I think the key component to my personal reading of post-Delphi Pharma is that he's trying to be a horrible person on purpose. Not "on purpose" in the way that people have free will to exercise their own choices, but in that Pharma's "mad doctor" persona is a performance he puts on to deliberately embrace how much everyone else hates him. Basically, if people already think you're a "bad Autobot" and a horrible doctor who just kills his patients for fun, why try to prove otherwise to people who have already made up their minds about you? Just fully embrace the fact that people see you as an asshole. Don't try to change their minds. Don't plead for their forgiveness or understanding. Just stop caring. If you're going to be remembered as a monster, you might as well be a memorable monster, and eke as much pleasure and hedonism as you can out of it before karma catches up to you and you inevitably crash and burn.
I mean, I guess you could just go the route of "Oh, Pharma was always a fucked up creepy guy and Delphi was just him taking the mask off," but I really don't like that interpretation because, for one, it feels really wrong to take a character like Pharma becoming evil under duress and going, "Oh well clearly he did the things he did because he was evil all along," as if somehow Pharma breaking under blackmail/torture/threat of horrible death was a sign of him having poor moral character. As opposed to, you know, suffering under the very real threat of horrible death for himself and everyone he cares about while being manipulated by a guy who specializes in psychological torture.
The second reason is that it just doesn't make sense to write Pharma as having been evil all along. I mean...
Occam's Razor says that the best argument is the one with the simplest explanation. Doesn't it make way more sense to take Pharma's appearances in flashbacks, his friendship with Ratchet, his stunning medical accomplishments, and the few we see of him speaking kindly/sympathetically (or in the least charitable interpretation, at least professionally) towards his patients and conclude "This guy was just a normal person, if exceptionally talented." Taking all of these flashback appearances at face value and assuming Pharma was being genuine/honest is a way simpler and more logical explanation than trying to argue that Pharma for the past 4 million years was just faking being a good doctor/person. I mean, it's possible within the realm of headcanon, but the fact is Pharma's appearances in the story are so brief that there simply wasn't room in the story for there to be some sort of secret conspiracy/hidden manipulation behind why Pharma acted the way he did in the past.
I just can't help but look at things like Pharma's friendship with Ratchet (himself a good person and usually a fine judge of character) and the fact that even post-Delphi, pretty much every single mention of Pharma comes with some mention of "He was a good doctor for most of his life" or "He was making major headways in research [before he started killing patients]" which implies that even the Autobots themselves see Pharma's villainy as a recent turn in his life compared to how for "most of his life" he "used to be" a good doctor.
And although Pharma doesn't know this, we as the readers (and even other characters like Rung) know about Aequitas technology and the fact that it actually works, so... if Pharma really was an unrepentant murderer, why couldn't he get through the forcefield too? The Aequitas forcefield doesn't require that a person be completely morally pure and free of wrongdoing or else how could Tyrest get through, just that they feel a sense of inner peace and lack feelings of guilt. Pharma has murdered and tortured people by this point, and put on quite a campy and theatrical show of how much he sees it as a fun game, so why then can he not get through?
It circles back to my headcanon at the start of this post that the "mad doctor" persona is just that-- a persona. Delphi/post-Delphi Pharma's laughing madman personality is just so far removed from every flashback we saw of him and everything we can infer based on how other people see/saw him before that, to me, the mad doctor act is (at least in large part, if not fully) a persona that Pharma puts on to put his villainy in the forefront.
To avoid an overly simplistic/ableist take, I don't think Tarn tortured Pharma into turning crazy. To me, it's more like the constant pressure of death by horrific torture, the feeling of martyrdom as Pharma kept secret that he was the only one standing between Delphi and annihilation, the physical isolation of Messatine as well as the emotional separation from Ratchet, being forced to violate his medical oaths (pretty much the only thing Pharma's entire life has been about), etc. All of that combined traumatized Pharma to the point that the only way he could avoid cracking was to just stop caring about all of it. Because at least then, even if he's still murdering patients to save Delphi from a group of sadistic freaks, Pharma doesn't have to feel guilty and sick about doing it. As opposed to the alternatives, which were probably either going off the deep end and killing himself to escape, or confessing to what he did and getting jailed for it.
In that light, Pharma becoming a mad doctor makes sense. It avoids the bad writing tropes of "oh this character who was good his entire life was actually just evil and really good at hiding it" as well as "oh he got tortured and went crazy that's why he's so random and silly and killing people, he's crazy" and instead frames Pharma's evil as something he was forced into, to the point where in order to avoid a full psychological breakdown and keep defending Delphi, he just had to stop caring about the sanctity of life or about what other people might think of him.
Then, of course, the actual Delphi episode happens, and Pharma's own lifelong best friend Ratchet basically spits in his face and sees him as nothing more than a crazy murderer who went rogue from being a good Autobot. Then Pharma gets his hands cut off and left to die on Messatine. At that point, Pharma has not only been mentally/emotionally broken into losing his feelings of compassion, he's received the message loud and clear: He is alone. Everyone hates him. Not even his own best friend likes him any more. No one even cared enough about him to check if he actually died or not. He will only ever be remembered as a doctor who went insane and killed his patients.
So in the light of 1. Having all of your redeeming qualities be squeezed out of you one by one for the sake of survival and 2. Having your reputation and all of your positive relationships be destroyed and 3. People only know/care about you as "that doctor who became evil and killed his patients" rather than the millions of years of good service that came before.
What else is there to do but internalize the fact that you'll forever be seen as a monster and a freak, and embrace it? People already see you as a murderer for that blackmail deal you did, so why not become an actual murderer and just start killing people on a whim? People already see you as an irredeemable monster who puts a stain on the Autobot name, so why beg for their forgiveness when you could just shun them back? You've already become a murderer, a traitor, and a horrible doctor, so what's a few more evil acts added to the pile? It's not like anyone will ever forgive you or love you ever again.
Why care? Why try to hold on to your principles of compassion, kindness, medical ethics, when an entire lifetime of being a good person did nothing to save you from blackmail and then abandonment? Why put yourself through the emotional agony of feeling lonely, guilty, miserable, when you could just... stop caring, and not hurt any more?
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