I always sort of cringe when I hear "narcissist"; it's like anything else. It's not BAD, in and of itself, but has the potential to be bad. There's a study, I posted it in one of the P/R threads a couple days ago, where almost ALL U.S. Presidents show some signs, to varying degrees, of narcissism.
I don't want to go too deep, it's not fair to them, but someone who was a big part of my life for a long time has narcissistic traits, but is an extremely successful person, well-liked, and in many cases, fun to be around. In many ways, including as a partner and a parent, they are accomplished; yet, in many other ways, they are shit. It's not JUST the narcissism; it's the narcissism coupled with a crippling insecurity, and an intense fear of failure. "Borderline personality disorder" is I think the proper term.
And while yes, it's sometimes hard to break through this, but I find that once you get to the real root of the problem, AND (hopefully) find the things that DO matter to them, that it is possible for these people to get help. And further, it depends on the therapist. They are not miracle workers, but they are skilled, and if the therapist can identify the real root of the problem, there are often ways of getting to a point that they can be a more positive influence on the people around them. The person I mentioned above got to that point when it became clear that they were hurting their kid.
On the other points: I don't know of too many people for whom meds were the only answer and the complete answer. I know a couple people for whom it was a help, but just as many for whom it was an impossible game to stay on top of. I think it depends on the person and the doctor.
And as for me, I am a therapy advocate. I go, weekly, and am a better person for it. Still have work to do, but it's like going to the gym for me (which I don't do). I recommend it to anyone, with the caveat that a) you can't go into it looking for affirmation, and b) you can't just assume that "all therapists are the same". Like any doctor, it does sometimes take time to find a good fit. But for me, mental wellbeing is one of the biggest problems facing our country, and I believe many of our more obvious problems - violence, our divisiveness - are directly tied to our (collective) mental health. We are an EXCEEDINGLY insecure nation. We seem to crave affirmation and acceptance in a way that has proven, imo, to be unhealthy.