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Psychotherapy In Skin Diseases

The place of mental influence in the treatment of skin diseases will
be best realized from the role that we know the mind plays in the
production of various skin manifestations. There is a whole series of
skin affections which depend to a considerable extent on mental
conditions, worries, anxieties, shocks, frights and the like, and a
number of skin affections that have been labeled hysterical which
occur in nervous persons, due to over-attention to self and their
conditions. It has been well said that it is possible to make the feet
warm by thinking about them. Certainly attention to any part of the
skin surface causes a tingling and hyperemia may follow. Blushing is
an illustration of mental influence on the skin, and anything that
would tend to make this endure for some time would give rise to
erythematous conditions. We know the creepy, uncomfortable, hot
feelings that come over us in times of suppressed excitement when we
are waiting for something to happen; and, on the other hand, there is
a pallor and tremor that accompanies fright or fear, which points to
mental influences over the vasomotor system in the skin.

Urticarias.--Certain skin diseases, especially those allied to the
urticaria group, are prone to occur in connection with excitement and
worry. In the chapter on Neurotic Intestinal Affections attention is
called to the fact that many patients who suffer from intestinal
idiosyncrasies and have excessive reactions to special kinds of food,
as cheese, strawberries, or the like, sometimes also suffer from skin
lesions and intestinal disturbance through worry or excitement. While
preparing for examinations or undergoing some physical trial or
suffering from worry or anxiety such persons may have urticaria or
even wheals on the skin. There may be some dietary disturbance to
account for them, but they would not occur, or at least would not be
so serious and annoying, but for the disturbed mental condition. Under
these circumstances dermatographia is a common manifestation. It used
to be considered a symptom of many physical conditions, but will occur
in almost any nervous person during the course of an examination by a
strange physician or when some important medical decision is pending.

Eczema.--Not only these passing conditions of the skin, however, but
more lasting affections have been connected with mental disturbance.
Probably every skin specialist has noted in a number of his cases that
a first attack of eczema came after a period of worry or excitement,
or sometimes followed directly on a fright. When relief from the
condition has been brought about by treatment, relapses occur
during periods of business worry or family anxiety or mental stresses
of one kind or another. Cabinet crises in England are found to be
likely to be followed by the recurrence of eczematous conditions in
older members of the Cabinet or by first attacks in some of those
whose skin has been irritated by some internal condition. Unless
business worries can be removed or family anxieties allayed the cure
of eczema becomes a difficult matter. Men or women who worry about
their eczematous condition apparently prolong it. This is particularly
true if they have little to do and are likely to be much occupied with
themselves and their condition.

Herpes.--Herpetic conditions resemble urticaria in their response to
mental conditions. Herpes preputialis and herpes progenitalis occur
particularly in people who worry over the possibility of some
infection of the genitals. The lesions are likely to be indolent until
the state of mind with regard to them is relieved by reassurance as to
their comparatively innocuous character. Even herpes zoster is prone
to come on after a period of worry and anxiety. It is due to
infection, but the infection becomes more possible after a lowering of
resistive vitality in the nervous system. This is particularly true as
regards herpes facialis. It has been noted again and again that facial
neuralgia is most likely to occur after fright, deep emotion, or
prolonged anxiety. Treatment of these cases will only be successful if
the mental state is set right. This is particularly true with regard
to Bell's palsy. Patients who worry much about it and who fear that it
may have lasting results are likely to prolong its course and to put
off complete cure for a good while.

Vasomotor Disturbance.--There is a series of skin affections connected
directly with the vasomotor system of the skin which are largely under
the influence of emotional or mental factors. These represent
particularly the milder forms of Raynaud's disease and the parallel
forms of Weir Mitchell's disease. In the one case there is a spasm of
the arterioles causing what the French call "dead fingers," and in the
other paralysis of the vasomotor system with venous congestion in the
parts. They are seen particularly in persons of highly nervous
organization and especially after periods of emotional strain or
stress. There is a series of affections related to these,
characterized by numbness, paresthesiae, going to sleep of the fingers
or members, tingling, and even milder forms of itchiness--sometimes
dignified as pruritus--which are largely due to mental factors. Some
physical condition will need to be corrected, but they will only
disappear if the mind is set at rest and if the patient is kept from
occupying his attention much with them. Concentration of attention
will make them chronic.

Scurvy.--Scurvy is not usually thought of as a skin disease, though it
has many local manifestations on the skin and mucous membrane. It is a
deep nutritional disturbance of such nature that it would seem the
mind could have but little influence over it. When scurvy was common,
however, it was often noticed that any change of attitude of mind in
affected persons brought amelioration or deterioration of condition.
Scurvy develops with special virulence during discouragement; it gets
better with the dawn of hope. It has been known to be much improved by
the prospect of a naval engagement when all the sick men wanted to get
into the fighting. The famous case of the Siege of Breda in 1625 is
often quoted. The city was about to capitulate because so many of the
soldiers were suffering from the disease. The Prince of Orange,
however, sent word that a new and powerful remedy had been discovered
that was sure to cure the affection, and that he had secured some of
it and it would not be long before they would all be well. What he
sent was a remedy that had been used with indifferent success for
scurvy when taken in large doses. He could send only enough to give a
few drops to each patient. This small dose was wonder-working in its
effect and proved to have the healing virtue of a gallon of the
liquor. Most of the patients got better and surrender was put off.

Warts.--A striking evidence of the influence of the mind upon the skin
is given by what we know of warts. All sorts of charms have been not
alone suggested for them but found to work in certain cases. Lord
Bacon in his "Natural History" tells the story of the charming away of
warts and exemplifies it by his own experience. When he was about
sixteen a number of warts--at least 100--came out upon his hands. One
of these had been there from childhood. The manner of their cure he
details as follows:

The English Ambassador's lady, who was a woman far from
superstition, told me one day she would help me away with my warts;
whereupon she got a piece of lard with the skin on, and rubbed the
warts all over with the fat side; and amongst the rest that wart
which I had from my childhood. Then she nailed the piece of lard,
with the fat towards the sun, upon a post of her chamber window,
which was to the south. The success was that within five weeks'
space all the warts went away, and that wart which I had so long
endured for company. But at the rest I did not marvel, because they
came in a short time, and might go away in a short time again; but
the going away of that which had stayed so long doth yet stick with

Lucian, the Greek satirist, tells that warts were cured by magic in
his time. Carpenter in his "Human Physiology," page 984, says: "The
charming away of warts by spells of the most vulgar kind belonged to
those cases which are real facts, however they may be explained." Dr.
Hack Tuke in his "Influence of the Mind Upon the Body" says: "In
visiting a county asylum some years ago my attention was directed to
several of the patients who were pestered with warts and I solemnly
charmed them away within a specified period. I had quite forgotten the
circumstance until on revisiting the institution a few months
afterwards I found that my practice had been followed by the desired
effect and that I was regarded as a real benefactor." This feature of
the method of removing warts, setting a date before which they shall
disappear, is noted in most of the successful charms. Dr. Tuke tells
of a case in which a gentleman on shaking hands with a young lady
noticed that she had many warts. He asked her how many she had; she
replied about a dozen, she thought. "Count them, will you," said the
caller; and taking out a piece of paper he solemnly took down her
counting, remarking: "You will not be troubled with your warts after
next Sunday." Now it is fact that by the day named the warts had
disappeared and did not return.

Neurotic Pigmentation.--Pigmentation occurs very commonly as the
result of neurotic conditions. Dr. Champneys, in his article on
"Pigmentation of the Face and Other Parts, Especially in Women," in
St. Bartholomew's Hospital Reports, Volume XV, has illustrated this
very thoroughly. The pigmentations of women during the phases of
genital life, menstruation, pregnancy, the menopause and the fact that
eunuchs are usually fair and fat, while deep pigmentation in the white
race is usually associated with sexual irritability, all make
interesting studies in this subject. From comparative anatomy
and physiology the influence of the nervous system over pigmentation
has been very well illustrated. Bruecke in 1851 established the
influence of the nerves on the color of the chameleon and of the frog,
and there have been many confirmations of his work. Pouchet, in 1876,
in the Journal de l'Anatomie et de Physiologie proved that fish
gained the power of changing color by practice and lost it by disuse.
The influence in most cases, animal and human, which produces
pigmentation is exerted by the nervous system through the vascular
supply. The duskiness that sometimes comes with emotion, the pallor
that accompanies strong mental disturbance, as well as the blushing
states, show that the vasomotor system can be influenced in every
part. Pigmentation often seems only a consequence of local continuance
of such disturbance. Many of the feminine patients in whom even deep
discolorations around the eyes occur in connection with menstruation
are typical neurotic individuals. It is worry in combination with the
physical disturbance that produces the pigmentation. There are some
cases on record where emotional states have caused loss of pigment in
the negro or other colored races, or in the hair, as when, in
well-substantiated cases, people's hair has become white in a single
night. In every case of pigmentary disturbance, then, the individual
must be carefully studied and as far as possible all emotional
disturbance must be eliminated. Without this other treatment usually

Pruritus.--Pruritus in the old is often a bothersome symptom. All
sorts of remedies, internal and external, are recommended for it and
successes are reported with them. Whenever there are many remedies for
a symptom complex, it usually means that the suggestive element in all
of them is large. For pruritus the influence of the patient's mind is
extremely important. Often it will be found that these old patients
are getting out scarcely at all, but are living in close confinement
in their rooms, the air of which is scarcely ever changed. I have
known even the keyholes to be stuffed and arrangements made by which
the cracks between the door and the frame were rendered impervious to
air. In these cases the most important feature of any treatment is to
secure a proper amount of air. Sir Henry Thompson, the great English
surgeon, in his advice how to grow old successfully, written when he
himself was over 80, suggested that the cells of the skin needed an
air bath every day. He advised that men should make all their toilet
arrangements for the day without any garments on. Washing, the
preparation of clothing, shaving, and whatever else was done in the
early morning was to be accomplished after the night clothes were
taken off and before other clothes were put on. He lived to be well
above eighty and was sure that this practice had been of help to him.
Stimulating rubbings, if done gently and without the production of too
much reaction, will always benefit these people.

If old people have no interest, nothing that attracts their attention,
and if they once develop pruritus their mind gets concentrated on
their cutaneous sensations and it will be impossible to relieve them
by any treatment until their minds get occupied with something else.
Anyone who wants to sit in a chair for a few minutes and think about
his cutaneous sensations will soon realize how vividly these can be
brought to mind and how annoying they can become. To sit and think of
a portion of the body is to want to scratch it before long. Scratching
produces a flow of blood to the surface that adds to the itchy
feeling. The only way to get away from it is to get the mind
occupied with something else. Of course, where circulation is weak
because of failing heart or disturbed because of arteriosclerosis,
treatment directed to these conditions should be employed, but the
influence of the mind on blushing and skin feeling must not be

When pruritus develops in the old in connection with phases of
arterial degeneration--its most intractable form--it is important to
remember that diversion of mind is the most important therapeutic
agent that we have. The old have few diversions. They have given up
their ordinary occupations, they are often no longer interested in
reading, friends whom they used to know have died, and they are left a
great deal to themselves. Under these circumstances anything the
matter with them brings about a concentration of attention. This is
even more true if they have been very well in earlier life and have
had practically no experience with sickness.

Hysterical Cutaneous Conditions.--There are certain cracks of the skin
with ulcerative lesions which occur in hysterical patients in the
neighborhood of the knuckles that represent a phase of unfavorable
influence of the mind. When these patients begin to worry or be
anxious they know that these skin lesions will follow. Expectancy
seems to make it certain that the lesions will come and attention adds
to their chronicity. It has been noted that "chapped hands,"
especially when accompanied by deep cracks in cold weather, are made
worse by anxiety or worry. In many neurotic patients it is impossible
to treat such conditions satisfactorily unless the patient's mind can
be put at ease. It is surprising how intractable these conditions can
be, but that is usually because all the physician's attention is
devoted to the skin instead of a considerable portion of it being
given also to the patient's mental and nervous condition.

Artefact Skin Lesions.--Of course artefact skin lesions produced by
the application of carbolic acid or nitric acid or ammonia or some
other chemical irritant, or by rubbing with pumice stone, or with the
thumb as schoolboys make what in my schooldays were called "fox
bites," are skin lesions connected with a special state of mind and so
deserve a mention here. The physician finds them under the most
unexpected circumstances at times and in patients apparently above all
suspicion of their self-infliction. They can only be prevented by
changing the patient's state of mind, though this is scarcely what is
ordinarily thought of in psychotherapy. Where skin lesions are
atypical it is well to bear in mind the possibility of this curious

The Mind in Dermatotherapy.--I have had old dermatologists assure me
that they felt that the mind influenced materially the course of many
forms of skin disease. Younger dermatologists are prone to be
localists; as they get older the treatment of the patient's general
condition is felt to be more important; after twenty years of
experience they realize the place of psychotherapy in the treatment of
their cases. What is said here is only meant to be suggestive, but
certainly sufficient data are supplied to make it quite sure that the
mind greatly influences skin conditions and must always be treated if
success, especially in chronic cases, is to be secured. I have seen
confidence in a particular physician or remedy do much for even the
most sloughing and obstinate psoriases. Eczema follows the same law.
If psychotherapy can help in the treatment of conditions that are so
often intractable, it must surely not be neglected in other cases.

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