First Contact

The Touch Research Institute promotes the laying on of healing hands

Infants ranging in age from new to 18 months spend much of the day napping in tiny cribs. Slightly older toddlers ramble to and fro with no real direction or purpose. The oldest kids -- those up to five years of age -- scamper around outside in a narrow playground fenced in by steel bars. At TRI Preschool toys and stuffed animals litter the grounds, crudely drawn portraits line the walls, and visitors run the danger of tripping over miniature chairs designed to accommodate extremely young behinds. By most outward appearances, this is simply a day-care center much like many others. But it is also a laboratory, and the 40 or so children who attend the school are its pint-size guinea pigs.

Not that it's a bad gig. John Alfonso, who is all of three months old, lounges patiently on a waterbed, contemplating an assortment of mirrors, toys, and other doodads that dangle from a small plastic swing placed over him. A few feet away, Marta Castello, a 73-year-old volunteer who exudes grandmotherliness, prepares to give John his daily rubdown. It will be a fifteen-minute feast of sensuous delight, lavished by Castello with baby oil and plenty of coos as she gently rubs John's round body with her palms and traces his tiny limbs with her fingers.

The massage session has implications beyond the grins it brings to John's face. Because the preschool, located a few blocks from Jackson Memorial Hospital, is run by the University of Miami School of Medicine's Touch Research Institute (TRI), "one of our main focuses is on touch and how it affects children," preschool director Ruth Rubin explains, as three children crawl over her and grab at her clothes. She doesn't seem to mind the distraction. "We do a lot of touching and hugging and holding and rubbing of backs."

Subsequent studies on the children will delve into such practical matters as the effects of touch on hyperactivity and feeding and sleeping patterns. (The findings in this last area may seem like a no-brainer: "They sleep much better [after a massage]," notes teacher Lucy Nue, as she watches John gurgle with pleasure while Castello works on his body. "This one will be going to sleep for two hours, easily.") But a far more ambitious objective is to accumulate an overwhelming body of evidence that dovetails with the institute's larger goal of demonstrating how touch -- even contact as seemingly inconsequential as a hug or a pat on the back -- affects physical and psychological well-being.

The concept is often lost on parents who enroll their children in the school. "They want us to do the flash card, better-baby program, where we can make musicians by age two and physicists by three," says Tiffany Field, Ph.D., a professor of psychology, pediatrics, and psychiatry, and director of the Touch Research Institute. When Field explains to parents the school's goal of promoting health and cooperation over academic competitiveness, and how hugs and massages are a major part of the curriculum, "they're all shocked," she claims. She adds that the parents' first question is "What's that got to do with anything?"

Field says the institute will eventually answer that question and many more about how increased touching might eventually lead to a society where peace, unity, and happiness reign. With a staff of 28 students, volunteers, and massage therapists, and a faculty that includes researchers at UM, Florida International University, the University of Florida, Duke, Harvard, and the National Institutes of Child Health and Human Development, it is the world's first and only research center devoted solely to touch. Field's goals for the four-year-old institute are threefold: to document the therapeutic benefits of touch, primarily in the form of massage therapy and its effect on a host of ailments; to explore the physiology of touch and find out precisely what happens in the body when the nerves in and under the skin are stimulated by physical contact; and finally, she says, "to demonstrate the positive effects of touching in general, so that ultimately touch can get back into society."

The United States is what anthropologists refer to as a "nontactile society." In lay jargon, that means we don't touch each other very much, especially when compared with the amount of touching -- whether incidental, friendly, or affectionate -- that goes on in other cultures. That's a cause of deep concern for Field who, sitting in her office six floors above the preschool, says more physical contact would go a long way toward addressing a host of fundamental public health and safety issues, ranging from diseases like diabetes, cancer, and AIDS to the abnormally high levels of stress, depression, and violence found in American society.

By her own admission, Field's objective of turning America into a nation of touchy-feely sorts will be difficult to achieve. Some gains on the tactile front were made in the Sixties, when the notions of open expression and free love led to experimental movements like encounter groups in which there were no boundaries to touch. However, Field asserts that the national taboo against touch has become strong in recent years. She believes the threat of civil lawsuits and criminal charges has reduced public arenas such as workplaces and schools to virtual no-touch zones.

"We're concerned that any touch is going to be construed as sexually or physically abusive," she frets. "There are lawsuits galore out there. Adults are so concerned about touching each other that they have now translated that into being paranoid about touching kids. I mean, even parents are afraid of how they're seen touching their own children in public places. You just don't see this in other societies."

In mammals the need for touch begins at the moment of birth, when the skin is the predominant sensory organ. Stimulation from the mother helps the newborn adjust to the new environment outside the womb and also triggers organic processes that signal the start of growth and development. Without its mother's behavior -- depending on the species, stimuli can include licking, nuzzling or breast-feeding -- a newborn goes into a survival pattern aimed at conserving its small store of energy: Metabolism slows down, and the comparative luxury of growth is stunted until external stimulation begins.

Dr. Saul Schanberg, a professor of pharmacology and biological psychiatry at Duke University and a member of the institute's faculty, says that while the extreme physiological reaction to the lack of touch lasts only through infancy and childhood, the need for tactile stimulation extends throughout life. Schanberg, who has been studying the physiology of touch for the past quarter of a century, uses a computer analogy to explain how touch works: The central nervous system is the built-in hardware and wiring, and the brain is the software that interprets the information collected and sent by the nerves. He says the amount of physical pleasure and relaxation that touch confers speaks volumes about its importance. "Most of us really enjoy getting hugged," he says. "Why hugging? Why isn't shaking hands great? Why isn't talking great? Why isn't a relaxation technique or just looking at waves great? It's nice. But it isn't like hugging. I mean, after a good massage you can hardly get off the freaking table."

In the book Touching: The Human Significance of the Skin -- a sweeping work, first published in 1971 and last updated in 1986, that is considered the seminal work on the subject -- anthropologist and social biologist Ashley Montagu included a long list of observations and studies demonstrating the tragic consequences of touch deprivation on infants.

In the Thirteenth Century, for example, Emperor Frederick II of Germany wanted to know what language people would communicate in if, as tested by experiment, they grew up without speaking to anyone. Would they speak Hebrew, Greek, Latin, or the language of their parents? As part of the isolation imposed by Frederick's experiment, foster mothers and nurses were forbidden to suckle, bathe, or wash the infants who had been separated from their parents at birth. "But [Frederick] labored in vain," wrote the thirteenth-century historian Salimbene, "because all the children died, for they could not live without petting." Even as recently as the early Twentieth Century, Montagu recounts, a New York pediatrician reported that the death rate for infants under one year of age who were placed in foundling institutions -- places where abandoned babies were warehoused and rarely if ever touched -- throughout the United States was nearly 100 percent.

In 1963 researcher Harry F. Harlow published the results of an experiment involving rhesus monkeys that demonstrated the importance of touch and physical contact to babies. When given a choice between a surrogate mother made of wire and outfitted with a nipple that supplied milk and a softer surrogate mother that offered no nourishment but was covered with terry-cloth "skin" concealing a heat-generating light bulb, "the babies spent 99 percent of the time with the soft, covered one," Schanberg notes.

In another study Harlow separated newborn rhesus monkeys from their mothers at birth, hand-reared them to adolescence, and then put the animals together in an enclosure where they were subjected to mild stress (for instance, a handler walking into the area). "So what did the monkeys always do?" Schanberg asks. "They ran to each other like crazy and grabbed hold of each other for what looked like dear life."

Harlow took a picture of four rhesus monkeys clinging to each other; the image is now referred to in scientific circles as "Harlow's Choo-Choo Train."

"I keep a big copy of the photo right in my office, because you look at that, you have no goddamned question -- there's no question at all -- touching is clearly security-giving and anxiety-reducing," Schanberg says. "They never saw touching, they don't know where it came from, they never saw each other. It's hard-wired. So you think about that: We're born with a genetic tendency for soft, touching things, for the ability to gain security and reduce our anxiety by hugging and touching and grasping."

Like Schanberg, Field also has a copy of Harlow's photo in her office. And there's no question in Field's mind either that humans need touch.

Ask her why touch is so essential and Field will talk about the central nervous system and its two states: sympathetic activation, more commonly known as the "fight or flight" response, seen when animals sense danger and adrenaline courses through the bloodstream; and parasympathetic activation, a state that most people would simply understand as relaxation. She will expound on skin, which, with about nineteen square feet per average adult, is the body's largest organ. She will talk about the thousands of specialized nerve receptors in the skin that, through electrical impulses transmitted to the sensory cortex of the brain, communicate everything from body movement to changes in temperature and allow us to distinguish between a playful poke and a lover's caress.

And she will lecture about chemicals the body produces -- in particular serotonin, a neurotransmitter associated with mood regulation (the antidepressant drug Prozac is designed to boost levels of the substance), and cortisol, a hormone associated with stress. Cortisol, she says, destroys body tissue and wreaks havoc on the immune system. Americans, because of their fast-paced lifestyles, carry around way too much of it in their blood, she adds. The institute's studies have shown that cortisol levels, as measured in subjects' saliva and urine samples, decrease dramatically after a massage, while serotonin, measured in the urine, is increased.

Field's interest in touch traces back to 1975, when she was a graduate student at the University of Massachusetts performing research on high-risk infants. As it happens, Field's daughter was born prematurely while she was conducting the research. "She was one month premature," Field notes, "but some other kids were three and four months premature, and they ended up staying in the hospital for a long time just to gain weight, so the basic thing was to find something to help them gain weight."

The prevailing medical wisdom at the time was that such babies shouldn't be touched at all, for fear of disturbing their fragile nervous systems. "That [belief] was based on invasive-procedure data," she says, commenting on the endless tubes and needles to which such sick infants are subjected. "What they didn't do is look at tender, loving touch."

In the study Field had the preemies suck on soft nipples while they were being tube-fed, and found that they gained weight faster. That led to a leap in logic: If stimulating the mouth helped, working the whole body might be even more effective.

A subsequent study that lead to TRI's founding was published eleven years later in the medical journal Pediatrics. Field (who was by then an assistant professor at UM), Schanberg, and other researchers used massage therapy on premature infants at Jackson. After fifteen minutes of massage performed three times daily, the 57 babies, on average, gained 47 percent more weight and went home six days earlier than babies who weren't massaged, for a savings of $3000 (which translates to $10,000 in today's dollars).

Among the obstacles the researchers faced were those imposed by physicians tending to the preemies. Unmoved by Field's findings and adhering to the view that their patients should not be touched, doctors were concerned that she and Schanberg would kill the frail patients. "We had to spend hours talking them into letting us do it," Schanberg recalls. "We had to overcome the world."

That study found its way to James Burke, then the CEO of Johnson & Johnson, the New Jersey-based company that makes baby products such as powders and lotions. "I had long believed that the key to the success of Johnson's baby toiletries was that it made it easier for mothers to touch their children and to take care of them in a physical way," says Burke, who retired as the head of Johnson & Johnson in 1989 and is now the chairman of Partnership for a Drug-Free America. "I further believed that it brought great physical benefits not only to the child but to the mother, and that this whole business of touch was not well enough understood."

In 1990 Field made a trip to Johnson & Johnson's headquarters to discuss her findings. "I showed them slides of the preemie research, and Jim Burke said, 'I think we'd have less war and less disease if we had more touch in our culture,'" Field remembers. After Burke twisted the arms of a few Johnson & Johnson executives, the company provided $250,000 in seed money to found TRI in 1992.

Most of the institute's 55 studies, some of which are ongoing, center around demonstrating the medical benefits of massage therapy. Among the findings so far: Premature babies gain weight faster; young psychiatric patients sleep better and are less depressed; immune systems in HIV-infected adults are enhanced; and stressed workers have less anxiety, depression, and fatigue. Massage is used, Field explains, because the firm pressure applied with Swedish-type massage, in which muscles are vigorously kneaded, provides the necessary stimulation to those nerve receptors in the skin. She leans across a table and presses an interviewer's forearm to make the point. "In order for all of the changes to occur that we're showing, like growth, like reduction in [the stress hormone] cortisol, enhancement of the immune system, changes in brain waves [associated with parasympathetic state], that only happens when there's pressure," she says with a prod.

Although some of the institute's studies and findings seem ridiculously self-evident -- one currently under way is expected to show that couples who massage each other before and after sex will have lower levels of performance anxiety and increased feelings of physical intimacy -- Field says documentation is necessary before massage is accepted by the medical establishment as a viable therapy.

A reasonable question might be, If touch is so important, why can't people just get what they need at home? What's the added value of occasional touching at work or school? "It shouldn't be occasional," Field responds. "You need a heavy dose of hugs, and that's what I'm saying. You need to have those pressure receptors stimulated." Field grasps her forearm and starts rubbing it. "The neurotransmitters in the brain need touch," she continues. "If you can't boost your serotonin with touch, you gotta go out and take Prozac. It's as simple as that."

How and why touch works magic within the body is still a matter of speculation. It's up to researchers like Schanberg, who performs most of his work with animals, to uncover the biochemical causes. Field notes that her study, despite its implications for preemies' health and hospital savings, has had a minimal effect in the treatment of premature babies -- even in Jackson's newborn intensive care unit, where her research took place, minimal touch is still the rule -- because the underlying mechanism has not been explained to the medical establishment's satisfaction.

Adds Schanberg: "It's like my grandmother said to me one time, 'You went to Yale all that time, and you got a Ph.D. and you got an M.D., and that's what you've shown? That touching babies is good?' I said to her, 'Grandma, you know science is slow. Sometimes science is very slow.'"

As glacial as science may be, Field says, at least there is forward progress. But the continuing reluctance of Americans to touch anyone other than family or the closest of friends and the trend toward stricter legal and social prohibitions on touch in the workplace and schools still cause her grief. "The only thing we're allowed to do anymore is shake hands," she fumes. "That's it."

This would be in contrast to, say, the Andaman Islands, situated in the eastern Bay of Bengal between Burma (Myanmar) and India. There, anthropologist A.R. Radcliffe-Brown observed, "when two friends or relatives meet who have been separated from one another for a few weeks or longer, they greet each other by sitting down in the lap of each other, with their arms around each other's necks, and weeping and wailing for two or three minutes until they are tired." The !Kung Bush people of southwest Africa tend to hang out together in bodily clumps, leaning against each other with arms brushing and legs overlapping.

Cross-cultural studies generally attest to the fact that Americans are, as a rule, uncomfortable with touch. It's a national attribute that has left social scientists casting the blame on such disparate sources as the country's English roots, Puritanism, technology, materialism, and the long-standing celebration of traits like individual independence and autonomy. The discomfort may also be traced to the lingering effect of late-nineteenth-century pediatric beliefs that practically forbade nurturing contact between parents and children (espoused by Dr. Luther Emmett Holt, whose 1894 booklet The Care and Feeding of Children is described by Montagu as "the 'Dr. Spock' of its time").

However, quantifying the extent of America's touch taboo is difficult at best, since such evidence -- like Field's account of a friend who is being sued for sexual harassment simply because he touched someone on the forearm -- is largely anecdotal. In fact, sifting through sexual harassment statistics for proof of an increased prohibition on touch is problematic, as the area is a broad one that includes remarks, gestures, and a generally hostile working environment. While the number of sexual harassment cases is on the rise -- 15,549 complaints were filed with the EEOC in 1995, compared with 6100 complaints in 1990 -- the cases are not broken down to show how many may have involved incidental touch. The increase may also be attributable to factors such as the 1991 Senate Judiciary Committee confirmation hearings on Supreme Court nominee Clarence Thomas. Anita Hill became a household name, and subsequent changes in the law increased monetary awards while lowering the legal hurdle for bringing such harassment charges.

"Worldwide, every culture has touch taboos; it just depends on the scale," observes Washington-based anthropologist David Givens. "In very few societies can you touch private parts of the body by just walking up to a person and laying on hands, but in the U.S., in the Nineties, it's like we're into a don't-touch thing in the career sector and in education. Now it's universal that you can't touch anybody anywhere, period, or else the lawyers will come into it."

Field reserves special ire for public schools, where she says all physical expressions of affection between teachers and students -- including simple hugs -- are slowly being mandated out of the educational process by lawyers and bureaucrats who are fearful of accusations of sexual molestation.

Technically Dade schools don't have a no-touch policy, says associate superintendent of schools Russ Wheatley, although that's pretty much the general advice given in the school system's manuals. "But it certainly is not meant to extend to pats on the back or holding the kid by the arm, or certain things that normally go along with working with kids," he adds. "I think it's a matter of common sense."

Teachers are getting much stronger advice from their own lawyers. Elizabeth J. du Fresne, an attorney and general counsel to the United Teachers of Dade for the past 25 years, says she's sympathetic to Field's views but has no choice but to advise teachers not to touch students. "When I began representing teachers, it was considered a normal and totally acceptable thing for someone who taught elementary school to hold children in their lap, to hug them, to kiss them when they did good," du Fresne notes. "If they fell down and hurt themselves, to kiss their knee where it was scraped. That would be how you would react."

But in the mid-Eighties, alarmed over the rising number of allegations of molestation made against teachers, du Fresne delivered new advice during a meeting of school union representatives. "Here are the words I never wanted to say," she recalls. "Do not touch a child to help them; do not touch a child to hurt them. Do not touch a child. If you must touch a child, make sure there is a second adult there. People stood and said, 'I've taught elementary school for 25 years. If I can't give a kid a hug when they do good or they're sad, I won't even know how to function. These are little kids!' And I said, 'You pay me to give you legal advice. I am telling you that the risk of touch having a negative impact on your professional life is so high that my advice is not to touch.'" Du Fresne says that risk includes a suspension or revocation of one's teaching license and up to $30,000 in legal fees to battle an accusation in administrative and criminal courts.

Du Fresne's legal tip is similar to the recommendation of the National Education Association, which represents 2.2 million teachers across the country. Now boiled down to a slogan, the union's official line is "Teach, don't touch."

Two years ago Field had a run-in with Dade schools over the issue when she proposed a study on children with Attention Deficit Disorder (ADD). "We had data showing that autistic kids benefit from massage, which we did in a private school in Broward, and I figured there's got to be a direct application to ADD kids. The ADD problem is one of the biggest problems any school system has," she says. The response from the school board: "They said that we couldn't touch the kids. I couldn't really even make my case or anything. It was very disappointing."

"We felt the research was sound, but this was not the setting to conduct a study like that," remembers Dr. Joe Gomez, chairman of the schools' research review committee. "The idea of touching and massaging the students just made a lot of people on the committee uncomfortable."

Undeterred, Field is now engaged in a three-year cross-cultural study comparing the incidence of touch and physical affection in France and the United States, in hopes of showing how touch -- or the lack thereof -- corresponds to levels of aggression and violence. For one month every summer, she travels to Paris and, clipboard in hand, posts herself in outdoor cafes, McDonald's restaurants, and schoolyards, observing the behavior of children, parents, and teachers while checking off what she sees on a chart every ten seconds. She uses the same procedure for recording stateside behavior.

Field has one summer of research to go but is enthusiastic about what she has seen so far. "It's turning out just like we predicted," she beams. "What we're finding is that French parents and teachers alike are more physically affectionate and the kids are significantly less aggressive."

All of which is no surprise to Field. "France is on top of the touch chart and on the bottom of the violence chart," she says. "The U.S. is on the top of the violence chart and on the bottom of the touch chart. That's an observation, and of course there are a million factors, and of course you never really sort out what's going on with all the other interrelated variables. But it's interesting. It's suggestive."

As for what she hopes to accomplish, Field says her idealized vision of American society is not extreme, just parents massaging their children at bedtime, parents and friends massaging each other, school kids lining up for massage trains in gym class, acquaintances greeting each other with hugs instead of handshakes. "I think that people are going to believe the medical data, that unless you have a dose of touch you're going to have high cortisol levels, and that's going to have effects on your health." She adds hopefully, "I think they'll believe that, and they'll come to appreciate the benefit of touch.

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