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Jerome Levin's book purports to be a discussion of the nature of narcissistic injury and strategies for its repair, but it reads more like a diary of a determined and able clinician very much in the trenches of clinical battles with some very disturbed patients. The monograph consists primarily of case studies, and its strength lies in the clinical descriptions of the patients, their struggles, and most poignantly, the struggles of their therapist as he attempts to understand and help them. Levin brings to life the lives and problems of his patients, and he candidly describes both his affective reactions to them and his clinical thinking. Indeed, although Levin does not ally himself with any psychoanalytic school, his frank accounts of his own feelings and how he dealt with them make this book more clearly and poignantly intersubjective than the work of many theorists who wrap themselves in the mantle of the intersubjective viewpoint. Most impressive are the results Levin achieves with some deeply disturbed, recalcitrant patients.
Despite the vivid and compelling clinical descriptions, this book has serious problems that interfere with its aim of contributing to our understanding and treatment of narcissism. First, the concept of narcissistic injury is used so broadly as to be virtually indistinguishable from general psychic pain. In his opening chapter Levin defines narcissistic injury as hurts that affect our most important feelings about ourselves, our self-esteem. In the body of the book, however, he labels almost all psychic pain “narcissistic.” For example, Levin refers to death as a narcissistic injury, but, according to his definition, this would be true only is one's self-esteem depended on immortality. Another example of Levin's overuse of narcissism is his discussion of a case of survivor guilt that does not include narcissistic injury.