The Power of Touch Beyond Pain and Pleasure: Shifting Medical Massage Research toward Trust and Transcendence

My mother has days when she sleeps more and more, moving in and out of a twilight state of consciousness, as she approaches the end of her physical life. She experiences, thankfully, not a great deal of pain, but intense discomfort and sometimes fear as her late-stage lung cancer progresses. Over the past two and a half years, she has let me massage her a little bit more on each visit, saying, “wonderful… wonderful,” and actually asking for more. Treasuring her personal dignity, she was reluctant to receive loving touch prior to this illness, even from me, a professional massage therapist! So it has been moving, and meaningful, to use the language of touch to bring a bit of grace into her difficult days. I am profoundly grateful that this language will continue as a bridge past the point when it will become nearly impossible for her to speak.

Therapeutic Touch

I am hardly the first to value massage as a treatment for the ill and frail, from birth to death. Ancient civilizations in India, China, Egypt, Greece, and Rome administered massage to the sick in healing halls and temples. Homer, Hippocrates, Plato, Socrates, and Galen are among the famous men who made a connection between massage and illness in classical literature. Hippocrates, the Greek physician, is credited with saying that “the physician must be experienced in many things, but assuredly also in rubbing.”

In the Christian tradition, touch, or “laying on of hands,” became part of care for the sick and dying. During the Middle Ages, it was church women who cared for those struck down by the plague and other epidemics, many physicians being unwilling to serve people who could not pay their fees. From the Renaissance to modern times, medicine morphed from a high-touch practice to a high-tech practice. Still, many hospitals still featured nightly backrubs for comfort, as well as physical therapy for rehabilitation. Hands-on healing had its advocates: Florence Nightingale, the creator of modern nursing, included massage in her training program. John Kellog, medical director at a sanitarium, wrote a book for his nursing curriculum in 1883, The Art of Massage, which remains a classic text. However, by the mid-1950s in the U.S., medical massage had dwindled almost to non-existence. Then it began a renaissance of its own.

The contemporary surge of interest in massage in hospital settings is fueled by intuitive wisdom on the one hand, and research on the other. So far, research has focused on the reduction of negatives: pain, anxiety, nausea, length of stay, expense. The results are encouraging, as shown by Gayle McDonald’s literature review of 59 rigorous studies (3). Twenty studies showed positive results for anxiety reduction immediately following massage, across a broad spectrum of patient populations: people with cancer, those undergoing rehabilitation, surgical and psychiatric patients, mothers in labor, children being treated for burns, and those in the intensive care unit. Massage also consistently reduced pain in the majority of studies reviewed. Massage reduced expense in specific ways: for example, a group of patients undergoing bone marrow transplantation saved an average of $750 per patient because they needed significantly less nausea medication, and saved another $800 per patient because they needed far less total parenteral nutrition (TPN). Two studies of premature infants who received massage (15 minutes three times a day for ten days) showed that the massaged infants went home five and six days sooner, generating a savings of $10,000! The list of benefits goes on.

Clearly such concrete measures are crucial. But we may find even more interesting results if we pay attention to intuitive wisdom and ask different questions. As Tedi Dunn points out in Massage Therapy Guidelines for Hospital and Home Care, “Numerous studies reflect…Americans’ social inhibitions and cultural prohibitions when it comes to touch. Paradoxically, ongoing social and medical research demonstrates that nurturing touch is a basic human need for maintaining health and for life itself.…In our high-tech, low-touch society, it is no surprise that massage has been embraced as a safe structure for receiving—and giving—the human touch that we intuitively know nourishes the spirit along with the body.”(4)

Touch Nourishing the Spirit

How exactly does massage nourish the spirit, especially for the ill and frail? How do we measure the presence of positives and not just the absence of negatives? Based on twelve years’ experience as a massage therapist, I believe the positives far exceed the easily measurable (immune system boost, improved performance, increased energy, better sleep). One of my favorite quotes from a client about massage is:

“The whole experience was so nurturing that when I walked out of there, I fell in love with the world again and saw everything with new eyes.”

In positive psychology terms, this would appear to indicate positive affect, relatedness, engagement, and meaning, all wrapped up in one powerful intervention.

Intangible Benefits of Touch

If I were designing a study to measure the more “intangible” positive benefits of massage for traumatized, ill, frail, or dying people, I would measure these four: Vitality. Acceptance. Trust. Transcendence. These seem highly inter-connected to me, in gentle and intricate ways, perhaps leading to subtle (or not so subtle) increases in other variables, such as love, generosity, and joy.

When I think of vitality, I think of an intensely traumatized Vietnam veteran who was my client. After receiving the first full-body massage of his life, he told me, he went home and, for the first time in twenty years, started dancing in the kitchen. Dancing! Embracing life instead of fighting pain; expressing life instead of resenting loss; affirming life instead of fearing the future. When I think of transcendence, I think of that client who reported falling in love with the world again after every massage: in Buddhist terms, a manifestation of a satori experience in which the ego is broken down, resulting in bliss. When I think of acceptance, I think of the many massages I gave to a friend while she lay dying. The glow I saw in her during that time was absolutely a glow of happiness, not just a bit of relief from pain. By focusing on and savoring the preciousness of connection in the moments she had left, she achieved a level of serenity and happiness rarely seen among those who take their lives for granted.

Touch Building Trust

And trust? I think of my mother, a vigilant woman who can see a miniscule bit of dirt on a carpet from a mile away; a person who can look at a beautifully decorated Christmas tree in her living room and comment, “too bad about that bare spot….” Yet she has slowly dissolved her own sense of decorum enough to accept that foot massage, hand massage, back and neck massage, and surrender to it, saying only, “Wonderful, wonderful.” The truth – life sucks, and then you die – sits right alongside this other truth: life is wonderful, and at a certain point, perhaps one can start to trust there might be something wonderful in the ending of life, as well. The energy we use up fearing pain, loss, and death can be freed up for better things: dancing in the kitchen, falling in love with the world, savoring what is, and surrendering to what will be.
 

How are we going to research and measure the usefulness of massage in increasing these positive intangibles, essentially spiritual aspects of our relationship with the world? Is there some way we can show that, as creatures of the hive, massage is one of the gateways which helps return to us our sense of belonging? Is our need for touch not all that spiritual after all, but simply a throwback to our primate habit of grooming one another, established over millennia and only recently lost? Your thoughts, perspectives, and research ideas welcome here. Me, I’ve got a whole bunch of massaging – er, “rubbing,” with a nod to Hippocrates — to do. Thanks for listening.
 

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References

Beard, B., & Wood, E.C. (1964). Massage: Principles and Techniques. Philadelphia, PA: W.B.Saunders.

Calvert, R.N. (2002). The History of Massage: An Illustrated Survey from around the World. Rochester, VT: Healing Arts Press.

MacDonald, G. (2005). Massage for the Hospital Patient and Medically Frail Client (LWW In Touch Series). Philadelphia: Lippincott Williams & Wilkins, 1-25.

Dunn, T., Williams, M. (2000). MASSAGE THERAPY GUIDELINES, For Hospital and Home Care, 4^th Ed. Olympia, Washington: Information for People.

Additional Resources

MacDonald, G. (2007). Medicine Hands: Massage Therapy for People with Cancer. Findhorn, Scotland: Findhorn Press.

Naisbitt, J. (1984). Megatrends: Ten New Directions Transforming Our Lives. New York: Warner Books.

Risse, G.B. (1999). Mending Bodies, Saving Souls: A History of Hospitals. New York: Oxford Press.

Images
Massage courtesy of Nick J. Webb
Backrub courtesy of Jhayne