SPECIAL SECTION: AGING
Working with Late-Life Patients
Audrey Kavka and Michael Slevin, Co-editors
Audrey Kavka, M.D., faculty member of SFCP, practices in Oakland, California. She currently chairs the APsaA Committee on Colleague Assistance, APsaA Study Group on Aging and Psychoanalytic Education and the IPA Committee Perspectives on the Ageing of Patients and Psychoanalysts.
Michael Slevin, M.S.W., is in private practice in Baltimore, and an emergency psychiatric evaluator of patients in crisis in the emergency department of Sinai Hospital. A former editor of TAP, he is co-editing a book, Therapists Talk about Race.
This special section of TAP is devoted to the topic of aging. It is a timely topic. The world population is experiencing a historic age demographic shift toward late life and our own APsaA membership mirrors that age demographic shift.
Unfortunately, it appears our psychoanalytic culture also mirrors the insidious and pervasive ageism of our broader culture. Ashton Applewhite in her book This Chair Rocks (2017), labels ageism as “the last socially sanctioned prejudice.”
Despite the respect for the wisdom of experience within the psychoanalytic culture, there is evidence that we tend as a culture to turn away from issues of aging. We hold in our collective memory outdated beliefs that legitimize neglect of late-life patients and issues.
Everyone seems to remember that Freud at the age of 49 (1904), wrote about the unsuitability of the older patient for psychoanalytic treatments. But we fail to remember that just 15 years later, Karl Abraham described older patients as some of his most successful cases. It is also ironic that Freud defined the older patient as 50 years and above and Freud, himself, went on to produce 17 volumes of written work after the age of 49.
We misread and misuse Freud’s description of the timelessness of the unconscious to explain why little attention goes to the study of mortality and death. We intend to write Professional Wills but never do.
More than 70 percent of the APsaA membership is 60 years of age or older, yet our courses on development often end at adolescence or midlife as if there is were no psychic development after midlife. Surely our own vitality speaks to late life as perhaps a challenging but rich period of ongoing psychic development.
The goal of this section is to shine light on psychoanalytic work being done by analysts in the field of late life. Each of the three articles highlights the opportunities for wider and deeper psychoanalytic engagement with late-life patients and issues.
Daniel Plotkin begins the series with a rich historical discussion of psychological thought on working in therapy with late-life patients. He elicits from Freud’s writings more complex views on the importance of death in our work than are commonly attributed to him.
Audrey Kavka, co-editor of the series writes “Twenty-First Century Perspectives on Aging,” in which she directs our attention to key issues working with those in late-life, and presents case vignettes.
Salman Akhtar’s, “In Talking of Death,” expands the horizon of our subject, developing the thesis that without discussing thoughts and fantasies of death, no analysis is complete.