Reactive depression in later life.

Abstract

I N ORDER TO GIVE a complete and systematic survey of depression in old age one would have to include organic states such as senile psychoses with a depressive coloring, various mood disturbances associated with arteriosclerotic and hypertensive cerebral disease, and other clinical entities.The purpose of the present paper, however, is to present some aspects of the psychopathology of depression in old age which have hitherto received little attention. It is based on observations made in the Gerontologic Unit at McGill University. Several of these observations have already been introduced elsewhere. 1 • 2 • s • 4 IMMEDIATE AND REMOTE PSYCHOGENIC FACTORSReactive depressions are particularly frequent in late life because old age is pre-eminently the age of "loss," loss of close relatives, of life-long friends, of position and of prestige. These situations, or their threat, are the immediate factors which all those engaged in psychiatric or social work with the aged have to deal with all the time. The conscious objective motives of grief and anxiety are more powerful in this age group than in younger adults. Therefore, it is important to work in each given case on the plane of objective reality. Nevertheless, it would be a mistake to remain confined to this plane in our evaluation of the case. In our experience there is in each case of reactive depression-no matter how overt the patient's motives areanother set of motives of which the patient is not conscious. If one studies the lives of such patients carefully, one can discern, as it were, three "condensation points": (1) the immediate and objective cause for the depression, (2) some phase in early adult life which is superimposed on this cause and without knowledge of which the present * Reported in The mechanism of reactivation in depressions of the old age group.