Letters to the Editor

From Drs Mark Ardern, Jane Garner & Ruth Porter

We enjoyed reading James McDonald's letter written in response to our paper and would like to thank him for his thoughtful comments. He is of course correct in pointing out that losses are not age-specific but occur throughout life. We wish to emphasise that in old age losses multiply and accumulate:

When sorrows come, they come not single spies,

But in battalions ………—Hamlet IV, Sc.5, 78.

We disagree, however, that loss of hope is necessarily age-specific. It reflects a depressive state of mind. In a realistic way the healthy older person still plans for the future in a spirit of optimism but the time-span is shorter and the plans less ambitious. A grandparent watching his grandchildren play and run no longer wishes to do this himself but enjoys watching and remembering when he did the same. Unconscious understanding promotes conscious acceptance of what is, rather than what might have been: acceptance of what is, rather than false hope for the impossible.

We agree that therapists at different stages in their own lives may bring different qualities and fears to the relationship but empathy is thought to be a personal characteristic not related to age.

The dream described in our paper was a manifestation of the patient's unconscious. The change in the dream engendered through therapy helped her mourn and see her life more realistically. On reflection, an important aspect was not only the actual dream but the fact that the patient brought that dream to her therapist and what it meant in the transference.

We are grateful that James McDonald's letter has given us the opportunity to think further about these issues.

Yours faithfully

MARK ARDERN