The Psychoanalysis of the Older Patient

IN HIS OPENING REMARKS, DR. STANLEY CATH, who chaired the panel in his absence, gratefully acknowledged the contributions of George Pollock in initiating and organizing this panel. Cath underscored that in the psychoanalytic literature, there has been a long delayed appreciation of the developmental potential inherent in the middle and later years. He noted that this oversight arose in part as a result of Freud's initial admonition against taking patients past fifty into analytic treatment. Although Freud indeed commented on the "inelasticity" of elderly people and stressed the difficulties in working through a lifetime of cumulative trauma and experience, it is nevertheless useful to recall that he formulated these sentiments during a period of profound grief over the loss of a beloved child, and at a time clouded by the onset of the malignant illness that was later to claim his life. Despite therapeutic pessimism regarding the prospects for change in middle and late life, and despite chronic premonitions regarding intimations of his own demise, Freud's conceptualizations regarding the criteria for analyzability remain as cogent and valid today as when they were written. These criteria, Cath stated, will serve as the best guides to prognosis, rather than a focus on chronological age. Evidence is accumulating from all over the world suggesting that chronological age, contrary to Freud's impression, is not a valid predictor of analyzability; that throughout evanescence and senescence, new assimilation, leading to modifications of psychic structure, and new enthusiasm and vitality, forged in the psychoanalytic crucible, remain possible. Aging is not a monolithic experience for all persons, and in late life, as in youth, it is just as important that potential cases for analysis be thoughtfully and appropriately selected.