PSYCHE AND THE SKIN

There is a very close relationship between what goes on in the mind and the state of the skin. There are a number of possible reasons for this, the first being the fact that in the embryo stage, the skin is formed from the same substance as the brain—the ectoderm. The skin and the brain are probably the most fascinating and complicated organs of the body. Like the brain, the skin is still to be fully explored and understood.

Secondly, the bond between the skin and the mind may well be related to the fact that there are more nerve pathways leading to the brain from the skin than from any other organ. These can relay messages to and from the brain faster than the speed of light, instantly recording pleasure, pain, touch, temperature or irritation. It is estimated that in just one square centimetre of skin you will find approximately 100 sweat glands, 10 hairs, one metre of blood vessels, four metres of nerve fibres, hundreds of nerve endings programmed to record pain, 25 pressure receptors sensitive to tactile stimuli, two sensory receptors to record cold, 12 sensory receptors to record heat, countless lymph vessels, and 15 sebaceous glands.

The skin also acts as an important erogenous zone. It is apparent how important in infants the effect of stroking, and caressing, is for satisfactory emotional development. Similarly, the skin has important sexual connotations, as well as being of great psychological importance to us with respect to our external appearance.

There is nothing at all that happens in our minds that does not affect our bodies, and the reverse is also true. The skin is paramount among all the body organs as an instrument of expression. Everyone knows that blushing signifies embarrassment, that anger provokes flushing, that fear is expressed in blanching, that sweating is a response to excessive emotional excitement. Presumably such reactions were, in ancient times, appropriate to some emergency, preparing our ancestors for some form of useful defence. In modem society these reactions have lost their functional aspect because of social disapproval of the expression of primitive instinctual drives; for us blushing, pallor and sweating are cutaneous signs by which the inhibited instincts are betrayed. The manifestation of emotions in the skin are brought about chiefly by neural discharges within the autonomic nervous system and changes in hormones from the endocrine system. There is a very dose association between both these systems and the skin.

Obviously, then, the mind will most definitely influence the type and timing of various skin disorders, and conversely, these disorders will affect the mind. Some doctors will deny that the psyche has any other than a superficial relationship to skin disorders, insisting upon organic causes in every case. Others may see the psyche lurking behind every pimple. It is a clinical fact that patients often react more strongly emotionally to skin diseases which are freely visible than to far more serious internal, and consequently hidden, disorders. The skin occupies a special place in the human psyche, being a kind of outermost representative of the ego. The slightest blemish may call forth deep hidden fears. A small patch of alopecia (hair loss) is not in itself a very serious symptom, but if the patient privately believes that it signifies loss of virility, his or her anxiety over the symptom may not seem so disproportionate. This then poses a special problem for the person making diagnoses. It is often quite difficult to know whether anxiety is causative or reactive, that is, whether the emotional distress caused the akin disease or the skin disease caused the anxiety. Often, of course, both factors are present in a viscious cycle. It may be true that skin diseases are not, on the whole, fatal, but it is also true that many of these disorders ruin life emotionally, even though they spare it physically.