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16
Disease Directory 

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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