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Lonely for Touch? A Narrative Review on the Role of Touch in Loneliness

Published online by Cambridge University Press:  15 July 2022

Catrin Noone*
Affiliation:
Department of Sociology, Durham University, Durham, UK
Phoebe E. McKenna-Plumley
Affiliation:
Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK
*
*Corresponding author: Catrin Noone, Department of Sociology, Durham University, 29 Old Elvet, Durham DH1 3HN, UK. Email: [email protected]

Abstract

Loneliness is an increasingly ubiquitous topic in academic, policy, and healthcare domains. This work typically focuses on its negative physical and mental health consequences, generally employing a singular cognitive definition of loneliness. In doing so, one central aspect of our social world has been neglected in loneliness research and policy: touch. Touch is a fundamental human behaviour and a powerful form of communication which plays a role in physical and psychological wellbeing. This narrative review outlines a conceptual basis upon which to consider the relationship between loneliness and social touch and reviews the available research examining this connection. There are strong indications that these social phenomena can interact in a variety of ways and this review argues that elements of presence, absence, and type of touch may impact upon loneliness experiences. Additionally, this review considers the challenges inherent to researching touch and loneliness, reflecting on their sensitive and subjective nature. The increasing relevance of the touch–loneliness connection is described in light of the COVID-19 pandemic and recommendations are given for research, policy, and practice. This review proposes that touch should be a key topic for investigation in loneliness research and outlines the potentially invaluable role of touch in understanding loneliness.

Type
Review Article
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Australian Association for Cognitive and Behaviour Therapy

Introduction

Loneliness is a subjective experience that is prevalent across different life stages and cultures (de Jong Gierveld, van der Pas, & Keating, Reference de Jong Gierveld, van der Pas and Keating2015; van Dulmen & Goossens, Reference van Dulmen and Goossens2013; Yang & Victor, Reference Yang and Victor2011). Academic, policy, and healthcare domains are paying increasing attention to loneliness, which has been described as an epidemic, in part due to its debilitating effects on health and wellbeing (Courtin & Knapp, Reference Courtin and Knapp2017; Holt-Lunstad, Smith, Baker, Harris, & Stephenson, Reference Holt-Lunstad, Smith, Baker, Harris and Stephenson2015). Unlike social isolation, which refers to the objective qualities of a person's social network, loneliness is generally described as a subjective experience that occurs when a person perceives deficits in their social world (Perlman & Peplau, Reference Perlman, Peplau, Gilmour and Duck1981). While loneliness is subjective, it is closely related to aspects of the social world such as social integration (Stevens & Westerhof, Reference Stevens and Westerhof2006), social support (Menec, Newall, Mackenzie, Shooshtari, & Nowicki, Reference Menec, Newall, Mackenzie, Shooshtari and Nowicki2020), and perceptions of social threat (Cacioppo & Hawkley, Reference Cacioppo and Hawkley2009). However, one key and ubiquitous aspect of the social world has been notably absent from much of the discussion regarding loneliness: touch.

Social touch is a fundamental human behaviour and an important form of non-verbal communication (Routasalo, Reference Routasalo1999) which enables humans to interact before they learn language and develop mutual understanding even when shared language is lacking (Burgoon, Buller, & Woodall, Reference Burgoon, Buller and Woodall1996). Della Longa, Gliga and Farroni (Reference Della Longa, Gliga and Farroni2019) and Della Longa, Carnevali, Patron, Dragovic and Farroni (Reference Della Longa, Carnevali, Patron, Dragovic and Farroni2021) found that at just 4 months old, infants were more likely to learn an unfamiliar face when their own faces were gently stroked by a parent, but not when stroked with a soft paintbrush or not stroked at all. This affective touch may be a cue which makes social information more salient and encourages social engagement. fMRI research with adults similarly indicates that patterns of activation to touch from a person are different to those for touch applied by inanimate objects, with larger responses to social touch in somatosensory areas and the posterior insula, emphasising the importance of human touch (Kress, Minati, Ferraro, & Critchley, Reference Kress, Minati, Ferraro and Critchley2011). Even brief touch can be impactful; young adults felt more socially connected after just a quick touch on the shoulder from an experimenter (Koole, Tjew A Sin, & Schneider, Reference Koole, Tjew A Sin and Schneider2014), and in old age, Fast (Reference Fast2002) suggests that the touching of objects can itself express loneliness, with the anxious fondling of objects understood by family as expressing desire for companionship. Touch also appears to have long-term impacts on relational, psychological, and physical health over the lifespan (Lockhart, Reference Lockhart2019; Thomas & Kim, Reference Thomas and Kim2021).

These impacts on physical health and wellbeing may also extend to loneliness. This review aims to provide an overview of current knowledge regarding the relationship between loneliness and social touch. Moreover, this review highlights the relevance of this relationship for research, policy, and practice around loneliness, and situates this knowledge in the context of the COVID-19 pandemic.

The Conceptual Basis for a Loneliness–Touch Relationship

Touch is a complex sense that can be employed directly or indirectly to express a range of emotions and communications. These range from threatening demonstrations of control to reassurance or solidarity. Loneliness, meanwhile, is a subjective and multidimensional experience that can be expressed through the body via tension, fatigue, emptiness, and language (Smith, Reference Smith2012). Metaphors for loneliness such as ‘left out in the cold’ reflect a lack of warmth and intimacy (Bound Alberti, Reference Bound Alberti2019) while ‘in touch’ and ‘out of touch’ are phrases used to indicate levels of connection (Montagu, Reference Montagu1971), pointing to the relevance of physicality in loneliness experiences. In aligning social touch and loneliness, three broad touch categories offer a foundation upon which to consider the relationship. These are welcome, unwelcome, and absent touch (Jewitt, Price, Leder Mackley, Yiannoutsou, & Atkinson, Reference Jewitt, Price, Leder Mackley, Yiannoutsou, Atkinson and Jewitt2020), which might also be considered in terms of ‘good’, ‘bad’, and absent touch (Green, Reference Green2017). The first relates to a touch type that is wanted and/or warranted and is positively received (such as a warm, welcome embrace from a loved one), while unwelcome touch is conversely negatively received (such as physical abuse). Absent touch instead refers to a state of being without touch and can be perceived in various ways.

Both loneliness and touch have independently received significant academic attention. One might assume that the negative consequences of loneliness (Courtin & Knapp, Reference Courtin and Knapp2017) would be minimised by the positive effects of touch as a branch of social connection. Indeed, this process has been explored in non-academic literature. In a 2020 Guardian article, author V (2020) describes how touch saved her from ‘unbearable loneliness’, bringing comfort, pleasure, agency, and healing. A COVID-era article from BBC News showcases the centrality of touch in lockdown loneliness, with the author craving touch and reflecting on the length of time since she had last been hugged (Gray, Reference Gray2021). However, this relationship is less acknowledged in the academic literature. While Gaev (Reference Gaev1976) proposed the term ‘physical loneliness’ to describe loneliness occurring when human contact and touch are absent, this definition appears to have received no further academic attention. Accordingly, Victor (Reference Victor, Nieto and Rubio2021) identified the possible association between loneliness and not touching loved ones as a key outstanding question for loneliness research.

There are several indications of the importance of touch for wellbeing across the lifespan, which is salient as touch is the first sense acquired and last to leave us (Green, Reference Green2017; Paterson, Reference Paterson2009). The majority of touch-based research has focused on the importance of touch in infant development, with evidence that human touch improves health outcomes in the short and long term (Barnett, Reference Barnett2005). Being touched also has significant positive effects on altruism (Guéguen & Fischer-Lokou, Reference Guéguen and Fischer-Lokou2003), social connection (Koole et al., Reference Koole, Tjew A Sin and Schneider2014), affect (Peláez-Nogueras et al., Reference Peláez-Nogueras, Field, Gewirtz, Cigales, Gonzalez, Sanchez and Richardson1997), and attachment (Jakubiak & Feeney, Reference Jakubiak and Feeney2016), and promotes the release of oxytocin and endogenous opioids (Holt-Lunstad, Birmingham, & Light, Reference Holt-Lunstad, Birmingham and Light2008; Jakubiak & Feeney, Reference Jakubiak and Feeney2017). In the field of nursing studies, touch is often considered an aid to therapeutic engagement (Playfair, Reference Playfair2009) which can be used to communicate support. By demonstrating empathy and reassurance, touch is also thought to impact feelings of loneliness (Sundeen, Stuart, Rankin, & Cohen, Reference Sundeen, Stuart, Rankin and Cohen1994). The comforting role of touch in times of crisis has been underlined by reports of the desire for touch among people in prison approaching death by execution (Blakinger & Chammah, Reference Blakinger and Chammah2021). Welcome touch, then, may be associated with a reduction of loneliness through conveying affection, reassurance, support, empathy, and mutual desire (Green & Day, Reference Green, Day, Green and Day2013). Indeed, research links interoception (the perception of our own body and its sensations) with emotional wellbeing (Björnsdotter, Morrison, & Olausson, Reference Björnsdotter, Morrison and Olausson2010; Burleson & Quigley, Reference Burleson and Quigley2021), which may underpin the relevance of social touch for feelings of connectedness. While the links between touch and wellbeing might extend to loneliness — a highly social aspect of wellbeing — a deeper understanding of the role of touch in loneliness is lacking.

Empirical Research on Loneliness and Touch

A growing body of research underlines the impact of touch on loneliness, despite touch having been historically undervalued in this field. One pivotal experimental study points to the potential role of touch availability in loneliness. Participants were asked about three aspects of loneliness (neglect, emptiness, and direct feelings of loneliness) and subsequently had oil rubbed onto their hands either by an experimenter or by themselves (Heatley Tejada, Dunbar, & Montero, Reference Heatley Tejada, Dunbar and Montero2020). The researchers found that single adults felt more neglected than adults who were in relationships, but that being touched by another person lowered these levels to meet those reported by coupled individuals. The authors suggest that the availability of touch for coupled individuals may play a role in this finding and point to touch as a potential environmental cue for the evolutionary function loneliness serves, which alerts us to seek social connection (Cacioppo, Cacioppo, & Boomsma, Reference Cacioppo, Cacioppo and Boomsma2014). Beyond this, a global study including almost 40,000 people in 112 countries found that positive attitudes towards touch were associated with lower loneliness and higher wellbeing, and that most respondents had a positive attitude towards touch (Wellcome Collection, 2020). While 43% of respondents felt that society did not enable touch enough, it is encouraging that the primary reason people gave for this lack of touch was consent. It appears that while the importance of giving and receiving wanted touch is recognised, such touch is lacking and implicated in feelings of disconnection for many people, making it challenging for practitioners and researchers to address. A blended framework of welcome, unwelcome, and absent touch offers a useful way to consider the relationship between touch and loneliness.

Welcome Touch

Welcome touch, or good touch, can encompass a variety of touch behaviours and patterns which are applied and received positively (Green & Moran, Reference Green and Moran2021). For example, while gentle rhythmic stroking is thought to enhance infant development (Blackwell, Reference Blackwell2000), supportive touch (of both planned and unplanned types) is also considered therapeutic (Phelan, Reference Phelan2009), as is comforting touch from a mother, which is thought to modulate negative emotions and generate positive ones instead (Peláez-Nogueras et al., Reference Peláez-Nogueras, Field, Gewirtz, Cigales, Gonzalez, Sanchez and Richardson1997). Indeed, slow, affective touch appears to lessen the distress caused by social exclusion (von Mohr, Kirsch, & Fotopoulou, Reference von Mohr, Kirsch and Fotopoulou2017). This is not limited to human touch however, as a significant reduction in loneliness was recorded among residents of long-term care facilities exposed to animal-assisted therapy whereby all participants reported that touching their pet made them feel good (Banks & Banks, Reference Banks and Banks2002). Physical embraces are also considered important for general life satisfaction, with efficacy dependent on relationship status (Packheiser et al., Reference Packheiser, Malek, Reichart, Katona, Luhmann and Ocklenburg2021). Only single participants benefited from increases in average embracing, with those in relationships unaffected, suggesting that touch was more impactful for those usually deprived of it. During the COVID-19 pandemic, a nationally representative online survey also found a dose-response relationship between loneliness and frequency of hugging, kissing, and partnered sexual contact, with more frequent touch associated with lower loneliness (Rosenberg et al., Reference Rosenberg, Luetke, Hensel, Kianersi, Fu and Herbenick2021). Similarly, in this context, loneliness was predicted by the frequency of intimate touch, such as hugs from a close family member, but not by friendly or professional touch, with more intimate touch predicting lower loneliness (von Mohr, Kirsch, & Fotopoulou, Reference von Mohr, Kirsch and Fotopoulou2021).

These instances constitute social touch, a type of evolutionary bonding that allows us to connect or reconnect with our social network (Heatley Tejada et al., Reference Heatley Tejada, Dunbar and Montero2020). It is integral to human relationships, both in the form of intimate touch with loved ones and informal greetings with strangers. Evolutionary approaches consider loneliness a primitive response that alerts the body to seek social connection in order to avoid loneliness-associated risks such as ostracism and death (Cacioppo et al., Reference Cacioppo, Cacioppo and Boomsma2014). Physiological aspects like interoception may also play a role in this process, with the sensing of signals which indicate pleasant touch and sensitivity to these signals potentially impacting feelings of connection (Arnold, Winkielman, & Dobkins, Reference Arnold, Winkielman and Dobkins2019; Crucianelli, Enmalm, & Ehrsson, Reference Crucianelli, Enmalm and Ehrsson2022). In this sense, welcome touch is both a preventative measure and a social tool with which to reaffirm or enhance social bonds (Dunbar, Reference Dunbar2012).

Unwelcome Touch

Unwelcome or bad touch involves ‘domination, threat, and coercion’ (Green & Moran, Reference Green and Moran2021, p. 174), can signify a warning or indicate power dynamics, and often constitutes violence and violation (Green, Warwick, & Moran, Reference Green, Warwick and Moran2021). Touch can be experienced as bad irrespective of how it was intended to be received and such experiences may impact loneliness and connection, with lonely individuals more likely to report less liking of touch (Saporta et al., Reference Saporta, Peled-Avron, Scheele, Lieberz, Hurlemann and Shamay-Tsoory2021). Evidence suggests that unwelcome touch, such as abusive touch in childhood, can have a negative effect on adult relationships (Johansson, Reference Johansson2013; Sakson-Obada, Reference Sakson-Obada2014). One's self-esteem and ability to form, develop, and maintain relationships (of both platonic and intimate types) can also be negatively impacted, preventing the formation of new connections (Sakson-Obada, Reference Sakson-Obada2014). Given the alarming rise in domestic violence cases during COVID-19 (Social Care Institute for Excellence, 2022), the possible link between unwelcome touch and loneliness demands imminent attention from researchers and policymakers. Experiences of unwelcome touch directly jeopardise the evolutionary bonding mechanism within social touch, which allows us to connect or reconnect with our social network (Heatley Tejada et al., Reference Heatley Tejada, Dunbar and Montero2020), potentially increasing the risk of experiencing loneliness.

Absent Touch

Absent touch encompasses a lack of access to touch. It may represent an unwanted lack of touch, where the person desires more touch than they can access, or a preferred situation (Green & Moran, Reference Green and Moran2021). Research implicates the lack of touch in feelings of neglect for single adults (Heatley Tejada et al., Reference Heatley Tejada, Dunbar and Montero2020). Indeed, the lower levels of loneliness reported by partnered individuals may be related to the availability of physical touch created by these relationships (Adamczyk, Reference Adamczyk2016; Beutel et al., Reference Beutel, Klein, Brähler, Reiner, Jünger, Michal and Tibubos2017). During the pandemic, research suggests that the longer individuals had been in lockdown, the more they craved touch, indicating a cumulative impact of touch absence (von Mohr et al., Reference von Mohr, Kirsch and Fotopoulou2021). A qualitative study of loneliness during physical distancing also found that participants reported missing touch in general and in relation to specific contexts, such as the inability to offer a supportive touch to bereaved loved ones, indicating that an absence of touch is subjectively perceived as contributing to loneliness (McKenna-Plumley, Graham-Wisener, Berry, & Groarke, Reference McKenna-Plumley, Graham-Wisener, Berry and Groarke2021). The absence of touch is considered, in part, a casualty of an increasing reliance on digital culture (Jebara, Orriols, Zaoui, Berthoz, & Piolino, Reference Jebara, Orriols, Zaoui, Berthoz and Piolino2014). In considering absent touch, it is important to bear in mind the distinction between people who do not desire touch and people who would like to engage in touch more. Differences in touch preference may be particularly salient with respect to loneliness, which constitutes the subjective experience of desiring different quality and/or quantity of social connections than are available.

It seems possible that welcome touch may protect against or potentially alleviate loneliness, while absent and unwelcome touch may give rise to feelings of loneliness. It is not yet known if touch can positively regulate negative effects of loneliness but the sporadic literature on the topic certainly suggests that social touch can be associated with reduced loneliness. The single experimental study of this effect shows that even instrumental touch from a non-intimate other can lower levels of loneliness (Heatley Tejada et al., Reference Heatley Tejada, Dunbar and Montero2020). Recent research further indicates that the absence of touch is associated with loneliness and that the provision of intimate touch specifically is associated with lower loneliness (McKenna-Plumley et al., Reference McKenna-Plumley, Graham-Wisener, Berry and Groarke2021; Rosenberg et al., Reference Rosenberg, Luetke, Hensel, Kianersi, Fu and Herbenick2021; von Mohr et al., Reference von Mohr, Kirsch and Fotopoulou2021). Currently, it remains to be seen whether touch interventions might be a reasonable approach to ameliorating loneliness. However, it seems possible that touch may reduce loneliness, although the impact and processes require further study.

The Current Landscape for Loneliness and Touch

In recent years, loneliness has increasingly occupied public discourse as an epidemic and public health crisis (Easton, Reference Easton2018; Holt-Lunstad, Reference Holt-Lunstad2017). Policymakers internationally have committed to alleviating the experience through strategies including tackling stigma and establishing evidence-based loneliness services (Department for Digital, Culture, Media & Sport, 2020; Ending Loneliness Together, 2021). Indeed, research demonstrates the value of variety in loneliness interventions (Fakoya, McCorry, & Donnelly, Reference Fakoya, McCorry and Donnelly2020). Strategies and funding to tackle loneliness have been introduced over the past decade in the Netherlands (Zolyomi, Reference Zolyomi2019), England (Prime Minister's Office, 2018), Scotland (Scottish Government, 2018), Wales (Welsh Government, 2020), Northern Ireland (Action Group on Loneliness Policy in Northern Ireland, 2020), and Australia (Ending Loneliness Together, 2021) but with minimal, if any, consideration of the role of touch. Research on loneliness has also increased pace in recent years; Web of Science indexes 3,024 articles published on the topic of loneliness in 2021 versus 804 in 2016. Despite indications from public forums and research that tactile experiences can play an important role in loneliness, touch types remain largely absent from loneliness research. Given the impact of the pandemic on remote working and digital practices, the absence of touch from loneliness policies and research is a cause for concern.

Policy is key to understanding the relationship between touch and loneliness not just because it has the means to develop initiatives and enhance interventions, but also because it has shaped the nature of the relationship itself. Touch-related loneliness, for example, might be linked to austerity-based policies which ration care and support and leave those at risk of loneliness with reduced access to necessary social resources (McGrath, Griffin, & Mundy, Reference McGrath, Griffin and Mundy2016). Austerity measures, which have impacted societies in the UK, Ireland, Greece, Brazil, and others in recent years, have restricted the potential of communities and limited organic opportunities for social and physical connection (e.g., in libraries or community centres) in the name of reduced welfare spending (Evans & McBride, Reference Evans, McBride, McBride and Evans2017). The pervasiveness of neoliberalism, an increasingly dominant ideology, also continues to impact connection by increasing perceptions of competition, and has been shown to generate feelings of disconnection and loneliness (Becker, Hartwich, & Haslam, Reference Becker, Hartwich and Haslam2021).

Alongside this, the COVID-19 pandemic has left low-income workers, women, and ethnic minorities at most risk, thereby changing the political landscape of touch further through a ‘syndemic of infectious disease and inequalities’ (Bambra, Lynch, & Smith, Reference Bambra, Lynch and Smith2021, p. xiv). The rise of digital means of connection (such as social media and video calling) along with hybrid working practises (Pink, Ferguson, & Kelly, Reference Pink, Ferguson and Kelly2021) have also shifted the ways we connect (Twenge, Spitzberg, & Campbell, Reference Twenge, Spitzberg and Campbell2019), displacing practitioners’ sensual bodies (Kong, Noone, & Shears, Reference Kong, Noone and Shears2021), and leaving many at increased risk of loneliness (Hwang, Rabheru, Peisah, Reichman, & Ikeda, Reference Hwang, Rabheru, Peisah, Reichman and Ikeda2020). Indeed, the move to digital forms of connection and removal of touch have been implicated in loneliness and attachment in this context (McKenna-Plumley et al., Reference McKenna-Plumley, Graham-Wisener, Berry and Groarke2021; Menzies, Neimeyer, & Menzies, Reference Menzies, Neimeyer and Menzies2020). Yet, we have limited understanding of the explicit links between pandemic inequalities, touch, and loneliness.

By recognising loneliness as an embodied and contextualised sensory experience, we might complement the strengths of pre-existing initiatives such as social prescribing by thinking more literally about connection. Investigations into the effectiveness of friendship benches (where strangers are encouraged to converse in a shared space) should consider the tactile elements of engagement they offer, designs for community centres should explore the value of physical closeness, and befriending services might further investigate the differences between remote and in-person services, and between new acquaintances and close connections. Disciplines like urban planning can contribute valuably to this end. Indeed, existing research indicates that aspects of the environment such as access to transport, housing density, and green space are relevant to loneliness (Gibney, Moore, & Shannon, Reference Gibney, Moore and Shannon2018; Lai et al., Reference Lai, Sarkar, Kumari, Ni, Gallacher and Webster2021). Understanding the experience of loneliness as both subjective and embodied may be key to the success of programmes aiming to tackle loneliness at a national and international level.

Challenges in Researching Touch and Loneliness

The lack of direct empirical evidence regarding touch and loneliness may derive from the ethical challenges of researching these topics. Both loneliness and touch can be sensitive and deeply personal subjects. Reflecting both its potential for comfort and harm, Spieldenner (Reference Spieldenner2021) labels touch as ‘a tool for intimacy and violation’ (p. 339). The same touch may also be experienced differently depending on factors like the relationship between the toucher and the touched, the social and cultural context, and the preferences or past experiences of the actors. Phelan (Reference Phelan2009) notes that despite a level of professional taboo around touch in psychotherapy, appropriate touch was not prohibited or described as a boundary violation by the ethics codes of any major psychotherapy association. Indeed, in a qualitative study of the therapeutic context from clinicians’ perspectives, the most mentioned negative consequence of touch was the potential for misconstrual by the client (Harrison, Jones, & Huws, Reference Harrison, Jones and Huws2012). Work with counselling psychologists found that decisions about touching clients were made with the aim of minimising harm and maximising therapeutic benefit, although little to no training is provided on this practice (Damon, Reference Damon2018). The boundaries, intentions, and interpretations of the person touching and the person being touched may not align so it is essential that such disparities are considered, acknowledged, and respected (Paradisi, Reference Paradisi2020). Cultural norms also regulate touch behaviour and may shape expectations of relationships and understandings and experiences of loneliness (Heu, van Zomeren, & Hansen, Reference Heu, van Zomeren and Hansen2021; Suvilehto et al., Reference Suvilehto, Nummenmaa, Harada, Dunbar, Hari, Turner and Kitada2019), indicating the potential significance of context and culture in the touch–loneliness relationship.

Other societally mediated factors such as gender and age may also play a role in touch, loneliness, and expectations about their interaction. Research indicates that women, perhaps due to more affiliative socialised gender roles, tend to interact at closer distances than male dyads (Evans & Howard, Reference Evans and Howard1973) and are more likely to perceive touch from strangers of a different gender as unpleasant and invasive (Heslin, Nguyen, & Nguyen, Reference Heslin, Nguyen and Nguyen1983). Meta-analytic work also indicates that females tend to rate affective touch as more pleasant than males (Russo, Ottaviani, & Spitoni, Reference Russo, Ottaviani and Spitoni2020). A 1992 study found that men felt more uncomfortable when touched by same-sex partners and this discomfort was associated with homophobic attitudes (Roese, Olson, Borenstein, Martin, & Shores, Reference Roese, Olson, Borenstein, Martin and Shores1992). This aspect of stigma may be echoed in research on gender and loneliness which tends to find that men are less likely to report being lonely when the word ‘loneliness’ is directly used (Nicolaisen & Thorsen, Reference Nicolaisen and Thorsen2014). In a recent study of transgender and gender nonconforming patient experiences, many patients reported that healthcare workers had refused to touch them or used excessive precautions (Polonijo, Gardner, Clinton, & Brown, Reference Polonijo, Gardner, Clinton and Brown2020). Discrimination, stigma, and social norms clearly impact the relationship between gender and touch in ways that are potentially pertinent to the experience of loneliness, but these interactions have yet to be explored.

These group-level and individual differences in touch and loneliness, as well as the potential ethical issues of studying touch, contribute to the complexity of exploring this important relationship. Although touch is highly present and commonly discussed in social life, it is conspicuously absent from the growing literature on loneliness. As a result, the use of retrospective reports, observational methods, and self-touch paradigms may be useful ways of advancing knowledge regarding loneliness and touch. It is vitally important that research and practice in touch and loneliness take into account the complexity of this topic in order to avoid over-simplifying the multitude of roles — good, bad, and absent — that touch can play in our social world.

Research, Policy, and Practice Recommendations

This review presents an argument for an embodied understanding of loneliness which recognises its somatic components. Given the increasing public and political interest in loneliness, this conceptualisation leads to a number of recommendations for research, policy, and practice. We recognise that these should develop alongside new knowledge in this field but suggest the following recommendations as a departure point.

  1. i. Research on loneliness should explore the role of touch.

If loneliness research continues to exclude touch, it will remain epistemologically invisible in this field despite its obvious relevance. To prevent this, more empirical work on the relationship is needed. Potential lines of research might explore whether the amount or availability of touch impacts the experience of loneliness and whether touch is experienced differently by individuals who are lonely and those who are not, using qualitative, quantitative, and physiological investigations to explore impacts of social touch.

  1. ii. Policy initiatives addressing loneliness should acknowledge varied facets of connection including touch.

Policy initiatives addressing loneliness have made great progress in advancing the conversation and breaking stigma. However, policy should value the varied facets of social connection relevant to loneliness which include the bonding, comforting, and supportive role of touch and deep pain of its absence. While initiatives like social prescribing might connect lonely people with community groups for example, it is important to acknowledge the variation in preferences, personal circumstances, and (dis)advantage that ultimately comprise experiences of loneliness (Fakoya et al., Reference Fakoya, McCorry and Donnelly2020). For some, it may be an absence of strong social ties which enable comfortable touch, while others require touch in order to form meaningful bonds.

  1. iii. Service providers and practitioners should ask about and meaningfully consider the role of touch for lonely service users and clients.

In recognition of the wide range of practitioners involved in addressing people's experiences of loneliness, and the subsequent variety of procedures and protocols surrounding their roles, we recommend the broad consideration of touch in loneliness services. As practitioners increasingly reflect on the impact of social isolation and connection, touch should also be considered. This is pertinent in light of recent social prescribing efforts as interventions are matched to the expressed wishes of lonely people. Questions related to clients’ tactile expectations and/or boundaries should therefore be considered. Is the person missing someone to hug or a hand to hold? What are the tactile expectations of their client? Beyond this, services might reflect more generally on whether they lack physicality or have assumed clients’ tactile preferences without enquiring.

Conclusion

Touch and loneliness are individually well-researched topics in various disciplines and areas of knowledge. Both play invaluable and arguably universal roles in the human experience, but how these concepts interact has been almost entirely overlooked. With their presence in public discourse increasingly relevant, we are presented with an opportunity to uncover more about the nature of their relationship. This paper has provided a foundation upon which such exploratory research can build and makes a case for imminent action. From here, existing (and emerging) policy can be enhanced to address the embodied nature of loneliness.

Funding

The authors would like to acknowledge their doctoral funding received from the Northern Ireland and North East Doctoral Training Partnership, funded by the Economic and Social Research Council with support from the Department for the Economy Northern Ireland [Grant number ES/P000762/1]. The funder did not play a role in the development of this paper.

Declaration of interest

None declared.

Footnotes

These authors contributed equally to this work.

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