Tolstoy’s novella The Death of Ivan Ilych is used to compare psychological defense mechanisms with cognitive distortions. The main character, Mr. Ilych, displays narcissistic personality traits throughout his life and in his confrontation with death from an unknown illness. Faced with his own mortality, he suffers what can be viewed as either a narcissistic injury (from a psychodynamic perspective) or a narcissistic insult (from a cognitive perspective) to which he responds through the use of the narcissist’s characteristic defense mechanisms or cognitive distortions, respectively. Both conceptualizations, which are functionally similar but conceptually different, account for Mr. Ilych’s life trajectory.