Dr. Sergio Lanari, D.ssa Maria De Federicis
Dermatologi – Falconara (An)
Psoriasis is a skin disease whose relationship to the psyche has already been extensively described… …in few other pathological skin complaints does this intersection of psychic element with the spreading of cutaneous manifestations, appear so clear and consequential. Many authors today classify Psoriasis among pure psychosomatic disease.
Skin disorders such as those that occur in patients suffering from psoriasis can change the relationship both with themselves and with others.
Consequently, the person may withdraw from society, experience states of depression and disordes of bodily image as well as developing a feeling inferiority (1).
According to Bahnson’s psychodynamic interpretative model, the Psoriatic patient tends to deny his inner conflict, his anxieties, distress and suffering, channelling them through his body, and expressing them by sketching a symptom on his skin.
Didier Anzieu observed (2) that every time there was a psychosomatic conversion sustained by the skin, the extent of the cutaneous alteration was proportional to the extent of the mental trauma.
We decided to investigate the psychodynamic aspects present in Psoriatic patients with the purpose of outlining some sort of parallel between Psoriasis and psychosis.
If it is true, as Biond observed (3) that the actual concept of psychotic personality is not always equivalent to a psychiatric diagnosis, but rather to a pattern of mental behavior, in as much as the psychopathological way of living is in a certain sense, accepted by the psychotic patients, who rather than fighting lives with his illness; we cannot help observing how the same way of living with the illness is found in most Psoriatic patients, who end up showing more pathophilic traits than pathophobic ones concerning their dermatosis.
In the personality profiles of the Psoriatic patients we observed, we often discovered psychic rigidity, “that inability to feel emotions, develop personal experiences and communicate with oneself”, which are also so frequently verifiable in the psychotic patients. This disharmony, this conflict, this mechanical feeling, devoid of life and warmth, is common to both personalities.
We examined a group of 33 Psoriatic patients (24 male and 9 female) aged between20 and 83 years who underwent a two-year observation.
Regarding the patients’ school education: there were eighteen patients who had attended only the Primary school (leaving age 11), seven had Primary and Middle school (leaving age 13), two had obtained their Senior school Diploma. One patient had a degree. Four patients had left school during the first years of Primary school, one patient was illiterate. A low academic level itself produces a personality more inclined to express himself through his body than verbally. The patients were first interviewed for their case history: the projective tests MMPI (or Minnesota), Rorschach’s test and the Machover test were then carried out. Only a few managed to complete the MMPI test, probably due to their low academic standards and intrinsic difficulty of the test itself. The Rorschach test evoked so few answers to render an evaluation of the results difficult. However all patients responded to Machover’s “human-form” test. We found this test particularly useful for the advantages the figurative activity afforded us in individuals such as Psoriatic patients who are so little disposed to verbal communication.
The deeper subconscious functions of the individual are often expressed through a figurative or graphic activity, which is more archaic than the verbal one and therefore nearer to psychosomatic thought.
Somatic regression expresses a change from a more differentiated structural level to a more disorganised and undifferentiated state (4).
- An insecure ego with a strong sense of inferiority;
- Dependent personality, often very sensitive to social critisism
- A very conflicting identification with sexual role;
- Mental rigidity;
- Very marked but inhibited aggressiveness;
- Difficulty in communicating and relating to the outside world;
- Sometimes exhibitionism.
1 Williams, R., “The psychosocial aspects of Psoriasis”, Physiotherapy Canada 36/5, 257-260 (1984)
2 Didier Anzieu, “Le moi peau”, Bordas Paris (1985)
3 Grinberg, L., Sor, D., Tabak De Bianchedi, E., “Introducción a las ideas de Bion. Grupos, conoscimiento, psicosis, pensamiento, trasformaciones, práctica psicoanalitica”, Nueva Vision, Buenos Aires (1972).
4 Pancheri, P., “Medicina psicosomatica”, in Reda, G.L., “Trattato di psichiatria”, USES, Firenze, 216 (1968).
5 Cossidente, A., “Il sognificato psicologico della pelle”, in Panconesi, E., “Lo stress le emozioni e la pelle”, Masson Milan, 41 (1989).
6 Graves, R., “Greek Myths”[/vc_column_text][/vc_column]