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The last stages of life are replete with narcissistic trauma. Changes in appearance, recession of sexual function, illness, retirement, increasing need for family and social help, deaths of close relatives and friends, and awareness of limited time, strain psychological resources and lower self-esteem. Dr Muslin brings the perspective of self psychology, centring on narcissism, to the treatment of older persons.
The nine chapters cover a definition of the self; its development and psychopathology in the elderly; diagnosis and planning of therapy; three forms of treatment— supportive, goal-limited and psychoanalysis; the inner world of the therapist; and an epilogue, discussing the fear of ageing. The self is defined broadly as a composite of the different structures of the mind, reflecting a particular culture as well as the individual's physical state. The emphasis in development is placed upon narcissism. Optimally, internalised early parental (selfobject) affirmation endows a child with self-worth; lifelong infusions of approval maintain this positive feeling and, with it, a cohesively functioning self. For the elderly, structural transformation is necessary to achieve a self in harmony with one's actual capacities. The expected psychological changes of ageing, such as slowing, diminished energy and uncertainty of recent memory, often lead to narcissistic vulnerability. Abandoning old ideals in the process of transforming them can be a major loss.
Psychopathology in the elderly is seen as resistance to transforming into a cohesive elderly self—appearing as neuroses particular to ageing, or neuroses and character disorders continued from earlier years. The viewpoint of self psychology is stated unequivocally: 'all forms of psychopathology are derived from defects in … the self or from distortions of the self—attributable to disturbances of self/selfobject relations in childhood … in contrast to classical analysis, the conflicts in the object-instinctual re