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Sensing and Feeling: Part 2

by Laura Rathbone

Hi everyone,

I hope that you have been enjoying this month’s paper:

In this short blog, I’m focusing on the final half of the paper (pages 745 - 750) which focuses on bringing the social and evolutionary perspective on touch, particularly affective and pleasant touch, to the proposed biological processes.

Why do sentient beings like to touch each other?

We choose, seek and develop around touch, but why?

Why even evolve the complex systems to have touch?

These are some of the questions that are becoming increasingly important as we develop technology with intelligence - do we need to programme in affective touch to machines?

What if we didn’t programme nociception? How would they develop as sentience emerges?

Should we programme in pain? And what would that programme look like?

These questions may seem un-related to the field of pain, but they are precisely the reason that pain is being explored and investigated with renewed interest, how important is pain to humanity and sentience? What is it? how do we do it? And perhaps, most challenging of all, why do we have this experience? And does it need to hurt?

The link between complex systems technology and healthcare theory and science runs deep and we walk hand-in-hand into complexity and uncertainty.

So when we read about and contemplate perceptual experiences of humans, the social, meaning and evolutionary perspective is an important one to consider. Pain and touch are obviously linked by much more than biological events, they are culturally constructed and how we have pained and touched is passed down through our genetic coding, each generation of being more precisely coded to do touch - and as we become more precise, our parameters for error become smaller. Does this tell us why we are more fragile? As a species, living in the west of Europe or affluent countries of the world, have we become too precise?

In this second part of the paper, the author attempts to shed some light on possible reasons for the development of the perception of affective touch, and what might happen if we don’t develop this.

As pain-interested clinicians and therapists from various backgrounds, exploring the role of touch might help us to understand why people with pain choose and value touch-based approaches over talking-based approaches that may go beyond validation and stigma. It may well be that on a physiological level, touch is playing a much more important and necessary role. this might lead us to ask questions about how touch is regulated and medicated in the healthcare vs non-healthcare therapies using touch.

When it comes to touch, are we missing the point?

In healthcare, touch is political, weaponised and both culturally and legally regulated. To the point where even as Physiotherapists, where touch is one of our principles of therapy, we are fearful, confused and unsure of how we are allowed to use touch. Systems of touch, like Manual Therapy, have medicalised and operationalised touch through a strict model of practice that has worked to create and widen the gap between ‘therapy’ and pleasure.

Medical touch must be targeted and have an evidence-based specific therapeutic affect for it to be justifiable and so touch in healthcare has inevitably become colder, disconnecting and less pleasant. Gone are the days of holding someone’s hand, offering up a cuddle in distress and the stroking of someones hair or shoulder in times of comfort. Even as I write this, I wonder, is this true? I look to my peads family and see them working hard to de-medicalise and re-introduce care, and I look to my elderly/geriatric care and neurorehab family and see them using our knowledge of touch, care and human connection in their practice. So why is it, that in the working age of population health, especially in bodily-situated pain, we are so hands-off? And what could re-introducing ‘care’ into our practice bring the people we work with?

This article boost the flame that I've been burning with for many years - adult working age healthcare must de-medicalise and re-commit to care if we have any hope of supporting people to thrive in society.

Touch is one of our earliest developed somatosensory pathways and there is evidence that fetus’ are interacting with touch from as early as 8 weeks in-utero. This is not an argument for fetal consciousness, watch out for running off with that because it is harmful to folk who have reproductive rights. There is early in-utero interaction with touch, which suggests that complex beings like mammals, have evolved to be highly interactive with the sense of self and other - the touched and the touching (toucher?).

So, I ask myself the question again, when it comes to touch…have we missed the point?

I’m left with so many questions after this paper…

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