Blau D, Berezin M A
J Geriatr Psychiatry. 1982;15(1):55-97.
This paper emphasizes the importance of understanding and treating the aged with neuroses and character disorders. Although they are often neglected by mental health workers, the aged with these emotional problems form a far larger group than the psychotic aged who receive a greater share of attention. Stereotyped attitudes and commonly accepted myths regarding the aged encourage an attitude of therapeutic nihilism and pessimism. The unconscious motivation for ignoring the obvious distress of older people is discussed. Certain specific myths, such as the "rigidity" of the aged and the tendency to "wastebasket" and to view all pathology as organic or caused by aging alone, are discussed. The fear of the devouring older person is also explored, as well as the myth of "family rejection." A number of clinical examples are given of the types of emotional problems frequently seen among the noninstitutionalized older population. Each case is described from the standpoint of dynamic understanding and management. A trial of observation and psychotherapy is recommended in all situations, since even "organic" signs may be reversed. Generalizations concerning the aged as a group are avoided in the belief that they lead to further stereotyping and the discouragement of scientific investigation. Individual assessment and understanding are emphasized. The persistence of unconscious attitudes, fantasies, and wishes from childhood is pointed out, but it is emphasized that they may not always carry the same value and meaning throughout life. Certain patients achieve insight through treatment, along with a greater capacity to enjoy life than they had before. Others are comforted by the relationship with the therapist for both its "real" and unconscious meanings. Some require assistance in accepting and tolerating more regressive behavior, while others need help in accepting and assimilating their changing feelings about their goals, objects, and sexuality in old age. Reminiscences are emphasized as important sources of elevating self-esteem. Concerns about death and common countertransference problems in work with the aged are examined. The need to be flexible but not to "lean over backward" is emphasized. Patients understand a genuine offer of involvement and concern as the most precious gift.
本文强调了理解和治疗患有神经症和性格障碍的老年人的重要性。尽管这些老年人常常被心理健康工作者忽视，但患有这些情绪问题的老年人所构成的群体，远比受到更多关注的老年精神病患者群体要大得多。关于老年人的刻板态度和普遍流传的错误观念助长了治疗虚无主义和悲观主义的态度。本文探讨了忽视老年人明显痛苦的无意识动机。文中还讨论了某些特定的错误观念，比如老年人的“僵化”、将所有问题“归为一类”以及认为所有病理状况都是器质性的或仅仅是由衰老导致的倾向。文中还探究了对贪婪的老年人的恐惧，以及“被家人抛弃”的错误观念。文中给出了一些在非机构化老年人群体中常见的情绪问题类型的临床实例。每个案例都从动态理解和管理的角度进行了描述。建议在所有情况下都尝试进行观察和心理治疗，因为即使是“器质性”症状也可能得到改善。本文避免对老年人这一群体进行一概而论，因为认为这样会导致进一步的刻板印象，并阻碍科学研究。文中强调了个体评估和理解。文中指出童年时期的无意识态度、幻想和愿望会持续存在，但同时强调它们在一生中不一定始终具有相同的价值和意义。一些患者通过治疗获得了洞察力，并且比以前更有能力享受生活。另一些患者则从与治疗师的关系中获得慰藉，这种关系既有“现实”意义，也有无意识意义。一些患者需要帮助来接受和容忍更退行的行为，而另一些患者则需要帮助来接受和接纳他们在老年时对目标、对象和性方面不断变化的感受。回忆被视为提升自尊的重要来源。文中审视了与老年人工作时对死亡的担忧以及常见的反移情问题。文中强调需要灵活应对，但不要“矫枉过正”。患者将真诚的参与和关心视为最珍贵的礼物。
