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Is It Too Late?

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This book brings together a selection of classic psychoanalytical papers related to ageing, dying and death that have appeared in the renowned International Journal of Psychoanalysis (IJP). Two papers address the analysis of an elderly patient directly and bring the work and the challenges it brings vividly to life. Also explored are such issues as death and the midlife crisis, loneliness and the ageing process, ageing and psychopathology, fear of death, transference and countertransference issues, and the final stage of the dying process.'The idea behind this monograph is to alert interested psychoanalysts, students and those working from an interdisciplinary standpoint to the possibility of a better understanding of the ageing process as well as a group of potential analysis that seem to exist in the shadow of our professional communications.'Each stage of life has its own somatic and psychic normality as well as pathology. Along the course of one's life span, we meet manifold psychic, social and biological challenges. In such times of transition from one phase of development to the next a great variety of adaptive strategies must be developed to deal successfully with new inner and outer conditions.'...Growing old is a relatively new phenomenon in the history of mankind... In about twenty years, half the population of European countries will be over fifty. Ageing will embrace a period of life that is at least as long as the period of childhood, youth and professional qualification together.'Living at the same time as one's children, parents, grandparents and great-grandparents harbours manifold conflicts within the family. A prolonged life span has come into existence in which new emphasis is placed on the quality of somatic and psychic integrity. It is the task of psychoanalysis on the one hand to contribute to a better understanding of psychic wellbeing in this phase of life while stimulating more knowledge and truth about the life lived up to now, thus maintaining psychic equilibrium for as long as possible.'- Gabriele Junkers, from the Editor's PrefaceContributors: Hanna Segal; Nina Coltart; Pearl King; Harold W. Wylie Jr; Mavis L. Wylie; Tor Bjorn Hagglund; and Erik Hamburger Erikson

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CHAPTER ONE: Death and the mid-life crisis

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Elliott Jaques

In the course of the development of the individual there are critical phases which have the character of change points, or periods of rapid transition. Less familiar perhaps, though nonetheless real, are the crises which occur around the age of thirty-five—which I shall term the mid-life crisis—and at full maturity around the age of sixty-five. It is the mid-life crisis with which I shall deal in this paper.

When I say that the mid-life crisis occurs around the age of thirty-five, I mean that it takes place in the middle-thirties, that the process of transition runs on for some years, and that the exact period will vary among individuals. The transition is often obscured in women by the proximity of the onset of changes connected with the menopause. In the case of men, the change has from time to time been referred to as the male climacteric, because of the reduction in the intensity of sexual behaviour which often occurs at that time.

Crisis in genius

I first became aware of this period as a critical stage in development when I noticed a marked tendency towards crisis in the creative work of great men in their middle and late thirties. It is clearly expressed by Richard Church in his autobiography The Voyage Home:

 

CHAPTER TWO: On loneliness and the ageing process

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Norman A. Cohen

Pearl King (1980), at the 31st International Congress, pointed out that it was the first time that a paper on the problems concerned with the psychoanalysis of elderly patients had been arranged. She indicated that researches in the theory and practice of psychoanalysis over the past few decades have necessitated a re-evaluation of our attitudes, and the criteria we use for the selection of such patients.

Among such researches, I particularly refer to the changes in psychoanalytic understanding and technique that have facilitated clinical exploration of severe narcissistic disorders. These have emphasized the function of the defensive organization as a means of dealing with mental pain, and given us a deeper understanding of the transference relationships that can develop in such patients. Such studies detail the excessive amounts of envy and destructive feelings, and the use of early defence mechanisms such as splitting, projection, denial and omnipotence. This form of defensive organization is bound up with the inability to mourn, and the recognition of dependency, separation and death, features that are basic for the successful adaptation to ageing.

 

CHAPTER THREE: Comments on Dr Norman A. Cohen’s paper: “On loneliness and the ageing process”

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Wolfgang Loch

Several authors have brought the theme “Mid-Life Crisis” to our attention during the last 10-25 years. But in particular it has been the papers of Jaques (1965) and Pearl King (1974, 1980) which started the discussion of the subject among psychoanalysts. King enumerated five factors representing five typical sources of anxieties and concern for this life period, in which the mid-life crisis forms itself, and Cohen (1982) refers to them exemplifying their dynamic effects with those narcissistic patients in whom their occurrence endangers and/or destroys an equilibrium which the narcissistic traits and fantasies had to sustain. Of course, the common denominator of King’s five factors is loss, and Cohen gives us a very good illustration of how his patient, having suffered various losses, was deprived of his narcissistic defence and was consequently confronted with “loneliness”, a symptom very frequently indicating a defective mastering of the depressive position. It was the loss by death of his first psychoanalyst, then the death of his father, the psychic consequences of which he compensated for by a homosexual relationship, and finally the threats arising from this latter relationship, which caused the manifestation of the symptomatology and brought him to therapy.

 

CHAPTER FOUR: On ageing and psychopathology—discussion of Dr Norman A. Cohen’s paper “On loneliness and the ageing process”

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George H. Pollock

Dr Cohen (1982) has raised many challenging questions in his paper, any one of which is worthy of extensive discussion. This not being possible at this time confronts me with the dilemma of choice. Obviously what is selected is what is closest to one’s own work and interest, and so I have decided to focus upon some issues that I have studied and hope to relate them to the clinical illustration presented by Dr Cohen.

In his recent Presidential Address to the Section on Paediatrics, Tizard discussed the effect Donald Winnicott had upon him. He writes that an

important lesson I learned from Winnicott concerned that difficult concept of “normality”. I had been to see him at his house in Chester Square and told him, in the course of conversation, that I had been re-reading for the seventh time Tolstoy’s Anna Karenina. You will remember that at the beginning of the book the Oblonsky household are at sixes and sevens because the Princess has discovered that her husband had been having an affair with the French governess. The very first sentence of the book reads “All happy families are more or less like one another; every unhappy family is unhappy in its own particular way”. I said to Winnicott: “Was not that a particularly wise remark?” After a pause he replied: “Yes, it is a very good remark, isn t it, only the truth happens to be exactly the other way around. And so it is; health and happiness have infinite variety; disease and unhappiness one sees again and again in stereotypes. [1981, p. 272]

 

CHAPTER FIVE: Fear of death—notes on the analysis of an old man

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Hanna Segal

This communication is based on the analysis of a man who came to treatment at the age of 731/2 and whose analysis was terminated just before his seventy-fifth birthday. He had suffered an acute psychotic breakdown when he was nearing the age of seventy-two. Following the usual psychiatric treatments (electric shocks, etc.), he settled down to a chronic psychotic state characterized by depression, hypochondria, paranoid delusions, and attacks of insane rage. Nearly two years after the beginning of his overt illness, when no improvement occurred, and when the psychiatrists in Rhodesia, where he lived, gave a hopeless prognosis, his son, who resided in London, brought him for psycho-analytical treatment.

His treatment with me lasted eighteen months. It was not, of course, a completed analysis, but it dealt sufficiently with the patient’s outstanding problems to enable him to resume normal life

and activity and to achieve for the first time in his life a feeling of stability and maturity. At the moment this paper is going to press, the patient has been back in Rhodesia for eighteen months, enjoying good health and having resumed his business.

 

CHAPTER SIX: The analysis of an elderly patient

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Nina E. C. Coltart

Freud was not optimistic about analysis with older patients, partly because of what he thought of as the mass of mental material, and also because of the rigidity of the character and the defences; though one has to add that strangely it seems as if he may have left one important older person out of this viewpoint, namely, himself. Of recent years, older patients have been treated more often by psychoanalysis, and accounts have appeared in the literature during the last twenty years. I have found that as I myself age, my interest in treating older patients has also grown steadily, and there is a quality to the work which in the last few years I have found increasingly appealing, and which has guided my choice in selecting new people with whom to work. This quality has much to do with a kind of now-or-never feeling which the patient brings into the analysis. There is a single-minded, often clear, sense of need, an intensity of devotion to the work, a skill in recognizing shorthand opportunities, and a reduction in shame and embarrassment (as if to say “Oh, I haven’t got time for all that”) which is very attractive. The patient under discussion, however, was one of my first, and at the point when the analysis started, I could not be said even to have entered upon early old age. He taught me a lot which I have found valuable since then, as the number of older patients in my practice has risen.

 

CHAPTER SEVEN: The life cycle as indicated by the nature of transference in the psychoanalysis of the middle-aged and elderly

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Pearl H. M. King

I think that I am correct in believing that this is the first time a programme committee has arranged for a paper to be given at an International Psychoanalytical Congress dealing with the psychoanalysis of middle-aged and elderly patients, and I am aware that I cannot assume that all psychoanalysts will agree that such patients are suitable candidates for psychoanalysis. Freud did not initially encourage psychoanalysts to do so and for many years both psychoanalytic theory and reported cases have tended to be concerned with problems of patients in the younger age range, that is, up to forty years of age, and the psychoanalysis of patients over that age was not recommended, ageing often being used as a contra-indication for psychoanalysis. However, in his paper on “Types of onset of neurosis”, Freud (1912c) discusses the possibility that developmental biological processes may produce an alteration in the equilibrium of the psychic processes, thus producing neurotic breakdowns at key phases of the life cycle at puberty and the menopause. He also describes “falling ill from an inhibition in development” (p. 235, my italics).

 

CHAPTER EIGHT: The older analysand: countertransference issues in psychoanalysis

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Harold W. Wylie Jr. and Mavis L. Wylie

Because psychoanalytic training takes so long, by the time the majority of candidates become practising analysts and thoroughly experienced in the techniques of their art, they are sufficiently into middle age to be classified as “older” rather than “younger”. Yet, one rarely hears analysts refer to analysands as old as or older than themselves. This may be in part due to that small proportion of the population in their fifth, sixth and seventh decades which comes for psychoanalytic treatment. However, contributing to this, we feel, has been an unexamined acceptance by analysts of the notion that decrements associated with age make psychoanalytic treatment for older persons unfeasible. Such an unsubstantiated assumption should alert our attention to the possible intrusion of unacknowledged countertransference issues connected with the consideration of analytic treatment for older patients.

Since we do not know the relationship of age (in an upward direction) to analysability, it raises the interesting question of whether and at what point age alone, barring organic impediment, renders a patient unsuitable for psychoanalysis. To this end a fruitful line of inquiry would be to study the outcome of analyses of older analysands who had previously had an intensive analytic experience as compared to the outcome of those older patients who had had no prior analysis, but were analysed for the first time as an “older” patient. This might help clarify whether, for example, age affects the individual’s capacity to “learn” how to think “analytically” and engage in an analytic process. In the absence of such studies and their confirming (or disconfirming) data however, we might ask if there is not an unsuitable contradiction in the thinking of practising psychoanalysts that permits on the one hand their agreement that the analyst’s self-analysis is a timeless and essential necessity in maintaining the required neutrality and flexibility in psychoanalytic work, but on the other hand demonstrates so little expectation of the same adaptability and flexibility in the prospective analysand above a certain age, regardless of sex.

 

CHAPTER NINE: The final stage of the dying process

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Tor-Björn Hägglund

The changes in the person’s adaptive ability and his defensive organization in relation both to the inner and the outer world form a prerequisite to the dying process. When dying, the person either surrenders or fights and defends himself against the loss of love objects (libidinal) or need-fulfilling objects (narcissistic). As always in psychoanalysis, observation of the feeling component and the ideational component of the dying person’s affects as such and in transference is the starting point. Strong counter-feelings are stirred up in the analyst by the patient’s physical regression, by the disturbance of his bodily functions, and by their ultimate termination. Analysing these counter-feelings can be a very difficult task. Likewise, when the analyst wants to retain the intimacy of communication, the intensity of the fantasy world of the dying person can invoke the fear of being drawn into the dying process itself, and thus the analytical intimacy may create a considerably difficult counter-transference when the reality of impending death is recognized.

 

CHAPTER TEN: On the generational cycle—an address

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Erik Homburger Erikson

I

I first must thank you all for the honour of addressing you, and the Programme Committee in particular for the cautiously generous assignment given to me. I was asked to speak on “a topic related to the human life cycle”. Since this plenary session is safely anchored, on the one hand, in the panel on transference as related to different stages of life and, on the other, in the final discussion of that subject, let me take the liberty to expand on a number of topics related to the human life cycle and, in fact, roam on its very periphery before returning to its daily, clinical implications. Life cycles are, of course, embedded in generational cycles, and generational cycles are experienced in different regions of the world in whatever larger configurations the dominant world view sees us moving, whether in heavenly courses of rebirth or in a straight line of secular progress, in natural evolution or in social revolutions. But this immediately raises the question as to the various connotations which in any world view a configuration such as “life cycle” may have in comparison with, for example, “developmental lines” which move in linear fashion from the stages of infantile immaturity to whatever mature stages can be expected to be achieved (to paraphrase Hartmann) in the average expectable adult. Freud 1930a knew well what we are up against with our more encompassing cycles when in a rare metaphor he mused: “Just as a planet revolves around a central body as well as rotating on its own axis, so the human individual takes part in the course of development of mankind at the same time as he pursues his own path in life”.

 

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