Wrong turns: psychoanalytic history and the treatment of older patients

Sadly, psychoanalytic institutions themselves have fallen prey to our society’s ageism and have enacted ageist policies. Plotkin (2019) has described in detail the obstacles he met in trying to use a septuagenarian patient, one eminently suitable for psychoanalytic work, as a control case. Turned down by his committee, he states, he received the permission he needed only by writing (in his words) “a shaming letter” to them, accusing them of falling short of psychoanalytic ideals in their display of prejudice. Eventually, they relented. But one wonders how many less assertive candidates simply gave up. The message was clear: psychoanalysis of older patients was unacceptable. Wagner (2005) similarly reports her institute’s initial rejection of an octogenarian as a control case. “Although no one would deny the elderly supportive psychotherapy,” she notes, “the possibility of psychoanalytic therapy still raises more eyebrows than genuine conviction” (p. 78). And Yu (2019) recounts receiving a phone call from an 83-year-old woman, eager to begin therapy, who had been turned down successively by numerous therapists who told her she was ineligible for psychoanalytic therapy because of her age. How many older adults have been deprived of beneficial treatment because of this prejudice? The damage we have done to potential patients as a result is disturbing to think about.

Psychoanalysts are trained to search for genetic roots: We look for the antecedents of individuals’ “problems of living” in their histories. Our profession, however, has had difficulty in recognizing the way its own history has influenced, and at tunes compromised, its theory and practice. I have come to believe that thr ee related aspects of psychoanalytic history have impeded our field’s ability to conceptualize and value the treatment of older patients: (1) the profound effects of the Holocaust on the early psychoanalysts; (2) the tensions and competitions in the field, which resulted in a sharp delineation between psychoanalysis and (much lower status) psychotherapy; and (3) the failure of the field to adequately conceptualize phenomena, such as late-onset trauma, attachment, loss, and death anxiety.