Getting In Touch

“50/50” is an uneven movie that tells the story of an uptight 27 year old boy as he struggles with the diagnosis and treatment of cancer. Thankfully, it is not a sentimental tearjerker, but more an exploration of the protagonist’s relationships with his girlfriend, best friend, physicians, therapist, parents and other cancer victims. The unevenness is the fault of the writer, who in his semi-autobiographical script, wastes the skills of some very talented actors by having them play caricatures instead of believable people. Angelica Huston is the aggrieved mother but nothing more. “I only smothered him because I love him.” Seth Rogan plays the same vulgar, drug, booze, woman-as-object seeking character as in all of his previous films. He is much less believable as a best friend without his posse. He has nothing in common with his neat freak buddy and in the end we are supposed to like him because he reads a book (though not to the end). Ron Howard’s daughter, Bryce Dallas Howard, who played the villain brilliantly in “The Help”, is again cast as the bad guy, but this time just gets to show off her full lips, wet eyes, blazing red hair, avoid intimacy and get booted out the door. Who could even believe she and the cancer dude would ever hook up?

The cancer dude, Joseph Gordon-Levitt, does a good job acting out the stages of illness and portraying a stiff learning to recognize his feelings. He is helped by his therapist, played by George Clooney’s “Up in the Air” sidekick, Anna Kendrick. She is just another incompetent practitioner in a movie that stereotypes doctors as unfeeling assholes. She, however, has an excuse because she is a mere student therapist. As I mentioned in my “Death Lessons” blog earlier this year, medical students are in fact stumbling, fumbling, and potentially dangerous, but those flaws make them likable to patients. Emotional intimacy and trust are common. The therapeutic relationship in “50/50” begins with an awkward touch by the novice psychologist. The importance and difficulty of touch in the practice of medicine are well shown in “50/50". That got me thinking…

35 years ago I attended an old girlfriend’s massage therapy class in San Francisco. In order to work in a California massage parlor in those days you had to have a license. In order to get the license you had to take a course in massage. The class I had the pleasure to attend that day was therefore what my friend called “half hookers, half healers”—50/50 if you will. The hookers in their tight hotpants with their stiletto heels and nail files sat on one side of the room while the bearded or braless (or both my brother would say) Birkenstocked healers massaged each other. That room was a metaphor for the dichotomy of touch. And that ex-girlfriend was my 1980s definition of friends with benefits. Sex was sex, but a full leg massage after a 6 mile run was heaven.

Touch is an integral part of the practice of medicine. In our Physical Examination course we are taught to first warm our hands, and then initiate contact with a gentle, unthreatening touch to the arm. Every subsequent touch is preceded by a verbal warning, “I’m going to listen to your heart”, giving the patients the opportunity to prepare for the invasion of personal space and object if they want. After each part of the exam the physician should offer reassuring words, “Your heart sounds normal”. A good poker face is an asset. Worried looks and “Whoa, what’s that” are to be avoided. When examining the opposite sex or a child, a chaperone should be present. Nowadays every patient is a potential adversary with many lawyers ready, waiting only an 800 phone call away. Touch enables me to take a blood pressure and feel a liver. It also allows me to comfort the anxious, the ill and the bereaved. Mostly, it helps me build a physician-patient relationship with mutual trust. Think of the brisk, unexpected insertion of a cold speculum by a clumsy gynecologist and then imagine the opposite. I try to be that opposite. Some doctors never get it. A medical school friend once told me that’s why they have pathologists and radiologists. I might add psychiatrists too. Traditional psychiatry teaches therapists never to touch their clients.

Ofer Zur, PhD teaches an online course in continuing education for psychotherapists. In one session he discusses “To Touch or Not to Touch: Exploring the Myth of Prohibition on Touch in Psychotherapy and Counseling. Clinical, Ethical & Legal Considerations”. It is a major academic treatise. Some interesting points: 90% of analysts admit to being sexually attracted to their clients while 10% have acted on that attraction. The meaning of a touch intended by the therapist is not always the same as that perceived by the client. The perception of touch is influenced by factors including culture, race, sex, age, religion and many more. Societies place many taboos on touching others and oneself. Touch is critical to the healthy development of the fetus, infant and child. His bottom line is yes, touch, but following defined guidelines and only with training, competence and reeducation as needed. But realistically speaking, if you’re hoping for a comforting touch, go to the masseuse, not the shrink.

“50/50” ends on an optimistic note. Cancer-free dude and Psychie chick get together for a date. His hair is growing back. She is holding a pizza box. They smile and she asks, “What next?” Producers wanted an on screen kiss. Cast refused. End of movie. Tender touch to follow. I like it when the students stop their fumbling and feel good about being doctors. Even without the happy ending, medicine still has its rewards.