The Hardest Passage

A fascinating narrative of a psychoanalyst’s experience of working with a patient with dementia. It is interspersed with current theory from the literature on attachment, object relations, and neuroscience, and ends on a substantial appendix of detailed notations about relevant articles to illustrate her work and provide further areas for research.

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When I can remain truly present with my dementing patient, even facing the hard truths about her decline, she feels more deeply accompanied and thus more available to experience the realities and possibilities available at this time of her life.



Maxine Anderson presents her account of three and a half years accompanying her patient’s journey into dementia. Sally, a psychoanalytic patient from several decades ago, returns to therapy as she begins to experience the early signs of Alzheimer’s, a disease she watched her mother descend into. Sessions start with Sally alone but soon involve Sally’s husband David and, later, her carer Connie. Psychoanalyst, patient, husband, and carer all learn together as they navigate the turbulent emotional waters caused by Sally’s condition.



The sessions brought out much to experience and to learn: about loss and the need to mourn, but also about the impulse to turn away out of fear and helplessness. The deepest lessons had to do with the value of patience and attentiveness in the face of fear and confusion. It is difficult to face the recession of capacities in our loved ones and our own helplessness. Yet, turning away to avoid the pain of loss may make the aging individual also turn away from facing the situation, enhancing the isolation and loneliness triggered by their waning capacities.



In navigating this hardest passage, Maxine came to realize that by remaining truly attentive to Sally’s experience, in the midst of loss and frustration, she could reach past the confusion and fear to help Sally feel emotionally accompanied, and thus more available to her own experience and realities. Surprisingly, when Sally felt accompanied, she could better face the hard truths about her decline. In addition, she and David were able to genuinely welcome change, amidst the necessary mourning, and managed to discover a new continent of experience and relationships. The encounter changed the lives of all involved and opened them up to new aspects of their own humanity.



This moving tale presents a unique perspective on living with dementia and is of interest not only to all professionals working with dementia, but also to those accompanying their loved ones on their own hardest passage.