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Jan Chess shares with us her sensitive, moving and poignant engagement with Joan, a fellow therapist struggling with Alzheimer’s dementia as well as with long-term depression. I’ll say at the outset that I don’t have any suggestions for what Jan might have done differently, nor any psychoanalytic insights that Jan has not already provided. My intention is therefore to connect this situation (and Jan’s work) to the wider psychological and medical literature, and to larger issues in our health care system and in our culture.
Jan helps shed light on an increasingly critical topic. An estimated 6.7 million Americans have Alzheimer’s and related dementias; that will double by 2050, to almost 14 million. Worldwide, that number will be over 115 million. In the US alone, the current annual costs (health care, long-term care, and hospice) for Alzheimer’s is $345 billion. By 2050, that will be $1 trillion. Plus, family and friends currently provide 18 billion hours of unpaid care each year (Carrillo, 2023). As a society, we need to learn how to do this well, and Jan’s paper illuminates the human dimension of caring for persons with dementia. That’s not typically where the health care system puts its emphasis. Gerontologist Bill Thomas (in Rossato-Bennett, 2014) laments that “Our health care system imagines the human being to be a very complicated machine; we’ve figured out the dials. We have medicines that can adjust the dials. We haven’t done anything, medically speaking, to touch the heart and soul of a patient.” Jan touches the heart and soul of Joan.
Kohut (1981) emphasized in his final talk that empathy itself does not cure. He seemed irritated at those who misinterpreted his perspective. He said, “They will claim that empathy cures. They will claim that one has to be just ‘empathic’ with one’s patients and they’ll be doing fine. I don’t believe that at all.” He then clarified: “I would say that introspection and empathy should be looked at as an informer of appropriate ac