Loss is a fact of life for all of us—whether it is failing to achieve a goal we set out for ourselves, losing a football game, having a friend move away, or experiencing the death of a loved one. Such losses can be a blow to our egos and create the emotional pain known as narcissistic injury.

Psychoanalyst James Frosch, M.D., an assistant clinical professor of psychiatry at Harvard Medical School, discussed the subject at a meeting of the American Psychoanalytic Association in New York City in January in a presentation titled "From Grievance to Grief: Narcissism and the Inability to Mourn."

The reason that people experience narcissistic injury in the throes of losses goes back to their earliest life experiences, Frosch said. This is the realization early in life that you are separate from others and that those separate others may not fulfill your needs and wishes. Later comes another agonizing discovery—that the people you need and care about will one day die and that you too will eventually die. In short, "Living presents narcissistic injury to all of us because we all have the unconscious wish to live in a world where people are not separate from each other and where we never disappoint or leave one another," Frosch emphasized. "Existence itself is a narcissistic injury."

When people are narcissistically injured, they may react to it in various ways, Frosch said. They may engage in magical fantasies in which they imagine that there is no separateness. They may feel helpless, shamed, or humiliated, and they may feel anger or blame themselves for the loss.

In some cases, time helps heal people's narcissistic injuries over a loss, Frosch continued. In others, it does not. People may become permanently aggrieved. In a dramatic example, Miss Havisham in Charles Dickens' novel Great Expectations stopped the clocks in her house to the time when her fiancée jilted her. If people become permanently aggrieved, they may engage in vengeance. He found another literary example to illustrate this point in Edgar Allen Poe's story "A Cask of Amontillado" whose narrator buried a man alive because that man had offended him. These people forever harbor grievance rather than being able to mourn losses, he pointed out.

People vary in their ability to cope with losses, Frosch said. Cynics might be viewed as individuals who have failed to achieve their dreams and who cannot bear the pain of this failure.

To spare themselves the anguish, rage, or other negative emotions provoked by loss, people need to develop a capacity to tolerate loss and mourn, Frosch asserted. "There is much that we do not understand about what enables resilience in the face of loss and narcissistic injury and how to facilitate this process in psychotherapy and psychoanalysis."

However, Frosch did offer one example of how psychotherapists can help patients cope with loss and narcissistic injury. Say a patient experienced an excruciating loss during childhood—the suicide of a father. The suicide flooded the patient with both rage and self-recrimination. Why had his father abandoned him? Why hadn't he been able to save his father? The suicide also set the stage for an adulthood characterized by dysthymia and joyless living. In a case such as this one, psychotherapy could slowly increase a patient's tolerance for such unbearable affect, Frosch suggested.

Also, in a later interview with Psychiatric News, Frosch made several suggestions as to how psychotherapists can help patients cope with loss and narcissistic injury.

For example, "When working with patients who are angry and who have a sense of grievance, psychotherapists should ask themselves whether, beneath the anger, there is a warded-off sense of unbearable loss," he said.

And if patients are narcissistically injured because they have disappointed themselves or because someone else has disappointed them, the therapist should help such patients accept that some wishes, however understandable and legitimate, will not be fulfilled and will have to be relinquished, he advised. And relinquishing such wishes is actually a grieving or mourning process, Frosch emphasized. "Patients frequently search endlessly for the ideal because they cannot accept the limitations of the real. Or they are chronically aggrieved."

Take the case of a man who continuously complained about his wife's defects and failures, Frosch said. "I would start by saying to him, ‘It's so painful when your wife doesn't respond to you the way you wish she would.’ I would explore the nature of his wish and how it feels when it does not come true. Over time I would try to help him understand how painful it is to accept that his wife might not be able or willing to fulfill his wish, yet that he needs to do so, and that the way to achieve this acceptance is by giving up, or mourning, the loss of his ideal."