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Paul Schilder believes that the conflicts involved in the psychoses and neuroses of middle and old age center around the feeling of sexual, mental and physical incapacity and the fear that one's erotic value is diminished. If the previous life experience has been unsatisfactory and the patient feels of no value to anyone, he may develop a psychosis. In the involutional depression the primary conflict is the fear of impairment of bodily function and sexual capacity. The patient may ward off his anxiety by using projection as a defense, fears of castration or of being robbed taking the place of the primary anxieties. At other times patients may use the defenses of increased fantasy and sexual tension, which in turn lead to guilt and again projection. The persecutors in the paranoid types of involutional depression often represent the endangered parts of the body. Introjections may alternate with projections to complicate the picture. The tremendous aggressions of these patients lead to extreme guilt feelings and sometimes to suicide. Often the object relationships become more primitive and part-objects take the place of whole-objects. Involutional paranoia and senile paranoia show predominantly sexual conflicts (fear of failure) which are solved by projections. The organic cases show deterioration, which is essentially a regression in both the intellectual and the emotional spheres. Intellectual regression is shown by the return to primitive gestalt principles in drawings and clay modeling. The libidinous regression appears in memory disturbances, which enable the patient to live out his infantile wishes, as, for example, by making himself the hero of every story. Through regression the anxiety of the presenium is overcome. There is a difference, however, from the regression in schizophrenia in that the patient goes back, not to a magical world, but to one which fulfils all his earlier wishes.
M. Ralph Kaufman believes that analysis is applicable to older