When I was in junior high school, I once got a bad case of warts on both feet. Walking to school day after day was excruciating as the warts grew larger. Finally, I complained to my parents, and my father, who was a physician, took me to a well-known dermatologist in New York City.
After examining my warts, this doctor suggested that I think of them as getting smaller and smaller. Specifically, he encouraged me to close my eyes and visualize the warts shrinking.
He worked with me on this for about 20 minutes while my father watched. What was this guy up to, I wondered? This was not my youthful idea of doctoring.
If nothing happened in three weeks, the dermatologist recommended, I should return for a second visit. For the next two weeks, I focused on my assignment. I practiced closing my eyes and trying to envision the warts becoming smaller. To put the shrinking into a context that my young mind could relate to, I imagined the warts as round. They started off as basketballs, then as baseballs, and finally as ping-pong balls.
It wasn't until a month or so later that I noticed the pain had subsided significantly and the size of the warts had reduced substantially. Eventually, they disappeared. Neither the warts, nor the pain that accompanied them, ever recurred.
This event left a lasting impression on me, and undoubtedly had a positive influence on my choice of psychiatry and on my work in the areas of pain and mind-body disorders.
We know that the skin as an organ system mirrors our emotions. Sweating, blushing, gooseflesh, and temperature alterations during various emotional states are signs that our mind affects this organ system. Therefore, it makes sense that psychiatric approaches could be valuable-and sometimes even necessary.
My experience in treating some dermatologic problems is related to eczema, psoriasis, and neurodermatitis. All the patients I've seen were referred by dermatologists who'd had a difficult time getting a positive treatment result and suspected a psychological component, or who'd responded to a patient's request for a psychiatric consultation.
One patient with eczema comes to mind. He was a 44-year-old man, a physician in a high-stress pediatric hospital practice. For him, the constant itching appeared to be a major part of his failure to get better with dermatologic care.
The strategies I used were straightforward. First, we discussed some of the ideas in the field of psychosomatic medicine. After teaching him a relaxation/hypnosis technique for 10-15 minutes, I had him envision himself on a beach on a warm summer day, with the sun beating down on the areas of skin that were not healing well because of his continued scratching and picking. The warmth this exercise produced, with continued practice in the techniques, brought the patient relief.
During the same time, I offered an alternative cold imagery technique that some other patients have found more acceptable. I asked him to imagine cold or ice on the area of the skin that was itching and not healing.
Either way, breaking the itch-scratch-itch histamine cycle by using imagery has proven to be effective, according to New York City dermatologist Dr. Michelle Pauporte, who sees a connection between emotions and some dermatological problems for difficult-to-treat dermatologic problems. She further believes that if a psychiatric approach helps the dermatologist in his or her treatment, that's all to the good. Many dermatologists like herself, however, simply don't have time to devote to teaching psychological techniques, helping the patient practice them, and then conducting follow-up visits to check on the patient's progress and use of technique.
My treatments with this patient lasted for three visits. He was instructed to routinely practice the technique that worked best for him, to modify it if a different approach worked better, and of course, to share this information with his dermatologist.
Given the power of the mind-body connection, psychiatrists, psychologists, and other mental health professionals have much to offer our colleagues in dermatology and other specialties. Using these techniques to empower the patient is in best interests of all involved parties.
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This blog aims to present psychiatric/psychological information to a general readership, offering insights into a variety of emotional disorders, as well as social issues that affect our emotional well-being. It includes the ideas and opinions of Dr. London and other leading experts. This blog does not provide psychotherapy or personal advice, which should only be done by a mental health care professional during a personal evaluation.