the face, is part of the disorder. Any area of skin can be affected.
The usual medical treatment uses topical, intralesional, or systemic
corticosteroids. Antimalarial and immunosuppressive treatments are rarely required
for skin involvement alone. Any disease in which the immune system is either
overactive or underactive is a potential applicant for psychological techniques.
SCLERODERMA (Progressive Systemic Sclerosis)
This systemic disease of unknown origin is believed to have an autoimmune basis.
This potentially life-threatening disease can involve multiple organs; one variant,
Morphea, is limited to the skin. Many treatments have been suggested, but at this
point, none has clearly emerged as effective. Physical therapy is important to
maintain flexibility and mobility.
Psychological techniques have a potential that remains largely unexplored. The
major involvement of the immune system, the use of pain control techniques, and
help with motivation and depression are likely applications.
Raynaud's phenomenon is often part of the disorder, and here the psychological
techniques have a solid track record. This disorder of circulation can make the entire
body, but especially the extremities, excruciatingly vulnerable to cold and the
formation of skin ulcers. Both hypnosiscxxxix and biofeedbackcxl are quite effective.
Control of blood flow is generally one of the easiest physiological dimensions to take
charge of. Images of increased blood flow and of blood vessels opening up to help the
flow can be augmented with scenes that would promote those effects. With one
woman whose life was hampered by ambivalence and an inability to make
commitments, we worked simultaneously on the circulation problems and her ability
to "let it flow" more generally. Being able to tune into her emotional "pulse," feeling
in touch with her heart, and confronting fears of her passions helped her not only
control physical symptoms but live a more "full-blooded" life.
SEBORRHEIC DERMATITIS
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(Griesemer Index: 41 percent; Incubation period: days)
In this condition, which resembles dandruff, accelerated growth of skin cells
produces red, scaly eruptions of the scalp. The cause is unknown, but stress has been
cited as a trigger factor. Involvement can spread to the head and face and even the
chest and areas of skin folds. Medical treatment for the scalp includes shampoos
containing selenium sulfide, zinc prythione, and tar. For severe scalp symptoms and
other areas, the most common treatments are corticosteroids, antifungals, and
antibiotics.
There has been little research into emotional factors that may trigger or follow
seborrheic dermatitis. Wittkower and Russell found that two-thirds of one hundred
patients experienced social difficulty: they feared ridicule or simply being
conspicuous. As a group, they were slow to make friends, but hardworking and
perfectionistic. Almost all described triggering incidents that threatened their self-
esteem.cxli
The techniques I've described may work in seborrheic dermatitis, but here,
more than with many other conditions, you must be your own researcher.
SELF-INFLICTED WOUNDS (Factitia)
(Griesemer Index: 69 percent; Incubation period: seconds)
People inflict a wide variety of wounds on their skin – tearing, cutting, freezing, or
burning themselves. The wounds may be treated by a physician but their cause is
clearly psychological and requires an appropriate approach.
You don't have to be crazy to damage your own skin, although some such self-
victims are in fact psychotic. Most are simply acting out in a particularly concrete
way the kind of self-destructive impulses that others do more subtly. There are ways
in which virtually all human beings treat themselves poorly – they range from the
extreme of suicide to self-defeating behavior ("fractional suicides"), such as self-
isolation, self-neglect, poor diet, and failure to take medication when indicated.
If you inflict damage to your own skin, don't feel like a freak – what you're doing
is a dramatic expression of a near-universal mechanism – but do make a determined
effort to get to the bottom of your symptom. The first step is owning up to the action
and taking responsibility for it – and regarding yourself and your trouble with the
same compassion you'd have for a friend. Shame and humiliation are a natural
response but are neither necessary nor helpful. Why flagellate yourself for something
you cannot, as yet, fully control?
This advice is also directed to anyone who in any way aggravates a skin
symptom, whether by picking or squeezing pimples, compulsively washing hands
plagued by dry skin, or rubbing places that are already irritated. Only when you take
responsibility for what you're doing can you become an active party in helping
yourself.
Any and all the exercises in this book may help you gain insight into the tasks
that your skin assaults are seeking to accomplish. Anger, love, and sexuality tasks are
likely to be particularly relevant. Self-damage is always a cry for help. It may attempt
to atone for an obscure sense of sin: some people report that they damage their skin
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with a feeling of purifying themselves, of releasing enormous pressure. It may seem
the only way to get special care and nurturance, especially for those whose parents
came through only in times of illness or distress.
Don't overlook loyalty as a motive for self-destructive acts. Anyone who treats
himself badly was taught to: often we take over the task of chastising ourselves to
keep up the work of physically or emotionally abusive parents.
Because the emotional nature of this symptom is particularly difficult to grapple
with alone, be ready to seek professional help.cxlii
How To Stop Compulsive Skin Picking, Scratching, and Hair Pulling
STIGMATA AND SPONTANEOUS PURPURA
Stigmata are marks that appear spontaneously, usually duplicating the wounds of
Christ: bruises may appear on the forehead, suggesting the crown of thorns; stripes
on the back, indicating the weight of the cross; and wide plaques on the hands,
corresponding to the nails of crucifixion. However, they also appear in members of
other religions, such as Islamic people, while contemplating the battle wounds of
Mohammed, for example, and in the nonreligious. Their cause is unknown, and there
is no medical treatment. They're a striking example of the interaction of mind and
skin.
Perhaps related are spontaneous purpura, or hemorrhages beneath the skin,
which often appear after violent dreams or hallucinations. Victims are predominantly
female and are usually involved in some sort of emotional turmoil; the phenomenon
is most likely to occur in the highly suggestible.
Hypnosis and psychotherapy may help in these conditions. In one woman, pains
of the hands and feet, which appeared while she was contemplating the crucifix,
disappeared with the help of hypnosis.cxliii
SUN ADDICTION
This is obviously not a skin disease per se but a way of making sure you get one. How
times change! Remember the old photographs of the elegant couple, cigarettes in
hand, basking in the intense Caribbean sunshine? Yesterday's ultrasuave, today's
ultrasenseless? (See also "Sun Addiction" in chapter 3.)
VITILIGO
(Griesemer Index: 33 percent; Incubation period: two to three weeks)
The cause of this disorder, in which areas of the skin completely lose their normal
pigmentation, is unknown, but the immune system may play a role. Topical
corticosteroids are sometimes helpful, as is PUVA (oral or topical psoralen and
ultraviolet A light). Stains or cosmetics are also used.
Vitiligo causes no pain, physical discomfort, or disability: it is purely a cosmetic
condition, but as such it causes extreme distress. In one study, two-thirds of patients
with vitiligo reported embarrassment; one-half said they were socially ill at ease, felt
ugly, or dressed inappropriately to hide affected areas. More than one-third said it
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interfered with their sex life. Two-thirds reported that strangers stared at them; 72
percent said they asked questions and 16 percent said onlookers made rude remarks.
A full 40 percent appeared to be chronically depressed by their symptom: "I hate
myself. I feel like a freak." were typical comments.
Higher self-esteem and ego strength characterized patients who coped best with
the burden of vitiligo. It appears that a person who generally feels better about
himself or herself will better handle the self-image assault and embarrassment of this
condition.
One complaint that emerged in patients' reports was their doctors' insensitivity
to their needs and problems; they felt they needed more personal interest,
encouragement, and support.cxliv A patient with vitiligo who feels this way might
reflect that those needs are absolutely legitimate but the dermatologist may be ill-
equipped, by training and temperament, to satisfy them; psychotherapy can better
provide support and foster adjustment to the disease.
One case history reports striking success against vitiligo with hypnotherapy.
Gajwani aw Sehgal of Goa, India, described a twenty-seven-year-old woman who had
an irregularly pigmented area near the left edge of her mouth for seven years. (In
India, the authors note, vitiligo carries a dire social stigma.) She lived in a strained
situation with her in-laws and had an unsatisfactory relationship with her husband,
whose business activities kept him from devoting much attention to her.
In six sessions of hypnosis (at which she proved adept), it was suggested that
her face was flushing and the white spots getting smaller. By the third session, the
area had shrunk to half its original size. By the sixth, it had disappeared completely.
On the doctor's advice, her husband spent more time with her, following a
"prescription" for movies, picnics, and walks. At follow-up, she appeared perfectly
healthy.cxlv
Generally, the fact that emotions play a triggering role in one-third of vitiligo
cases suggests that hypnosis and other psychological therapies may be helpful.
WARTS
(Griesemer Index (multiple, spreading warts): 95 percent; Incubation period: days)
Warts are benign skin tumors caused by a virus. They are common, particularly
between the ages of twelve and sixteen (a British survey found them in 16.2 percent
of school children,cxlvi and usually are removed easily by such dermatological
procedures as mild acid, electrocautery, and cryosurgery (freezing). When they recur
and spread widely, however, they can be extremely troublesome. See chapter 19 for
emotional factors and treatment.
The treatment of warts is the area where psychological techniques have made
the greatest inroads into the mainstream of dermatology. Warts seem to disappear
and return spontaneously, but their behavior is often linked to emotional factors. The
critical factor is likely the immune system, which keeps the virus in check or allows it
to flourish.
Human beings have long exploited the emotional sensitivity of warts with a
huge arsenal of folk cures. Toads have been sacrificed, cats brought to graveyards at
midnight, rituals performed, and incantations sung in efforts to make these growths
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disappear. There's substantial evidence that such cures work beyond the
spontaneous remission rate.cxlvii
Warts often respond dramatically to simple suggestion; as mentioned, I've had
patients report their disappearance after calling me for an initial appointment.
Laboratory investigations and clinical trials have shown hypnosis, in particular, to be
effective.cxlviii One group of children, under treatment for other diseases with drugs
that suppressed their immune system, were vulnerable to warts that resisted medical
treatment. Even here, hypnosis was successful, with the better hypnotic subjects
enjoying the best results.
Psychologist Owen Robbins described a young boy who was plagued by severe
recurrent warts and by a difficult family situation. His skin cleared quickly after he
performed the overdue act of punching his intrusive, overbearing younger
brother.cxlix I've been impressed by how often warts become a problem for people
who are deadlocked in an emotional crisis, a stalemate that must be resolved for life
to continue, a general impasse in the process of growing up.
The most effective psychological approach to warts combines hypnotic
techniques with exploration of troublesome issues, focused on today's impasse. With
insight and life changes that release the patient from his emotional bind, the
prognosis, even when warts are severe, is good. Rapport with a doctor who sincerely
believes in these techniques is essential. Severe recurrent warts are one of the most
frequent reasons people come to see me. Results are particularly favorable.
WARTS (Genital or Venereal) (Condyloma Acuminata)
These have a special emotional impact because of the area where they appear – the
genitals and around the anus. These warts are the second most common sexually
transmitted disease (after Chlamydia trachomatis). They also can increase the risk of
some types of cancer.
Topical podophyllum resin is emerging as the treatment of choice. Mild acids,
cryotherapy, electrocautery, and laser surgery are all used as well. See chapter 9 for
the role of emotions and psychological techniques.
Most people with warts find an ideal imaginary environment that incorporates
cooling, and perhaps tingling, to be helpful, along with direct suggestions that they
disappear. If these measures don't work, try to understand and clear away any
possible emotional impasse: headway here often allows hypnotic techniques to
become effective. See also chapter 19 for further information about these warts.
lxxx
J.E. Fulton and E. Black, Dr.Fulton's Step-by-Step Program for Clearing Acne (New York: Harper &
Row 1983), is a very useful, readable, popular book; G. Hirsch, ' Understanding the Adolescent Patient," Major
Problems in Clinical Pediatrics 19(1978):28-38; and R.J. Schachter, et al.,"Acne Vulgaris and Psychological
Impact on High School Students," New York Journal of Medicine (1971):2886-2890, may be helpful to parents of
adolescents.
lxxxi Ikemi and Nakagawa, A Psychosomatic Study (1962).
lxxxii S. Bray, Personal Communication (1983).
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lxxxiii A. Frazier, Psychosomatic Aspects of Allergy (New York: VanN ostrand, Reinhold, 1977), is a popular
book.
lxxxiv I.I. Secter and C.G. Barthelemy, "Angular Cheilosis and Psoriasis as Psychosomatic Manifestations,"
American Journal of Clinical Hypnosis 7 (1964):7981.
lxxxv M. Jabush, "A Case of Chronic Recurring Multiple Boils Treated with Hypnotherapy," Psychiatric
Quarterly 43-3 (1969):448-455.
lxxxvi E.S. Epstein, et al., "Psychiatric Aspects of Behçet's Syndrome, " Journal of Psychosomatic Research 14
(1970):161-172.
lxxxvii See R.J. Wakeman and J.Z. Kaplan, "An Experimental Study of Hypnosis in Painful Burns," American
Journal of Clinical Hypnosis 21 (1978):3-12; and Crasilneck and Hall, Clinical Hypnosis Principles and
Applications.
lxxxviii See Psychological Dimensions of Cancer, edited by J. Cohen, et al. (New York: Raven Press, 1982);H.
Dreher, "Cancer and the Mind: Current Concepts in PsychoOncology," Advances, Institute for the Advancement
of Health 4,3 (1987): 27-43;B. Fox and L. Temoshok, "Mind-Body and Behavior in Cancer Incidence,"
Advances, Institute for the Advancement of Health 5,4 (1988):41-56; S. Locke, et al., Healer Within: TheNew
Medicine of Mind and Body (NewYork: Dutton, 1986); and A. Weissman, Coping with Cancer (New York:
McGraw-Hill, 1979).
lxxxix O.C. Simonton, et al., Getting Well Again (New York: Bantam, 1982).
xc
L. LeShan, "Psychological States as Factors in the Development of Malignant Disease: A Critical
Review," Journal of the National Cancer Institute 22 (1959):1-18; see also his Cancer as a Turning Point (New York: Dutton, 1989).
xci
F.I. Fawzy, et al., "A Structured Psychiatric Intervention for Cancer Patients, Archives of General
Psychiatry 47 (August 1990):720-735.
xcii
G.N. Rogentine, et al., "Psychological Factors in the Prognosis of Malignant Melanoma: A Prospective
Study," Psychosomatic Medicine 41 (1979): 647-655.
xciii Simonton, et al., Getting Well Again and S. Simonton and R. Shook, Healing Family (New York:
Bantam, 1984). See also B. Siegel, Love Medicine and Miracles (New York: Harper & Row, 1987).
xciv
M.P. Janicki, "Recurrent Herpes Labialis and Recurrent Apthous Ulcerations: Psychological
Components," Psychotherapy and Psychosomatics 19 (1971):288-294.
xcv
C.A.S.Wink, "A Case of Darier's Disease Treated by Hypnotic Age Regression," American Journal of
Hypnosis 9-2 (1966):146-150.
xcvi
R.A. Spitz, "The Psychogenic Diseases of Infancy," Psychoanalytic Study of Child 6 (1951):255-275.
xcvii M.E.Obermeyer, Psychocutaneous Medicine (Springfield, Ill.: Charles C. Thomas, 1955).
xcviii E. Wittkower and B. Russell, Emotional Factors in Skin Disease (New York: Hoeber, 1953).
xcix
Griesemer and Nadelson, "Emotional Aspects of Cutaneous Disease."
c J. Twerski and R. Narr, "Hypnotherapy in a Case of Refractory Dermatitis," American Journal of Clinical
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Hypnosis 16-3 (1974):202-205; and Brown and Bettley, "Psychiatric Treatment of Eczema"; R.M. Miller and
R.W. Coger, "Skin Conductance Conditioning with Dyshidrotic Eczema Patients," British Journal of
Dermatology 101 (1979): 435-440; and M.F. Cataldo, et al., "Behavior Therapy Techniques in the Treatment of
Exfoliative Dermatitis," Archives of Dermatology 116 (1980):919-922.
ci
O. Hansen, et al., "My Fingers Itch but My Hands Are Bound: An Exploratory Psychosomatic Study of
Patients with Dyshidrosis of the Hands," Zeitschrift fur Psychosomatische Medizin und Psychoanalyse 27-3
(1981): 275-290.
cii
Y. Ikemi and S. Nakagawa, "A Psychosomatic Study of Contagious Dermatitis," Kyush Journal of
Medical Science 13 (1962): 335-350.
ciii
Obermeyer, Psychocutaneous Medicine.
civ
Ibid.
cv
A.M. Kligman, "Pathologic Dynamics of Human Hair Loss," Archives of Dermatology 83 (1961): 175.
cvi
Wittkower and Russell, Emotional Factors in Skin Disease.
cvii
Obermeyer, Psychocutaneous Medicine.
cviii R.D. Mehlman and R.D. Griesemer, "Alopecia Areata in the Very Young," American Journal of
Psychiatry 125 (1968):57-65. For more adult information, see I.Cohenand], D. Lichtenberg, "Alopecia Areata,"
Archives of General Psychiatry 17 (1967): 608-614.
cix
T. Oguchi and S. Miura, "Trichotillomania: Its Psychopathological Aspect," Comprehensive Psychiatry
18 (1977): 177-182.
cx
M. Sticher, et al., "Trichotillomania in Adults," Cutis 26 (1980):90-101.
cxi
Oguchi and Miura, "Trichotillomania: Its Psychopathological Aspect."
cxii
T.J. Galski, "The Adjunctive Use of Hypnosis in the Treatment of Trichotillomania: A Case Report,"
American Journal of Clinical Hypnosis 23-3 (1981): 198-201.
cxiii D.P. Langston, Living with Herpes (New York: Dolphin, 1983). See also S.L. Sacks, The Truth about
Herpes (Seattle: Gordon Souleskis, 1988).
cxiv
Heilig and Hoff, llberpsychogene Entstehung.
cxv
D.D. Schmidt, et al., "Stress as a Precipitating Factor in Subjects with Recurrent Herpes Labialis,"
Journal of Family Practice 20-4 (1985): 359-366.
cxvi
R. Glaser, et al. "Stress, Loneliness and Changes in Herpes-Virus Latency." Journal of Behavioral
Medicine 8-3 (1985): 249-260.
cxvii See Scott, Hypnosis in Skin, for this case and Obermeyer, Psychocutaneous Medicine, for other
background. See also Langston, Living with Herpes.
cxviii M. Pistiner, et al., "Psychogenic Urticaria," The Lancet 22/29 (1979): 1389, a brief report; Saul and
Bernstein, "The Emotional Settings of Some Attacks of Urticaria," Psychosomatic Medicine 3 (1941): 349-369,
is a much richer source.
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cxix
J.R. Dane and J.C. Rowlingson, "Hypnosis in the Management of Postherpetic Neuralgia: Three Case
Studies," American Journal of Clinical Hypnosis 31-2 (1988): 107-113.
cxx
Z. Kaneko and N. Takaishi, "Psychosomatic Studies on Chronic Urticaria," Folio Psychiatrica et
Neurologica Japonica 17-1 (1963): 16-24.
cxxi
G.R.Werth, Hives Dilemma," American Family Physician 17(1978): 139-143.
cxxii T. Graham and S. Wolf, "Pathogenesis of Urticaria," Journal of the American Medical Association 143
(1950):1396-1402.
cxxiii E. Wittkower, "Studies of the Personality of Patients Suffering from Urti