Psychoanalytic Investigation of a Seventy-One-Year-Old Man with Senile Dementia

Since there has been no detailed report of a psychoanalytic investigation of a man with senile dementia up to the present time a few introductory remarks may be justified. The process of investigation, the nature of the material obtained, the analytic situation, the management of transference, the psychoanalytic interpretation and construction, and further, the scientific and therapeutic goals of a case study of a psychotic, especially a demented person, are fundamentally different from anything commonly experienced in an average analytic practice.

Not only is the senile person's relationship to reality changed by his psychotic withdrawal but the reality situation itself is fundamentally changed by the biological and social dependence and helplessness of an old man. This fact and the genital impotence of old age make the analytic situation similar to child analysis. In both, the analyst is not a more or less unreal image but a vivid active part of reality engaged in the management of the patient's hospital life.

The psychoanalytic investigation of this patient was undertaken mainly as a research problem. The aim was not to reveal the possible causes of senile dementia. These causes are probably organic in nature and in the case of this old man the dementia was partially due to a cerebral arteriosclerosis. It was rather a psychoanalytic investigation of a case of senile dementia in an attempt to establish and to understand psychological facts such as the development of the psychosis, and to show that such a development is governed by