The Psychoimmune System in Later Life

Abstract

Since 1978 the faculty, staff, and students of the Older Adult Program at Northwestern Medical School have been studying the etiology, symptoms, and typical course of late-onset psychiatric disorders in middle-aged, young-old, and old-old men and women. For the author, these investigations have led to a still evolving but clinically useful conception: namely, that the various functions of the psyche constitute a de facto immune system, dedicated to preserving the consistency and continuity of the Self. When the immune system is in place, the individual experiences what Erikson (1952) has called a “self-sameness,” and self-recognition in the face of flux and change; when the system fails, the result is self-fragmentation, as well as psychoses based on hectic attempts—“fevers of the soul”—to restore the lost continuity. In later life, immune systems—whether psychic or physical—tend to degrade. The late-onset disorders do not, as commonly assumed, result from the piling-up of nonspecific Stressors and insults in later life; they result from specific, meaning-laden, and potentially reversible attacks on the psychic immune system itself.