I often tell my patients not to focus narrowly on the diagnostic label
dermatology gives their skin problem. Your eczema or acne may be responding to
the same needs, fears, and emotional tasks as your neighbor's psoriasis or hives,
but I know that most people suspect that they have at least something in common
with others who suffer the same rash or itch and they want to know what my
approach can offer their symptom or disease. Certain skin conditions can
be associated with certain specific tasks, and they respond best to certain
techniques. Knowing this can foster insight and guide treatment.
For this chapter, I combed medical reports that have appeared in journals in a
dozen languages over the last hundred years. The goal is to help you understand
the emotional factors behind your particular disease, to answer the question "What
will these techniques do for me?"
A few cautions:
'Science advances by generalizations, but you are an individual. What works for
others might not work for you and vice versa. Although "stopping the clock"
is a common task behind adult acne, your acne may be "crying for
love."
'The Griesemer Index (see chapter 4) gives only a rough, relative idea of each
symptom's emotional responsiveness. If you are one of the 36 percent of herpes
sufferers whose symptoms are worsened by emotional factors, your sensitivity
is 100 percent.
'Because any persistent or severe skin problem has emotional impact, any skin
patient with any disease can benefit from the techniques in this book. Even if
emotional factors don't trigger or aggravate your problem, techniques such as
relaxation will make it easier to live inside your troubled skin.
If you can't find your symptom or illness here, ask your dermatologist for
various ways it may be identified or check one of the general references I cite.
Often one skin condition goes under several different names. For the basic
description and conventional treatment of each disease, I have used Fitzpatrick's
Dermatology in General Medicine and Arndt's Manual of Dermatologic
Therapeutics. See the Bibliography for each book's full citation.
Acne
(Griesemer Index: 55 percent; incubation period: two days)
When the sebaceous glands begin producing their oily secretion just before
adolescence, the common condition called acne frequently develops, with pimples,
pustules, cysts, blackheads, even abscesses. Most acne, no matter how severe,
disappears by the twenties, but the condition may persist or recur, or even
start for the first time, later in life. Most medical and proprietary treatments
for acne are topical preparations. Tretinoin (Retin-A) is usually the most
effective, with salicylic acid (Stridex) as a backup. These medications are
often combined with benzoyl peroxide and/or antibiotic creams. In moderate to
severe cases, doctors often add systemic antibiotics, usually tetracycline. Accutane,
a medication related to vitamin A, is effective but must be handled with care.
It has been clearly identified as a cause of birth defects.
There seems to be general agreement that stress can trigger and exacerbate
adolescent acne, although the condition itself is basically physiological and
hereditary. When acne outlasts adolescence, the importance of emotional issues
increases, particularly conflicts surrounding growing up; the skin, quite
literally, remains in adolescence.
The anguish of acne is unquestionable. Coming in the midst of the turmoil of
adolescence, it can promote isolation, damage body image, provoke feelings of
isolation, and impede sexual development. Acne sufferers frequently feel that
their disease is "dirty" and makes them "repulsive." Many
teenagers with severe acne can benefit from supportive psychotherapy and
reassurance; an honest approach that recognizes and addresses teenagers'
tendency to connect acne with guilt and punishment is critical. No tranquilizer
can replace rapport and explanations that dispel fears and anxieties.
Psychological techniques that promote relaxation and reduce stress have proved
valuable additions to medical therapy for acne. You may supplement these
techniques with diagnostic work aimed at exploring growing-up, stopping-the-clock,
and sexuality issues that may heighten the symptom.
Allergies
Allergy is not a disease but a mechanism that causes many diseases, including
asthma and hay fever. Allergic skin eruptions follow exposure to plants or
animals or ingestion of food to which a person is sensitive. Such symptoms as
hives and eczema are often caused by allergy.
These skin problems reflect a biological predisposition (probably involving the
immune system), but psychological factors play a major role.
As the Japanese lacquer tree study cited earlier showed, an allergic reaction
may follow exposure to a harmless substance to which a person believes he is
sensitive. By the same token, an allergic reaction can be conditioned, linking a
particular substance to an emotional issue. One girl developed a strong allergic
reaction to wood and wood products. When hypnotherapy allowed her to connect
this to her difficult relationship with her father, who was a carpenter, the
allergy vanished.
Perhaps the most intriguing demonstration of the emotional side of allergies
comes from Chicago psychiatrist Bennett Braun. A pioneer in working with
multiple personalities, he reports people who have an allergic reaction to a
food in one personality but have no trouble when they have shifted into another
personality.
These are just two of many research and treatment reports. I present more under
the name of specific skin symptoms (such as hives or contact eczema). Hay fever
and especially asthma are also fertile ground for these approaches.
Angular Cheilosis
Ulcerations and cracks appear in the skin at the angles of the mouth,
usually in connection with dental difficulties. Effective treatment requires
dental correction of conditions that may cause drooling and skin irritation. A
less acidic diet, topical preparations, or systemic antibiotics may also be
needed.
Secter and Bathelemy linked excess salivation to this symptom in one patient.
She used her own self-hypnosis procedure? Imagining her salivary glands to be a
faucet, which she could adjust to maintain optimum flow? And focused on the
disappearance of the lesions themselves for noticeable improvement.
Bacterial skin infections (Furuncles [Boils], Folliculitis,
Impetigo, Recurrent Infections, Pyoderma)
(Griesemer Index: 29 percent; Incubation period: days)
Skin infections are usually treated with antibiotics and appropriate hygiene.
Because the microorganisms responsible are for the most part ubiquitous, it
seems that susceptibility to recurrent infections often involves a lapse in the
body's own defenses. Emotional stress of various kinds is known to depress
immune function, and many people have noted the appearance of boils or other
infections at a time of turmoil.
Thus, any techniques that help you handle emotional conflict and defuse stress
may have a beneficial effect on recurrent infections.
In one case, described by Jabush, hypnosis brought dramatic improvement where a
host of other therapies had failed. The patient was a thirty-three-year-old man
whose chronic condition of oozing boils dated back to his teenage years. By now,
his body was covered with boils, furuncles, and scars. The organism responsible
was known to be the common Staphylococcus aureus, but no medical
treatment was effective. An emotional factor in his illness was suggested by the
fact that the new boils appeared on his face after bad dreams and restless sleep.
Under hypnosis, the patient was told to imagine cold, tingling, and heaviness in
the infected areas. He was instructed to use self-hypnosis and autogenics to
relax and to extend the effect of hypnosis. His skin improved dramatically
within a week and continued to clear over thirty-three sessions.
Behcet's Syndrome
Recurrent ulcerations appear on the mouth, genitals, and sometimes the
eye, where it threatens sight. Behçet's syndrome can affect other body
systems; when the nervous system becomes involved, mortality is 50 percent.
The cause is unknown but may be viral, hormonal, or immunological. There is no
definitive medical treatment.
An emotional dimension to Behçet's syndrome was suggested by a
study by Epstein and colleagues of ten patients. All had severe psychological
problems, especially excessive concern about bodily illness and aggressiveness,
and difficulty dealing with anger. They had all suffered their initial symptoms
and major relapses during emotionally critical periods?crises involving family
deaths, job loss, hysterectomy, and economic setbacks. A recurrent theme in
these crises was a relationship shift that forced the patient to take on a more
or less grown-up role.
As a group, these patients were childlike and dependent on a parent or spouse.
They had difficulty growing up and feeling like autonomous men and women. They
were prone to severe depression.
A short series of three to four psychotherapy sessions was helpful to them.
Chapter 5 may be a helpful exercise for Behçet's syndrome patients, with
particular attention to feeding and sustenance issues surrounding the mouth and
sexuality when genitals are a focus.
In looking at the Time Line and other diagnostic exercises, be alert to tasks
surrounding growing up, anger, and sex. With this potentially life-threatening
illness, it is especially essential to get down to serious emotional work,
possibly with a therapist?as a possible deterrent to future recurrences.
Burns
Burn is possibly the most painful assault on the skin. Not only is
the original injury extremely painful but therapeutic procedures applied along
the long road to recovery are frequently agonizing as well.
Hypnosis and other psychological therapies have dramatically proved their value
in controlling pain and easing the emotional trauma that accompanies serious
burns. Studies have shown that hypnosis can reduce the need for painkilling
medication. Children and adolescents seem to profit particularly, perhaps
because of their generally superior trance capacity.
Psychotherapy to support and strengthen patients in their difficult passage back
to health has proved effective by helping them mobilize their own coping
abilities, focusing more on their resources and less on their liabilities. Group
meetings for families are often a useful adjunct.
Cancer
[Griesemer Index (for basal cell carcinoma): 0 percent]
The role of emotional factors in the development and course of cancer is one of
the most controversial questions in the mind-body area. Very little has been
written on skin cancer per se but volumes have appeared advancing and attacking
various hypotheses linking emotions, life history, and cancer.
Some studies have connected depression and despair with a high risk of cancer.
Others focus on the suppression of anger: malignancy, they say, is a
biological result of repressed rage. Simonton and coworkers described the cancer-prone
personality as unforgiving, self-pitying, and resentful. Because cancer
typically takes years?even decades?to develop, it is difficult to link specific
events to the disease, but trends have been noted. One study found, as a
persistent pattern, the loss of a serious love object six to eighteen months
before the diagnosis. Fawzy and colleagues provided patients who had just had
surgery for malignant melanoma with six weeks of group psychotherapy, including
education, relaxation, and support. Six months later, group members were less
depressed, fatigued, and confused. They also had more vigor, active and
effective coping strategies, and more effective immune systems than
comparable patients who had not had the group treatment.
Rogentine and associates at the National Center Institute tried to predict which
patients with malignant melanoma (a particularly virulent skin cancer) were more
likely to recover without relapse. He found that one question was a better
predictor than all other social, medical, or personality factors: "How
great an adjustment did your disease require of you?" Those who experienced
the greater impact, who felt their feelings, were the healthy ones. Those who
kept a "stiff upper lip" succumbed to the disease.
Psychological techniques may be useful for skin cancer patients if only to
ameliorate the emotional impact of this disease. Skin cancer is not life-threatening
in its most common forms, but the word "cancer" retains an exaggerated
power to arouse terror, shame, and guilt. As for treatment, proper medical
management may be augmented by techniques that promote relaxation and reduce
anger and depression. Simonton and coworkers have used imaging techniques
against many forms of cancer, and anyone interested in them should read this
book (see also the section on "Sun Addiction" in chapter 3).
Disease Directory Part Two
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