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.

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.