ABSTRACT
This chapter examines some of the unconscious factors involved in the silencing of debate at a particular point during the 1980s and early 1990s regarding the provision of long-term care for people in later life suffering from dementia. The difficulty in the later stages of dementia is that, in terms of internal containment, no robust mental structure, in a dynamic sense, with a sustained capacity for self-awareness and thought, is left. The pervasive, unremitting pressure of a stance based on the denial of need had a major impact on the area of long-term care, with its sustained denial of the reality of ageing and of distress. The politics of individualism, taken to the extreme and pushed into national long-term planning, ultimately held within it an omnipotent phantasy. When organic deterioration is severe with a resultant loss of capacity in the individual to mentalize internal objects, then there is a clear limit to the role that formal psychotherapy can play.
