In sickness and in health: An exploration of some of the unconscious processes involved in the decision by family caregivers to place a family member with dementia in residential care

This paper explores the feelings, conscious and unconscious, evoked by the difficult decision to place a family member with dementia into residential care. In an exploratory study I interviewed five people who had made this decision with a view to exploring some of the unconscious processes involved in their decision-making. The interviews were interpreted paying attention to my understanding of the transference and my countertransference feelings and as triangulated by a psychodynamic supervision group.

Intimate contact with ageing and death evokes fears about mortality and activates primitive anxieties. The progress of dementia may amplify primitive or psychotic states of functioning, particularly those involving evacuatory projection, and family carers may resort to splitting off unbearable feelings of anxiety which such projections can evoke and may contribute to their decision to look for residential care.

Once placed in residential care different dynamics evolve and further difficult questions arise: how often to visit; whether and when to dispose of the person's possessions and ultimately how to grieve. The focus of this paper is, as far as it is possible, on the partner without dementia as an individual and the impact of their relative's dementia on their lives.