Article
Ageing
Care
Change
5 min read

Delicate, fragile, frail: how we cope when we age

The insights and analogies that help.

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

An old woman wearing a shawl looks pensive.
Valentin Balan on Unsplash.

“Who could dissect a portion of the human frame without marvelling at its delicacy, and trembling at its frailty?” mused preacher Charles Spurgeon in the nineteenth century. Songwriters, artists, authors and surgeons alike are fascinated by frailty. Within, beneath and beyond that fragile frame though, could there be a deeper reality, waiting to arise – and endure? 

Fragile Lives is the ‘heart-stopping memoir’, operation by operation, of heart surgeon Professor Stephen Westaby. “The finest of margins,” he writes, “separates life from death, triumph from defeat, hope from despair – a few more dead muscle cells, a fraction more lactic acid in the blood, a little extra swelling of the brain. Grim Reaper perches on every surgeon’s shoulder.” 

To what shall we compare this fragility of frame? - which means we can shatter sudden as glass, our “breath becoming air” in the blink of an eye? (Paul Kalanithi, a young neurosurgeon, called his memoir When Breath Becomes Air as he fought his own battle with cancer). A snowflake? A spider’s web? A butterfly wing? In Dutch still life paintings, the transience of life is variously depicted in dry, fallen withering petals, rotting fruit, and a glass vessel, like a vase. At some funeral services, it is said that we are made from dust, and to dust we shall return. Elsewhere in the Bible, we are likened to a mist that appears for a little while and then vanishes, or to a flower that withers away, a fleeting shadow that does not endure. Our days are a mere handbreadth, our life but a breath, writes one Bible songwriter. 

Medics talk more commonly of frailty than fragility – and it’s not just a byword for old age. According to the British Geriatrics Society, not all old people live with frailty; not all people living with frailty are old, though age is a recognised risk factor, with nearly 40 per cent of adults aged 85-90 being frail. Described as a vulnerability to external stressors which can result in sudden marked deterioration in function, frailty might feature as a combination of falls, immobility, delirium, incontinence, and increased side effects of medications, suggesting the body is struggling to cope. “A minor infection or minor surgery results in a striking and disproportionate change in health state – from independent to dependent, mobile to immobile, or lucid to delirious,” writes a team of doctors in The Lancet

Frailty is a sign of advanced biological rather than chronological age. Often, it’s an unwelcome term, with consultant physician Patricia Cantley noting that, “from a patient or relative’s point of view, the word frailty seems to be at best somewhat vague and at worst, derogatory and demotivating”. She prefers to talk in terms of paper boats. Picturing young healthy patients as little tugboats of wood and steel, built to withstand storms, she likens the frail patient’s clinical situation to a paper boat, which can sail the sunny seas, but is soon buffeted and may be brought down by ‘medical winds’. 

Encompassing also psychological and cognitive symptoms alongside the physical, frailty is not a fixed state, nor is decline in mind and body inevitable once frailty begins. Seen increasingly as a dynamic spectrum, reversal of frailty is sometimes possible; the paper boat being, to a degree, storm proofed and made to chart a different course. According to Dr John Travers, professor of public health at Trinity College, Dublin, twenty minutes of daily exercise can reverse physical frailty and build resilience in over 65-year-olds, while others suggest that movement based mind-body therapies such as tai-chi and yoga can strengthen both mind and body. Could there also be something of a spiritual strengthening in the frail patient? As the body decays and declines, could the soul, the spiritual self, enlarge, emerge and ultimately endure as life ebbs away? This was certainly the sentiment of Paul, one of the early church leaders, in the Bible, who, after much suffering, wrote: “Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day…we fix our eyes not on what is seen, but on what is unseen. For what is seen is temporary, but what is unseen is eternal.” 

Her late Majesty Queen Elizabeth II was seen on our television screens to diminish physically in her last days, her purple hands, tiny frame and walking cane causing concern among viewers. She was, at her funeral, described simply as “our sister Elizabeth”, her small coffin dwarfed by pageantry and a crowd of 2,000 including presidents and kings. And yet, the former Moderator of the Church of Scotland has revealed that she talked much of her Christian faith in her dying days, while her funeral was an explosion of scripture, hymns and sermons that expressed the strength of her personal faith. “It was her way of eloquently, beautifully and powerfully speaking to me and 4.1 billion other people of her Christian faith,” writes Pastor Skip Heitzig. For me, the funeral brought to mind the tides (continuing with the theme of the sea). As the tide recedes, the waters move away from the shore, in what is known as an ebb current. As the tide rises, water moves toward the shore in a flood current. As our Queen’s life ebbed away physically, her spiritual self arose, roaring like a mighty flood. Ocean motion, in currents, waves and tides, is driven by the sun, moon and the planets. Our late Queen also looked upwards, to her God, for spiritual succour that would turn life’s ebb to a soul-flood.  

Hymnwriter Timothy Dudley-Smith sought a similar exchange, from the physical to the spiritual, the mortal to the immortal, in yet more words about boats, in his hymn “My boat so small”, based on the Breton Fisherman’s Prayer. 

“Adrift when strength and courage fail, O Spirit, breathe to fill my sail” 

And, happily, he trusts a safe voyage, finishing with - “My voyage done, all trouble past, to haven bring my soul at last.” 

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Interview
Care
Change
Community
Masculinity
5 min read

There’s a simple solution to society’s lost boys

Mentoring the fatherless helps and heals

Belle is the staff writer at Seen & Unseen and co-host of its Re-enchanting podcast.

A teenager slumped against a sofa plays a video game
Zach Wear on Unsplash .

What if nearly every major social pathology could be halted upstream? What if there was evidence to suggest that they commonly flow from one singular factor? What would we do – would we sit back and wait for the State to intervene, pointing to where we know the problem is beginning? Or would we wade up that stream ourselves, and start damning up the current?  

Richard Kay and Robert Mansel Lewis have chosen the latter option. They are the founders of Chapter2, a charity that offers mentoring for boys aged seven to 16. And they have identified fatherlessness as the factor that is linked to many major social pathologies to be found in Western society today. 

Earlier this year, the Centre for Social Justice brought out a report called Lost Boys. It found that2.5 million children in the UK do not live with a father figure, and that just under half of young Britons grow up with one biological parent, more often than not their mother.; 

Back in 2013, the numbers were strikingly higher in low-income areas, with 65 per cent of children aged 12–16 in the bottom 20 per cent of income households not living with both birth parents – this was 26 per cent higher than in better-off households. What’s more, when children were aged three, the chance of them being in the bottom income quintile was 21 per cent if their parents were married, and a massive 81 per cent if they were in lone-parent families.  

So, we can already see a clear line drawn between fatherlessness and poverty,. Chapter2 (informed by the work of psychologist, Stephen Baskerville) also point out that fatherlessness is linked to alcohol abuse, drug abuse, truancy in school, incarceration, and mental health difficulties – all among young boys, in particular.  

There’s a smorgasbord of factors and influences that are making it increasingly complex to be a ‘healthy’ and ‘happy’ man right now. “You don’t even need to put the word ‘toxic’ in front of ‘masculinity’ anymore, Kay points out. “It’s just assumed. If we need to ask what healthy masculinity is, people really don’t know.” 

As I’m writing this, I’m sitting in a coffee shop with ‘boys will be... what we teach them to be’ emblazoned on the side of it. It feels as though multiple destructive forces are making a beeline for young men right now, and we’re panicking. We’re manically trying to halt a fast and violent flow - but what if we waded upstream? 

That’s what Kay and his colleagues are trying to do. The charity’s mission is to  

bring good men into the lives of young boys who are living without a father. These men – all volunteers (?) - are committed to being there for the long term (two years, minimum) and to build a trusted friendship. That’s it: the beginning, middle, and end of the mission.  

I was struck by the radical simplicity of it. Young boys get referred to Chapter2 through social services, schools, and by family members or guardians – they told me that referrals have never been something they’ve had to work hard to gather. Which is pretty heart breaking in itself. 

The reality is, the fatherlessness crisis isn’t going to be solved by State-led intervention, and nor should it be. The solution lies in community living as it should do. It can be helped by the smashing down of hyper-individualism and the dismantling of our obsession with the nuclear family. It can be eased by reminding ourselves that it really does take a village to raise a child. Oh, and that we’re the village. When we spoke, Kay talked about his initial reluctance to found a charity that does this work, weary that it somehow relieves us all of our responsibility to live wide-open lives. Chapter2 is working toward a world in which the mentoring of young, fatherless, boys is normal, not a last resort.  

I like that. 

The longevity of Chapter2’s goal is pretty counter-cultural, isn’t it? We’re a commitment-phobic-culture. That’s pretty anti-love-your-neighbour, right? But the only way to respond to the wound of abandonment is by showing up – relentlessly, consistently, self-sacrificially. It’s the art of staying – come what may.  

I was told that this takes the boys a little getting used to; that Kay and Mansel Lewis warn the men they’re training that there will come a point when the boys will try and push them away, assuming they’ll leave sooner or later and feeling more comfortable having that happen on their own terms. It’s a symptom of the abandonment wound, I guess. But the men stay, and the boys begin to trust them.  

And here’s the other biggie for Chapter2: there’s no agenda. No goals. No solutions. No fixing. Just presence - consistent presence.  

Again, I was struck by how foreign that must feel to the boys. Everybody else in their life needs and wants something from them – better school attendance, better behaviour at home, less trouble with the police – and rightly so. But the Chapter2 mentors are only interested in the boys’ company and trust. They’re not trying to fix them, they’re just trying to know them – if there are no measurable changes, they’ll still show up. Zero conditions.  

The poet, rapper, author, and pastor, Joshua Luke Smith, often talks about a father as being someone who will  

‘bind up your wounds and catch you when you fall’,  

because that that’s what every young man needs – someone to care enough to do those two things. Because hurt people tend to hurt people. So, wounds need to be bound before they become ‘an excuse to wound others’. Again, it’s all very upstream, don’t you think? It’s very Chapter2-esque.  

One Chapter2 mentor recently received a Father’s Day card from a boy he’d built up a relationship with. Another young boy who’d been arrested twenty or so times in twelve months eventually realised, thanks to his mentor, that it’s not worth getting into trouble. His mentor, he said, ‘is someone he can trust, he’s consistent and he knows he cares about him’.  

This is community living as it ought to. Is this also the solution to the pandemic of fatherlessness?  

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