One of the fundamental methods of treatment of children in Chinese medicine is via physical contact. It is an essential element of connecting with the child, a diagnostic method in its own right, and the basis of various treatments. These include the most widely used, paediatric tuina, which includes pushing and stroking along the body surface, rubbing points, knocking and tapping with fingers, mobilising and stretching, squeezing and pinching. Touch is also a necessary component of the use of instruments for scraping, pricking, and needling. In this essay I wish to focus on the elemental qualities and role of touch in treatment rather than how to use these methods. A clinical encounter illustrates the power and meaning of touch for a young boy.
Touching nature
Traditional societies around the world have used touch as an intrinsic aspect of healing throughout history, perhaps a reflection of the physical nature of being alive that is shared with the rest of the animal kingdom. A dog will lick its wounds, a cat will purr when stroked, a foal will nuzzle the mare, the child will rub the pain away, a person in pain is held until the pain subsides. Shamans, witchdoctors, tohungas and other indigenous healers invariably used touch as part of the diagnostic and healing process, the laying of hands a part of the spiritual and mystical experience. In this context we are a part of nature, subject to its laws.
Touch is an intrinsic need in the human condition, to seek it, to desire it, to give it. We associate touch with intimacy, physical closeness allowing us to believe we are not alone in our own worlds. Touch can define boundaries, where we can and cannot touch, how we touch, and when, and whom. Touch implies a physical interaction, although our language recognises other more subtle influences inherent in the physical experience. For instance, we may be “touched” by a picture, sound, thought, feeling or vibration. Through touch we can convey, communicate, contain, keep safe.
Physical contact is a primary source of learning in the infant, only gradually becoming overwhelmed by visual, aural and kinetic experiences our society, customs and practices endow. Children learn first by touch, and develop remarkably sensate selves when this is affirmed. Deeply embedded neural reflexes are highly receptive to subtle changes in stimuli, and the body readily responds to human contact in versatile and adaptive ways. Within the first three years of life children develop the complex abilities to manipulate objects, develop fine motor coordination to explore the properties of the physical world around them. They learn and grow beyond instinctive response to comfort, satiation, discharge, sleep, and gravitate toward gratification and exploration, away from physical discomfort and painful stimuli. They can take genuine pleasure in touch, uncluttered by inhibition or connotation. They can understand the messages transmitted by touch in a way verbal language abstracts beyond their comprehension. I have seen parents holding detailed discussion with their child about proper and improper conduct in social situations where a holding hand would amply suffice. Needless to say, the child usually repeats the behaviour until some form of physical gesture, in the form of facial expression or physical removal or undue physical discipline finally results.
Informed Touch
Within medicine, the highest caste are those who have become those furthest from direct care and contact with the patient; Specialists, surgeons, consultants. It was undoubtedly no accident that as modern hospitals emerged the physical therapists was to be found in the basements and ground floors, while the surgeon was on the top floors. Practitioners in these various disciplines are rarely taught or trained sufficiently in the ideas of their counterparts, and each discipline tenaciously asserts authority over their respective domains. Individuals who broach the divide are often exposed to criticism, injunction and suspicion. Consumers of health services often under-rate or compartmentalise their own complex complaints, and practitioners who work with the body frequently focus on structural anatomy and functional physiology to interpret and analyse them.
Yet any tactile therapist who has accumulated clinical experience will affirm the phenomenon of verbal and emotional catharsis during physical treatment, and the less dramatic but nonetheless significant conversational intimacy that can arise during treatment. Conversely, a few years of counselling, psychotherapy or spiritual caring teaches even the most skilled guide that our body demands its own attention, exacts its own revenge and suffers its own way.
For the general public, and in particular those seeking attention to some bodily dysfunction, the polarisation of health care is frequently reflected in a relative ignorance or distorted understanding of physiology and anatomy. A recent internet article I read produced by a lobby organisation argued that according its own research, engaged Google users dealing with a health complaint end up knowing more than their treating doctor. This casts the practitioner in the unenviable position of being both untrustworthy and expected to provide the “right” answers. It also leaves both doctor and patient with little room to acknowledge the whole-systems nature of disorder, both preferring often to compartmentalise complaints and data according to category. So the doctor and the physical engineer may only hear about the pain, or the functional disturbances of the viscera, or the fatigue or other the pathogen. The counsellor may only hear about the anxiety and fears, the stresses and strains.
Touch, especially touching children, has become a minefield of perceived risk, and fear of physical abuse, paedophilia or other boundary violation often means the experience of touch is confined to that encountered in the home, however that may be. In Australia we have a system using Working With Children cards, to ensure a person even volunteering at a school has had a check of police records and is certified safe. As a male practitioner working with children, I sometimes encounter this fear, and pre-empt this by ensuring parents are present during my sessions, or in rare cases withdrawal by explicit mutual consent. I also witness the imbalance in the qualities of permissible touch. Parents readily accept soft, gentle, or comforting touch for their child, and I am perceived as safe when I have a medical rationale for using massage. However my experience is that most children have a natural inclination and enjoyment of being “man-handled”, wrestled a little, pushed a bit harder, and often crave it, being thrilled and disinhibited by powerful movement and comfortably tolerating pain as long as they feel safe. Unless I am comfortable and relaxed in myself, and in my hands especially, the child cannot feel that way.
The touching space
When a child enters the clinical arena, with parents, I usually let them explore the room, the toys, something to pick up and examine. They are the first to touch, while the parent shares the history, the problem, the progress. At times, initial contact with me is in the parent’s lap or arms, but usually, after I have addressed them directly, engaged from a relative distance, they readily climb my treatment table. Most are prepared for some form of physical exam, a procedure familiar to some children already experienced with clinical attendance. Typically, treatment feels safe when there is a routine of sorts, starting with palpation of affected areas, other parts of the body. When the problem doesn’t belong to a body zone are physical feature, but a behavioural, developmental or functional disorder or some sort, the novelty of a non-medical health care experience allows them to suspend judgment, though the younger the child, the more important to have the parent beside them at the table. After a few visits, it becomes more like at the dinner table without the food, chatting, moving about, listening and responding.
Frequently, children become impatient for the attention, demand commencement of proceedings, love the play and fun, the ticklish delight. Some of these can be very precocious. These children tend to have a strong need to control what’s going on, and their parents are usually struggling with setting boundaries for behaviour, often most difficult at bed time. Very occasionally, it can take several visits before a young child stops clinging to the mother, or crying as soon as I make my move. I tend to keep going, even if gently and briefly, to establish the pattern of the visits and invite familiarity with my tactile language. I know I’ll win them over, sooner or later, and that seems to help. These same children are often the most enthusiastic once they feel safe, and always, the characteristic of early encounters has some meaningful place in my understanding of the presenting complaint.
The disordered body state produces its own unique patterns of disharmony, as the combinations of constitution and innateness, personal and medical history, diet and lifestyle with the emotional, psychological and mental forces interact to disrupt normal physiology. It may be an instinctive urge to promote resilience that leads a parent to a tactile practitioner such as I, or it may be that the parent cannot find a satisfactory medical explanation or intervention for their child’s malaise and is therefore confronted with choices they would not otherwise make. A “belief” in Chinese medicine is not important, but gaining the trust of these parents is usually important to the child’s own sense of safety. Conversely, parents may be very keen to engage my services, while the child takes an oppositional stance. However a child inevitably transfers the trust barometer to their felt experience once treatment commences. I am often awed and thrilled by the growth and change in children that occurs when such innate language from the body is answered. Parents are often surprised too, not prepared for the impact on health and behaviour that body-centred work can infuse into a child’s development.
The touching method
The practitioner is likely to touch the client in several ways, including physical palpation, voice, physical environment, appearance, and emotional responses. The challenges for the practitioner, the parent and the child are to identify and establish through appropriate media and method the terms and conditions for the use of touch as healing in order to integrate the structural, physiological, psycho-emotional and energetic dimensions of disorder and restore relative equilibrium.
From history taking, mobility assessment, voice and behaviour, other observations and palpation, the practitioner is confronted with the immediacy of the presenting complaint and the need to exercise subjective judgment. Examination, diagnosis and differentiation of patterns, while informing therapeutic treatment, is a subjective process using objective parameters. The practitioner systematically gathers, sorts and evaluates a wide range and quality of information prior to and during treatment. The resulting impression must be modified to accommodate the nature and importance of responses which may include symptom changes, pain threshold and tolerance, postural stress and relaxation, altered breathing and speech, memories, insights and emotional states. The practitioner must be capable of acknowledging the subjective experience of the child while mindful of their own responses to effectively guide and transfer to them a more harmonised state.
There is no universal form of therapeutic relationship and individuals seek assistance according to their capacity, need, culture and opportunity. Practitioners too are shaped by their training and background. In my experience, many modern urbanised parents hover about their children monitoring and pacifying if there is any discomfort, and even pre-emptively offering reassurance or rewards. In practice we must be able to relate their personal orientation in a way that supports the purpose of the visit. Both the parent and child have a problem for which the parent at least is seeking guidance and support. Regardless of their role in that discomfort, we are there to serve that need in a way that connects with them and their needs. Personal histories of trauma, early prohibition or inhibition, religious or gender taboo can also affect individual capacities and boundaries for touch. While this obviously applies to the child and parent, it can also be reflected in the technical methods of the practitioner to the application of direct bodily contact. A successful intervention occurs when there is an authentic willingness to engage genuinely to provide a meeting point for healing, and sufficient integrity to share the healing space within those boundaries.
The touching practitioner
Tactile modalities, traditionally uniquely localised and specialised have become distinguished less by technique, which are often borrowed and plundered, and more by the theoretical and philosophical systems that underlie them. Clinically, differences are typically expressed in the relative emphasis of surgical, musculo-skeletal, postural, and kinetic assessment, or energetic, spiritual and lifestyle considerations. They are also represented in the selection and choice of supplementary methods of intervention. These can include guided imagery and active visualisation, breath-work, exercise systems and home care advice, application of heat or cold, selection and use of medicinal agents either externally or internally, emotional and psychological support and counselling. They can also include application of therapeutic devices such as electro-stimulation, magnetic sources, infra-red and laser therapy, acupuncture, thermal and orthopaedic braces and various other aids.
While technical sophistication gathers momentum, we confront the risk of undermining the importance of the touching relationships in our lives, ever fragile in our modern era. As the tactile industry has grown, opportunities for, and to touch on a personal level have been inhibited by changing social values, concentrating the parameters of allowable touch. The sense of potential danger, and the imperative to protect children from discomfort and risk are also growing barriers. We have fewer children and live in smaller spaces, more women are in the paid workforce, more children are in paid care, where rules of engagement provide strict codes for acceptable physical contact. These trends have contributed to the way carers seek and purchase touch, and to the explicit legitimisation of tactile treatments.
Those professionals that are prepared to address the risks as well as the benefits of healing touch, that recognise the social and moral ambivalence of touching others and promote awareness and discussion about this will be capable of and instilling an appreciation of the nature of touch within our own professions and the general public. A failure to do so will thwart the celebration of “natural” therapy we are currently experiencing, and propel the emerging generations into the great split of soma and psyche. It is insufficient to be mindful of touch – we must help the community to engage in touch in healthy ways. This includes by promoting the cultural and social as well as therapeutic role that touch performs, perhaps by teaching parents how to be physical with their children, and incorporating them into home-based treatments. By paying attention to our responses to touch we can refine and revive our tactile senses, teach children about their bodies and utilise the natural gift of touch, for pleasure, for resilience, for care, for health.
The touchers
Most therapists drawn to tactile methods have some sort of gift in their hands, an ability to touch sensitively, to receive the subtle feedback signals from others, the strength in the hands. In order to express the potential of this gift, we must develop our skill, use our tools of trade well and often, keep them in good order. The practitioner can then intelligently apply specialised knowledge, skills and experience to recognise underlying patterns in physical malaise manifesting in the child’s body. Through this we can apply appropriate tactile, behavioural, dietary, exercise and medicinal intervention strategies. Such sensitively discriminated knowledge provides a clinical efficiency that can be critical in achieving positive outcomes. While the personal experience of the practitioner can provide insight and wisdom, the spectrum of personal histories, personalities, needs, challenges, diseases and contexts is far wider than any personal experience can provide, so we must continue to learn throughout life. Understanding arises when we apply our knowledge, test the limitations of accepted belief, and remain present and involved in the experience of the child while maintaining sufficient distance and wisdom.
The touched
There is an abundance of books, charts, therapies, interpretations and other exposures to bodywork which can inform choice for the consumer. However once a suitable pathway is established and compatible practitioner discovered, the whole family benefits most when they actively commit to a therapeutic partnership, to exploring these questions together in a relationship of trust and respect. It is then that an incorporation of touch can make the significant difference for the child, who is able to feel safe in “good hands”.
Humans have a natural and basic need for sensory development through touch, and studies have demonstrated the damaging influence of sensory deprivation. My observation is that we don’t touch or be touched enough. Developments in illness management must not occur at the expense of the personal, the inward dimensions of disharmony. Medicine is increasingly mediated via instruments, the objectification of the body produces abstraction of our felt experience and touching can be taboo. In an age where terror and insecurity prevail, where the economics of medical care strain against the limits of technology, and where our social structures, methods and resources more often isolate rather than connect us, touch can provide a bridge for human encounter. Tactile professionals are custodians of that bridge connecting soma and psyche in healing; this must be kept safe, preserved honorably, and we all are entitled to it. Perhaps if we can learn to touch and be touched in healthy ways, and allowed our bodies more often to respond freely and without fear, with safe others and in healing space, we may yet overcome the imposition of ignorance and outmoded aversion to our bodies and give healing touch the honoured place it deserves.