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The Dimensions of Frailty

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The following is the text of Archbishop Zygmunt Zimowski's second talk at the Annual Medicine, Bioethics and Spirituality Conference at the College of the Holy Cross, in Worcester, Massachusetts. Archbishop Zimowski is president of the Pontifical Council for Health Care Workers.

May 7, 2015

To speak about the spiritual dimension in a state of human frailty is a rather difficult task, not so much because of the complexity of the subject and its frequent and debated recurrence, but because it is not easy to address because of its strong subjective resonances. Indeed, it belongs to the horizon of the meaning of the dual definition of the term as meaning and as orientation. To speak about the spiritual dimension in a state of frailty means, therefore, to understand at a deep level its aspects which concern the character of human hopes, the future and the meaning of personal human life, that is to say the set of relationships with other people and with the surrounding world, and to bring out its influence in daily experience. For believers, there inevitably comes into play the relationship with the Other who is God and with the community of faith to which they belong.

Frailty

First of all, what do we mean by 'frailty'? What is it to be frail? In common parlance, fragility is the property that certain materials have to break brusquely without any resistance or previous deformations or weakening. In this sense, those objects that lack flexibility and resistance are 'fragile', for example glass. Hence the figurative meaning of the term by which the adjective 'fragile' (or 'frail') also applies to human personal and social situations in order to indicate their fundamental precariousness and weakness. A summarising description of this state is supplied to us by the seventeenth-century Frenchman, Blaise Pascal (1623-1662), in his observations on the grandeur and the smallness of man: 'Man', he observed, 'is but a reed, the weakest living thing in nature: but he is a reed who thinks. The whole universe does not have to arm itself to crush him: steam, a drop of water, are enough to kill him. But when the universe also crushes him, man is always more noble than what kills him, because he knows that he is about to die, and as regards the advantage that it has over him, the universe knows nothing'.

Although human frailty coincided with the appearance of the species (one need only think of the imperishable Greek myths, of tragic literature or of the Biblical accounts of man's origins), contemporary culture, instead, is marked by a 'widespread form of frailty due to difficulties in giving a meaning to one's life', which brings to mind the famous incipit of the Book of Ecclesiastes: 'Vanity of vanities! All is vanity' (Eccl 1:1).

In contrast to the past, contemporary frailty affects in a broad way the socio-cultural sphere, where a strong uncertainty is perceived as well as a generalised disorientation as regards the meaning of life and the severe trials that it imposes, in addition to tiredness and an existential boredom. This induces people to increasingly see how much frailty is, on the one hand, connatural to human life, which it overbearingly conditions, and, on the other, how much it has always presented various facets marked by various nuances of a spatial-temporal and historical-cultural character. For example, the frailty of a newly born child, who needs everything to survive, is, in fact, different from the existential frailty of an adult who is searching for the meaning of his or her life and professional and social role. In the same way, the frailty of an adolescent in his or her move from childhood to adulthood is different from the frailty of an elderly person who does not have physical strength, or of a sick person in intensive therapy, or again of a person with a permanent disability.
All of these frailties, however, have in common a condition of precariousness, a consequent malaise, as well as an impelling need for a person to provide concerned care and take care of the person involved through an action that is at one and the same time liberating, friendly and able to foster the greatest possible autonomy for those who are its beneficiaries. This expectation and invocation are in themselves a look towards a better future, a hope that is underway.

In such a perspective, human frailty is fundamentally a profoundly personal experience of the intrinsic limit that every human being must face. And when it finds practical expression in that form that can be referred back in a special way to illness and suffering, then it provokes in us a series of acute questions about the meaning of life and the surrounding world, about the meaning of human action and its inability to solve so many human problems, about the existence of certain things and the reason for evil, about the meaning of the condition of human existence, and in a special way about the reason for illness, suffering and death. Saint John Paul II made the following observations on this subject: 'Within each form of suffering endured by man, and at the same time at the basis of the whole world of suffering, there inevitably arises the question: why? It is a question about the cause, the reason, and equally, about the purpose of suffering, and, in brief, a question about its meaning. Not only does it accompany human suffering, but it seems even to determine its human content, what makes suffering precisely human suffering'.
Yes: our weakness, our frailties and our limits never thin out, not even in the face of our most striking successes, proofs of our strength, our thirst for power and the infinite! However, our frailty keeps us with our feet on the ground and asks us about the real substance of our projects, the real substance of the world that we are building, our values and our operational choices, etc. This is an alarm bell that makes us avoid the temptation to flee or forgo everything, rejection of the hardship of growth, pain, illness, disability, old age and death. And it is precisely at this point that the fundamental weakness is surreptitiously transformed into a powerful interior force and becomes an indispensable human value, which, as the Veronese psychiatrist Vittorino Andreoli puts it, makes us understand our true humanity.

But one comes to ask: how is it possible that frailty can become an inescapable human value? In his encyclical letter Spe Salvi, on hope, the Holy Father Benedict XVI, declares: 'The true measure of humanity is essentially determined in relationship to suffering and to the sufferer'. In other words, our being men and women of our time derives not so much from avoiding our condition of being frail and limited, but, rather, from our drawing near, whether a success or a failure, to suffering and the suffering people that we meet on our journey.

In a book of a few years ago, Cardinal Gianfranco Ravasi wrote about pain (a condition of evident frailty) that it is a metaphor, a human symbol. It unites within itself a multiplicity of meanings that affect the person in his or her totality. 'Suffering is a great human symbol which contains within it opposites: the silence and the word of God, the misery and the splendour of man, the most absurd darkness and the most luminous meaning, blasphemy and praise. It is, therefore, the great risk in which we all, sooner or later, find ourselves involved, enveloped and overwhelmed'.

And after referring to Kafka's Diaries and the Secret Book of D'Annunzio, he adds: 'Suffering is never only physical, it symbolically involves corporealness and spirituality, the frame and the soul'.

As is well known, illness never coincides with its symptoms and the pain of the sick organ inevitably has consequences for the whole organism and profoundly involves all of the dimensions of the person — the physical, the psychological and the spiritual. Thus human frailty, if well understood, is an invitation to man to open himself to the highest of horizons – the overcoming of himself. This is what Saint John Paul II observes in his apostolic letter Salvifici Doloris on the meaning of human suffering: 'even though man knows and is close to the sufferings of the animal world, nevertheless what we express by the word "suffering" seems to be particularly essential to the nature of man. It is as deep as man himself, precisely because it manifests in its own way that depth which is proper to man, and in its own way surpasses it. Suffering seems to belong to man's transcendence: it is one of those points in which man is in a certain sense "destined" to go beyond himself, and he is called to this in a mysterious way'.

We thus understand why instead of diminishing the singular preciousness of human life, the condition of frailty exalts it, and at the same time the need to take care of it in every circumstance and context — and in particular in a situation of grave and incurable illness — is made stronger and more urgent. The dignity of the person certainly does not depend on his or her efficiency or how much he or she is worth in the eyes of other people.

In the Christian vision of life and of human life in particular, frailty is taken on and opened to hope by the Divine Word made flesh, who came into the world 'that whoever believes in him should not perish but have eternal life' (Jn 3:16). As is borne witness to in the Gospels, the life and the mission of Christ, from his Incarnation until the Resurrection, is an intertwining of frailty and hope. During his earthly life, indeed, the tribulations of life, its sufferings, the trials of a tiring and difficult journey, are neither ignored nor cancelled but, rather, taken on, opened and shared. They find meaning in participation in that redemptive love that took Christ to the cross for the salvation of the world and made St. Paul cry out: 'I complete what is lacking in Christ's afflictions for the sake of his body, that is, the Church' (Col 1:24).

Spirituality

When one speaks about the spiritual in general one refers either to the life according to the Spirit of the domain of Christian theology or to the human 'dimension often called the "heart", which is the soul, interiority, the ability to enter into a relationship with God', according to a conception of a more philosophical matrix. In the experience alluded to, the two dimensions refer to each other and often penetrate each other, without necessarily coinciding or being opposed.

In an article of a few years ago with the emblematic title 'Spirituality and End-of-Life Care', Shannon and Tatum wrote: 'Whereas patients at the terminal stage adapt to the irreversible nature of their illness, their needs like the centre of their care change. Spiritual questions can become a fundamental concern for them; addressing these problems can be a key to alleviating their suffering'. The question that arises spontaneously is that of knowing what is meant by 'spirituality' in such a precise field as medicine. The answer is less immediate! Although there exist major convergences both in medical literature and in the literature of the suppliers of health-care services in emphasising the importance of the spiritual dimension in care for sick people, especially those who are at the terminal stage, divergences emerge immediately when it is a matter of giving a definition of the term 'spirituality'. Some link it to faith in God; others limit it to a scale of values that are not necessarily only material. These last try to define spirituality in a very broad sense and above all not in religious terms so as to make it a more inclusive concept. Addressing the subject with reference to the medical literature of North America, Proserpio and Clerici write: 'The term spirituality implies a sense of transcendence that is not necessarily identified with God, a sense of universal unity with other people and with the world that does not necessarily require a participation in rites'.
However, spirituality has historically been defined in religious terms, with reference to an immaterial component of human nature and its relationship with the divine. Moved by a need for a greater inclusiveness, a large part of the medical literature in this field sees spirituality simply as a search for the meaning of one's life. Even though this does not correspond to the origins of the term (spirit) or to its use in history, it remains a pragmatic definition for medicine inasmuch it captures the practical meaning of the traditional meaning of the concept without excluding the philosophical and non-religious meaning. From this point of view, there is a clear distinction between spirituality and religion but without there being necessarily a separation. Thus Koenig, McCullough and Larson define spirituality as 'the personal search for satisfying answers to the ultimate questions about life, meaning and the relationship with the sacred or transcendent world, able or otherwise to lead to the emergence or development of religious rituals and the formation of community'. This is echoed by Fr. Bernard Charles André SJ, the former Professor of Spirituality at the Gregorian Pontifical University, who sees in spiritual life not only the need to become aware of lived reality but also a commitment to its growth through the achievement of a personal progress according to the values adopted to begin with, which, for a Christian, come from faith in Christ.

Towards a Spirituality of the Person in a State of Frailty

The previous observations on the concepts of frailty and spirituality, whose purpose was prevalently clarification, have indirectly directed our gaze to the need and urgency for frail people to look towards the broad horizons of transcendence and – why not? – of faith. This is required by the acute question about the meaning of life, the meaning of the human condition, the meaning of the values that we choose and cultivate, and the reason for suffering and death. Now, we ask ourselves, can values and experiences that are quintessentially spiritual affect a frail life, and, if so, in what ways? Starting from the human sciences, an influential current of thought which has largely been developed in the United States of America is advancing a very original and interesting interdisciplinary analysis of the subject. Prof. Dharma Singh Khalsa, the President and a consultant of Alzheimer's Prevention International (Tucson, Arizona), begins his article in which he describes the deliberations of a conference organised some years ago in Rochville (Maryland) by the International Center for the Integration of Health and Spirituality on the subject of 'The Integration of Health and Spirituality' with the following question: 'Are religious practices and spiritual experience good for your health?' On the basis of the results of specific investigations, the answer is decidedly in the affirmative, according to the speakers who gave papers at the above-mentioned conference. In the past, and the recent past as well, Prof. Idler observed, the benefits of religious practice for physical and mental health were not perceived. Religion was practised for its own sake because it was held to be true, and, as a consequence, for its moral and spiritual values. Now, medical doctors had also discovered its positive influence in health. Thus they began to personally encourage their patients to follow their own inclinations in religious matters. Thus things were changing and according to scientific research, thought to be serious, sponsored by the National Institute of Health – which in the meantime had become the International Center for the Integration of Health and Spirituality, religious practice and spiritual life procure a lasting benefit whose effects are cumulative. Recourse to religion and spirituality during moments of serious difficulty is a constant in the history of humanity. For example, Professor Koenig, of the Duke University School of Medicine, the founder and director of the Center for Study of Religion/Spirituality and Healthy, observed that since the attacks in New York of 2001-2013, 90% of Americans had turned to religion and spirituality to deal with the stress and grief generated by the dramatic situation that had been created. The values most referred to were forgiveness, giving meaning to things and a sense of belonging. The benefits of spiritual life and religious practice are also extended to social life in terms of cohesion and the search for harmony and a strengthening of justice.

A distracted mind could think that these authors had discovered the blindingly obvious because the Church has taught and practised these things ever since her foundation, referring to the example of her divine Founder and Teacher. This, however, would be to ignore the influence of the scientistic ideology in the field of medicine which has led man to be seen solely with reference to his biological dimension and to leave aside that quintessentially biographical dimension which is so dear to the humanistic idea of man. This concept is better explained by Saint John Paul II in the Motu Proprio by which he instituted the Pontifical Commission for Pastoral Assistance to Health Care Workers (which later became a Pontifical Council) in which he points to the idea of the person which guides the Church as she draws near to suffering man: she is interested not only in his physical sub-stratum but also, and above all else, in his somatic-spiritual unity because it is known how often 'the illness which is manifested in the body has its origins and its true cause in the recesses of' the human psyche'. And Prof. Pangrazzi makes the precise point that: 'Healing is not limited to the corporeal, it also concerns the mind (the way of thinking about and looking at things), the heart (healing feelings and wounds), and the spirit (fostering reconciliation with God, suffering, other people, oneself and one's own past'.

The Holy Father in his encyclical Spe Salvi speaks about 'settings where we can learn in practice about hope and its exercise'. Amongst these, he gives pride of place to prayer as a school for hope: 'A first essential setting for learning hope is prayer. When no one listens to me any more, God still listens to me. When I can no longer talk to anyone or call upon anyone, I can always talk to God. When there is no longer anyone to help me deal with a need or expectation that goes beyond the human capacity for hope, he can help me. When I have been plunged into complete solitude...; if I pray I am never totally alone. The late Cardinal Nguyen Van Thuan, a prisoner for thirteen years, nine of them spent in solitary confinement, has left us a precious little book: Prayers of Hope. During thirteen years in jail, in a situation of seemingly utter hopelessness, the fact that he could listen and speak to God became for him an increasing power of hope, which enabled him, after his release, to become for people all over the world a witness to hope – to that great hope which does not wane even in the nights of solitude'.

The Church, through her presence in health-care institutions, through her gospel teaching and her practice of the sacraments, and in particular the Eucharist, reconciliation and the anointing of the sick, carries out her mission to proclaim the Gospel of life, reminding everyone that with Christ suffering took on a new status: from being a temptation it became an opportunity for spiritual growth. But this does not mean that it should in any way be sought for its own sake: 'Christianity does not make suffering an end of the spiritual life, or its obligatory instrument. The spiritual goods acquired in suffering are not received from it but through the opportunity it offers. And they depend less on suffering itself than on the approach that man adopts towards it'.

Paper given on the occasion of the FIASO-AGESPI national conference on 'The Frail Person: Scenarios and Models of Care and Assistance', Milan, 22 November 2010

Spirituality in Frailty: Prayer and Healing

Many people drew near to Jesus during his public ministry, directly or through relatives and friends, and they asked him to restore their health. The Lord welcomed these requests but always insisted that these people should have faith. 'If you can!', answered Jesus, 'all things are possible to him who believes' (Mk 9:23). For centuries, people of faith have offered up prayers for the sick, often with surprising results. In recent times medical research has shown in a consistent way that faith and prayer have positive results for sick people. Holy Scripture illustrates the force of prayer, including prayer for the recovery of the sick, which is based upon faith and trust in God. Thus the Apostle James exhorts us to raise up prayers of faith and not only prayers of supplication: 'Is any among you sick? Let him call for the elders of the church, and let them pray over him, anointing him with oil in the name of the Lord and the prayer of faith will save the sick man' (Jas 5:14-15).

Convinced of the therapeutic power of faith, the Christian tradition sees prayer as an instrument of healing. In this area, prayers can be offered up by the sick person, for the sick person and together with the sick person. Often people ask for healing, for grace or for the capacity to accept illness in a spirit of faith and conformity with the will of God. Healing obtained through the power of prayer has different forms. It can mean the recovery of physical health or of a mentally-ill person, or social and spiritual harmony even when complete physical healing has not been achieved. Prayer truly contributes to transforming illness into a journey of faith that gradually helps a sick person to strengthen his or her relationship with God, to learn the lesson of weakness and human limitation, to have a renewed adherence to the fundamental options of life, to grow in solidarity with those who suffer, and to deepen faith in eternal life.
It is therefore praiseworthy that the faithful ask for healing for themselves and for other people. In addition, the Church prays for the health of the sick in her Liturgy. In celebrating the sacrament of the anointing of the sick she commends her sick members to the Lord so that He may give them relief and save them. Obviously enough, recourse to prayer does not exclude, indeed it encourages, the use of natural instruments which are useful in conserving or recovering health, as indeed it also leads the children of the Church to take care of the sick and give them relief in body and spirit, trying to defeat illness.

Indeed, 'part of the plan laid out in God's providence is that we should fight strenuously against all sickness and carefully seek the blessings of good health'.

Prayer should also be offered up for those who are involved in providing assistance to the sick in our communities. It is important to remember that medical/health-care activity is a ministerial instrument of the effusive love of God for suffering man; and it is at the same time a work of love for God which is manifested in loving care for man. For a Christian it is an actualising continuation of the therapeutic charity of Christ who passed by doing good and healing everyone. The service rendered by a health-care worker is also an expression of love for Christ, who takes on the face of the suffering brother or sister (Mt 25:31-4). Catholic health-care workers should, therefore, accompany their work with prayer so that they can be strengthened and guided by the Holy Spirit and be effective instruments of this mission.

Message on the occasion of the Tenth Pan-American Annual Dialogue of Catholic Health Care, Valle de Angeles, Honduras, 20-21 April 2010 without the first paragraph.


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