a functional one he would be given help instead of power, which is literally the opposite of what he needs to be able to recognize his problems and heal.

He is who he is because the only way he can see himself as valuable at all is if he's basically the savior of the world. Anything less than that is unacceptable garbage. Anyone who believes differently must be manipulated or destroyed.

There's no way he can ever be happy. He needs help. It's tragic that we live in a society where he can't even see how much he needs help.

None of that takes away from the behaviors he expresses. The fact that his manipulation of others comes from his insecurity doesn't take away from the manipulation, the feeling of unreality, that comes from experimenting that manipulation. Both of these things can and do exist at the same time.