The Struggle Between Living and Dying: The Analytic Treatment of a 90-Year-Old Woman

I should like to present the case of a 90-year-old woman, Mrs. R, whom I saw in therapy from the time she was 90 years old to the age of 97, when she died. She was in a large urban nursing home where she needed 24-hour nursing care, and was a severe management problem. Mrs. R was obstreperous, at times paranoid, and occasionally banged her bedpan against the wall. She was severely depressed and was given antidepressants and tranquilizers. In addition she had a history of gastrointestinal problems that required her to go to the bathroom frequently and caused constant bathroom accidents. Shortly after having been admitted to the nursing home, she had an amputation of her left leg necessitated by gangrene from a diabetic condition.

My first impression of her when I came into the room was that I was talking to a corpse. She herself felt empty, frightened, and lonelier than ever before; life was not worth living and she felt worthless. She described the aides and orderlies as cruel, unfeeling, neglectful, and, most importantly, she felt as though she were in a concentration camp. Frequently it was impossible to tell the difference between her accurate observations and her paranoid distortions. Obviously I wondered whether she could