Clinique du délire dans le désordre démentiel

Abstract

Reaching a very elderly age can be a critical experience, involving massive often painful loss. Losing one's physical capacities, loved ones, social status, home, etc. can provoke an identity crisis, potentially leading to a new approach to self, or in certain persons, to psychiatric disorders. As life expectancy, and by consequence the prevalence of age-related morbidity, increases, the human and social impact of psychopathological disorders in the very elderly is becoming a major challenge for scientific research. Based on the clinical case of a 70-year-old nursing home resident, we propose a reflection on persecutory delusions as a mode of deterioration in a context of early-stage dementia. Considering the patient's past history and her own comments on her life experience as an institutional resident, as well as the transfer movements operating during the interviews, we attempt to highlight the way in which delusional construction and reconstruction processes created meaning for her, examining the way delusion can function as a supportive element for a coherent identity. In a determinedly clinical approach, articulating an analytical reading and a phenomenological approach, we shall be interested in her history as well as her current real-life experience in institution such as she delivers it to us during the conversations. By pressing us on the movements in the transfer, we shall try to bring to light the way the delirious construction and the reconstruction can make sense for her, and which functions the delusion can have in the preservation of a shape of identical cohesion.