title: The abuses of a certain knowledge.
abstract: In the psychiatric institution, the sex act is a matter of controversy, all the more so when elderly patients with dementia are concerned. Yet, a question imposes itself: thinking beyond the biomedical model, the current governing paradigm for explaining senile dementia, what effects does the repression of the sex act have on the symptoms of the demented patient? The psychoanalytic exploration of the institutional situation described here suggests that the sexual demands of the patient suffering from dementia would not be meaningless, but would constitute a defensive modality against the return of a former threat of castration. Their repression, by means of practices that impede the libido in its search of an object, would reinforce the process of dementia by encouraging a regression toward earlier stages of development. More generally, the authors argue that unconscious dynamic processes might play a major role in the development of senile dementia. They show that psychoanalysis constitutes an essential method for the understanding of dementia and challenges the predominance of the biomedical model and its therapeutic arsenal in this context.
authors.affiliation: Division of General Psychiatry, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Fabienne
authors.initials: F
authors.lastname: de Bilbao
authors.affiliation: Division of General Psychiatry, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Paola
authors.initials: P
authors.lastname: Bonavitacola
mesh_terms: D000368:Aged; D000375:Aging / Q000523:psychology*; D003704:Dementia / Q000523:psychology*; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D011567:Psychiatric Department, Hospital; D011574:Psychoanalytic Theory; D012725:Sexual Behavior / Q000523:psychology*
keywords: Alzheimer disease; biological psychiatry; castration anxiety; incest taboo; institution; morality; psychotropic drugs; regression; repressive measures; sex act; treatment