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Character Problems as an Insanity Defense

"It is an ill issue to knock against a deaf-mute, an imbecile, or even a minor. He that wounds them is culpable, but if they wound him they are not culpable." (Mishna, Babylonian Talmud)
Some personality issues are culture-bound. Critics charge that these "mental illnesses" mainly serve as an organizing social principle and are tools for societal handle and coercion. But if character disorders will not be objective clinical entities - what should we make on the insanity defense (NGRI- Not Guilty by Explanation of Insanity)?
The insanity defense (when someone is held not accountable for his criminal actions) rests on two pillars of evidence:
1. That the accused was unable to inform proper from wrong ("lacked substantial capacity either to appreciate the criminality (wrongfulness) of his conduct" - diminished capacity).
two. That the accused didn't intend to act the way he did (absent "mens rea") and/or couldn't handle his behavior ("irresistible impulse"). These handicaps are usually connected with "mental illness or defect" or "mental retardation".
Still, the "guilty but mentally ill" verdict seems to become a contradiction in terms. All "mentally-ill" people operate inside a (usually coherent) worldview, with constant internal logic, and guidelines of right and incorrect (ethics). The issue is the fact that these private constructs seldom conform to the way most of the people perceive the planet. The mentally-ill, as a result, cannot be guilty because s/he features a tenuous grasp on reality. Mental overall health specialists prefer to talk about an impairment of a "person's perception or understanding of reality".
Reality, however, is actually a lot much more shaded and complicated that the rules that purport to apply to it. Some criminals are undoubtedly mentally ill but nonetheless keep a perfect grasp on reality ("reality test"). They're, hence, held criminally accountable (Jeffrey Dahmer comes to mind). The "perception and understanding of reality", in other words, can and does co-exist even together with the severest types of mental illness. It truly is, therefore, not very beneficial in distinguishing the criminally insane in the merely insane.
This makes it much more difficult to comprehend what exactly is meant by "mental disease". If some mentally ill individuals keep a grasp on reality, know appropriate from wrong, and can anticipate the outcomes of their actions, usually are not subject to irresistible impulses (the tests set forth by the American Psychiatric Association) - in what way do they differ from us, "normal" people? Are personality disorders mental illnesses? Can somebody with all the Narcissistic Character Disorder (a narcissist) effectively claim the insanity defense? Are narcissists insane?