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Can We Touch?

Physical contact remains vital to health, even as we do less of it. The rules of engagement aren’t necessarily changing—they’re just starting to be heard.

The Atlantic

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Tiffany Field has spent decades trying to get people to touch one another more.

Her efforts started with premature babies, when she found that basic human touch led them to quickly gain weight. An initial small study, published in the journal Pediatrics in 1986, showed that just 10 days of “body stroking and passive movements of the limbs” for less than an hour led babies to grow 47 percent faster. They averaged fewer days in the hospital and accrued $3,000 less in medical bills. The effect has been replicated multiple times.

Field, a developmental psychologist by training, went on to found the Touch Research Institute at the University of Miami’s Miller School of Medicine. She was a pioneer in highlighting the effects of “touch deprivation” among kids, famously those in orphanages. She explained to me that the effects are pervasive, influencing so many bodily systems that kids are diagnosed with “failure to thrive,” resulting in permanent physical and cognitive impairment, smaller stature, and social withdrawal later in life—which often includes aversion to physical contact.

Physical touch doesn’t make adults larger, but its effects are still coming to light. Field has published similar findings about the benefits of touch in full-term infants, and then children and pregnant women, adults with chronic pain, and people in retirement homes. Studies that involved as little as 15 daily minutes found that touch alone, even devoid of the other supportive qualities it usually signifies, seems to have myriad benefits.

The hug, specifically, has been repeatedly linked to good health. In a more recent study that made headlines about hugs helping the immune system, researchers led by the psychologist Sheldon Cohen at Carnegie Mellon University isolated 400 people in a hotel and exposed them to a cold virus. People who had supportive social interactions had fewer and less severe symptoms. Physical touch (specifically hugging) seemed to account for about a third of that effect. (The researchers conclude: “These data suggest that hugging may act as an effective means of conveying support.”) Cohen and his colleagues continued to show other health benefits of physical contact, such as a 2018 reveal in the journal PLOS titled “Receiving a Hug Is Associated With the Attenuation of Negative Mood That Occurs on Days With Interpersonal Conflict.”

Part of the reason this research didn’t happen sooner is that it was seen as extremely obvious. Yet even as evidence of the importance of physical touch has piled up, the world has been moving in the opposite direction. “You don’t see people touching each other anymore, in large part because they’re all on their phones and iPads and computers,” Field said. “It’s very disturbing to see parents doing less touching of kids, if they’re just sitting there on screens.”

The dissonance of people benefiting from touch but doing less of it is only made more confusing by statements like Joe Biden’s. In a video posted to his Twitter account in April 2019, a response to widespread concerns about excessive hugging and incidents of hair sniffing and the like during his time as vice president, the 2020 presidential candidate said he had no intention of making anyone uncomfortable. He then pivoted to claim that people are less open to being touched: “Social norms have begun to change. They’ve shifted, and the boundaries of protecting personal space have been reset, and I get it, I get it. I hear what they’re saying. I understand it.”

The explanation raises the question: Are boundaries changing? (And does Biden get it?)

The research is clear on that fact that people both need and react well to physical touch—in controlled environments. There is no evidence that people like to be touched any less than in previous generations, only that negatively received touch is more openly vocalized. What’s new is that people who didn’t appreciate being touched in previous decades, or who were always made uncomfortable by it, especially from people in positions of power, are empowered to process the fact that it’s not something they need to put up with. They have platforms for speaking up, channels for recourse, and supportive listeners to cushion the blowback.

“There is a lot of research on how touch is hierarchical, and males can touch females but not vice versa,” Field said, noting that caretakers in nursing homes tend to touch female residents much more than males, and the latter are at higher risk of touch deprivation. “I think some of that is reflected in what’s going on, where people are seeing the hierarchical aspect of the touch and not the supportive aspect.”

Attributing situations like Biden’s to an overall change in people’s willingness to be touched is a sweeping claim that stands to make a physically isolated culture even more so. As we get more isolated, Field argues, we need platonic touch more than ever, even if we don’t realize it. A vicious cycle is happening, wherein the less people initiate, the more abnormal it seems when someone does, and the more likely it is to be upsetting. “I think Biden’s got it right that it’s generally good to show physical affection as a way of supporting people,” Field said—with the caveat that any touch is imbued with meaning, and that people bring different histories to their responses.

So how should a person go about touching?

It’s not that there are new, mysterious rules that are constantly changing, Field said. Limits of acceptability have always existed. The key to practicing touch well is to appreciate the emotional power—which is the basis of all the positive effects, and so the basis of much potential for negativity. If anything, knowing that people bring a history of emotional experiences to each new touch can inform better, healthier interactions.

The phenomenon of reacting to touch is often described as an autonomous pathway, which it technically is: Receptors in the skin detect pressure and temperature and movement, and these signals shoot up the spinal cord and into the brain, which adjusts its chemical output accordingly. That the emotional responses become physical in predictable patterns suggests that our bodies evolved to respond favorably to touch—or at least, to miss out on benefits when we are physically isolated. MRI scans show physical touch activating areas of the cerebral cortex, and other studies show decreased heart rate, blood pressure, and levels of the stress-related hormone cortisol. Massage therapy has proven effective for depression, and neurotransmitters that modulate pain are stimulated by touch.

It’s as if all the things we’re promised in bottles of dietary supplements and luxury serums is right there in one act that can be costless and readily available.

But even for all the benefits shown in research, it’s not so simple as to say that hugs are good or hugging is healthy. If it were, we’d all have hug robots that we’d hug all the time. Some of us would get addicted. Some would die of dehydration in the arms of the machine. Even people who have no memory of being touched can be affected by it. A hand on the shoulder, one study found, made subjects more likely to agree to a request. Though the firing of synapses in the skin that fly up to the brain is an automated process, it’s modulated by other inputs. The exact same touch would likely be received differently from a person who is smiling versus a person who is laughing maniacally.

The simplistic message that personal boundaries are being redrawn is a missed opportunity to think about how touch is supposed to work. This doesn’t need to draw on some idea of political correctness; it’s right there in the studies. None of the touch studies involved unwanted, unexpected, or unpredictable touch. For example, Field did a study to see whether the effects of massage therapy were different in people who had and had not experienced past sexual abuse, and there was no apparent difference—both groups saw similar benefits. But this should not be expected to apply to the way both groups would react if a man on the subway initiated a shoulder massage.

The unwanted hug is an act on a spectrum of submission that produces neurochemical responses similar to any other violation of autonomy, from having a credit-card number stolen to feeling your car lose traction on the highway. A perceived absence of control becomes a spilling of neurotransmitters from the brain into the blood. If a boundary is being redrawn, it’s around people’s ability to continue to make others feel that. The benefits of a hug evaporate when a person perceives it as aggression. The trove of pro-touch research involves consenting volunteers and professional researchers in controlled scenarios where the interaction isn’t loaded with potential for escalation, or imbued with subtext or meaning based on prior interactions. In the real world, the exact same touch might cause blood pressure and heart rate to increase, and stress hormones to surge.

If it can be said that touch has medicinal properties, then, like any medicine, touch is not good for everyone in every situation. To play the metaphor out: Appropriate dosages vary, and any particular responses are dependent on what’s already going on with that person. This is why many doctors start a medication at a low dose and monitor the patient’s response closely. If it’s well received, the doctor can titrate dosing up and, over time, be less vigilant about monitoring for adverse reactions.

The analogy, of course, isn’t perfect, but experts in platonic touch advise the same: Start with small gestures. Some people might recoil at a touch on the shoulder; others will reach back and touch yours. It is not some mysterious code that should scare people into simply never trying to touch anyone—but it is a code predicated entirely on power dynamics. Just because a person is not actively pushing someone else away does not mean that touch is well received. Active reciprocity may be the surest sign, though even that is imperfect.

If the current lexicon of physical touch feels too loaded with meaning, there is also room for innovation. Americans largely practice one of two types of hug: the full-body press that’s generally reserved for close relationships, or the “A frame” type: bending at the back, partially twisting, and barely even touching. There are many ways to deviate from the hug canon in less awkward and potentially even fun ways, Field noted, citing a book of hugs numbering more than 300 in type—written by someone named “Dr. Hug,” whose credentials I can’t verify. “We’re getting a lot of calls about cuddling groups,” Field said with some degree of marvel, “which I think is related to a decline in touch not just among strangers, but even among intimate couples.”

In his statement, Biden went on to say that he is always seeking out “human connection” because “life is about connecting to people.” This is difficult to disagree with, but it carries the implicit qualifier that life is about connecting with people in meaningful, mutually beneficial ways. People always have and always will find meaning in life via positive connection, and there is all the more reason to consider the role of physical touch in that.

Field is already hearing from men who have told her that after “this Biden episode,” they believe they need to wait for women to initiate physical contact, if there is to be any. “I do think men need to be more careful. Which can be unfortunate for genuinely affectionate people,” Field said. “And if women want to be touched, then it may be that they’re going to have to initiate.”

James Hamblin, MD, is a staff writer at The Atlantic. He hosts the video series If Our Bodies Could Talk and is the author of a book by the same title. | More

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This post originally appeared on The Atlantic and was published April 10, 2019. This article is republished here with permission.

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