Historian Amie Bolissian reflects on the Northern Network for Medical Humanities Research Congress’s “Ageing” panel back in the spring of 2021.
Throughout written history, European cultures have associated the changing seasons with stages of a human life. With its new beginnings and rebirth, spring is usually linked to youth, while old age is depicted as decaying winter. As we head into autumn, I am now looking back and reflecting on an unexpected ‘Spring of Old Age’ I experienced earlier this year.
There is no reason why old age cannot be associated with new beginnings, projects, learning, and rebirth, as the continuing efforts of ‘positive ageing’ messages and policies have tried to emphasise, and spring 2021 provided an abundance of new and exciting events and scholarship on old age that spoke to this idea. I’ve already discussed the stimulating ‘Old Age Care in Times of Crisis: Past & Present’ Symposium – held by London School of Hygiene and Tropical Medicine and Birkbeck, University of London – elsewhere on The Polyphony, but here I would like to discuss the ‘Ageing’ panel at the Northern Network of Medical Humanities Research Congress, which focused on the theme of ‘(In)visibility’.
As a historian of early modern ageing health, I found the diverse range of papers in this panel, given by a literary scholar, artist, and linguist, inspirational in the creative ways they challenged depictions of ageing ‘decline’, and many of the themes chimed with my own research in ways I hadn’t expected. The three speakers at the NNHMR presented work that sought to interrogate the sorts of cultural assumptions that either relegate older adults to archetypal and predictable wintry degeneration and dissolution, or ignore age-related suffering in favour of exclusively ‘positive’ messaging.
The first speaker was Dr. Elizabeth Barry, Associate Professor of English and Comparative Literature at the University of Warwick. Barry’s insightful paper ‘Between Chronicity and Crisis: the Elusive Time of Frailty’ explored ways in which the process of ageing, as revealed through the writings of the twentieth and twenty-first-century memoirists and philosophers, can broaden understandings of how humans experience time, change, and selfhood. Focussing, in particular, on Joan Didion’s memoir Blue Nights – with its themes of old age and motherhood – Barry demonstrated how to approach the subject of health changes in old age in an admirably balanced way. Not dwelling solely on catastrophic senescent deterioration, nor taking ‘positive ageing’ to the extremes of denying a person’s experiences of fear, disorientation, or physical and emotional suffering in old age, Barry investigated ideas of frailty and vulnerability.
I am a researcher who struggles with a personal bias towards optimism and positivity, always trying to moderate my rose-tinted perceptions and acknowledge the empty half of the glass. Thus, I was inspired by Barry’s unflinching and in-depth explorations into the experience of ageing. It is true that previous bleak and miserable histories and depictions of old age told only a portion of the story. Nevertheless, in our efforts to highlight the lived experiences and power of hitherto neglected historical actors, we can sometimes focus too heavily on their triumphs – shying away from the suffering right in front of us in the sources. Barry provided sensitive interpretations of the complex, multi-layering of disadvantages and benefits that can manifest with the changes in old age. For example, she explained how Didion’s disturbing loss of embodied confidence and spontaneity, as she aged, had afforded the writer fresh insights into what it was like for those, such as her own daughter, who had lived with bodily and/or mental ‘frailty’ for their entire lives.
This notion that a perceived deterioration might provide a new perspective was also a theme resonant in the artist and researcher Lucy Carolan’s paper ‘Picturing a cloud of unknowing: photography, lostness and cognitive decline’. Carolan cited Craig Dworkin’s statement that ‘Erasures obliterate; but they also reveal; omissions within a system permit other elements to appear all the more clearly’, and her artworks and research demonstrated this movingly.
Interrogating perceptions of loss and lostness in dementia, she persuasively argued for the value of practice-based visual arts research in articulating and conceptualising experiences of dementia. Through Carolan’s own photographs and object pieces, we saw how the ‘lostness’ and disorientation that often accompanies certain types of dementia might be explored via the visual, along with effects on memory, and temporal and spatial perception.
The image of clouds, in particular, were revealed to be a recurring metaphor for altered states of mind in descriptions of cognitive decline; with their historical and modern-day invisible/visible associations with obfuscation, and as repositories of memories. Carolan has also used metaphors of books, libraries, and tangling as persistent motifs. Her striking layered artwork involving rectangular book-shaped Perspex blocks with images of clouds embedded within, suspended above the ground, was both affecting and intriguing. Each work managed to simultaneously invoke the intimidating solidity and spatiality of cognitive blockage and obscurity, while showing how these states might also be transparent, fragile, and mutable.
The mutability and unpredictability of cognitive decline, and dementia as a ‘slippery’ concept, also featured in applied linguistics doctoral researcher Emma Putland’s final paper of the panel: ‘Seasonal Changes: Visualising the Changes of Dementia’. Putland’s presentation showed how illustrations of cognitive decline used by charities and in the press, often depict a steady, relentless deterioration of faculties and personhood, like the changes of the seasons.
Putland’s ground-breaking collaborations with those living with a dementia diagnosis, and their caregivers, challenge these conceptualisations, interrogating the assumptions that age-related cognitive disorders progress in a constant, predictable manner. Her interviews and focus groups, where patients and carers discussed published press images of dementia campaigns, showed that perceptions of the experience of dementia were more erratic and sporadic, with ‘good’ days and ‘bad’ days, and unique to every person. One illustration, used by a number of charities and news outlets, of a human profile shaped like a tree, with its leaves changing colour and then falling away as if in autumn, conveys the notion of a permanent and natural decay. This was not the experience of Putland’s interviewees, and their responses resonate with some of my own findings, three hundred years earlier.
Early modern English culture was prone to defining ‘the winter of old age’ by its own limited set of stereotyped attributes. The theologian Lewis Bayly described old age as a ‘receptacle of all maladies’ and a terrifying stage of ‘stooping under dotage, with … wrinckled face, rotten teeth …having no use of any sense, but of the sense of paine’. The notions of a still active and relevant early old age – or ‘third age’ – and Gilleard and Higgs’s ‘social imaginary’ of the dependant and decrepit ‘fourth age’, also have their early modern equivalence. The civil war surgeon Thomas Brugis, claimed that recent writers had endorsed a two-stage model of old age, creating a boundary between an active stage with little ‘manifest debility of strength’, and a final ‘decrepit’ old age.
In many medical and cultural works, however, the Galenic threefold division was favoured, which included a symbolically significant, and variable, ‘declining’ old age between the vigorous and decrepit stages. This declining phase of old age was neither predictable nor steady. Moreover, the life-writings of those who self-identified as ‘old’ or ‘aged’ indicate that, not only were the chronological boundaries between these various stages of old age flexible, but they were also porous. State of health was a major defining factor of old age; health, or a person’s perceptions of their own health, might change for better as well as worse.
As infirmities multiplied or receded, a person’s perceptions of their own ageing adjusted. Each malady had its own complex significance for the patient, according to how it affected their embodied and spiritual lived experiences. Their ageing health was constantly in flux, and they were fully aware of this.
While diarists might at times have described steady decline, at other times there might be a sudden senescent drop-off, or even a welcome reprieve and seeming rejuvenation. Unlike the ‘event horizon’ of the decrepit ‘fourth age’, with all of what Marlene Goldman has critiqued as its ‘gothic horror’, it was possible to return from the ‘black hole’ of early modern decrepitude and proximity to death. Seventeenth-century Essex farmer, Ralph Josselin wrote in his diary at the age of 64, while both he and his wife were suffering from serious illness, ‘I hope this sickness recovered will even make us young againe’. Thereby, hopefully, engendering a welcome Spring of Old Age.
Amie Bolissian is a Wellcome-funded doctoral researcher at the University of Reading, specialising in the history of health, medicine, and emotions. Her PhD study, ‘The Aged Patient in Early Modern England c.1570-1730’, investigates medical understandings of old age, and the experiences and feelings of older patients, and those that cared for them. She tweets at @AuntieAmie.
 D. Keeble-Ramsay, ‘Exploring the Concept of ‘Positive Ageing’ in the UK Workplace-A Literature Review’, Geriatrics (Basel), 3/4 (Oct 18 2018)
 Craig Dworkin, No Medium, (Cambridge, MA, 2015), 9.
 Lewis Bayly, The Practice of Pietie, (London, 1613), 87.
 Chris Gilleard and P. Higgs, ‘Aging without agency: Theorizing the fourth age’, Aging & Mental Health, 14/2 (2010/03/01 2010), 121-28.
 Thomas Brugis, The Marrow of Physicke (1648), 10.
 Marlene Goldman, ‘Re‐imagining dementia in the fourth age: the ironic fictions of Alice Munro’, Sociology of health & illness, 39/2 (2017), 285-302, 286; Gilleard and Higgs, ‘Ageing without agency’, 210.
 Ralph Josselin, The Diary of Ralph Josselin, 1616-1683, Alan Macfarlane ed. (London, 1976), , 630.
Bayly, Lewis, The Practice of Pietie, (London, 1613).
Brugis, Thomas, The Marrow of Physicke, (London: 1648)
Dworkin, Craig, No Medium, (Cambridge, MA, 2015).
Gilleard, Chris and Higgs, P., ‘Aging without agency: Theorizing the fourth age’, Aging & Mental Health, 14/2 (2010/03/01 2010), 121-28.
Goldman, Marlene, ‘Re‐imagining dementia in the fourth age: the ironic fictions of Alice Munro’, Sociology of health & illness, 39/2 (2017), 285-302.
Josselin, Ralph, The Diary of Ralph Josselin, 1616-1683, Alan Macfarlane (ed.) (London, 1976).
Keeble-Ramsay, D., ‘Exploring the Concept of ‘Positive Ageing’ in the UK Workplace-A Literature Review’, Geriatrics (Basel), 3/4 (Oct 18 2018).