Mkntai. Aspects of Ageing 45 



lialliicinations; and catatonic features. ThoujL^h common, 

 tlicse sym})toms cannot be regarded as specific. None of them, 

 and no combination of them, is restricted to the elderly: there 

 is no clinical ])ictiire supposedly typical of involutional 

 psychosis that I have not seen in the same form in men and 

 women in their twenties — though it will then be given a 

 different diagnostic label. Why agitation, hypochondriacal 

 delusions (especially about the bowels) and paranoid distortion 

 should be so much oftener seen in later life is unclear. Some 

 would relate them to the painful experiences, generating fear 

 and insecurity, wdiich arise out of waning powers, lessened 

 status, and narrowing field of activity as age advances. Others 

 have put forward psychoanalytical concepts of enhanced 

 narcissism, introjection of ambivalently loved and hated 

 objects which are then identified with over-libidinized viscera, 

 and frustration of sexual desires leading to the revival and 

 entrance into consciousness of infantile fantasies; but as these 

 explanations are equally applicable to similar phenomena 

 in younger people, they do not account for the frequency of 

 the constellation of symptoms in the elderly. 



Briefly, then, mental illness in middle-aged and elderly 

 people can occur in every form that occurs at other phases of 

 adult life, but is more often characterized by somatic delu- 

 sions, terror and distrust. If the illness is less severe, these 

 characteristics may still be there, but may seem no more than 

 harmless neurotic symptoms. They are then taken to be 

 accentuated traits expected in the elderly — "senes morosi, 

 philauti, deliri, suspiciosi". That these traits — suspicion, 

 anxious self-concern, agitation — are in fact typical of old age 

 is no more true than that their opposites are — credulity, self- 

 confidence, apathy. The mental abnormalities of late middle 

 life, apart from dementia, are the late realisation of consti- 

 tutional tendencies, though the genetical factors seem com- 

 plicated, and not specific to senile or involutional illness. 

 The healthier the personality in early life, the less chance of 

 failure to adjust to the changed circumstances and capacitise 

 of advancing age. 



