En español | She hates climbing into a cold bed. Beverly Herzog has been widowed for 21 years, but she still can't get used to this absence. She married at 18, and every night for 49 years, her husband, Bernard, was snuggled up next to her. "I miss that terribly," she says.
She bought a body pillow, which helps a little. But it's not the same. The truth is, there's no replacement for human contact, even if — maybe especially if — you're 88. "I like being touched, being stroked, being held," says Herzog, who lives in the Hebrew Home at Riverdale, a skilled nursing facility in New York. "Anyone who says they don't isn't telling the truth. You feel abandoned if you haven't been touched. We all need somebody."
The Hebrew Home has put an unusual emphasis on that idea. Staff here are encouraged to hold residents' hands and offer gentle caresses. Beauticians are trained to massage the feet during pedicures, as well as the scalp and neck during shampoos. And intimate relations between residents are not discouraged — a rarity in long-term care. Since she moved here almost three years ago, Herzog hasn't fully taken advantage of this groundbreaking policy, but she's been able to enjoy the company of "a few gentlemen," she says — though their dates sound as chaste as those of mid-century teenagers. "I won't be intimate with just a Johnny-come-lately who walks off the street," she says. "But I'm in favor of people being close. People like to feel alive. How do you feel alive? Being close to somebody."
When you're younger, it might be easy to take touch for granted. The skin is our largest sensory interface with the world. And it's always on. We can close our eyes or plug our ears to imagine losing sight or hearing, but it's hard to imagine losing the ability to feel. It's thought to be the first sense that we develop in the womb. Depriving newborns of touch is a disaster — growth is slowed, and serious cognitive and behavioral disorders emerge that can persist into adulthood. Touch is crucial for forging that first emotional bond with a parent and for creating the unique human experience. "Seeing's Believing," wrote the 18th-century English physician Thomas Fuller, "but Feeling's the Truth."
Connecting through touch
The essentiality of touch endures as we age: It is the social glue that binds parents with children, and sexual partners into lasting couples. Nonsexual social touch connects people in the community and in the workplace, fostering gratitude, sympathy and trust. Doctors who touch their patients are not only considered more caring — their patients have better outcomes. One study showed that basketball teams that engage in more celebratory touch, such as high fives and chest bumps, play more cooperatively and win more games.
When we grow older, our sense of touch degrades. At about age 20, we start to lose nerve endings in skin at a rate of about 1 percent each year. On average, an 80-year-old has just one-quarter of the touch receptors of a 20-year-old. The loss is so gradual that we might not even notice, but the muting of our sense of touch over time can take a corresponding toll on quality of life. The cruel irony, of course, is that as sensitivity fades, the more we need to be touched — but the opportunity to experience touch often diminishes as well. "Aging people get touched less," says Tiffany Field, author of the book Touch and the founder and director of the Touch Research Institute at the University of Miami Miller School of Medicine. "Their grandchildren aren't nearby; their spouses die. It's very unfortunate."
What happens when we are touched
A massage changed Julia Wilcox's life. Not one she received but one she performed. This was two decades ago, when she accompanied her mother, then in her 60s, on a wellness retreat for stroke survivors and their caregivers. Free massages were on offer to all guests, so she signed up her mom and herself. Her mother, who also had diabetes and suffered from nerve damage in her legs and hands, climbed up on the table. The massage seemed to offer nearly instant relief. "She just melted," Wilcox, now 57, recalls.
The massage therapist, sensing her interest, invited Wilcox to help him rub her mother's back and legs. "We mirrored each other's strokes," she says. "That was it for me." For Wilcox, who lives in West Bloomfield, Michigan, the experience launched a new career: In addition to signing up her mom for monthly massages, she left her job in information technology and became a full-time massage therapist.
What exactly is going on under the skin when we are touched? The cascade of physical effects is surprisingly complex: The sense of touch is formed by an array of sensors embedded in the nerve endings of our skin, each a beautiful, specialized micromachine that extracts information about the tactile world. There's one sensor for texture, another for vibration, yet another for pressure. Therapeutic touch lowers levels of the stress hormone cortisol and increases the amount of oxytocin, the so-called love hormone, which is credited with mother-and-child bonding, among other things. When we put our hands on each other, we're tapping into deep associations between touch and emotion that are kindled at the dawn of life.
The good news is that there are all kinds of ways to harness this power. Even just rubbing your own skin in the shower can be therapeutic, Field says — it increases activity along the vagus nerve that runs from the brain stem to the abdomen. Stimulating it can offer various benefits throughout the body, from improved digestion to a jolt of the mood-boosting neurotransmitter serotonin. "It's the body's natural antidepressant," she says.
When it comes to touch, giving can be even better than receiving: In one study, Field had a group of volunteers with an average age of 70 get massages three times a week. Then the same volunteers massaged infants in a shelter for three weeks. Both activities produced benefits, but after massaging the babies, the group reported lower levels of stress hormones, took fewer trips to the doctor and had higher levels of social interactions.
Daniel Reingold, president and CEO of RiverSpring Health, which operates the Hebrew Home, has seen how therapeutic touch can improve the lives of residents. "It may be that the sense of touch diminishes with age, but I'd argue that the impact of touch increases," he says. He's found that residents with cognitive issues who received a combination of massage, yoga and physical interactions with therapy pets slept better and experienced a host of behavioral improvements, compared with residents on traditional medications. Other studies report a slew of benefits associated with massage, for conditions ranging from arthritis to voice disorders: One showed that older adults with dementia were more likely to eat nutritious food when gentle touch accompanied verbal encouragement.
How cuddle parties help
But the Hebrew Home is best known for its trailblazing — often controversial — approach to residents' sexual well-being. In 1995, the facility established a Sexual Expression Policy for consensual sexual behavior, a first for a skilled nursing facility. The policy helped to shift the thinking about sexual intimacy as a civil right for residents in long-term care. New York state has since instituted mandatory training for facility staff and distributes a video made by the Hebrew Home on the subject. Other states have followed suit, and now the subject is a regular part of discussions about care for older people. "Touch is one of the last pleasures we give up," Reingold says. "Our philosophy is that consenting older adults can engage in whatever they wish, as long as it doesn't hurt someone or is dangerous. It's the difference between waiting to die and getting up in the morning happy to see their beloved."
While the Hebrew Home takes a measured approach to the importance of touch, Len Daley does not. A psychologist and massage therapist in Montgomery, Alabama, the snowy-haired Daley teaches tai chi, yoga and self-massage to veterans at the Central Alabama Veterans Health Care System in nearby Tuskegee. Since 2005, he's also been an organizer and facilitator of Cuddle Parties — public gatherings for the touch-deprived.
The concept traces its roots to the 1970s, when Daley and a massage- therapist friend came up with the idea of Hugs and Cuddles events, where attendees could meet to give and receive nonsexual caresses. In 2004, a pair of New York massage therapists, Reid Mihalko and Marcia Baczynski, revived the idea and established a framework of rules and principles for structured events. A website — and a movement — was born: Today there are more than 100 trained Cuddle Party facilitators organizing gatherings worldwide. A handful of other groups promote similar events, and there are even brick-and-mortar "cuddle shops," which offer paid by-the-hour cuddling services.
Despite what the name might suggest, Cuddle Parties are scrupulously nonsexual, Daley insists. Each event opens with an hour-long orientation and workshop led by the facilitator to make sure attendees understand the rules — for example, before you touch anyone else you have to receive explicit verbal consent. Many attendees change into pajamas, but they must be chaste and nonrevealing — "flannel, not lace," Daley says, and clothes stay on at all times. After orientation, participants can start cuddling — or not. "People ask for what they want," Daley explains. "Sometimes it's as simple as conversation; sometimes, it's lying on the floor and embracing. Or it's a drawerful of spoons in a long line, or shoulder-rub chains."
Two hours later, attendees get back into street clothes and return to the real world, stress-free and buzzing on megadoses of oxytocin. Cuddle Parties are usually mixed-gender, intergenerational events, but organizers have arranged parties for diverse groups. Some have only same-sex or LGBT participants; other events are geared specifically to college-age or older cuddlers. "My mother is 91 — she goes to Cuddle Parties and loves them," Daley says.
In these touch-hungry times, do we really need to invite strangers over for group back rubs to satisfy our human need for connection? Daley thinks it might not be a bad idea: "Thirty years from now, the cuddle business will become medicalized — there will be bonding clinics. It's ahead of its time. The whole culture would turn around."
David Linden is a professor of neuroscience at Johns Hopkins University and the author of Touch: The Science of Hand, Heart and Mind. Martha Thomas is a writer based in Baltimore.
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