ABSTRACT

Subsequent psychoanalytic thinkers have instead taken the view that the impact of changes will depend upon the individual’s capacity to bear loss and the extent to which losses are experienced predominantly in depressive or paranoid–schizoid states of mind. This will determine the extent to which experience can continue to be engaged with creatively and intimacy, including sexual intimacy, can be sustained. The importance of the capacity to adapt and adjust to the changes and losses of old age and to sustain intimacy is highlighted in research that shows that marital closeness moderates the negative psychological impact of functional disability in later life in terms of depression, anxiety, and self-esteem. The couple were just entering later life, and facing depression as lifelong defences were wearing thin, he having had affairs throughout the marriage and confronted by impotence as a consequence of treatment for prostate cancer.