Narcissistic Disturbances as the Bedrock of Difficulties in Emotional Regulation and Self-Destructive Behavior in Melancholic Patients: A Psychoanalytic Re-Evaluation of Narcissus Myth

Objective: The association of narcissistic disturbances in patients with melancholia symptoms has been described in various studies. The mechanism by which narcissistic disturbances may contribute to difficulties in emotional regulation and self-destructive behavior in melancholic patients have not been explored well. This lack of attention represents a vital theoretical ambiguity about the interaction of narcissism and death drive, which was introduced to the literature by the arbitrary way of Freud interpreted Narcissus myth. Based on an intense clinical case study, the aim of the current qualitative study is to elaborate on the contribution of narcissistic disturbances in difficulties of emotional regulation and self-destructive behavior in melancholic patients.  Methods: A female melancholic patient with severe self-destructive behavior and suicide attempts was interviewed through 72 sessions of the psychoanalytic therapeutic interview by a trained and supervised ego-psychology oriented therapist. The interviews were analyzed qualitatively via reflective analysis. A modified investigators triangulation method was used for testing and maximizing the validity and reliability of the interviews. Results: The analysis of interviews revealed that the patient resorted to narcissistic defenses and mechanisms such as narcissistic identification and high ego ideal for dealing with frequent traumatic losses, and serious narcissistic assaults in her childhood. These narcissistic disturbances not only cussed melancholia by interfering and preventing the work of mourning but also lead to self-mutilation and self-destructive behavior. Conclusion: Narcissistic disturbances in melancholia might give the upper hand to death drive in preventing the work of mourning as normal and necessary emotional regulation process after a traumatic object loss and attacks object relations through disobjectalizing function. We argued that considering Narcissus as a melancholic and his death as a suicidal act is more productive in elaborating the interaction of narcissism and death drive.