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2012/09/11 - News from medical groups

SKIN IN PSYCHOANALYSIS (Karnac Books, London, 2007)

By Jorge C. Ulnik

Peter raises himself from the couch. Once he has left, his psychoanalyst notices that Peter has left silver scales of epidermis which stand out against the black leather of the couch.

Could we term these phenomena "Skin in psychoanalysis"?

The psychoanalyst would probably reply in the negative: Peter’s psoriasis is genetically determined; his skin comes off in small pieces and there is nothing he can do about it.

Peter has an appointment with the dermatologist after his session. While he undresses for the physical exam he leaves a pile of scales on the floor. The dermatologist asks him how he is doing and Peter, pointing to the scales on the floor, replies, "look, there I am".

What Peter sees in his own scales is himself, as if he were another who leaves traces everywhere. This other "presence" is disavowed by his dermatologist and his psychoanalyst, who just hoover the floor, as Peter’s wife always does, and put Peter’s "other me", which, incidentally, is torn to pieces, in the rubbish bin. The author learned this from a patient with psoriasis who spoke of her divorced mother saying "If I moved in with Dad, Mum would fall to bits", while her skin came off in small pieces.

In our present cultural context, where interdisciplinary work is essential and where a piercing or a tattoo grant a feeling of identity to youths whose subjectivity is at risk, the issue of the skin seems to be receiving a lot of attention and the psychoanalysts must bear in mind that Freud used to consider it "the erogenous zone par excellence", and that it was also the entrance and the exit door for many emotions and situations which mark us.

The author of Skin in psychoanalysis has devoted his entire professional life to psychosomatics. He has observed that patients usually have outbreaks of the disease after key significant episodes, among which separations - due either to divorce, abandonment, dismissals, immigration or the death of loved ones - occupy a very important place. Thus, he has been trying to understand diseases as singular experiences which are inscribed as chapters in the vital history of people. His interest in psychosomatics led him to the dermatology ward, where doctors asked for interconsultations with greater frequency. He thus began developing joint consultations (i.e. consultations where patients were seen by a dermatologist and a psychoanalyst), group therapies for patients with psoriasis and, finally, private sessions of psychodynamic psychotherapy and interdisciplinary activities as well as research in Latin America, Spain, Italy Australia and Portugal.

His aim giving psychotherapy to psoriasis patients is to understand, interpret, accompany and mitigate in some way the misery internally experienced by patients and displayed on their skin. This suffering, like psychological suffering, is minimised by all, and can only be understood by those who have experienced it, or at least, by those who have analysed it with a non exclusively visual curiosity.

The book is the result of more than fifteen years of work with patients with psoriasis. It might provide an answer to questions such as: What is the relationship between skin, the psyche and the gaze? What kinds of internal sensations are experienced by someone who, for instance, frantically scratches or tears off small portions of his own skin? What do chronic psoriatic patients really expect when they wander around different consulting offices? What is the difference between a tattoo and a lesion on the skin? What would the aesthetic value and the dignifying effect of suffering from skin ailments be? Is blushing a display of sensitivity that unchains desire? How does a psychoanalyst work with patients with psoriasis?

Doctor-patients relationship and placebo effect in psoriasis are also examined. Analyzing the comments provided by NPF members in a book titled "it works for me", Dr. Ulnik considers a very surprising fact that patients testify having good results by using the most varied and peculiar range of household products and original combination of elements. He thinks that this deserves both a scientific and psychological explanation. The chapters dealing mainly with psoriasis cases also include a theorization about the skin and the gaze, the symbiotic relationships, the medical publicity regarding the skin and some literary examples taken from Franz Kafka (In the penal colony) and John Updake, the most famous psoriatic writer. Psoriasis is omnipresent in the whole book which helps patients and doctors to think about themselves, the disease and the clinical practice from both sides of the healing process.

To conclude, "Skin in psychoanalysis" sheds light on that deep suffering which is felt in the soul and reflected on the skin.

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