Letters to the Editor

From Mr James McDonald

I was interested to read the paper, Curious Bedfellows: Psychoanalytic understanding and old age psychiatry, by Mark Ardern, Jane Garner & Ruth Porter (Psychoanalytic Psychotherapy 12, 47-56). I would like to comment on two matters.

Loss can, indeed, be a central feature in the lives of old people: losses, sometimes seemingly unmourned, can from a very early age be cumulative in nature. But those listed in the paper are, in fact, not ‘age-specific’: loss of family, friends and pets, for example, can occur at any age. One profound loss that is ‘age-specific’, but is not mentioned is that of hope. Although one may perhaps cling to some remnant of hope, it is likely to be of little comfort for old people if not supported by any realistic expectation of fulfilment. Thinking about and planning for the future which in a spirit of optimism can sustain younger people is largely denied them. Hope dwindles with the increasing sense of time running out. I do not know the ages of the writers but I wonder if perhaps older therapists are likely to be more readily able to empathise with old people in this particular loss which, though ‘age-specific’, is omitted from the list given.

It may be that dreams sometimes afford comfort as it is said they did for Mrs Q. However, my experience has been that this is not always the case, and I think it is important to acknowledge that they can also be an additional source of grief, poignantly reviving the sad sense of loss. One old lady recently told me that a loving dream of her long-dead husband, which brought her warmth and happiness within the dream, resulted in intensely sad feelings of loss the next day. The comfort given in the dream was not, for her, worth the heavy emotional cost she later had to pay and, given a choice, she would elect not to have such dreams.

As Rupert Brooke says in the poem Sometimes Even Now.

It does but double the heart-ache

When I wake, when I wake.

Yours faithfully

JAMES T MCDONALD

Psychoanalyti