Massage and other touch therapies, such as acupressure and reflexology, have a PR problem. In media, jokes about happy endings abound, and practitioners are often characterized as ditzy free spirits or muscle men and “mannish” women who emasculate straight, cis-male characters. Think flowy-clothed portrayals, perhaps most famously Phoebe Buffay on Friends, but also an extra-nervous George Costanza on Seinfeld who, when faced with a male massage therapist, perches on high alert, unable to form answers to simple questions about a hamstring injury because he is wholly incapable of divorcing touch from a sexual advance or feeling. Similarly, there’s a running joke on King of the Hill about John Redcorn treating neighbor Nancy’s “migraines,” their “massage” sessions a thin guise for an obvious extramarital affair. These archetypes reflect serious cultural hang-ups about touch, attitudes that are likely preventing more people from accessing the real benefits of nonsexual therapeutic touch.
Although the field of massage has formalized as an industry with licensing, governing professional organizations, and partnerships in healthcare and research, the term “massage” still carries sexualized implications, as well as inadvertent confusion about the difference between a masseuse and a massage therapist. A good massage education includes training in setting boundaries, ethics, and ways to respond to awkward (if physiologically normal) responses such as erections. But massage is one of the few occupations primarily and historically held by women—88 percent of U.S. massage therapists identify as women, according to the American Massage Therapy Association (AMTA)—and it requires its recipients to be physically vulnerable with a stranger. In other words, it’s work that is readily devalued. And yet, massage and other touch therapists have a long history of providing one of the most fundamental gifts we can offer those who are traumatized, sick, and suffering: human contact.
Therapeutic touch dates back thousands of years in many cultures around the world, but the rise of massage in the West is commonly noted to have originated in Sweden in the 18th and 19th centuries. Also called medical gymnastics or physiotherapy at the time, it was this school of massage that gained popularity in the United States and the United Kingdom, and by the start of World War I, a movement of massage to treat wounded soldiers had begun. Around this time, Pauline Payne Whitney, an American heiress, moved to England with her British-born husband Almeric Paget. She suffered many ailments and found massage helpful; they both believed in the effectiveness of this therapy and privately funded and founded the Almeric Paget Military Massage Corps in 1914 to support the war effort by helping speed the recovery of wounded soldiers. (The records of the United Kingdom’s National Archives reveal that the Corps also used hydrotherapy, electrotherapy, and heat therapy.)
Distinct from the Nursing Service, the Massage Corps grew to employ thousands of massage therapists, primarily women, working both at home and abroad. Seeing its success, the Royal Army Medical Corps eventually supported the operation with a grant, but Whitney would not see the full fruition of her efforts. In November 1916, she succumbed to illness and died at 42. The recovering soldiers in her clinics so adored her that they nicknamed her “the Angel of Summerdown” and served as pallbearers at her funeral. Her legacy persevered and in January 1919 the Massage Corps was absorbed by the War Office and came to be known as the Military Massage Service.
Today in the United States, massage therapy for veterans is widely accepted. The AMTA offers continuing education to teach therapists how to navigate the Department of Veteran Affairs (VA), citing research that massage can address many symptoms veterans suffer from, including PTSD, chronic pain, anxiety, depression, and insomnia. In 2017, the VA conducted a mapping project of existing evidence-based research on the effectiveness of massage in treating pain. The findings convinced the organization to include massage among the treatments covered by the Veterans Health benefits package.
In addition to supporting veteran recovery, massage therapists often deploy themselves in response to major disasters. These efforts are done almost exclusively on a volunteer basis and are typically funded by the therapists themselves. In the December 2001/January 2002 issue of Massage & Bodywork, editor Karrie Mowen included personal accounts from massage therapists who answered the call in the days and weeks after 9/11. Mowen reported that she received an influx of communications from touch therapists asking, “How do we help?” Mowen wrote, “We all needed a way to remove ourselves from the terror and tragedy, and helping others was a way to take back control.” They set up makeshift treatment stations in shelters and firehouses, and even on sidewalks; one account describes being identified by “masking tape labels saying ‘Medical Massage Team.’” The therapists witnessed the pain, exhaustion, and trauma of those closest to the tragedy. Through touch, they connected with survivors, families of victims, and first responders, as well as clergy and other volunteers. They found purpose and some peace in affecting those telltale signs of relief and relaxation in those they touched: a smile, a sigh, deepened breathing, nodding off, muscle tension dissipating under their soothing hands.
At its most basic, therapeutic touch works on the autonomic nervous system (ans), which regulates involuntary physiological processes in response to sensation, perception, or other stimuli. When the body senses danger—real or perceived, in the past or present—the sympathetic side of the ans is activated and the body goes into fight-or-flight mode: increased heart rate and respiration, decreased digestion, and sexual arousal. This response is necessary for our bodies to survive. It’s when the danger fades but bodies remain in that high-alert state—known as hypervigilance—that problems arise, often in stress-related illnesses and ailments. The body is no longer protecting itself; instead, it’s misfiring. It’s here that a relaxing touch can help recover a feeling of safety and restore the body to a parasympathetic state of “rest and digest.”
Sympathetic activation is not reserved for major events. Psychiatrist and trauma researcher Bessel van der Kolk, MD, notes, “The general public tends to associate trauma with the military and terrorism, but the vast majority of traumas occur within families, schools, and neighborhoods, the very people whom they depend on for safety and security…our zip code has a more profound effect on health and well-being than our genetic code.” By extension, we can understand “our zip code” to mean race, class, citizenship, and other markers of social inequities. When considering the contributing factors of stress-related diseases, Dr. Robert M. Sapolsky, neuroendocrinology researcher and one the foremost experts on stress in the United States, asks, “How do people with your social status get treated in your society?”
The United States’s reaction to the aids epidemic in the ’80s and ’90s is instructive: A novel and deadly illness primarily infecting stigmatized populations, combined with limited public knowledge of virus transmission and a government determined to ignore the whole thing, made pariahs of the infected. When a close colleague was dying of aids, massage practitioner Shawnee Isaac Smith saw that his suffering was compounded by being isolated at a time when he needed human contact the most. “People wouldn’t touch him,” Smith told the L.A. Times in 1999. “To me, that was very painful to see.” Smith massaged her colleague through the final stages of his disease, and saw the benefits of human touch on a person transitioning through the end of life. The experience led Smith to develop a method of compassionate touch and became the foundation of the Santa Monica–based nonprofit the Heart Touch Project, whose volunteers provided compassionate touch at no cost to aids and hiv-positive patients. The organization continues to operate, with an expanded focus that includes pediatric oncology, hospice, and other specialized training and services. “It’s not so much that we’re going to cure people,” says Smith. “It’s really about touching someone who feels untouchable, who has been made to feel untouchable.”
A clergyperson administered foot-washing to the wife of a wrongfully detained man. When the clergy’s hands made contact,
the woman began to weep.
Smith’s words reverberated for me in 2017, when the Trump administration’s ginned-up immigration crisis led to families forcibly separated at the U.S.-Mexico border, and Immigration and Customs Enforcement (ICE) raids that terrorized undocumented communities. One moment at a multi-faith demonstration in Los Angeles will stay with me forever: In the shadow of the city’s Metropolitan Detention Center, a clergyperson administered foot-washing to the wife of a wrongfully detained man. At the moment the clergy’s hands made contact with her feet, the woman began to weep. As a massage therapist, I witnessed this quiet act of touch and considered the implications. Clinical psychologists Karen W. Saakvitne and Laurie Anne Pearlman, in their book Transforming the Pain: A Workbook on Vicarious Traumatization, itemize five basic human needs that trauma undermines: to be safe, to trust, to feel some control over one’s life, to feel value, and to feel close to others. This woman and her family were in the midst of prolonged trauma; point for point, those needs had been eroded by systems of oppression bigger than any of us supporting her on the ground. In offering that safe touch, the clergyperson honored those needs and eased the woman’s fight-or-flight response, relieving and sharing in her burden if only momentarily.
Recognizing that healing touch is more than a way to address isolated physical injuries has become more crucial than ever. The pandemic didn’t necessarily create new inequities in U.S. society, but it has undoubtedly highlighted and exacerbated existing ones. In March 2021, Sakinah Irizarry, a Black massage therapist practicing in upstate New York, wrote about her inoculation experience for the blog of Associated Bodywork & Massage Professionals (ABMP). New York classifies massage therapists as first-tier health professionals, meaning Irizarry could be among the first to get the vaccine. While being vaccinated early would have offered peace of mind and allowed her to safely reopen her practice, Irizarry’s caregiver mentality made her hesitate: “Surely there are people more at risk than me, I thought. Surely there are people more in need than me. Surely there are people more deserving than me. Despite the knowledge that Black people were being infected and dying at rates three times more than white people, this mindset persisted.”
Irizarry discussed these feelings with her colleagues, and ultimately joined frontline workers in getting vaccinated, writing about the vaccine’s significance for a Black health professional:
“It means I have a little less worry about being on the receiving end of the disparate access to, and application of, healthcare because of my skin color, since being Black in America threatens to make us into statistics in every measurable way every day…
It means I am aware of the painful history and unconscionable present of how Black bodies are treated far too often in medicine…. It means I continue to educate myself and others about racial health disparities, and to agitate for healthcare equity for the disenfranchised, the vulnerable, and the forgotten…. It means I have work to do. And, so do you.”
I realized that this work would be about more than relaxation and pain relief—that I would join a legacy of providers for whom touch was an act of solidarity.
That work includes grassroots organization: In 2020, Irizarry cofounded the Anti-Racism Initiative in Massage (AIM) Alliance, a community program that cultivates both discourse among massage professionals as well as action beyond the field, including a social-media blitz to secure justice for Elijah McClain, the 23-year-old Black massage therapist from Aurora, Colorado, who was killed by police in 2019. (In 2021, three officers were charged with manslaughter by a grand jury.) AIM also organized providers to divest from organizations and conferences that do not showcase diversity, and support those that do. One that does is Healwell, an Arlington, Virginia–based nonprofit whose mission is to improve the quality of life for people with acute and chronic illness. On a recent episode of the podcast Massage Business Blueprint, Healwell’s executive director noted that they offer social-justice courses for practitioners addressing things such as implicit bias, weight stigma, inclusivity, and a curriculum created by Irizarry called “Challenging Racism in the Massage Industry.” Healwell’s workshops are similar to those in other industries that emphasize diversity and inclusion in leadership and offer strategies for avoiding tokenism and cultural appropriation. But such issues have extra-high stakes in massage, where physical and emotional immediacy can be imperiled by ingrained historical biases in medicine, such as those about racial difference in pain tolerance. Challenging still-common beliefs requires massage therapists to willingly examine their own biases and release self-aggrandizing industry attitudes such as one that Irizarry described in a November 2020 Massage magazine article as: “‘Oh, I treat everyone the same; I come to everyone with love.’ No matter what our good intentions,” she writes, “people are being treated differently when they walk in the door to your office.”
Since March 2020, the effects of isolation and touch deprivation have become their own kind of crisis, and massage initiatives have offered one way to serve the frontline healthcare teams that have shouldered—and continue to shoulder—so much of the pandemic’s burden. Since June 2020, I’ve been among them. The simple act of service quickly became a personal mission when, on my first day, a nurse thanked me for “not being afraid of us.” I realized that this work would be about more than relaxation and pain relief—that I would join a legacy of providers for whom touch was an act of solidarity. In a still-uncertain moment, those needs are many and compounding. They are physiological, psychological, and social, and have fallout that we cannot predict or map onto a time line. Our suffering hasn’t been uniform, but we have shared a common experience of social distancing that’s further complicated our cultural and personal associations with touch. In some ways, the pandemic elevated massage, as patients in oncology, hospice, and other palliative treatment settings asserted that massage therapists were among essential members of their care teams during lockdown. In public spaces, however, touch became more stigmatized, with even the least invasive forms like hugs and handshakes reframed as potential sites of infection. And the pain of being unable to be at the bedsides of loved ones who were sick or dying, in being prevented from holding their hands and saying goodbye, in not being able to gather at funerals will remain with us. But I would like to think that, in its wake, we will treasure physical connection even more fiercely, value touch more highly, and appreciate further possibilities for touch to help heal bodies, minds, spirits, and communities.
In his book The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, Dr. Bessel van der Kolk boldly identifies a few fundamental truths, among them, “Our capacity to destroy one another is matched by our capacity to heal one another.” In the face of death and disease, traumas and injustices, human and institutional failings, it would be easy—reasonable even—to succumb to overwhelm. But that would be to forfeit our potential for healing. covid has inspired challenges to and renegotiations of unjust systems and failing social structures. Hopefully, it has also inspired more examination of how we heal, as individuals and as communities, and more consideration of how we might, safely and therapeutically, extend our hands to touch one another with tenderness, compassion, and the intention to mend.