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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Review
Ageing
AI - Artificial Intelligence
Culture
Film & TV
5 min read

Foundation shows you can’t ‘Ctrl+V’ a soul

A sci-fi classic unearths transhumanism’s flaws

Giles is a writer and creative who hosts the God in Film podcast.

A woman confronts a man whose clone stands behind her.
Apple TV.

One of the reasons that science fiction has had enduring popularity as a genre is its ability to illustrate thought experiments. The way it can attempt to answer questions that can’t even be asked in any other kind of fiction is what gives it power as a form of storytelling. One question that keeps coming up is: what if you could live forever, through technology?  

One person to attempt to answer this question is Isaac Asimov, one of the early giants of the sci-fi genre. Born in 1920, Asimov arrived into a world that was rapidly changing, and yet, his imagination was still able to outpace it. Much of what he is known for is his depiction of robots, with ‘Asimov’s laws of robotics’ influencing the depiction of androids in Star Trek: The Next Generation. However, direct adaptations of Asimov’s own work were few and far between. Robin Williams’ Bicentennial Man released in 1999 and Will Smith starred in I, Robot in 2004 were the best of the bunch. That is, until Apple TV began adapting Asimov’s Foundation

Asimov’s Foundation books were written across the span of fifty years. The premise of the stories is that in a distant future, a galactic empire is beginning to fail and cannot be saved. The mathematician Hari Seldon develops the theory of psychohistory, where he uses statistical laws to predict the future of large populations. In the wake of the empire’s fall, Seldon predicts a dark age lasting 30,000 years before a second empire arises. Seldon devises a plan to reduce this dark age to just one thousand years by preserving a ‘foundation’ of knowledge. The novels describe some of the dramatic events that frustrate, or are a result of Seldon's Plan. One of the features of the story that the Apple TV show of Foundation focuses on is attempted immortality.  

Foundation gives us three depictions of ‘immortality’. Firstly, Seldon orchestrates having his conscience eventually uploaded into the Prime Radiant, a super-computer in order to allow him to shepherd his plans beyond the limits of his own human lifespan. Secondly, his protégé, Gaal Dornick is throughout the first season put into a cryo-sleep that lets her move into the future without ageing. Finally, the characters of Dawn, Day and Dusk attempt immortality through cloning. The tyrannical emperor Cleon decided that the only person fit to succeed him was…himself. So, he creates a revolving triumvirate of his own clones: Brother Day, a Cleon in his prime; Brother Dusk, an aging Cleon who serves to advise Day; and Brother Dawn, a young Cleon being trained to succeed Brother Day. This "genetic dynasty" has been ruling with an iron fist for 400 years by the start of the series.  

These interpretations of immortality grant each character the ability to shape and curate history in a way that no one human could ever achieve. But as there’s no drama without conflict, Foundation shows us the downsides of this kind of immortality. Firstly, Gaal’s version, being frozen in cryo-sleep for decades might literally extend her life, but from Gaal’s perspective, it is no longer than it would have been otherwise. Whilst she does get to see history play out, she loses connections with people like her family and her lover Raych. She is unable to build the life she would have planned for herself.    

No-one mourns your absence because there’s an identical copy of you still walking about. 

Seldon’s version of immortality is flirted with by tech bros and transhumanists like Peter Thiel. The idea of a computer that has the processing power to replicate a human brain turns up in numerous stories, but it’s another false immortality. Firstly, the original Hari Seldon still dies, and the ‘digital version’ stored eventually in the Prime Radiant is merely a copy. We might not think much of copy and pasting a document or file on our computer, but it doesn’t quite work the same for human beings. A copy is not the same as the original. You can’t ‘Ctrl+V’ a soul. In addition to this, we find out at one point that due to a mistake, Hari’s digital self has been trapped in darkness, fully conscious but with no rest, no distractions and no way of communicating with the outside world for 148 years. This naturally drags Hari into an interminable madness.  

Lastly, the Empire run by the clones, Dawn, Day and Dusk suffer much the same problem as the other two. It’s not a real immortality; as each clone eventually dies. But in many ways, it’s even worse than death. No-one mourns your absence because there’s an identical copy of you still walking about. This is a trope that is troubling, because a protagonist dying and being returned via cloning is often presented as a ‘resurrection’. It has been used as a story arc in the X-men comics and in Peter Capaldi’s era of Doctor Who, with very little outcry from their respective fandoms. Possibly because the thought that the producers have canonically killed the main character and replaced them with an exact copy is simply too uncomfortable to consider. In Foundation itself, the clones are judged by their fidelity to the original (a cold and petty despot) and any deviation is met with a death sentence. Whilst clones may be one way to rule a sci-fi galactic empire, it’s possibly their inability to adapt to changing circumstances that contributes to the fall of civilisation.  

The great irony in all of these interpretations is; you are only immortal to those observing you, and an immortality that relies on perspective is not really an immortality at all.  

It seems that hard science fiction, and ancient Greek myths can at times, overlap in their focus. Viewed in one light, Asimov’s Foundation series can be seen as one long story of Prometheus, who steals fire from the gods to give it as a gift to mankind, only to be punished by Zeus for his actions. Asimov appears to be telling us that mankind can’t accurately predict the future and you can’t live forever. So despite being a staunch atheist, one of the great minds of science fiction might be suggesting that immortality may belong squarely in the realm of the divine.

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