Growing Old: A Journey of Self-discovery arose from the personal experiences of the author, Danielle Quinodoz, whilst working with older people as a psychoanalyst practising in a private clinic in Geneva. She proposes that growing old lends us an opportunity for discovery and advocates the benefits of reconstructing memories as the end of life approaches. The 14 chapters use examples from fictional literature and the arts, and anecdotes from patients' analysis to illustrate points about how an older person may work at reconstructing their internal life history to enhance their sense of self. Themes include the work of remembering, phases of life, anxiety about death, resources of old age, grandparenthood, losing, and loving. Quinodoz usefully makes a clear distinction between growing older passively and growing older actively. Passive ageing juxtaposes elements of our life story without combining them into a coherent narrative, which Quinodoz suggests hinders the work of growing older and creates conflicts in psychological health; whilst active ageing integrates the different periods with the present in order to view the life story as a whole object. This active ageing, she proposes, allows time to be experienced through ‘small seconds of eternity’ (p. 9) or intense moments of emotion that combine to form a progression of the lifespan, and aid the sense of a personal life story that has relevance and is coherent.
Chapter 5, ‘Anxiety about death’, deals with the realisation that life is limited, and the indecision surrounding the meaning of life. This thorny issue is tackled by a discussion of the psychological need for reconciliation and dying at peace. It is illustrated with anecdotal evidence from a patient, and with reference to novels about the discovery of cancer and the possibility of limited life. The interweaving of fictional material with anecdotes from clinical settings aids our understanding of the point Quinodoz is making, but does lack the ‘hard’ evidence of a case story.
Chapter 6, ‘What lies behind the decline of very old people?’, makes a useful distinction between growing old and mental decline. This chapter briefly explains brain plasticity and reduction of brain volume and moves on to psychological matters relating to suffering losses in terms of mourning and depletion of responsibility. Dementia is given an extremely brief mention and is described as a defence against anxiety of death, with surprisingly no mention of the organic basis of the disease. Alzheimer's disease and its relationship with psychoanalysis is mentioned in Chapter 7 from the carer's position, but sadly nothing is offered from the sufferer's position about gradual loss of memory and how that may affect the reconstruction of a life story.
It is not until Chapter 10 that we learn about the analyst's point of view of conducting psychoanalysis with an older person, and the possible benefits that may be gained from it. This chapter may be of particular interest to those people involved with counselling or psychotherapy and highlights issues such as the psychoanalytic treatment of depression manifesting as accident proneness or somatic illnesses. This chapter is brief and provides a very basic outline and explanation of some issues surrounding psychoanalysis; such as mistaken meanings attributed by the analyst to the patient's therapy session, and guidelines for procedures in appointment making. This is a useful glimpse into the world of psychoanalysis.
Chapter 11 is encouragingly titled ‘Psychoanalysis and elderly people’, and provides an outline of Freud's views on the undertaking of psychoanalysis with people over 50 years old as worthless. Quinodoz successfully defends her position that ‘psychoanalysis of an elderly person is not fundamentally different from that of a younger adult’ (p. 146). This refreshing comment supports the anti-ageism movement in relation to health care, but also confirms the view that the majority of the issues discussed could easily be generalised to all ages, and are not specific to older people.
It is often the introduction of fictional accounts combined with clinical anecdotes that undermines Quinodoz's discussion throughout the book. She tackles many important issues and raises interesting and thought-provoking points for discussion, but this not a text book in the scientific sense. If the reader is seeking to understand ageing from a psychological stance, then this deeply psychoanalytical position may not tackle issues as expected. In her concluding chapter Quinodoz states that ‘new ways of looking at the work of growing old have been explored [throughout the book]’ (p. 193); this is certainly true of psychoanalysis, possibly assisting the formation of a coherent life story. However, the lack of concrete examples is a frustration for those engaged in more evidence-based disciplines.
