troubled the experimental side, the least troubled the control. As you go through your
treatment exercises, focus on the experimental side; imagine that your control side is
entirely indifferent to what you're doing. As improvements occur, this method will
highlight and dramatize them, and once the first side improves, you can rest assured
the other side will respond to the same techniques.
Symptom Substitution
Even when the emotional issues behind a symptom are stubbornly hidden and
difficult to work through, it is often possible to negotiate with them. That is, you may
be able to exchange your symptom for a "counterfeit" activity that accomplishes the
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same emotional tasks in a benign fashion: scratching away at a violin, for example,
instead of scratching your skin.
W. S. Kroger, a pioneer in hypnosis, treated a woman whose persistent
scratching had resisted all dermatological and psychological therapy for seven years.
However, over a period of two weeks, she was able to substitute'scratching the "skin"
of a large doll, which she kept beside her while she slept and watched television, for
scratching herself.lii
If you can't trade in your symptom for a harmless substitute, you may be able to
"trade down" for a less troublesome version. Often symptoms substitute themselves
spontaneously. A person who suffers from eczema as a child may later in life enjoy
clear skin but endure persistent hay fever. The energy of needs, fears, and emotional
tasks may take many paths, appearing now as symptoms in the skin, now as
manifestations elsewhere.
The ability to give yourself a headache may seem a dubious power, but it is
power all the same. To exchange your itch for a headache demonstrates your mastery
of your body. By proving that the symptom is yours, substitution may take you an
important first step on the road to controlling it well enough to let it go.
In the healing state, plant the suggestion that an innocuous activity will do the
work of your skin symptom. When angry, you might tell yourself, you're going to
chop wood or beat carpets or pound the pavement in a five-mile run. You will satisfy
your "need" for scratching by applying sandpaper to wood. If this seems too abrupt,
suggest a deal to yourself. For example, if mild headaches would be easier to bear
than your chronic itch, plant the substitution suggestion. Remind yourself of it from
time to time throughout the day. You may find, in fact, that your skin is better while
you "pay dues" with occasional headaches.
Making Your Symptom Worse
If you remain absolutely unconvinced of your power to make your skin better and
are about to add this book to your pile of rejected doctors and their remedies, I have
one last challenge: can you make your symptom worse? I don't recommend this
technique routinely – I save it for angry, skeptical, disgusted patients who need a last-
ditch demonstration. Perverse as it sounds, a number of people have used this
exercise to feel their power over their bodies. It was a first step toward applying that
power for health.
Fred was a hard-nosed, logical engineer who simply could not relate to the
psychodynamics of symptoms. His skin was red, raw, and itching, he firmly knew,
because there was a physical problem, as a mechanical malfunction invariably
reflected something physically wrong with a machine.
I challenged Fred. I told him he had the power to take any patch of skin that was
clear and make it itchy. The perversity of the idea appealed to him and he gave it a
try; before long, he became able to experience much of the saine discomfort in
healthy skin that he'd had in the red, raw patches. He saw for himself that the mind-
body connection was real, and this was an enormous help in getting on with other
techniques.
If you can make your skin worse, you can make it better. The idea is to do
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anything you can think of in the most negative, stress-inducing way possible,
maximizing its adverse effect on your skin. It's a challenge – can you make your skin
worse with mind power? For example, try nonrelaxation. Go down through your
body, step-by-step, heightening feelings of tension. Imagine all your annoyances
getting worse and inflicting themselves on your skin, making symptoms more severe
and intense.
Place yourself in a nonideal imaginary environment: summon up the worst
times of your life, the times you felt most miserable and betrayed. Make a list of
everything that makes your skin most uncomfortable and construct an imaginary
environment that brings all these features together. Are you fed up, disgusted, angry
with the time and money you've wasted with dermatologists … and now with this
book? Keep these angry feelings at the front of your mind as you exert all your
energies in a last-ditch attempt to make it all worse.
From here, it may be a short step to the beginnings of selfmastery that will make
it better.
I want to stress again that this gallery of exercises is primarily for your
contemplation. With the exception of the shorthand technique, many of my patients
don't use any of them – they concentrate on the four central exercises. Virtually no
one adds more than one or two to the treatment program.
You might do best simply to read about them as interesting background
material – things that have worked for various people – and forget about them. If you
need them, they'll probably just pop into your head at the appropriate time. Feel free
to experiment with any or all of these exercises as long as you don't fall into a
dilettante approach that skips from one to another without ever getting a serious
commitment.
Above all, don't worry about choosing the exercise that's right for you. It's all a
matter of taste and style, and it would make as much sense to worry about whether
you should prefer chocolate or vanilla.
If you're inspired by any or all of these exercises to improvise your own
technique, that might be the best choice of all.
xlix
Oyle, The Healing Mind (Berkeley, Calif: Celestial Arts, 1975).
l Bresler, Free Yourself from Pain.
li M.L. Rossman, Healing Yourself (New York: Walker & Co., 1987).
lii
. W.S. Kroger, Clinical and Experimental Hypnosis (Philadelphia: J.P. Lippincott, 1963).
10. Thinking: Enemy or Ally?
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10 Thinking: Enemy or Ally?
Throughout this book, I've focused on two parts of the typical skin problem – the
physical symptom itself and the feelings connected to it, but we don't just feel our
problems, we also think about them. Your thoughts about your skin are too
important to overlook.
This is particularly true for the many people who are more comfortable talking
about thoughts than feelings. Engineers and scientists, for example, often find
extended discussions of emotion mushy and imprecise; they relate more readily to
logical statements that can be proved true or false.
Many people are more in touch with their thoughts than with their feelings.
They don't consciously feel unloved or guilty or empty inside, but because they're
tuned in to their thoughts about themselves and others, they can calmly, logically
relate that ''This herpes may hurt my odds in the marriage market." If you ask them,
they'll tell you they have no feelings about this turn of events; it's just a statement of
fact.
The feelings, of course, are there – somewhere. It's less painful to dwell on
thoughts than to experience feelings, and people may fall into this over
intellectualized habit of mind for self-protection. The tendency itself becomes painful
in those who can't get thoughts out of their heads and who run the same thinking
tape over and over. Such people, who suffer from what psychologists call obsessional
neurosis, are often highly organized and productive. Their thinking processes are
admirably developed, but they run on ceaselessly with a life of their own, like a head
without a horseman.liii
Such thoughts were a big part of Charles B.’s problem. When Charles, a writer,
contracted genital herpes, he entered a protracted period of moral anguish. He
became obsessed with his symptom and the sense of his own badness. Unable to stop
thinking of either, he endured an endless stream of self-recrimination on the subject
of his low morals and the harm he might have done to women in the months before
he realized that he was "contaminated." He uncontrollably moralized to himself like a
relentless evangelist addressing a shameless libertine.
At one point, Charles's obsession took a bizarre turn. While listening to a radio
discussion of herpes, he heard about herpes encephalitis, an exceedingly rare
complication in which the virus attacks the brain. This is never a consequence of
genital herpes, but when he shortly thereafter developed a rash on his scalp, Charles
was convinced that he'd been struck by this rare, fatal infection – just deserts for his
evil behavior!
In Charles's case, one hapless person harbored three illnesses. There was the
physical herpes, caused by a virus; there was "psychological herpes," the self-
punishing thoughts that made the physical disease an exaggerated torment; and
there was a scalp rash brought on by the obsessive attention that Charles had focused
on this part of his body. Charles had thought himself into this last illness.
In therapy, I helped him to look beyond the obsessional thoughts to their
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emotional message, which had nothing at all to do with herpes. Why did he feel
himself to be such a bad person; when and how had he been brainwashed? All this
difficulty and anguish, he came to realize, had begun long before he'd ever heard of
herpes; the better he understood this, the more in touch he became with the feelings
of badness that lay beyond the distorted thoughts ("I got herpes because I'm
depraved") they engendered.
Charles did well in psychotherapy as he learned to see the anger and sexual
feelings that lay beneath his obsessive thoughts. Similarly, he came to realize that his
concerns about his brain were linked less to any real danger than to the grim reality
of his father's health, whose mind was deteriorating with Alzheimer's disease.
Some therapists feel that many if not most emotional problems reflect distorted
thinking patterns: depression, anxiety, and other ills, in their book, follow false ideas
about oneself and the world. I believe that these distortions and painful emotions are
like the head and tail of a coin.
This is particularly clear in people whose thoughts are distorted into delusions –
they are convinced they have a disease, for example, that does not physically exist.
Recently, a psychiatrist in San Francisco reported growing numbers of people who
visit doctors with the conviction that they have genital herpes. There is no evidence
of the disease – not even the most minute lesion, in some cases – but they are
convinced. They experience the full gamut of guilt, rage, and self-blame that many
authentic herpes patients endure.
The psychiatrist compared these people to those who come forth to confess
whenever the papers report a grisly murder. Such imaginary murderers are obsessed
with a deep sense of their own badness. They feel as if they've done something
unspeakable; then when they read about the murder, they're convinced this is the
unspeakable thing they've done. The delusion fits their sense of guilt.liv
In the same way, victims of "delusionary herpes" have been convinced by
exaggerated press, TV, and magazine reports that herpes is a dreadful thing, the
fitting punishment for promiscuity and depravity. They already feel evil, and thus it is
natural for them to delude themselves that they harbor the disease. If the false belief
is firmly entrenched, all the dermatologists and negative lab tests in the world cannot
shake it. Genital herpes is such a perfect metaphor for their feelings about themselves
that they cannot let go.
A person with such a delusion has serious emotional problems and urgently
needs professional help. The best thing anyone can do is help him to get the therapy
he needs; with proper care, these disorders are often quite treatable. One thing you
can't do is talk such a person out of his delusion to argue that the "lice" that torment
him are actually lint or that the horrid rash that is taking over her entire body is
invisible to everyone else. Keep in mind that the delusion itself is but the tip of the
iceberg: a person who feels consumed by a nonexistent disease is actually telling you
he is tormented by unbearable feelings. His beliefs may be an inaccurate description
of physical reality – there are no lice, no herpes lesions, no rash – but they clearly
express his inner emotional anguish.lv
In a similar if less flamboyant way, the distorted thoughts that torment many
skin sufferers may express emotional realities with which they are out of touch.
Thoughts like "These hives are gross. Nobody wants to touch me" or "Psoriasis shows
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I have weak genes. I'm biologically unfit," inaccurate as they are, may point the way
to important emotional truths.
Why become more aware of your distorted thinking about your skin problems?
For one thing, when you tune in to the silent statements you constantly repeat to
yourself, you've taken a first step toward seeing the less alarming truth. Their
emotional underpinning gives these thoughts staying power – they resist the light of
reason – yet many people become able to argue with their distortions. Challenged
repeatedly, they lose some of their power to torment. For another, these automatic
thoughts can be a valuable clue to the needs, fears, and tasks that lie deeply buried,
especially if you are the kind of person who is "not in touch with your feelings."
For example, a patient of mine who suffered from severe acne habitually
thought to himself, as he walked down the street; "I look like hell. Nobody wants to
be seen in public with me." If an attractive woman approached, Jack would flinch in
anticipation, thinking, "She's going to be repulsed when she gets a look at this open
sore I call my face."
There was a little truth in Jack's train of thought but a lot of distortion. True, his
face didn't look as clear as it might have, and he'd have been more attractive with
better skin, but the fact was that the skin of his face was only a small portion of his
total idea that onlookers were disgusted and avoided him was absolutely untrue, as
he himself conceded when we compared his self-tormenting ideas with his actual
experience.
Jack had been playing this tape of terrible thoughts so long that they'd become
second nature. An important first step was just becoming aware that he'd fallen into
this habit. A second step was separating feelings from fads and recognizing that in
the light of logic, these beliefs were false. He gradually learned to substitute a more
accurate train of thought: "My skin is not superb but it doesn't look that ghastly. Plus,
I have a lot to offer behind my face. My friends are clearly aware of this, and it's
possible to make others see it too."
Jack had found it hard, up to this time, to tune in on his feelings about himself
and his skin condition, but these habitual thoughts, once recognized, provided a
handle on his feelings; he came to appreciate how he tended to see things in black
and white (if his skin wasn't great, it was terrible) and to come down hard on himself.
He simply felt unworthy and unlovable, for reasons that had nothing to do with his
acne. This realization began a process of changing the images and feelings that had
long made Jack miserable in a way that was anything but skin deep.
Our ideas are products of our social environment: the more of a stigma a disease
bears, the more difficulty it's likely to create. Thus, people like Jack, whose skin
problems are highly visible, have particular trouble with self-punishing thoughts.
This is also one reason why people with genital herpes are so vulnerable to
tormenting thought distortions: they've swallowed a steady diet of mythology that
equates herpes with evil sexuality, and this has infected their ideas about themselves
more than any virus.
Knowing the truth may not make you entirely free but it can ease pain with
perspective. Remember one thing: social mythology is irrational and changeable.
Today there's a strong social stigma attached to lice, for example, but back in the
Middle Ages, lice were a nuisance for lords and ladies as well as the common people
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and reflected nothing on one's character, morality, upbringing, or class; but psoriasis
– now there was a disease that marked its victims as outcasts. Why? Because it was
mistakenly thought to be a close relative of leprosy, a disease with which it actually
has absolutely nothing in common. Psoriatics were shunned – and no doubt thought
terrible things about themselves – because of tragic misinformation.lvi
On some level, we know the truth about herpes; even in the panic that may
follow the first lesion, there's a small corner of the brain that keeps these facts on file.
The task is to recognize what distorted thoughts have taken over to logically combat
distortion with fact and ultimately to recognize what emotional drives give the
distortion its power. This is what we will attempt in the following exercise.
Many people find this easiest with a large sheet of paper divided into three
columns. Tune in to the inner monologue of thoughts about your skin. Become aware
of the statements – the pseudofacts – that you habitually repeat to yourself. Jot them
down in the first column. For the second column, look at these statements coolly and
logically. Sum up the real facts that correct the distortions of column one. The third
column is where you explain to yourself where the distortions of column one came
from. This means opening yourself up to the buried feelings, needs, and fears that are
expressed in your automatic thoughts.
For example, one distorted thought that commonly bedevils people with genital
herpes is: "No one will want to have any relationship with me. I'll never be able to
marry." In the second column, the logical refutation might go: "I will have to take
precautions and sometimes talk about my problem in a more open manner than I
would otherwise, but I know that many people with herpes have good sex lives and
good marriages." In column three, introspective analysis might suggest: "Before I
ever heard of herpes, I was prone to self-doubt. I've long worried about my
desirability, and that doubt has fastened on herpes." Anything that helps you to
understand where the pseudoconclusion of column one comes from belongs in
column three. You might include the "scarlet letter" line that part of society sells
about herpes.
This exercise demands logic and honesty to separate half-truths from real
truths. The thought that oppresses many long-term sufferers of conditions such as
herpes, vitiligo, psoriasis, and alopecia is one such half-truth: "I've suffered for years
and I'll suffer forever. There's no cure for my illness." The truth is that while doctors
and their medical technology can't totally cure these ills, many people have gotten
better spontaneously, through their bodies' own healing forces. Psoriasis is not
"curable" but is treatable, and a person who goes for years with only a small patch
here and there has won an important, if not total, victory. Similarly, about one-third
of people with herpes suffer only a single outbreak, and then the virus retreats more
or less for good to its hiding places in the nerve cells. New drugs help suppress the
virus, and it is possible to live with it without pain or trouble – millions of people do.
Even for those who do have continuing recurrences, each is successfully cured by the
immune system. What emotional needs and tasks might make you dwell on having an
incurable disease? Do you find hard for some reason to accept the idea of curing
yourself? Put the answer in column three.
Similarly, a common concern among people with chronic skin problems is: "My
body's defenses are shot. There's something weak about my constitution or else the
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problem would not torment me. A really serious disease – cancer? AIDS? – is just
around the corner." The fallacy here is apparent if you consider all the organisms and
illnesses that your immune system fights off every minute of every day. Even if your
warts linger or your herpes recurs regularly, most of the time your immune system is
keeping the virus under control. In column three, where you dig for the roots of your
thought distortions, you may note that you tend to cast things in black and white and
perhaps that your belief in the weakness of your body's defenses reflects deeper
feelings of weakness and incompetence. Similar distortions may be unearthed by
people with hereditary diseases, such as psoriasis, who believe that they have
"tainted genes" or "bad heredity." The truth is that illness carried by one gene or gene
set says nothing about the millions of other genes with which we're each endowed;
the belief in poor genes, however, may say a good deal about your feelings about
yourself and your parents.
Your feelings about yourself and your parents? Does that truly have all that
much to do with your skin problem? If you've read this far and still find yourself
thinking under your breath, "All this sounds fine but I know my lupus is a purely
medical matter, a question of plumbing," write this in column one. In column two,
you might observe (if indeed you've made the observation) that your skin does in fact
improve and get worse in good times and bad times; that much evidence does, in fact,
link your mind and your body. Column three? Perhaps you are frightened to think of
how large a role emotions play in your life, how active your participation in your
illness may be. Perhaps you find it more comfortable to see yourself as a victim.
Although I hate think of anyone's using my book this way, I can imagine any
number of people reading it, shaking their heads ruefully, and saying to themselves,
"This guy's telling me what I knew all along. If only I had my head on straight, I
wouldn't have all this trouble. I'm a real loser – not only do I have this revolting skin
but I gave it to myself." If you're giving yourself this kind of hard time, try to be
objective and logical in column two – write down what you'd say to a friend who
came out with that sor