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The essential question in the recurrent periods of depression in the aged is not the turning inward of unconscious hostile impulses; it is rather the loss of self-esteem caused by recognition of weakness and by inability to obtain necessary narcissistic supplies and to defend against threats to security. Eighty-five percent of the subjects of this study could trace the onset of depression to some specific stimulus: increased physical suffering, lowered financial, professional, or social status, or any increase in stress. The depressions do not appear to be attempts to force an object to give necessary love nor do they appear to be aimed at placating the superego. Those persons who have no planned activity and those who devote time to passive or receiving activities are much more prone to depressive episodes than those who through their own efforts can receive satisfaction. The ability to participate in creative activity is very much influenced by the extent of the education of the subject. Hypochondriasis is invariably linked with depressive episodes and feelings of neglect and persecution are also found. Nearly all old persons with hypochondriasis are found to have a poor relationship with their children. The authors suggest that this may be a result and not a cause. Yet it is striking that eighty percent of this excessively hypochondriacal group were parents who had been rated as poor mothers and fathers. Evidence from psychological testing indicates that many elderly persons possess little capacity to express warmth and spontaneous feeling toward others. In a sense they are miserly with their affections and seem to be fearful that should they invest an object with positive feelings it is unlikely that such feelings will be returned.
The authors conclude that elderly persons deserve the attention of our society, but they could profit if time were devoted to preparing people for old age and to research on preventive techniques.