‘Beyond forgetfulness’: How psychoanalytic ideas can help us to understand the experience of patients with dementia

We must cast ourselves forwards to a time when words must fail (Samuel Beckett, Happy days, 1961). This paper approaches dementia and its care from a psychoanalytic perspective. It recognizes both the psychoanalytic literature on dementia and a biological understanding of neuro‐degenerative processes. Using neuro‐psychoanalysis to synthesize the two views, meeting points are found that may take the theoretical understanding of dementia processes a small step further, introducing the death instinct as one example. The mind and the brain are distinct entities which are also intimately related. A mind/brain model was proposed by Freud in his ‘project’ (1895). It pre‐dated his psychoanalytic work but was abandoned. None the less it runs as a rich vein throughout his work. Although other causes exist there are two main types of dementia. Alzheimer's and vascular dementia have distinct differences and similarities in their respective clinical presentations. This paper explores the complex deterioration of brain...