You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
This work is a unique contribution to the psychoanalytic understanding of dementia, a subject rarely approached by psychoanalysts. At its best, it weaves psychoanalytic theory, in particular the theory of the representational world, into case descriptions in clinical practice that help to define and elucidate variations in functioning, behavior, and psychopathology in the elderly. The author clearly has considerable experience with demented people, and the text is replete with detailed interviews to illustrate his conceptual framework. Indeed, it would be interesting to know the setting in which his work took place, nowhere mentioned in the book. The general theoretical framework is a classical Freudian position, at times somewhat archaic. The book is an amalgam of important new insights and theoretical understanding of the demented person, certain classificatory schemes that pertain to differential diagnosis of the psychopathology of the demented, and recommendations for psychotherapy which, on the surface, may sound strange (since we tend to discard the demented), but which have an internal logic in light of the author's theoretical position and experience. Most important is the author's emphasis that demented people, impaired though they may be, remain psychological beings, and that our understanding of psychic functioning may ameliorate the suffering accompanying dementia.
The heart of the book and the most significant contribution Le Goués makes has to do with the loss of internal representations in the demented and how this is reflected in object relations. In the context of memory loss, internal representations of important figures are forgotten, and it is these losses that lead to depression in relatively well integrated demented people. The outcome of the memory loss will be affected by previous psychic organization. Individuals who have major conflicts and who have not developed beyond the level of "narcissistic object choice" are incapable of resp