This very sensible book argues that we need to be more open and honest in facing up to our mortality - and that psychotherapy has an important place in enabling us to do so. In between, Ann Orbach covers a range of topics from natural death, death by suicide, euthanasia and the death of children to Near-Death Experiences and whether any part of our humanity survives the body. The most eye-opening section for me was that which describes the appropriateness of psychotherapy for those who are very old - the following passage in particular.
"Where is my mind?" wrote a poet of 94. She thought her memory was failing and she was going mad:
Give me grief, despair,
A hopeless hope - anything but this void
I wander in, only my body sovereign,
Eating, sleeping, living the empty
Daily round.
She wrote to a psychoanalyst whom she had met in the past, when she was teaching children and he was a child analyst. In her letter she told him that she felt bewildered and disorientated, had dizzy spells and a fear of falling. These symptoms had come on soon after her husband's death. Could he take her on as a patient? She did not think she needed prolonged therapy. Earlier in her life she had had a bad experience with an analyst so she did not want a stranger. She was quite aware that treatment would limit the friendship they had enjoyed up till now: "Her turning to me and being in such acute distress made me feel I should honour her request" (Settlage, 1996, p.550 - see Note below).
Initially he saw her for psychotherapy over a period of three months and did not feel that her advanced age made the treatment different from that of other adults. She was reacting strongly to the death of her husband, whom she had looked after through his last illness. "Instead of 'grieving as would be appropriate', she saw herself as being in a self-centred martyrdom" (p.550).
Both the analyst and her doctor wondered whether dizziness and failing memory were due to organic causes. But her memory returned after she admitted not wanting to remember her husband in his state of physical and mental decline. She, at first, denied having been angry during that time but then remembered, and brought to the next session, a poem she described as "laced with anger".
Treatment then focused on the anger she had repressed from childhood, at not being acceptable to her parents, and how this was now being expressed in physical symptoms. Her dizziness soon disappeared. Instead of the variety of symptoms presented at the beginning, and the guilt that went with them, she became able fully to mourn her husband's death.
At the age of 99 she asked for analysis. Again, she had physical symptoms. "My palpitations must be psychological, so I turned to you" (p.553). She was generally healthy and unimpaired mentally but had now become housebound, moving only between chair and bed during her daily routine. So she had to be visited at home and chose the study where she wrote her poems, rather than the living room, which was for meeting friends. In calling what followed 'psychoanalysis' and not 'psychotherapy', Settlage felt it met with the necessary criteria:
Although the analytic couch and the usual frequency of four or five sessions a week were not employed, the treatment had the hallmarks of psychoanalytic work: free association, the use of dreams, transference, transference interpretations, resistance to the exposure of repressed mental content, insight, the resolution and working through of intrapsychic conflict and change in psychic structure. (p.558)
Some might claim the same for psychoanalytic psychotherapy or even psychodynamic counselling. There are obvious overlaps and a lot depends on what our training organisations allow us to call ourselves. What is impressive in this account is that a centenarian was able and willing to benefit from what she asked for and was given. The analysis continued for five years, ending when she died aged 104. ...
Settlage wrote that his patient was lucid when she died, that she accepted her mortality and was composing poems almost to the end. Helped, as she undoubtedly was, by her analysis, her dying and her creating could come together. She and her analyst were both intensely sad but she had lost her earlier depression and fear.
Note: Settlage, C. F. (1996) 'Transcending old age - creativity, development and psychoanalysis in the life of a centenarian', International Journal of Psychoanalysis 77, 540-563.
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