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Interest in the psychoanalytic understanding of continuing growth and development throughout the human life cycle has been slowly accelerating in recent years. Freud (1905) cautioned against the rigidity of the personality in attempting to analyze older patients, but Abraham (1960) wrote with a sense of surprise of the successful analyses of patients in their 40s. Erik Erikson, who had personally redirected his own life as a young adult, broadened the perspective of personality as a continuous developmental process from birth to death. His concepts were broadcast to a generation of medical students and psychiatric residents in the publication of The Person by Theodore Lidz in 1968.
The Middle Years grew out of a two-day meeting organized by the Association for Psychoanalytic Medicine and the Columbia University Center for Psychoanalytic Training and Research. Some of the chapters are papers given at the meeting and others are by invited authors. Each author was asked to apply his special psychoanalytic interest to the study of the middle years. Twenty-two authors, including the editors, wrote 18 chapters; the following consolidates their views.
There are three models for a psychoanalytic understanding of the middle years. The first model relates to the theory of neurosogenesis that conflict, neurosis, character structure, and behavior are derived from unconscious fantasies that arise in early development and are constant throughout life. Psychoanalysis of older patients is a reworking and resolution of current conflicts based on the same fantasies. The second model holds that with life experiences there is a remodeling of defensive systems so that the older patient has constellations of drive and defense different from those of his youth. In the third model, there can be new fantasies, with new conflicts, defenses, and character formations.