Disease
Directory
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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)
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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 cremes. 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 aimedat exploring growing-up, stopping-the-clock,
and sexuality issues that may heighten the symptom.lxxx
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.lxxxi 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.lxxxii
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
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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.lxxxiii
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.lxxxiv
BACTERIAL SKIN INFECTIONS
(Furuncles [Boils], Fol iculitis, 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.lxxxv
BEHÇET’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.
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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.lxxxvi
Chapter 5 may be a helpful exercise for Beçhet'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.lxxxvii
CANCER [Griesemer Index (for basal cel 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.lxxxviii
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.lxxxix 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
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love object six to eighteen months before the diagnosis.xc 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.xci
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.xcii
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 bookxciii (see also the
section on "Sun Addiction" in chapter 3).
CANKER SORES (Aphthous Stomatitis)
These painful sores appear recurrently on inner cheeks, lips, gums, tongue, and
palate. They afflict 20 percent of the population, most commonly between the ages of
ten and forty. Treatment is symptomatic: Xylocaine for pain, corticosteroids for
inflammation, and antibiotics for secondary infections. Their cause is unknown, but
recurrences have been linked to emotional and physical stress, premenstrual tension,
injury, and fever. Emotional stress is the most commonly cited precipitant,
particularly domestic, financial, and sexual problems.xciv
If you suffer from canker sores, use your Time Line to discover what, if any,
stresses appear to trigger them. The most common tasks associated with this
symptom involve difficulty growing up, expressing anger, and looking for love – but
as in all symptoms, individual emotional links may differ.
Canker sores are often seasonal: worst in the winter and spring, better in the
summer. Examine your own seasonal pattern for hints that will help you design an
effective ideal imaginary environment.
DARIER DISEASE (Keratosis Follicularis)
Genetic at least in part, Darier Disease (no longer referred to as "Darier-White")
usually appears between the ages of ten and twenty. Blockage of sebum production
causes pustular sores at hair follicles, palms, nails, and mucus membranes. There is a
risk of secondary infection.
One controversial theory connects Darier Disease with vitamin A deficiency; in
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fact, ointments of vitamin A or its derivatives have proved effective for some.
A clinical report by Wink found hypnotherapy effective. A railroad worker had
suffered recurrent pimples on his forehead, hands, and upper back since adolescence.
It flared up when his wife cuckolded him, as happened periodically, and improved
when she returned. After vitamin A and steroids had failed, hypnotherapy produced
some improvement: the top of his left forearm improved noticeably within a week, as
had been specifically suggested in the trance state. Further remission was achieved
by having him return, in imagination, to the time before the symptom had appeared,
when he was twelve years old. The results were then even more striking.xcv
Often, but not invariably, Darier disease follows a seasonal pattern: it improves
in cooler weather and is worst in the summer; sunlight in particular aggravates it.
These facts may be helpful in designing an appropriate imaginary ideal environment.
DERMATITIS (Eczema)
(Griesemer Index: 52 to 76 percent; incubation period: seconds to days)
Eczema and dermatitis are interchangeable names for the same group of conditions –
inflammations of the skin that may include redness, swelling, eruptions, oozing,
crusting, and scaling. Itching, often severe, commonly accompanies eczema. There
are five types of eczema – lichen simplex chronicus, atopic dermatitis, contact
dermatitis, hand dermatitis, and nummular dermatitis.
Atopic dermatitis often appears early in life but may arise at any time. Medical
treatment includes environmental adjustments to minimize irritation; local creams
and medications, including steroids; and antihistamines and phototherapy.
Many investigators have linked eczema to very early unsatisfied hunger for love
and affection. Victims are often the children of anxious, undemonstrative,
overprotective mothers who, often despite the best of intentions, cannot provide the
stroking and cuddling that babies require to thrive.xcvi Significantly, the rate of
eczema is lower among breast-fed infants; the critical factor may be the cuddling and
skin contact that accompanies nursing.xcvii Along with the hunger for love, eczema
patients frequently must deal with much anger, typically unconscious.xcviii
I regard atopic eczema as a disease of two or more people, not just the patient
himself or herself. The original relationship is usually mother and child; in adulthood,
the same emotional turmoil is transferred to marriage, particularly one that revives
the same issues of love and rejection.
No one profile fits all atopic eczema sufferers, but many are intensely active,
compulsively driven people. They tend to be bright children who learn quickly and
do well at school. Possibly, this striving personality type, like the eczema itself,
represents a reaction to the insecure feeling of being unwanted and unloved.
The emotional impact of atopic eczema can be devastating. It can interfere with
the stroking and fondling a young child needs to build a strong sense of self. The skin
becomes the focus of attention and emotion to which all else becomes secondary:
happiness, anger, sadness, and joy are embodied in the scratching and treating of
troubled skin, leaving little room for normal relationships with friends and family.xcix
In adolescence, the pain and embarrassment of eczema interfere with normal
relationships; focus on the pleasure and pain of scratching can disrupt the normal
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course of sexual development.
Because emotional issues are so central in the course and impact of atopic
eczema, the whole range of psychological techniques and biofeedback have all been
used with documented success.c Be especially alert for certain tasks: "crying for love,"
"expressing anger," and "control." The material in chapter 8 should be particularly
helpful.
Nummular dermatitis (named for its coin-shaped pattern of skin lesions) is
usually more troublesome in the winter and may go into remission in the summer;
consider this in developing an ideal imaginary environment. One study documented a
major role for emotional difficulties in this type of eczema: all exacerbations were
linked to stressful events.
In hand eczema (dyshidrotic eczema orpomphyolyx), the skin of the hand
becomes dry, cracked, and flaking. Victims are typically driven and self-critical,
oppressed by a sense of failure and guilt. In some cases, the eczema follows
compulsive behavior patterns: the "dishpan hands" of the fanatic housekeeper and
the cracked, desiccated skin of those whose compulsive cleanliness leads to constant
hand washing.
A German study links dyshidrotic eczema to a struggle for autonomy, an attempt
to "take one's life into one's own hands," or an expression of the contrary feeling that
“I can't handle this."ci Military reports suggest that eczema of the hands and feet may
express the wish to avoid marching to danger or using the hands to kill.
Psychological techniques, including short- and long-term psychotherapy,
hypnosis, psychoanalysis, behavioral therapy, and biofeedback, have worked well.
Contact eczema would seem to be a straightforward matter of the body's
response to noxious chemicals or plants, but in fact psychological factors are often
important, as dramatized by Japanese studies (see the Introduction).cii
The course and treatment of contact dermatitis are complicated when
occupational exposure is involved. Suspicion and fear about noxious chemicals –
quite justified by the American industrial tradition of disregard for workers' welfare
– may lead to excessive hand washing, which aggravates any irritation. Workers'
compensation rewards continued illness and penalizes recovery. Contact dermatitis
is more prevalent where workers are dissatisfied and alienated, suggesting a
combination
of
chemical
and
psychological
factors;
fast-spreading
"pseudoepidemics" have been known to take place.ciii
Lichen simplex chronicus (neurodermatitis) refers to specific patches of eczema
caused by rubbing or scratching. Chapters 5 and 12 may prove especially useful.
Obermeyer described a forty-year-old woman who developed a rash on the nape of
her neck: she had stilled her conscience, guilty over an affair with a married man, by
"putting it all in the back of my head."civ
Generally, the earlier eczema appears and the more widely it spreads, the more
work will be necessary for improvement. The different kinds of eczema are among
the problems that people present to me most often. They have provided some of the
most gratifying applications of the techniques.
HAIR DISORDERS
Diffuse Hair Loss (Telogen Effluvium)
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(Griesemer Index: 55 percent; Incubation period: two to three weeks)
In contrast to alopecia, in which hair loss is total or limited to well-marked areas, hair
is lost gradually and diffusely over the entire head or body. It resembles the hair loss
that often comes during pregnancy or two to four months after childbirth or that
follows a serious illness. The cause of telogen effluvium is unclear, and there is no