On ageing and psychopathology: discussion of Dr Norman A. Cohen's paper 'on loneliness and the ageing process'.

In an aetiological perspective one has to consider the following in working with the older adult: antecedent psychopathology, situational crises that strain the ego's ability to maintain equilibrium, organic illness which can increase reactive symptoms. Age in and of itself need not preclude psychoanalytic treatment. In my successful work with middle aged and older adults, I have found: the capacity for insight, for therapeutically induced transferences for dreams and the ability to relate these dreams; the capacity for self-observation; the mobilization of motivation to change and also of libidinal and constructive aggressive energies; the institution of a mourning-liberation process. In the treatment situation, the elderly easily distinguish between the facade of interest and genuine caring and involvement on the part of the therapist. Older patients wish to be useful, and to preserve their dignity. Unlike younger patients, they do not fear death. At times they may welcome it as a relief from pain and anguish. The goal of psychoanalytic treatment is to make more of people available to themselves for present and future creative and satisfying life experiences. This can occur in individuals who are middle aged, older aged, or in the younger group of analysands.