are optional. Your imaginary environment can be hot and cold at the same time, icy
but warm – if this is where you imagine your skin to be most happy, so be it.
Among my patients, the single most popular imaginary environment motif has
been the ocean. One woman who had plantar warts imagined wading in the cool sea
on a favorite beach in Maine; a woman with eczema imagined herself on a hot,
steamy tropical seaside. Airy images are second in popularity. Many people like to
feel themselves floating free on the clouds or soaring through the sky like a sea gull
as the cool air rushes past.
For some, the imaginary environment is a skin-soothing experience at the
center of a psychologically rewarding situation. A violinist with hand eczema
imagined listening to a favorite piece of music with her father in a pleasant, rustic
summer setting and picking up a drink in a frosty glass; the coolness of the glass, the
exaltation of the music, and the comfort of a close relationship with her sometimes
elusive father made this scene triply soothing for her skin and herself. A young man
with hives used the image of a drizzling, humid morning in Cambridge after he'd
finished his exams. The damp, cool air eased his skin from the outside as his freedom
from the usual burden of anxieties and pressures relieved the tension that often
exacerbated it from within.
Remember, you are the sole expert on your ideal imaginary environment. One
does not fit all, and it's not a matter of tailoring the prescription to the specific
problem. A majority of people with psoriasis, for example, find warmth and sunlight
helpful, but for the minority for whom coolness works better, the ideal environment
will be a northern pine forest, not a tropical beach.
Give your imagination free rein to invent an ideal environment; let it include
features that don't exist in this imperfect world (what else is imagination for?). For
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you, the epitome of soothing relief may be swimming the backstroke in an Olympic-
size vat of yogurt. If cold cream makes your skin feel a little better for a little while,
perhaps some quintessential moisturizing lotion, which concentrates five hundred
bottles of water in a single vial, will multiply the feeling.
You may want to use your experiences with medicated lotions and creams.
Many people get some improvement with steroid ointments but are concerned about
side effects and avoid using them too frequently. Your mind's "conceptual cortisone"
can become just as effective with no side effects.
As with the ideal well-being exercise, the idea is to imagine clearly and in as
much detail as possible. Use the healing state's power to focus your mind and turn
your imaginings into vivid reality, building up the scene in layers of sight, sound,
smell, tang of air, quality of light. If you're walking on a beach, make it a particular
beach, whether Martha's Vineyard or Puerto Vallarta. Is it noontime sun? Late
afternoon? Fresh, bright moming? T-shirt? Bikini? Nude? Whether you're walking,
sitting, or lying down, imagine the feeling in your muscles and joints, the body
consciousness that belongs to the activity. Imagine the visceral sensation of peace or
excitement that goes along with dawn in the mountains or sunset on rocks sprayed
by pounding surf. This is an exercise for the poet in you.
The more real you imagine the ideal imaginary environment, the more real the
physiological changes that belong to it will be. These are valuable in two ways. First
is simple symptom relief. The idea of this exercise is to imagine conditions and
situations that will make your skin feel better, make the itching stop, ease the
burning and the pain. This relief usually lingers for well beyond the exercise time
itself. The exercise also nudges your skin's physiology toward a healthier state. A
world full of things that your skin likes is also a world full of whatever your skin,
disease dislikes: an internal climate less hospitable to illness.
Very slight physiological changes can have large results. I call this the
Houseplant Effect in honor of the exquisite sensitivity displayed by many of the
creatures with which we share our homes. A plant that shrivels and withers in a
sunny window may do fine if you alter its living conditions slightly and put it in
partial shade; another will perk up and thrive in a corner that's five degrees warmer
(or cooler) than the corner where it seemed destined for geranium heaven.
I made the point earlier that a chronic skin problem is often a matter of delicate
balance – it's a disease that never gets completely better or continually worse.
Anything that will nudge the balance toward health can make a critical difference; as
with a houseplant, a slight change in the physiological environment may turn the
trick. The small but real bodily changes that accompany the ideal imaginary
environment can make life that much less easy for the virus, bacteria, or
inflammatory process that is bedeviling your skin.
There's no rigid prescription for the ideal imaginary environment. Simply enter
the healing state and remain in the environment as long as it feels right – five, ten, or
twenty minutes. Repeat the exercise as often as you have the time and need the relief
it brings. Many people find that practice brings speed and depth; the more you do the
exercise, the more easily you find and enter the ideal environment. Your body
becomes conditioned to the rhythm of the procedure and will move smoothly from
one step to the next.
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After you've begun to feel at home in the ideal imaginary environment, you may
find it possible to enter it briefly almost at will. In addition to your regular sessions,
summon the image up to flash through your mind dozens of times a day whenever
you need it, a healing resource of inestimable value.
An Additional Technique
Some patients have successfully used a variant of the ideal imaginary environment
inspired by a technique used for pain control. Imagine your hand filled to the brim
with the most healing and soothing sensations imaginable. In effect, concentrate all
the best features, the most comforting feelings, of the ideal imaginary environment,
distilled to their essence, and pour them into the hand. When that feeling is real and
full in the hand, pass it lightly over troubled areas of your skin. Imagine the healing,
soothing sensation pouring forth from your fingertips, suffusing and flowing over
them, leaving no room for itching, burning, or pain. When the healing sensations
begin to run out, simply withdraw the hand for a few moments, let it fill up again, and
then replace it on the affected area for renewed relief.xlvii
EXERCISE 3: THE CELLULAR BATTLE
Your skin disorder can be thought of as a battle: the virus or bacteria against your
body's immune system (as in herpes, shingles, and warts) or simply the forces of
health against whatever it is that is disrupting your body's natural good order. In this
last self-fulfilling prophecy exercise, you will visualize the forces of health
themselves, right among the cells, and encourage them by imagining them
overcoming whatever foreign agent or disordered process is causing your skin grief.
For inspiration, consider work that has been done with cancer patients.
Pioneering doctors such as Simonton and associates in Texas guide their patients to
imagine the struggle that is taking place between cancer cells and their bodies'
defense forces. The patients are encouraged to personalize the struggle, to come up
with meaningful images of cancer cells and the immune cells and other forces that
oppose them: white knights against gray, greasy goblins, for example. In theory,
imagining the power and potency of the body's defenses as victorious may
strengthen the forces of health, much as grief and depression weaken immune
functions.xlviii
I've used a similar technique with my herpes patients. Herpes recurrences
reflect a struggle between a virus and the immune system. When the immune system
is stronger, the virus is kept in its place; when the virus gets the upper hand, it comes
out of its hiding places and into an active lesion. (The same process occurs in shingles
and warts.)
I ask my herpes patients to imagine what the struggle looks like, what the
herpes virus is like, to them, and what kinds of forces oppose them. Using the focused
power of the healing state, they image the battle with the forces of health victorious.
Images on the cellular level are as personal as the well-being and ideal-
environment images. A professor saw the virus as little asterisks and his body
washing them away like a fire hydrant with a gush of water. A dress designer saw the
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virus as long fish, and the body's defenses as swordfish that swim up alongside and
skewer them. To an artist, the virus was black and brittle, like freeze-dried coffee, to
be burned by his body and flushed away.
The essential process is making the struggle real and finding a way to
participate in it actively to aid your own body in getting well. Your body's drive
toward life and health is mysterious – no one knows exactly what the forces are and
how they work. Here is a way to make them concrete and encourage them.
This exercise may be applied to any skin problem. It helps to have a notion of
the physiology of the disease; knowing just what is or may be going wrong helps you
envision your body's efforts to stop the process and correct the disorder. Psoriasis,
for example, involves the rapid growth of cells that come to the surface of the skin
before they're fully mature. One patient imagined them being "half-cooked" and
served up by a short-order cook under pressure from his boss. His healing image was
simply a more understanding boss, who encouraged the cook to slow down.
A woman with hyperhidrosis – excessive perspiration – imagined a small,
lovable cleaning woman with a mop who relentlessly mopped up excess perspiration
inside the cells themselves, leaving her skin clean and dry.
A patient with recurrent skin infections imagined each one as the wound of an
arrow, then imagined a transparent shield between her skin and the slings and
arrows of daily life. Everything shot at her bounced off the shield, which had an
added psychological meaning: while she was growing up, her often sadistic parents
continually shot barbs of verbal and physical abuse at her.
Your images can be as close to or as far from physiological reality (as you
understand it) as you wish, as long as they are a personally meaningful way to make
the struggle concrete and tilt in your favor. A scientifically inclined person may image
viruses as they appeared in his college biology textbook, with anatomically correct
lymphocytes their conquering enemy. A more mathematical imagination may see the
viruses as polyhedral soccer balls to be deflated by a man with a needle. You may
contrive a full-scale drama with little people dressed up as cells and body parts, á la
Woody Allen's Everything You Always Wanted to Know About Sex (But Were Afraid to
Ask). In any case, keep in mind how powerful your body's healthful forces are – and
remember how they routinely protect you from all manner of viruses and bacteria
that thickly inhabit the world we live in. Aid this already powerful system by
imagining allies that you endow with everything you consider strongest and most
powerful in yourself. Concentrate the power you already have and bring it to bear in
the struggle.
INTEGRATlNG THE EXERCISES INTO YOUR SELF-TREATMENT
This group of exercises is probably the most useful and powerful in the book. I've
used the ideal imaginary environment, in particular, with just about all my patients,
with a wealth of results both in immediate relief of symptoms and gradual
improvements leading to skin health. Their very simplicity carries some dangers,
however. They are meant to be done seriously, in an integrated self-treatment
program that also includes the diagnostic work of the earlier chapters. It's easy to go
through a superficial version of these imaging exercises, then if they don't work (as
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they very well don't, done in this spirit) the natural response is to shrug your
shoulders and give up. This sabotages the whole effort, wasting a potentially valuable
source of relief. Remember that the same psychological forces that may have kept
your skin problem hanging on will also work underground to keep you from
overcoming it. This is why I urge you to ante up the energy to work on the earlier
chapters, uprooting negative images at the same time that you're placing them with
these carefully chosen positive ones.
These exercises themselves sometimes add valuable diagnostic information,
your images may supply useful insights into the roots of your symptom. One woman
troubled by severe scratching created an ideal imaginary environment between cool,
crisp bedsheets, which suggested underlying sexual problems she hadn't realized
were involved. When asked to image the struggle between herpes and her body,
another woman imagined putting the virus on the plane to Europe – a way to "get rid
of it," certainly, but an extremely nonaggressive mode of battle. Her choice suggested
discomfort with the idea of fighting and winning, an overly conciliatory attitude that
had taken its toll on more than her skin.
Often, the cellular battle exercise reveals self-sabotage that short circuits
attempts to get better. If you only see your body's good guys holding their own, not
winning – or if the bad guys actually win – it's time to stop and wonder why; likewise,
if you choose images that make victory all but impossible – seeing the problem as a
swarm of mosquitoes and the body's defense as hands swatting them, for example.
These exercises are based on the power of belief, but it's difficult to believe
they'll work until you've seen some results. Self-doubt will creep in as you learn this
unfamiliar process, and healthy skepticism is only realistic. As you learn to
coordinate parts of yourself you've never used before, there's bound to be a
discouraging period when nothing comes together. Imaging is a skill; like playing the
piano or windsurfing, it improves with practice. If you haven't felt a bit foolish at
times, you're playing it too safe. If you haven't quit in discouragement, then started
over a few times, you haven't really started.
If there's a single key to making these techniques work, it's making sure they
don't become work. Keep your eye on their gamelike quality. They're a productive,
grown-up version of "Let's pretend" and they shouldn't be drudgery or a struggle.
They're not a prescription to be swallowed, not an exercise to do for me, your
dermatologist, or your family, but something soothing and enhancing to do for
yourself.
xxxvi For more general background, see Altered States of Consciousness, edited by C.T. Tart (New York:
Doubleday, 1969); and Alternate States of Consciousness, edited by N.E. Zinberg (New York: MacMillan, 1977).
xxxvii See H. Benson, The Relaxation Response (New York: Morrow,1975); H. Benson, et al., Beyond the
Relaxation Response: How to Harness the Healing Power of You rPersonal Beliefs (NewYork: Time,1984); and
H. Benson and W. Proctor, Your Maximum Mind (New York: Random, 1987).
xxxviii For more reading on hypnosis and self-hypnosis, I suggest F. H. Frankel, Hypnosis: Trance as a Coping
Mechanism (New York: Plenum, 1976); K. Bowers, Hypnosis for the Seriously Curious (Monterey, Calif,:
Brooks-Cole, 1976); Hypnosis: Developments in Research and New Perspectives, edited by E. Fromm and R.E.
Shor (Hawthorne, N.Y.: Aldine de Gruyter, 1979); and Crasilneck and Hall, Clinical Hypnosis Principles.
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xxxix Benson and Proctor, Beyond the Relaxation Response.
xl
For more information on biofeedback, see: Biofeedback and Family Practice Medicine, edited by W.H.
Rickles, et al.(NewYork: Plenum,1979); Biofeedback: Theory and Research, edited by G. E. Schwartz, et al.
(New York: Academic Press, 1977); and Clinical Biofeedback: Efficacy and Mechanisms, edited by L. White, et
al. (New York: Guilford Press, 1982).
xli
K.W. Koldys and R. P. Meyer, "Biofeedback Training in the Therapy of Dyshidrosis," Cutis 24 (1979);
219-221.
xlii
J. Benoit and E.H. Harrell, "Biofeedback and Control of Skin Cell Proliferation in Psoriasis,"
Psychological Reports 46 (1980):831-839.
xliii
P. Duller and W.D. Gentry, "Use of Biofeedback in Treating Chronic Hyperhidrosis: A Preliminary
Report," British Journal of Dermatology 103 (1980): 143-146.
xliv
B.W. Brown, "Treatment of Acne Vulgaris by Biofeedback" Assisted Cue "Controlled Relaxation and
Guided Imagery," Dissertation Abstracts International 42 (1981): 1163-B.
xlv
For general background on imagery, try The Function and Nature of Imagery, edited by P.W. Sheehan
(New York: Academic Press,1972): or Imagery: Current Theory, Research, and Application, edited by A. A.
Sheikh (New York: Wiley & Sons, 1983).
xlvi
Ikemi and Nakagawa, "A Psychosomatic Study."
xlvii See Bresler, Free Yourself from Pain, for innovative uses of this technique.
xlviii While highly controversial, 0.C. Simonton, et al., Getting Well Again (New York: Bantam, 1982); and S.
Simonton and R. Shook, Healing Family (New York: Bantam, 1984): are very useful resources.
9. Reinforcements: More Techniques To Help Now
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9 Reinforcements:
More Techniques To Help Now
The four techniques I've just described – the healing state and the three ideal
imaginary environment exercises in chapter 8 – are the backbone of my program.
Most people find these the most helpful against skin symptoms, but because it's a
difficult, ever-changing adventure, different for everyone, I'm going to augment the
basic tools with replacements and reinforcements. Depending on your personal style
and needs, you may find that one or more of these extra exercises will work
particularly well on a regular basis or for an extra boost over obstacles and rough
spots.
Some of these techniques are best done in the healing state, as a supplement to
the basic four exercises. Others can be done at odd moments throughout the day
when you need extra help.
SHORTHAND RELAXATION
The full-scale relaxation techniques described earlier have physiological benefits that
extend beyond the ten or twenty minutes that you practice them. The relief you
experience during the exercise itself will cast a soothing shadow into the rest of the
day.
There are times, however, when your skin needs emergency help, when
tensions mount and you feel the anxieties of life turning into eruptions. With this
capsule procedure, you can bring the benefits of relaxation to the moments when you
need them most.
After you've practiced the relaxation procedure for some time, your body
becomes used to its sequence of physiological and mental events. You've learned the
relaxation habit, and as with most habits, you can initiate the full chain of events with
a few simple cues. If you use a relaxation exercise that involves closing your eyes and
feeling lightness concentrated in your right hand, for example, simply lift your right
hand and touch it to your right eyebrow. Close your eyes briefly in a prolonged blink,
reminding yourself of the eye closure that begins relaxation. Take a deep breath and
let it out slowly and feel relaxation flow through your body.
Possibly the best way to develop this shorthand relaxation technique is to
practice it while in the healing state. Experience how effective it can be, then keep it
in reserve for when you really need it.
DISSOCIATION TECHNIQUES
Rare is the skin condition whose torment is purely physical; most people can't help
compounding the agony with feelings of shame, guilt, anger, and helplessness. They
develop an aggravating, punishing relationship with their symptoms, and as in many
difficult relationships, they can gain insight and even plant the roots of lasting
improvement by changing perspective – in this case, by putting some distance
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between themselves and their troubled skin.
The human mind has the capacity to achieve just this kind of valuable
detachment. A characteristic of certain altered states of consciousness is dissociation,
a temporary reshuffling of relations between the mind, emotions, and body. This may
be highly dramatic, such as the "out-of-body experience" many undergo when close
to death or during drug experiences, but they are also commonplace and normal,
occurring in the course of the average day when we focus our attention strongly on a
task or on absorbing reading matter. What we experience when great art or music
"takes us out of ourselves" is another familiar kind of dissociation.
Dissociation in Time and Space
In the healing state, form an intense image of yourself in the future – a person with
clear, comfortable skin. Your problems are totally under control and you're
thoroughly enjoying life. From this vantage point, look back on yourself as you now
are, suffering with your troubled skin. These bad old days may be hard to remember
from the perspective of the healed, healthy new you; they're just a memory now, no
longer relevant to the life you lead.
Stroll casually through the experience, with no particular goal in mind; you're
just reminiscing about the past. The healthy you is a sympathetic onlooker, not
callous or detached from the suffering you but not emotionally involved either. When
you feel like thinking about something else, just return to the healing state and life in
the present.
You may find it easier to detach yourself from your symptom in space rather
than time. If the symptom is limited to a single part of your body, imagine that
afflicted part floating away from you across the room. Now it's in its normal place,