Life and Death: Some thoughts about the challenges of ageing and late life
Published in Blog by TR on 24 November 2025
TR CEO Andrew Balfour is a Clinical Psychologist, an adult psychoanalytic psychotherapist, couple psychotherapist and author of the book, Life and Death: Our Relationship with Ageing, Dementia, and Other Fates of Time. In the first of our new series of thought-leadership articles, he explores what might influence our capacity to manage ageing and face death.
Loss and mortality in everyday life
Loss is at the heart of ageing, and is at the centre of our experience, from the beginning of our lives. Discovered in those everyday moments of change and transition, in the return to school or work after a holiday, in the coming to an end of an intense experience, and inescapable in the pain and long-term aftershocks of the death of someone close. It is the knowledge of our limited time, of the inevitability, one day, of the loss of those at the centre of our emotional lives, which shadows everything; each separation, each change or development in our lives gains part of its shape, the outer edge of its definition, by the finitude it reveals to us. Even if we choose not to apprehend it, or can do so only partially, lest it spoil the life that is there, this is the contour of our experience. Not just the ultimate horizon-line of the end of life, but the current lived shape of experience, determined by loss and by the prospect of loss.
Denial, dependency, and vulnerability in late life
How do we manage this? Most obviously, by denial, by refusal to believe it can be true. Yet even if we try to hold onto this notion, it cannot last. Eventually, sooner or later, the limits that give life its shape confront us inescapably.
People are living longer, our populations are ageing, many of us now likely to reach an age that would have been considered very old a generation or two ago. Living longer means more of us are exposed to age-related illness that bring a new relationship to our body, which signifies the diminution and loss of capacity and eventual death. Given this, greater understanding of the psychological factors which support or prevent us from engaging creatively with late life is very important — what helps us to sustain and inhabit our longer lives?
In my book I have drawn on psychoanalytic developmental models, in which early anxieties and defences, and the failures and achievements of our earliest years are seen as important in understanding how we negotiate the challenges of late life.
For some, there may have been an equilibrium established earlier in life that doesn’t hold under the weight of the difficulties of later life, in which early and more primitive anxieties may re-emerge and expose vulnerabilities and fault lines which are the legacy of earlier times. Where there have been early difficulties in dependency relationships, the threat of vulnerability and dependency in late life can be felt as a trauma to be avoided at all costs. The point is that this is a trauma that has already happened in infancy, with the crucial difference that the infant is growing and developing with the potential for new experiences to repair things, whereas for the older person, the trajectory is towards actual death. So, the challenges of later life may elicit powerful infantile anxieties and how these are experienced will depend on previously achieved development.
The novelist Penelope Lively said in an interview:
"In old age, you realise that while you’re divided from your youth by decades, you can close your eyes and summon it at will…. The idea that memory is linear is nonsense…. As to time itself—can it be linear when all these snatches of other presents exist at once in your mind?"
(Guardian, 25 July 2009)
Crossing the “shadow line”: midlife and mortality awareness
As we move past the mid-point in our lives, we cross what the writer Joseph Conrad called the “shadow line” of our generation — where we move over the brow of the hill to view, on the other side, the prospect of our mortality (see Segal, 1984). Jacques (1965) describes a crisis at mid-life, stimulated by the awareness of encroaching mortality, which must be worked through for creativity to be sustained.
Time, memory, and the unconscious
Psychoanalytically, two essential dimensions of time are distinguished: the atemporal unconscious mind, of primary process, the moveable nature of the psychic experience of time, regression and 'après-coup', for example, and linear, diachronic time — the reality of where one is in one’s lifetime. Two seams, the atemporal unconscious world in which the contents of a lifetime sit together, undiminished, and unseparated by the passage of time on the one hand, and on the other, the reality of temporality and limits of time passing: these are the potentially conflicting dimensions of time in our psychic life. They are brought into sharp focus as we “get towards the end of the line”, so to speak. How the crossing of the “shadow line” in later life, and awareness of mortality is experienced depends on the relationship to diachronic time — on the capacity to tolerate the losses that the passing of time brings.
Conrad’s “shadow line” is an interesting image: a line is a liminal point — implying a crossing from one state to another. Indeed, the idea of a mid-life crisis has within it the notion of a critical point, which requires a working through at a particular developmental stage in the lifespan. The consequences of this knowledge of death are profound — perhaps giving shape to one’s life — providing a point of perspective and definition of “the road travelled”, as the psychoanalyst Quinodoz (2009) puts it, but anxieties associated with death and defensive responses to this knowledge can also be profoundly disabling.
"There are times when, on the journey through life — especially as it draws to a close — people forget that they are travelling… all that remains is the monotony of everyday existence…. However, the very savour of life is linked to the fact that it is by nature transient… by unconsciously effacing death, so too the interesting features of life are lost — “because the prospect of its end, gives shape to the journey.”
This latter point is close to the philosopher Heidegger’s (1929) view — that the meaning of existence is in the fact of our death — he writes of “existence towards death” (Dasein zum Tode), and he sees this as fundamental to our apprehension of time. As Bell (2005) says, the feeling of oneself existing in time is an important developmental achievement, but for some is a catastrophe to be avoided by retreat into a timeless world.
The work of mourning in old age
In the transition to old age, the work of mourning becomes more urgent. Clinically, we can see people for whom the mental pain of loss and vulnerability associated with facing the passage of time, and ultimately death, seems impossible to bear. For all of us, the losses that are current in our lives will reawaken, at an unconscious level at least, earlier experiences of loss. Where there is not the internal support for facing losses and the diminution of capacities in later life, then defences may have to be increased, and for some people, may no longer hold up at the point when they are most needed, leading them into the internal refuge of psychic retreat.
Psychic retreat and the risks of withdrawal
The pull into such states can affect us at any age but perhaps we can see a particular form of this in some older people, associated with a psychic stasis, a retreat from engagement with life and experience — as though to “freeze time”. The difficulty with such a retreat is that it is also destructive of good objects — leaving the person without resources for life or for facing death.
These states of retreat are not unique to old age. I have younger patients for whom the struggle between renunciation and living is acute, where the state of retreat can feel preferable to the risks of life and intimacy. However, as the realities of ageing impinge more, and the weight of loss builds, there may be problems, particularly when earlier developmental difficulties leave the individual without an internal support for working through the losses of old age.
Resilience, containment, and facing mortality
In summary, the clinical picture I am exploring here is one in which the inner world situation of failures of containment in early life and the contemporary internal legacy of difficulties in facing loss and mourning, join up with the experience in old age of loss and displacement at an individual, and a social level. In the face of this, we can see how some people might migrate, internally, to a psychic retreat, in the face of the losses of ageing and impending mortality, as internal and external realities converge.”
You can read more from Andrew Balfour on this subject in his book Life and Death: Our Relationship with Ageing, Dementia, and Other Fates of Time available from Routledge:
