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Hands-On Care for Those in Later-Life Stages

By Ann Catlin, LMT, NCTMB, OTR

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Have We Created a Touch Deprived Society?

I recently attended a memorial service for a long-time friend of my husband's. There were lots of people there; some I knew well, others were strangers. Mingling at the reception I noticed how much people were touching. I bet I gave and received 25 hugs, not to mention handshakes and greetings that included touching an arm or shoulder. Since I was in the midst of writing this article, I wondered why we are so much more open to touch in this personal situation when, as a society, we're disconnected from it. Come to find out, I'm not the only one asking. Scientists and researchers in neuroscience and human behavior are, too. Touch is getting its due attention. Bit I wonder, have we created a touch deprived society?

Hard wired for touch

It's long been acknowledged that touch is the first sense babies develop in the womb and that holding the baby at birth cements a bond between mother and child and that babies need physical contact to develop and thrive. My training in occupational therapy included how to assess and treat tactile and sensory dysfunction, a common symptom of disease or trauma of the nervous system. I could tell you all about a patient's ability to feel a pin prick in precise tactile tracks in the body (dermatomes) or distinguish a comb from a fork just by feel (sterognosis). But I don't recall ever discussing the emotional impact of human touch. Denworth (2015) tells us, [Scientist's] growing body of research has uncovered another dimension of touch that is separate from its discriminative function. This newly recognized system, known as affective or emotional touch, consists of nerve fibers triggered by exactly the kind of loving caress a mother gives her child. It is possible that these neurobiological foundations of attachment might play a far more significant role in human behavior that has been recognized, forging connections and increasing our chance of survival. "Hertenstein et. al., (2009) investigated our ability to distinguish or decode distinct emotions from touch alone, without the context of facial expression and body language. They found that people reliably decoded emotions of anger, fear, disgust, love, gratitude and sympathy when touch was the only means of communication. I wonder if our current social habits detach us from this potent means of communication and human connection.

hug - Copyright – Stock Photo / Register Mark Can we Skype Grandma?

I've thought some about the use of various technologies and how they enhance the lives of our elders. Many grandparents have discovered the "Skype visit." These long-distance visits can help families stay connected or help family members monitor how grandma is doing. While I believe that these "Skype-visits" are a good thing, I do question if some families will skip the trip to grandma's and substitute a Skype-visit instead. There's no substitute for a real visit where people share an experience; where grandparents feel and touch their grandchildren who then can remember what grandma's wrinkly skin felt like or the smell of her Jergen's lotion; where grown children take time to simply show up and be present. Technology will play a huge role in aging baby boomer's lives, but maybe we should keep some good old fashioned visits along with it. As a new grandmother, I can tell you there's no substitute for holding that little baby boy who will someday call me Nana.

The Daycare Dilemma

I was a working mom and was really lucky that my workplace had an excellent daycare center and preschool on-site. For the babies, they had volunteer "grandmas" whose only job was to sit in rocking chairs and hold the kids. One grandma took a liking to my baby son and held him a lot. I loved that! Even the older kids swarmed around these women. I would like to think those ladies would still be there. But I wonder when the notion of touching kids in daycare and schools is laden with fear and anxiety in today's risk-avoidance culture. Piper, H. and Stronach (2008) examined this issue in depth and found that daycare workers and teachers "hands are tied" by policies aimed at protecting children but their sensible instincts suggest the rules are an unnatural way of caring for kids.

The Doctor/Patient Relationship

A favorite story of mine is told by Dr. Abraham Verghese in a 2013 TED talk. Dr. Verghese appeals to physicians the importance of a hands-on physical examination of their patients at a time when MRI's, CAT scans, blood tests, and tele-medicine have replaced the ritual of palpating and listening. I share an excerpt from his presentation as he tells it because I think his words are so powerful.

"I recall one patient who was at that point no more than a skeleton encased in shrinking skin, unable to speak, his mouth crusted with candida that was resistant to the usual medications. When he saw me on what turned out to be his last hours on this earth, his hands moved as if in slow motion. And as I wondered what he was up to, his stick fingers made their way up to his pajama shirt, fumbling with his buttons. I realized that he was wanting to expose his wicker-basket chest to me. It was an offering, an invitation. I did not decline. I percussed. I palpated. I listened to the chest. I think he surely must have known by then that it was vital for me just as it was necessary for him. Neither of us could skip this ritual, which had nothing to do with detecting rales in the lung, or finding the gallop rhythm of heart failure. No, this ritual was about the one message that physicians have needed to convey to their patients. Although, God knows, of late, in our hubris, we seem to have drifted away. We seem to have forgotten as though, with the explosion of knowledge, the whole human genome mapped out at our feet, we are lulled into inattention, forgetting that the ritual is cathartic to the physician, necessary for the patient, forgetting that the ritual has meaning and a singular message to convey to the patient. And the message, which I didn't fully understand then, even as I delivered it, and which I understand better now is this: I will always, always, always be there. I will see you through this. I will never abandon you. I will be with you through the end." I relate to this story very much. I have a hospice client now that I've seen for three years. We have a ritual to our session. She likes having her back massaged with lotion or powder and, although it's an effort for her, she lowers her robe so she can feel my hands on her skin covering her emaciated back. After the massage, her face, and my heart, is filled with gratitude.

I believe that perhaps our real work as massage therapists, regardless of your clientele, is to help usher in a new age where human touch returns to its rightful place in our world. There are lots of signs of hope such as these telling lyrics in Greek electropop band the Berlin Brides' song, Ballad for the Touch Deprived:

I'm living my life in perfect bliss
Though there's one thing I truly miss
I sing this ballad for the touch-deprived
If you hold my hand I'll be revived

References

  1. Denworth, L. (2015) The Social Power of Touch, Scientific American Mind, Volume 26, Number 4, pgs. 30-39.
  2. Hertenstein, M. and Weiss, S., (2011) The Handbook of Touch: Neuroscience, Behavioral, and Health Perspectives, Springer Publishing, 11 West 42nd Ave, New York, NY 10036.
  3. Hertenstein, M. el. Al. (2009) The Communication of Emotion via Touch; Emotion: American Psychological Association Vol. 9, No. 4, 566–573.
  4. Piper, H. and Stronach, I., (2008) Don't Touch: The educational story of a panic. Routledge 270 Madison Ave., New York, NY 10016.
  5. Verghese, A., (2013) A Doctor's Touch, accessed at https://www.ted.com/talks/abraham_verghese_a_doctor_s_touch/transcript?language=en.
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