The use of psychodynamics in understanding elderly in-patients

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Abstract
This paper is a descriptive account of phenomena observed whilst working as a psychiatric Registrar as part of the team responsible for the admission and assessment of patients over the age of 65 years suffering from a functional psychiatric illness. Amongst the issues described are the difficulties faced by young psychiatrists in dealing with this group of patients who are, in one way or another, grappling with the tasks of growing old and facing death. The concepts of loneliness and regression have been outlined with particular reference to their contributions in the normal ageing process the symptomatology of illness in the elderly and, again, the effects these may have on the care-givers. I have looked briefly at the dream life of this group of patients and considered the usefulness of this enquiry in a routine interview. A preoccupation with bowel function and, accordingly, of laxatives, was found in over fifty per cent of these patients and was seen to be far higher rates than a comparable group of elderly inpatients with physical illnesses. In an attempt to understand the meaning of this, the material is viewed from Kleinian and Freudian perspectives. An additional prescription anomaly compared with the geriatric group was the use of Hypromellose, a conjunctival lubricant known as “artificial tears”, to the patients. The meaning of tears and weeping in psychoanalytic literature is described with this observation in mind.

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