In intensive care units, doctors and nurses hold the hands of those very ill or dying—alone and frightened—of coronavirus. Nothing more piercingly conveys the power of touch. In the outside world, we are told to not touch, to keep apart from each other for fear of transmitting or contracting the virus.
Touch has become a physical and cultural minefield, and Professor Tiffany M. Field, director of the Touch Research Institute at the University of Miami Miller School of Medicine, is surveying just how fraught this minefield has become.
In the era of COVID-19 and social distancing, when there is a prohibition on us being within six feet of each other in public, when touching a stranger appears the worst idea, Professor Field—through the “Covid-19 Lockdown Activities Survey”—wants to know if you are in a relationship or family situation where you are able to touch and receive touch from loved ones. Maybe a pet is your significant touch-other.
Or are you alone, relishing the thought of touch, missing taken for granted social touching (fist bumps, hugs, kisses on the cheek) or the more intimate touching of sex? Are you having lockdown hook-ups? Or are you quite content not being touched at all, thank you very much; to be in—as academics put it—“touch isolation”?
Professor Field told The Daily Beast that she and a team of research students are beginning to study the responses flowing into the survey—running at least through the end of April—that asks not only how respondents feel about touch but also about a range of their quarantine emotions.
Field said, “We’re asking things like, ‘Are you touching more than you were before; how are you touching; what exercise are you doing; how lonely do you feel; how depressed are you?’” The survey is aimed at all ages, the single, coupled, and families; it also looks at sex, sleep, anxiety, and the issue of whether COVID-19 has also triggered any post-traumatic stress disorder linked to past events.
Francis McGlone, Professor in Neuroscience and Post Graduate Tutor at the School of Natural Sciences & Psychology at Liverpool John Moores University, has launched another survey into touch deprivation because of Covid; like Professor Field’s it is as illuminating for the person filling it in as it is for the researchers.
For one fiftysomething New Yorker who requested anonymity, technology means he is in heartening touch with friends. “But the one thing that can’t be replicated is touch. I miss it,” he told The Daily Beast. “When I had a dog who loved to cuddle, I had a temp, a stand-in who filled the skin-to-skin gap in my life. But right now it’s hugging a friend, the occasional accidental bumping of shoulders or brushing hands that I miss, as well—and maybe just as much—as intimate touch: a hand on a cheek, or two hands massaging my shoulders.
“I’m someone whose pattern was to often freeze or run away when genuine intimacy was offered—and I’m not talking just sex, because that can be intimate without being truly intimate. Maybe one of the resets in my own life that this experience seems to do for me is making me realize how much I miss intimacy—and how much I’ve missed it for many years when it was potentially possible. The lockdown has made me appreciate physical human connection in a way I never had before.”
Victoria Abraira, an assistant professor at Rutgers University specializing in the study of touch, told The Daily Beast that a positive upshot of COVID-19 and its quarantines, prohibitions around contact, and isolation is that it has focused attention on touch itself: its importance, science, and meaning.
“This pandemic shows why touch should be studied in the same rigorous way as the other senses,” Abraira said. “For every 100 papers on vision, there is only one on touch. We need more scientists to study it, even if this is a nightmare experiment to have to go through. What I hope will come out of it is a sense of appreciation for touch, and the recognition that in studying it as a sense we can tap into the regions of the brain and how the brain rewires itself to be healthier and better socialized within humanity.”
Professor Field said the new Miami COVID-19 study followed another, cut short by the pandemic, that her team was undertaking in airports to study the manner of touching at departure gates. The answer, she laughed, was very little. Around 98 percent of those observed were glued to their cellphones, scrolling and texting. “There was not much touch going on,” said Field, “so I’m not sure if people will be feeling deprived of touch that much. Americans were never that touchy-feely.”
Field and her students had also studied French and American adolescents in McDonald’s. “The French students were all over each other. The Miami kids were flipping their hair and cracking their knuckles.”
Americans now seem to be missing the power of touch. As one friend said to me, drily: “People are complicated, and having touch of any sort requires navigation, and I think that can be rewarding and I miss it. I want to squeeze my friends and go on bad dates. Touch is always complicated to me, so everything around COVID-19 will just get thrown on to the anxiety list. And the relief and joy will be added to the happy list. It has been a relief to find out in this time how much I enjoy human company.”
Hans-Jöerg Renner, a New York City massage therapist, stopped work nearly four weeks ago, when the city’s barbers and hair and nail salons were ordered closed.
“It’s very scary,” Renner told The Daily Beast. “People may begin to go back to work slowly, but not me. The nature of my business is touching human bodies, and I don’t want to catch the virus or transmit it to others. A lot of my clients are over 65, with underlying conditions. I don’t want to be the one who harms them. There is so much uncertainty over everything—the disease itself, and the time frame.”
“Right now, people are afraid. They may be sick, out of a job, they don’t know how to pay bills. They are health care workers, policemen, firefighters, all under a tremendous amount of stress. When you and your body are under such a prolonged period of stress, it can weaken your immune system. Unfortunately, at a time when touch is so needed, we can’t have it—not through massage, or even a hug between friends.”
Researchers have studied the many physical and psychological benefits of touch. It has been shown to bolster the immune system, to help with sleep and digestion, and ward off colds and infection, and to lower blood pressure.
Professor McGlone told The Daily Beast that research he had contributed to had shown there were “two separate senses of touch receptors in the skin—a fast one and a slow one. It’s the slow one that’s responsible for all the emotional benefits—or lack off if not stimulated.”
It is, said McGlone, “gentle touch that is so vital to our mental health and wellbeing. All social mammals, including humans, have a population of gentle touch sensitive nerves in the skin called c-tactile afferents (CT) that respond optimally to a caress. These are not the same touch nerves that tell you when someone has touched you—those nerves are myelinated which means they send signals to the brain in tens of milliseconds. The CTs are unmyelinated, and for them when stimulated it takes a couple of seconds to get to the brain and they project to emotion processing regions where ‘feelings’ are represented.”
Abraira told The Daily Beast that she and her colleagues had been studying the effects of “touch isolation” before COVID-19 hit; the presence of the disease has made the research more timely and urgent. A lack of touch, as experienced by people over a sustained period of time, can lead to “severe psychiatric issues,” said Abraira.
She cited the example of the range of conditions suffered by the horribly neglected children from Romanian orphanages as they grew into adults. “There’s something innately essential about the development and maintenance of the social brain that requires the sense of touch,” Abraira said. “Those in isolation in jails suffer because their social brains are rewired. We have evolved as a species to be social, and the sense of touch is key to uncovering our social brain and allowing it to develop.”
In the first wave of coronavirus publicity, elbow bumps were the thing, “and people seemed to like them,” noted Field, even if that innocent time seems like an eon ago. “Now it’s elbow bumps done at a distance, thumbs-up, and waves,” said Field. “We are OK making eye contact but not physical contact. I think we will be social distancing for a while, especially if the prognostic indicators of a second wave are true.”
Like many, Abraira herself said she felt a little “touch deprived” right now and a “little bit depressed” as a result. How we respond to a lack of touch may depend on age, she said, and if we have a predisposition to depression or a medical condition that makes us even warier of touch now. We should use Zoom meetings and other technology to remain connected, Abraira said. “It’s not the same as touching, but it can substitute for now. The longer this goes on, the longer the return to normal, will be detrimental and have effects on us all.”
Abraira said she is fortunate to have a partner and 3-year-old daughter at home. She knows, through her own study of mice “who go crazy after a couple of weeks of isolation, that someone living in total isolation for a period of time “can also go crazy.” Enforced isolation is one of the most severe punishments a human can endure, Abraira said.
Abraira recommends giving your skin whatever luxury makes it feel its best: baths, lotions, whatever sensory experience makes it come alive. “The big difference between humans and mice is that we have a large cortex,” Abraira said. “We are really good at adapting. Even though we are faced with social isolation, we are equipped to come out of it—and I am hopeful that we will.”
Those within families and relationships will not be touch-deprived in the immediate future, said Field. To those who are single or are deprived of touch, she recommended doing exercise or anything, including showering and washing of hands, that stimulates the pressure receptors under the skin, “which puts the nervous system in a relaxed state. Your heart rate and blood pressure go down if the stress hormones are reduced. Anything that moves the skin is helpful.”
Our brain will adapt to whatever the situation it is in, said Abraira, and it will adapt to quarantine. But the giving and receiving of things like hugs, massage, and sexual intimacy releases oxytocin, the “love hormone,” which releases stress and make us feel good. (Abraira would be fascinated to see a study of those not being touched in this era and what has happened to their oxytocin levels.) This could lead to increases in levels of stress, said Abraira, “which is why people with pets are also fortunate, as stroking them and being with them is similarly de-stressing.”
Or, as a single friend with a dog put it: “Having a pet is such a wonderful, simple connection—you just love and love them more, and they return it.”
If our present experience of touch is complex, one can say the same of its history.
Constance Classen, author of The Deepest Sense: A Cultural History of Touch, told The Daily Beast: “Although in earlier centuries people did not know how diseases were transmitted, and many thought it must be by smell, it was obvious in cases of epidemics that close contact with infected individuals increased one’s risk.
“This concern over touch as a medium of disease went hand in hand with the new sense of individualism that developed in Western cultures in modernity, and which also required a greater restriction of tactile contact in order to safeguard one’s newly important private space and promote one’s sense of importance as an individual—and not just as a member of a group. This is the greatest shift in Western tactile history, but it took place slowly over a long time and it was not the result of any one traumatic epidemic.”
The modern decline in the social importance of touch, said Classen, “was accompanied by a rise in the social importance of sight. A key factor here was the development of new technologies for exploring the visual world and recording previously fleeting images... In our age of social media, it sometimes seems that visual representations matter more than physical experiences.”
This immersion in a visual-dominated online world has intensified for people at home under the coronavirus lockdown, said Classen, “teaching us a sensory language in which sight dazzles and touch shrinks.”
Sex and touch: “People are sad and fearful... they want things they didn’t have”
A single friend who is missing sexual touch during the social-distancing lockdown told me: “Sometimes the best part is the lead-up and kissing—that’s what I miss the most. But all the other sexual smacking of skin—video sex can’t replace that no matter how hard we try. And trust me, I try—once even earlier today.”
It’s not just singles suffering with intimacy issues. “People with partners have stresses with work and money. You want to know what the biggest boner- or desire killer is? Yes, this pandemic!” sex therapist Melissa Novak told The Daily Beast, with a wry laugh.
Novak is counseling a lot of clients who claim to be missing touch right now. “It really feels like it’s that thing of people don’t miss something until it’s gone,” Novak told The Daily Beast. “I ask them if this is something that they really always wanted or needed, or is touching something they cannot have right now, and therefore they are longing for it. I have clients who weren’t dating or doing anything touch-related before all this, and now they’re saying, ‘I’m not getting touched.’ And I say, ‘But you weren’t getting touched before all this.’ People are sad, scared, and fearful, and that makes them want things they didn’t have.”
Ken Howard, LCSW, a gay men’s specialist psychotherapist and founder of GayTherapyLA.com, said that rather than touch, discussions with clients had revealed a big difference between the lived experiences of quarantine of the single versus the coupled. For couples, the key issue is how much space they have to share. Predictably, the less space, the more tricky the quarantine time spent together; the more space, the happier the living situation.
In place of touch, Howard’s single clients have been using the phone and cyber tools to connect with others, Howard said, socially (like watching TV shows together) and sexually. Howard is talking to clients about “adaptive coping,” that is coping with what is “next to normal, as the Broadway show called it.” Yes, he said, people are using technology to mitigate isolation, “but they say, ‘Nice try. It’s not the real thing.’”
Novak recommends all kinds of self-touch—including masturbation, and doing things like making yourself as comfortable as possible when talking to friends. “Be intentional when it comes to your hands being on your body. They may not be perfect alternatives to being touched, but they’re options so you don’t have to go totally without.”
If you’re comfortable with it, Novak recommends sharing sexy pictures or stories via technology, or having phone or camera sex with a trusted sex partner.
When it comes to hooking up, and breaking social distancing to do so, Novak said, “American culture is very individualistic. Right now, everyone is being asked to think more collectively. If people want to hook up, I would ask them make sure they socially isolate for 14 days after that so they take care of other people around them. People can decide what level of risk they want to engage in, but I would also them to think about what their responsibility is socially. And that’s hard. A lot of people, I know, feel marginalized and disenfranchised, and feel like why they should give two shits about society when society hasn’t given two shits about them. I get that.”
Novak recommends that people think of this as a brief time period, and to think of things they can explore around their sexuality at this time that doesn’t involve interaction.
The gamut of sexual behavior Howard has heard of from clients spans enforced celibacy right through to those “throwing caution to the wind” and having hook-ups. Those hook-ups have been negotiated, he said, like the condom-less hook-ups that predated the introduction of PrEP, in which both partners—on the basis of negotiation and absolute trust—establish that the other is “safe” (in COVID-19’s case, not exhibiting obvious symptoms).
This, of course, is in no way failsafe, because people can have COVID-19 and be asymptomatic. “Maybe they’re avoiding kissing, and just giving or getting a blow job or giving or receiving fucking,” said Howard. “And I have noticed it can correlate with age. Younger people are more confident as they often can be, older people are more cautious.”
Howard, who all-too-well recalls the AIDS era and the many and varied discussions around safer sex of that time, talks to his clients now about a “harm reduction approach: How can you get this sexual need met without having viral exposure? It’s about managing the conflict of needing to express yourself sexually and remaining medically safe. There are parallels with the AIDS crisis at its height: We are talking about reducing risk, not no risk, and also negotiating risk.”
Some people, said Howard, as in the AIDS era and pre-PrEP, are forming “very closed, maybe one or two people” networks, who are “cuddle or fuck buddies,” where trust is again paramount, exposure to illness is (hopefully) proscribed, and where any signs of illness are being monitored by all parties. Absolute trust is key, but it does not offer a 100 percent assurance of no risk.
Touch in the future: “It’s going to be problematic for a long time”
The insoluble truth when it comes to both sexual and social touch is that, even when humans re-emerge from quarantine, touch will remain freighted with a sense of danger in what it can transmit from one person to another.
Perhaps, as Victoria Abraira of Rutgers optimistically posits, in time a vaccine or effective medicines will make COVID-19 manageable, and we may live with and around it in the same way we do the flu—“though maybe not sometime soon.”
“When you undergo a period of ‘touch isolation,’ you might find something we could call ‘touch PTSD,’” Abraira told The Daily Beast. “The brain has not been used to receiving those signals for a period of time and may react differently to it. It’s like seeing out of an eye that has had an eye patch over it, or a suddenly unblocked ear that had been blocked. It can take time to adjust to a new bombardment of sensory information. But the brain is fairly plastic and will readjust.”
“It’s going to be problematic for a long time,” said Professor Field of the Touch Institute. “I think everyone is afraid of the return the virus, of being exposed. Young people aren’t so much afraid, but people in risk categories will make sure they keep their social distance. I’m not pessimistic. As time goes on, I do think it’s true that there is a divide between the experiences of those people who are touching and being touched, and those who are not. You will be able to tell who is with someone and someone who is alone.”
Professor Dr. Gary R. Lewin, a neurobiologist interested in touch at the Max Delbrück Center for Molecular Medicine in Berlin, told The Daily Beast that the long-term effects of COVID-19 on human touch are unknown: “We’re going through this unique experiment.” He conceded, “It’s probably not as bad for people like me stuck at home with families, compared to the singles out there stuck inside weeks on end.”
Dr. Lewin hopes “people will get back to normal pretty quickly,” although he says it will be interesting to observe if touch itself becomes widely perceived as unpleasant, and whether friends and work colleagues avoid it.
The acceptability or prohibition around touching will remain vexed because of the so far invisible, unidentifiable transmission of COVID-19, Abraira concedes. “People will naturally isolate depending on their level of discomfort. And it may be generational. But I hope it will get better, especially as a vaccine is developed. I hope we get back to normal, but it may not be a really long time.”
The human brain, she thinks, will at the right moment “dissolve” the prohibitions on touch it is currently operating under, when it is reassured that it safe to do so. “People are already anticipating getting together, and how that will feel. It will just take time.”
Abraira wonders if technology or science will ultimately offer up surrogates for touch: lotions or robots that may mimic what a tactile experience can be on your skin. “But even then, touching another human being is such a complex experience. Skin is the largest organ of your body. It’s the receptacle of thousands and thousands of tactile interactions, temperature, and movement. The connections between our brains and our skin are so intricate, with so many neurons conveying so many subtleties.
“It’s hard to imagine technology coming up with a way that mimics the nuances of touch. Think about when someone touches your shoulder. It depends on who that is, and whether you love or hate them, how that feels. How do you mimic that?”
Hans-Jöerg Renner, the masseur, is hoping to be able to return to some kind of normal when more is known about COVID-19, and how to treat it. He has friends who are yoga teachers and psychologists who have successfully migrated their businesses online. “But that is not an option for a masseur,” he said, although he has reached out to all his clients to check on them and offer advice on staying healthy.
Massage alleviates physical and emotional stresses, said Renner, so it pains him that he cannot do the job that he finds so fulfilling to help others. “My advice is to stay in touch with each other. We are a society, we are not alone.”
While it is hard to speculate about the future, said Dr. Lewin, he agreed that our acceptance of touch, and the way we will approach touching others, will most likely be governed by what comes to be known about diagnoses and treatments for COVID-19. What had been astonishing, he said, was how rapidly it had killed so many people in such a short space of time, and the mystery of its transmission.
If, Dr. Lewin said, we continue to space ourselves six feet apart for safety and to avoid touch (and if it emerges that so-called aerosol transmission is taking place), that will change the nature of our communication—as he put it, will there still be chats closely seated together around the table in a bar? Some people naturally socially distance, others are “in your face,” as Lewin put it. Some people are sensitive in how they are touched, others are not. If and when we go back into the world, the great collective test will be in how we occupy the space around us, in how we touch and how we accept or avoid touch.
However that tightrope is negotiated, for Abraira touch remains a vital lens through which to understand both the pandemic and the society it is occurring within.
“Our skin is the way we wiretap into the brain and help it become healthier,” Abraira told The Daily Beast. “People think of massage therapy as a frou-frou science, but I think there is a real science behind it we don’t understand. Touch is so huge, and skin is so huge. Because of its complexity people decide not to study it, yet of all the senses it is the most important because of brain health. I hope people realize that touch is a compelling sense that should be studied as a legitimate science.”
Constance Classen, author of The Deepest Sense, is also optimistic.
“We still very much like and need to touch. Touch not only brings us together in a way no other sense can, it provides us with comfort and pleasure, with a feeling of physical connection with our environment, and with a wealth of information about the world. Unless the current epidemic proves long lasting, or we have repeated waves, people will mostly return to their earlier tactile practices once the scare is over—though it may take time.
“One development in the future of touch to keep in mind is that haptic technology seems set to bring more and more of the tactile realm into cyberspace, transforming touch into a distance sense like sight and giving it an alternative virtual life.”
As a scholar of touch, Classen hopes that the coronavirus crisis “will encourage people to think more about our tactile involvement with the world, from how we interact with each other, to how we interact with animals and the natural environment—all areas in which a more respectful and caring touch is much needed.” Problematic as it presently is, touch may yet re-emerge, newly complex—but still treasured. If you doubt that, just look to those doctors and nurses in intensive care, ensuring that their patients do not suffer, or die, untouched.