Psychoanalytic Approach to Dermatological Diseases

Psychosomatic disorders are defined as a half way between the mental and physical by Winnicott in 1949. Winnicott (1960) also said that There is no such thing as an infant, meaning, of course, that whenever one finds an infant one finds maternal care there would be no infant. That means, mother-infant cant be considered as two different people, they both exist in the need of other. Mother (caregiver) is responsible to provide the perfect environment for infant to take care of his needs which is quite necessary in early phases of life for the healthy growth of the continuity of being. Continuity of being is related with having infants omnipotence which claims that infant has independency from his mother and believes that mother is offset of his body to satisfy his drives.
According to Kleins object theory (1946), she put forward an idea that, there are 2 positions of infant object relationship with mother. First one is called paranoid-schizoid position from birth to 6 months, which is about paranoid anxiety with external frustration of annihilation, catastrophes, threats. Infant uses some defence mechanisms (projection, introjection, splitting of objects; good-bad mother, good-bad breast) to overcome with anxiety and paranoid thoughts. Then, the second one is called depressive position from 6th month to a year, which is characterized by the integration of split objects (bad mother + good mother = only mother). Infants get into depressive position because of the fear rejection or to be abandoned by mother because of their aggression, violence to bad mother etc. in the first phase. In the second stage, mother gets out of primary maternal preoccupation (Winnicott, 1956), which cuts off the omnipotent thoughts of infants, paralyses the infants continuity of being.
According to observations of Esther Bick in 1968, the lack early object relationships with mother cause deficiency on defense mechanism with the persecutory, depressive ideas. This inability of coping mechanisms ruins the mental functioning structure of infants which will be followed by the dermatologic diseases. She claims that infant needs inclusive, covering mother to cope with these persecutory ideas. In the absence of covering mother, infants create secondary skin (mostly hold on muscular, skeleton power or focus an object), when they stand alone with these destructive, catastrophic thoughts. Mother figure is crucial for the early period of life which is considered as a boundary to hold infants body together from the external threats (annihilation, disintegration etc.) like a skin. Mother is thought as a device, which helps infant to introject external object to bind with social environment and to develop emotional skills.
Didier Anzieu was a psychoanalyst who has developed skin-ego term, in the light of his works with dermatological patients in 1974, in Paris. The root of his study comes from Freuds drive theory, primarily, self is somatic self itself. It is considered that self is developed by somatic expressions, reflections (Freud, 1923). Anzieu defined the skin as a narcissistic psychic envelope which is vitally important for development of mental apparatus and existential self continuity in early phases of life. With the thought that every mental action is bonded with biological actions, the libidinal (narcissistic) investment is delivered by touching between mother and infant. Because, skin (the organ of touch) is the first and only channel to communicate between mother and infant, in the phase prior to word presentation and the use of word symbols. And infants self only reflects his mental, psychological context by the experiences on the surface of his body. Infant starts to imagine his self as a gathering of psychic, mental contexts (envelopes) by the experiences of the body surface. At the same time, the skin-ego is fantastic reality too, which discourses in the current language, fantasies, somatic behaviours and the deficiency of mentalization. Touching, holding or breast-feeding are really important for the satisfaction of infants drives and narcissistic self development. Untouched babies drives, impulses cant be satisfied in the lack of covering mother, so that infants start reacting the dermatological symptoms to replace with absent mother stimulus. The skin functions as a supportive, inclusive, preservative shield. The skin-ego is consisted of many psychic envelopes, which runs as a narcissistic envelope for a mental apparatus to record communication prints with mother and shows outputs of quality of this relationship on the skin as dermatological diseases. In addition, Michel Fain was one of the founders of Paris Psychosomatic School who worked with children with eczema in orphan house. And he claimed that the skin reacts symptoms to cover body, to protect body from external threats, to feed libidinal desires and for the continuity of self as a shield to replace mothers absence with the dermatological symptoms to soothe infants (Sever, 2015).
According to psychoanalytic psychosomatic perspective, the figure of mother has a substantial impact as a predictor of further relationships, on mind through the skin functioning. It is assumed that there is a correlational relationship between the lack of maternal care and dermatological diseases based on early object relationships. The absence of maternal care results with mental poverty and deficiency of coping mechanism on infants, and it causes to the creation of second skin or deficiency on skin-ego which induces dermatological diseases.

Prepared by Hilal Üney

References;
Anzieu, D. (1989) The Skin Ego: Psychoanalytic Approach to the Self, trans. C. Turner. London: Karnac.
Bick, E. (1968) The Experience of Skin in Early Object-Relations, International Journal of Psycho-Analysis, 49: 484-48.
Freud, S. (1923). The Ego and the Id, J. Strachey et al. (Trans.), The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XIX. London: Hogarth Press.
Klein, M. (1946). Notes on Some Schizoid Mechanisms. International Journal of Psycho-Analysis, 27: 99-110.
Klein, M., (1997). Evny And Gratitude And Other Works 1946-1963. 3rd ed. London: Vintage.
Sever, A. E. Y, (2015). Lecture notes of Psychoanalytic Psychosomatic. [PDF doc.].
file:///C:/Users/LENOVO/OneDrive/Masaüstü/DERS%20NOTLARI/psikoloji%20bölümü/Donem_8_DersNotlari_Materyalleri1/Psikosomatik/psikosomatik_hastaliklar_2015_vize-final.pdf
Winnicott, D, (1949). Mind and Its Relation to the Psyche-Soma. British Journal of MedicalPsychology, 25: 201-209.
Winnicott, D. W. 1956 ‘Primary Maternal Preoccupation.’ (10) to (20) are included in: Collected Papers: Through Paediatrics to Psycho-Analysis. (London: Tavistock, 1958.)
Winnicott, D.W. (1960). The Theory of the Parent-Infant Relationship1. International Journal of Psycho-Analysis., 41:585-595.