warts has asked that question. It can be far more than a cry against fate. Beneath it
lies “Who am I?" – a riddle that will lead you to a fuller understanding of your skin
problem and ultimately to relief. It was Hippocrates, the father of medicine, who said,
"It is more important to know who has a disease than what disease he has."
You already know who you are? Not likely. Few of us have a grasp of our
identity on all its buried levels. The search for self-knowledge is a lifetime task that
goes beyond psychotherapy: it wasn't Freud but an ancient Greek philosopher who
commanded, "Know thyself."
Will self-knowledge heal your skin? It's not that simple, but the better you know
yourself, the more able you'll be to confront your emotional needs with your head
and heart, freeing your skin to carry on its normal physiological duties, and the better
you'll cope with the psychological burden of problem skin.
This kind of self-knowledge – discovering what emotional task your skin is
trying to do – is a special challenge. The same fear and pain that kept you from facing
your emotional needs in the first place keep your naked need for love, respect, and
protection deeply buried. Don't expect your inner self to yield up its secrets without a
struggle.
You've seen a minor league version of this struggle if you’ve ever hunted in vain
for the vacuum cleaner on a day when you didn't really want to clean. Your heart
wasn't entirely in the search: you were the hider and the seeker simultaneously. A
similar process may keep a word on the tip of your tongue but tantalizingly out of
your conscious grasp. There's something within you that doesn't want the word to be
found.
Similarly, when you look within to discover your deepest needs and feelings,
you will find the truth in spite of that part of you with a stake in keeping that
vulnerable side hidden. I recall one patient who grew up with the "I’m-tough-and-I-
don't-need-anything-from-anyone" worldview. He had suppressed his need for love
until psoriasis, which required tender care, voiced it for him. Before he could change
his life to satisfy these needs directly, he had to accept them, and this meant
wrestling down the stalwart (but actually terrified) guardian of a macho self-image.
When you start living with the question “Who am I?" you might expect your
pursuit of the answer to be double-crossed by ambivalence as the inner hider evades
your inner seeker. At the outset, commit yourself to pushing toward the deeper
truths about yourself, no matter how uncomfortable it gets. Remind yourself
relentlessly how much you can gain by finding what you have hidden.
Once you get started, you'll probably find the pursuit of self-knowledge less a
trial than an adventure. Many people who begin psychotherapy (a guided, intensive
quest to know themselves) worry about opening a Pandora's box of dreadful
revelations. In my experience, however, no one ever wants to go back to the status
quo once he or she has turned the corner with major discoveries and the changes
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they bring. It's not a question of finding out some awful truth about yourself but of
realizing new dimensions of your personality. This is the essence of growth, the great
adventure of explanations in inner space.
Learning to know your inner self and its links with your troubled skin is partly a
logical process, like solving a murder mystery, but more a creative exercise, like what
an artist does in combining the right colors and shapes to evoke the majesty of a
mountain. While logical intelligence proceeds in a straightforward 2+2=4 manner,
creative thinking leaps by association, connecting things that have no apparent link;
thus, it is best equipped to grapple with the hidden parts of your personality that you
have tried to bury under the logical facade of adult life.
There is no road map to self-knowledge; your path must be your own discovery.
The only rule I know that applies nearly universally is this: be alert for surprises. Be
ready to learn things about yourself that you always believed untrue – things,
perhaps, that contradict a family or personal party line. Were you always the mild-
mannered sister, the one kid who never lost her temper? Do you still think of yourself
as a person without an angry bone in her body? Don't turn away if your self-
searching finds a deep reservoir of anger. Many people are mild-mannered because
they harbor anger that they fear is destructive and dangerous.
Where will you find clues to your inner self? If your eyes are truly open, you'll
find them everywhere. Personality is like biology. Just as each cell of your body
contains a full set of genes – the inherited code that determines what, biologically,
you are – every experience, every introspection, and every interaction with others
bear the unique stamp of your personality.
You may find it useful to keep a notebook. I once asked a novelist friend how he
invented his characters. For months before he sat down to the actual writing of a
novel, he told me, he'd note down random events in the lives of his characters as they
occurred to him. He sketched details of their appearance, imagined quirks of their
conversation. Eventually, from these scattered mental brushstrokes would emerge
full-fledged (but fictional) human beings. You may discover your inner self the same
way. Don't worry about filling pages with grammatical prose. Just jot down whatever
you want to hold onto: the same forces that buried your feelings of fear or anger once
will work double-time to make you forget them again.
EXERCISES IN SELF-KNOWLEDGE
I can't give you a magic flashlight to find your hidden self because there isn't any, but
I will share some exercises my patients have found exceptionally useful in
illuminating those dark corners of the self most often linked to skin problems. To
begin with, here is a toolbox of techniques to help you glimpse your inner self
through the mask of your everyday life.
What Do You See in Childhood Photographs?
Study these windows on your early world for insight into family politics and key
relationships. Who stands with whom? Who's looking at mother – or away from
father? Are you staring into the camera or gazing away? What moods are reflected in
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your family's faces – in your own face? Are you happy? Is there a surprising hint of
anger or sadness?
Particularly valuable are family photographs taken just before or after your skin
problem started. What's going on here? Remember, we're not engaged in logical
analysis. Don't dismiss a mysterious hunch about the picture. It may be part of the
hidden truth.
One of my patients, whose genital herpes recurred constantly and painfully,
used to talk evasively about sexual identity issues – his doubts about himself as a
man. When he brought in a family picture, taken when he was five years old, the issue
suddenly became very concrete. There were his three older brothers – brawny kids
who looked like junior linebackers. My patient was dressed like a darling little girl,
complete with long ringlets. It seemed his herpes recurrences served a necessary
psychological function focusing attention on his penis and providing reassurance it
was still there. His parents, apparently, had unashamedly wished it were not.
How Do You Dress?
Your second skin may play out the same scenario as your real skin. Become aware of
how you dress. Is the style strikingly older or younger than you really are? Are you
more or less formal than your peers? Some people dress to camouflage their
sexuality, others to flaunt it. A natty dresser may put high emphasis on his packaging
to compensate for doubts about the interior. Others dress so shabbily as if to say:
"I'm nothing. Don't take me seriously."
Choice of colors is more than simply a matter of style. A woman may dress in
''basic black" and other somber shades because her heart is always at a funeral – a
clue to depression so obvious that it's easily overlooked. Bright, cheerful colors may
reflect an authentically sunny outlook or an attempt to mask hollow feelings of need.
Paradoxically, one can dress in orange for the same reason another dresses in black.
Do you feel the way you dress?
Some people are constantly "in costume." Let your mind associate freely: are
you dressed like a doll, like Cinderella, like Dumbo? Do you look like a bar mitzvah
boy, the high school floozy, or a sixties leftover?
A patient once described to me her discomfort at being a woman as she sat in
my office dressed in combat boots, baggy pants, and a work shirt. "My camouflage,"
she said. Discussion brought memories of her fear at her father's interest in her
burgeoning sexuality and her need to hide it from him and from other men. Her long-
standing rash (which she abetted by lax skin care) was part of the camouflage, she
came to understand.xx
What Does Your Body Say About You?
In the circles of a tree trunk, you can read not only the age of the tree but its history.
Good years and lean years leave their mark in fat rings versus pinched, dry rings;
similarly, what we live through leaves its mark on our bodies, on how we stand up to
the world and move through it.
Postures, stances, and movement styles express our relationship with others.
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You've seen people who walk down any street or enter a room as if going through a
sniper zone, hugging some imaginary wall, trying to be as close to invisible as
possible. The caricature of the dry intellectual, body eclipsed by the head, has some
counterpart in reality. The development of arms, legs, and upper and lower body
reflects heredity but also the physical and emotional habits of years. Your whole
body, not just your skin, tells your story.
Stand in front of a mirror unclothed and look at yourself sensitively. Ignore your
skin but focus on your proportions, your shape, your posture. Do you breathe fully or
tentatively? Do you look frail, brittle, mechanical, angular? Are you well grounded,
solid on your feet, or a bit wobbly? Do you stand as if the weight of the world were on
your shoulders?
It's often far easier to see the inner man or woman within the body of another
person. Practice these observational skills on strangers in the street; look
inquisitively at friends and family. Do you see echoes of their personalities in bodily
shape, stance, and motion? Do they remind you of anything in yourself?xxi
What Tones of Voice Do You Use?
Become aware of how you sound in conversation. Do you always speak with the same
voice? Most of us lapse into different intonations and vocabularies to fit the occasion.
This can reveal our identifications, the aspects of other people we've swallowed
whole. When we listen objectively and sensitively, we often hear more personality
clues in the "tune" than in the words themselves.
Susan D., for example, was a ship captain's daughter, a successful executive who
had trouble forming relationships with men. I noticed in therapy that she'd
occasionally shift into a brusque, authoritarian voice that said "Don't mess with me" –
a captain's voice. This worked wonders in the boardroom but apparently it
frightened her male friends. She'd shift into her father's voice, she ultimately realized,
in anxious, intimate situations: a clue that her identification with her father left little
room for other men.
On appropriate occasions, your voice may awaken echoes of early life,
suggesting tasks you haven't yet resolved. Another patient, Laura B., realized that
when she asked her husband for favors, she automatically lapsed into a meek little-
girl voice. This realization in turn aroused childhood memories of standing outside
her busy father's study, wondering if she dared disturb him. From this came a clue to
the insecurity behind a tense, miserable marriage and hives that wouldn't go away.
Psychologists have long recognized special times when the unconscious self
speaks with particular clarity. If you open your mind to its language, you can learn
much.
What Do You Dream About?
Have you left the understanding of your dreams solely to soothsayers and
psychoanalysts? While experts are particularly able to grasp their depths and
subtleties, dreams can reveal the emotional life beneath the surface to anyone willing
to tune in to them. Become aware of your dreams and take them seriously.
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You are the sole scriptwriter, producer, and director of your dreams, so you can
begin by accepting responsibility for them. Why do you have your dreams? Freud
suggested that dreams reflect wishes – usually in disguised form. If something
horrible, frightening, or shameful happens in your dream, don't dismiss it out of hand
but ask yourself (it takes courage): "In what sense does this dream belong to me?"
This can spark fertile insights into the paradoxical, unacknowledged wishes and fears
behind your skin problem.
George M., the young man in chapter 2 who was plagued by warts and an
inability to express anger, made good strides in releasing his buried emotions to the
point where he rallied himself to begin training for a career he really wanted: driving
long-haul trucks. Then one night, he dreamed he was driving a big truck and had an
accident in which several people were killed. This clarified to him the danger of his
anger, as he'd always imagined it, and helped him understand how he'd immobilized
himself to protect others from it.
Everyone dreams; if you think you never do, it's because you resist the self-
knowledge in your dreams. Dreams are freshest and clearest right after you have
them, so keep a notebook and pen or tape recorder at your bedside to jot them down
immediately on awakening.xxii
What Are Your Daydreams and Fleeting Fantasies?
More accessible than dreams, these often express the same unacknowledged wishes.
Daydreams may attempt to solve the same tasks you're giving to your skin, but free
from real-life logical constraints. Frequently recurring fantasies and images have
special importance.
Often the wish behind the daydream is clear enough: we fantasize about wealth,
success with the opposite sex, fame, and achievement. Not as obviously, frequent
daydreams on such subjects suggest a feeling that you lack something in those
particular departments. People who feel secure in their financial lives may not object
to winning the lottery but they rarely daydream about it.
Unpleasant fantasies of being chased, attacked, or humiliated are paradoxical.
What kind of wishes are these? They may represent an attempt to master a particular
fear, the same way you go over a near accident for days afterward in an attempt to
come to terms with the experience.
You must take the idea of "wishing" – in both dreams and daydreams – broadly.
A young man who often fantasized about being chased and shot at, escaping just in
time, expressed a wish to escape, not to be threatened. It was an attempt to rewrite
history: a childhood in which his father constantly took verbal potshots at him and
otherwise belittled him. His fantasies also satisfied the wish to be loyal to a family
party line that had cast him as a target. Tuning into the trauma that he repeated
endlessly, he took a step toward challenging it.
What Causes Your Flashes of Thought and Flashes of Feeling?
Have you ever walked down the street and felt an unaccountable twinge of sadness
or surge of joy? Like daydreams, isolated thoughts and feelings seem to arise out of
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nowhere but in fact come straight from your inner self; respect the fact that they
have roots and you may come to understand them.
One summer day when I was hiking, I stepped around a rock and was struck by
a mysterious wave of sadness. Following the experience back, I realized that in
stepping awkwardly I had planted my toes outward, and that had been an eerily
familiar sensation. As a child, I recalled, I'd been pigeon-toed and teased by other
kids. I was told to fight the habit by walking with my feet planted outward – the same
way I had walked moments before. This helped tune me in to a reservoir of negative
feelings about my body, which wasn't what others wanted it to be.
Hunches and intuitions that pop into your head are similar. They come out of
context with no apparent logic because they're the product of intuition. No matter
how bizarre they are, think of them as metaphorical hints and they may give you
insights that logic will take forever to reach.
What Causes Your Slips of the Tongue?
There is much to the idea that "Freudian slips," misplaced or mispronounced words,
are messages from the unconscious.xxiii Tune in to them and allow yourself time to
wonder what they mean. One of my patients was talking about family pictures when
he referred to a "phonograph" of his mother; he came to realize that he avoided
looking at her and thought of her as an endlessly nagging broken record.
Similarly, try to be sensitive to the images and recurring phrases of your
personal language. A patient of mine constantly referred to each business project as
his "baby." When we discussed this, what emerged was striking envy of his pregnant
wife because he himself couldn't bear a child. Another patient expressed himself
dramatically: "Here's a real killer for you," he would introduce his stories. "I blasted
out the office … but the traffic on the expressway was crushing." He was unaware of
the constant undertone of mayhem in his conversation. Bringing this up helped him
to appreciate his buried concerns about anger and safety.
What Do You Forget and Why?
It's a psychological axiom that you forget what you want to. Perhaps one part of you
resists actions that are out of tune with your inner needs." Your party line – the idea
of yourself that you received years ago from your family and still confirm with
friends – may blandly assume you like to bowl, that "I'm a person who loves
bowling." If so, why is it you never can find your bowling shoes? It may be that your
inner self really doesn't care for bowling and is rebelling against the force of loyalty
that allows you to be trapped into doing what you don't much want to do.
Do you often forget your keys, meaning you must bum a ride? Do you leave your
wallet home, forcing you to borrow lunch money? It may be that the payoff – perhaps
getting others to take care of you – more than makes up for the inconvenience.
What Troubles Do You Have with Other People?
In the reactions of others, we see ourselves. Are you mystified by the way friends and
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acquaintances react to you? Do they seem unaccountably angry at times? Do they
tum morose or lapse into teasing sexual innuendos? Do they never seem to hear what
you're saying? Your buried emotional life may come through your behavior to arouse
reaction more appropriate than you know. For example, others may tune in to your
hidden anger and respond with anger of their own.
Conversely, you can learn much about yourself by becoming more aware of your
own reactions. Does weakness make you especially angry? Duplicity? Arrogance? We
often accuse others of things we fear finding in ourselves, and any disproportionate
response suggests emotionally charged issues. One of my patients often spent
therapy time railing angrily about "freeloaders" and "welfare cheats." It eventually
came out that his family had been on relief when he was a child. His indignation was
a reaction that walled up the anger, pain, and humiliation of poverty.
Paradoxically, the things that bother you most about friends and family may
alert you to what you find attractive. The woman who is first attracted to her
husband because of his even-tempered consideration may later complain that he
lacks spontaneity and seems "wishy-washy." She may marry a man who is "dynamic
and effective" and divorce him because he's "driven and insensitive" – the vices are
relabeled virtues.
Other people can actively assist your quest for self-understanding. Feel free to
ask selected friends and family for help. They won't have the same stake in keeping
the roots of your problem hidden. Test your perception of yourself against theirs. If
someone says something about you that seems farfetched, completely at odds with
what everyone knows is the "real you," give it a fair, open-minded hearing. Perhaps
there is something "constantly cheerful," "morbid," or "flirtatious" about you,
something with an important bearing on your skin problem.
In a herpes treatment group that I directed, one man announced that he was
ready for a serious romantic relationship. Members of the group pointed out that
whenever his involvement started becoming more than pure sex or pure friendship,
he'd get a herpes recurrence. This was a pattern he couldn't see, but after repeated
emphasis by group members – people he'd grown to like and respect – he finally
opened himself to this insight about his fear of intimacy and its role in his disease.
SUN ADDICTION
Sadie L. was living what many people would call the ideal retirement life-style. Fit,
active, vivacious, her winters in Florida were full of friends, adult education and
aerobics classes, and the pursuit of her love of nature. Summers she'd be back in New
England enjoying her grandchildren and philanthropic activities. Widowed some
years earlier, Sadie had enough money and other resources to feel as secure about
the future as anyone can in an unpredictable world.
However, there was a darker underside to her yearly routine. In the winter, she
would enjoy long walks on the beach and sitting in the sun. In the summer, she would
return north to the dermatology department of a teaching hospital where some of the
world's best doctors would cut off small parts of her body. Conferences beforehand
were devoted to the details of the surgical procedures. The stock " … stay out of the
sun; use sunscreen; you have malignant melanoma; you are destroying your skin;
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untreated this will kill you … " lecture was dutifully delivered afterward. Then the
whole yearly cycle would begin again.
Sadie heard them, she knew they were right, she resolved to stay out of the sun
– then didn't. She knew what Mark Twain meant when he said of smoking, "It's easy
to stop. I've done it hundreds of times." Her doctors knew that they were bailing a
boat with a hole in the bottom but were also resigned to the cycle.
It didn't take long for us to discover that there was more to her ad