 | Few physicians talk about the clinical use of touch, and few medical schools teach it specifically, even though touch is a unique tool for diagnosis and therapeutic applications, as well as a means of communicating a caring attitude. In the poem "Line Drive," by Allen Ginsberg, the physician realizes that he "forgot to touch or be touched" while giving bad news to a patient. This line reminds us that touch includes not only physical touch but also emotional and compassionate possibilities as one person's experience affects another's. But contemporary medicine, in part because of time constraints and sophisticated diagnostic interventions, often limits the use of touch in patient care. The public has noticed this change, as suggested by the title of a recent New York Times article: "Are Doctors Losing Touch with Hands-on Medicine?" Medical educators and practicing physicians can learn from our colleagues who are experts in using touch and associated therapies.
In this book, Field, director of the Touch Research Institutes at the University of Miami School of Medicine, argues that Western society, including the medical profession, marginalizes and minimizes the importance of touch. She reviews many factors, such as concerns about sexual harassment, legal repercussions, and an aging population, that diminish the use of touch in general. Calling America a "touch-taboo" society, Field questions the restrictions placed on touch. One example of an area in which the trend is to limit touching is education: legal restrictions and fear of lawsuits restrict a teacher's ability to comfort a child.
Touch is a sensation that not only helps us understand our environment but also connects us to others. Field cites the pioneering work of Ashley Montagu in Touching: The Human Significance of the Skin (2nd ed., New York: Harper and Row, 1978) and Harry Harlow's research at the University of Wisconsin during the 1950s. Harlow's experiments with infant monkeys and surrogate mothers demonstrated that the infants "preferred the cloth mother without milk over the wire mother with milk" -- observations that suggested the importance of touch stimulation in early life.
In the initial chapters of her book, Field reviews the traditions of touching in many cultures from sociological and anthropologic perspectives. She also examines the effect of touch on growth and development, the effect of therapeutic massage on the progression of various illnesses, and the usefulness of massage in maintaining health and preventing disease. Field explores these and other topics as she reports on research involving infants, children, adolescents, and adults, most of it sponsored by the Touch Research Institutes. Committed to both the use of touch in health care and other settings and to the scientific exploration of touch, Field offers this book as her attempt to help bring touch into the mainstream of our lives.
Touch offers information to readers with scientific backgrounds and those with general interests in touch and related therapies. There are, for example, concise, informative reviews of the skin and its neurologic connections and of therapies that involve touch. These presentations are clear and concise, but they are not a comprehensive or detailed review of the topics.
I had several concerns as I read this book. One is the emphasis on Field's own research. She may be a leader in the field, but there are other investigators whose contributions are not mentioned.
In addition, the outcomes (e.g., weight in infants, sleep habits, and levels of anxiety) of touch interventions, usually massage, and physiological measurements (e.g., cortisol levels) after the use of such interventions, are presented without a description of the details of the study. The quality and validity of such findings cannot be assessed without consideration of the study design and methods used. Critical readers will have questions about many of the reported outcomes of touch interventions, and conclusions based on evidence cannot be made from reading this book. On the other hand, to report all the details of the studies would result in a different book. Field appears to be addressing a broad audience: experts in touch therapies, persons interested in expanding the use of touch interventions in health care and other settings, and health care professionals in general. In the absence of information about the study design and methods, readers need to use caution in accepting (or rejecting) study outcomes. References are provided for readers who want to take a closer look, and most of the cited articles are in accessible journals.
Field's conclusions, contained in a single paragraph embedded in the last chapter of her book, unfortunately do not further the direction of research, provide ideas for curricular innovations at schools for health care professionals, or indicate specific recommendations for the integration of touch therapies in our society. Field's book provides a review of the historical and cultural research on touch, an overview of touch therapies, and a summary of contemporary topics of research. The outcomes of much of the research remain in question because of the author's reporting style. Experts in touch therapy will see this book as a review of their field, and some may feel excluded, whereas persons who are interested in beginning research on touch or integrating touch therapy into everyday practice may be pleased with this book as an introduction to the topic. They will need to draw their own conclusions about the effect of massage and other touch therapies used in various settings. (from a New England Journal of Medicine review, 2002 )
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Touch by Tiffany Field, Ph.D.
