Skin in Psychoanalysis

Jorge Ulnik

• Publisher: Routledge
• Year: 2020
• ISBN:
  9780429919282
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Skin in Psychoanalysis is an important theoretical contribution, revising several authors starting with Freud in whose writing we can now discover multiple direct or indirect references to the skin. It adopts a decidedly complex point of view regarding the skin here: the skin as source, the skin as object, the skin as protection and as a way of entrance, as contact and as contagion, the skin 'for two' within the relationship with the mother, the skin as envelope and as support, as a shell presented as 'second skin', as demarcation of individuality, as a place of inscription of non-verbal memories, toxic envelops and so on. Also, being the result of more than fifteen years of work with dermatologists and patients with skin diseases, psoriasis in particular, the book can be seen as a serious proposal for interdisciplinary work between dermatologists and psychoanalysts.'The hospital is a place where both tragedies and miracles occur, where many people go to heal but many others go in search for punishment.

CHAPTER ONE
The skin in the work of Freud

Although Freud expressly refers to the skin in several passages throughout his work, and even goes so far as to grant it the status of “erotogenic zone par excellence”, referring to the skin in the Freudian work is not exclusively to speak of the skin as an organ and its eroticism, but also to speak about the functions and diseases of the skin, the drives which are originated in it, the action of touching and its consequences, as well as contact in general and its relationship with contagion, the relationship between the skin and identity, and lastly, about the Ego and the functions of boundary, surface, protection and perception. With this in mind, the references to the skin and its functions will be arranged into the following sections:

• The skin as an erotogenic zone
• The skin and its functions with regard to the unconscious
• The touching drive and the skin as the source and object of the drive
• Contact as a general idea. Contact and contagion
• The skin as a cortical layer: its functions of boundary, surface, protection and perception
• Mention of skin diseases and their interpretation or articulation with psychic facts

As is usually the case, these subjects are not mutually exclusive; certain quotations and reflections can be placed in more than one section. However, it can easily be seen that arranging this information into different sections is merely a teaching resource the aims of which are to clarify and make reading easier, as well as to enrich the analysis. In the development of each section, the subjects I have considered more important will be put forward, certain quotations from the work of Freud will be transcribed, and along with the theoretical development, certain reflections will be pointed out. In addition to this, I will discuss clinical cases and examples which in my opinion emerge from the application of these subjects to clinical practice and to everyday life.

The skin as an erotogenic zone

For Freud, the skin is the erotogenic zone par excellence (1905a, p. 169). This hypothesis emerges from psychoanalytic clinical practice, mainly from the study of hysteria, although Freud also makes reference to this subject in his analysis of everyday life as well as in dealing with obsessional neurosis and psychosis. In everyday life, the idea of the skin as a privileged erotogenic zone comes from the study of infantile sexuality and the expression of affect.

STUDY OF INFANTILE SEXUALITY

On studying infantile life, Freud discovered that the skin could be stimulated or could be the source of sexual excitation as a result of different motives such as:

• Washing and rubbing in the course of a child’s toilet (1905a, p. 187)
• The action of intestinal worms, fungus and wounds (ibid., p. 188)
• Rhythmic mechanical agitation of the body (ibid., p. 201)
• Romping or wrestling with playmates (ibid., p. 202)
• The auto-erotic action of thumb-sucking (ibid., pp. 179–180)
• The expression of the emotions (1905b; p. 286)
• Corporal punishment and painful stimulation (1905a, p. 193)
• The close contact of the mother’s body (1909a, p. 111)
• Thermal stimuli (1905a, p. 201)

• The action of the eyes, which take the skin as an object (ibid., p. 169)
• The constitutional disposition of pleasure derived from cutaneous contact, and because different zones of the epidermis generate a certain amount of pleasure due to the excitation inherent in affective states (1907, p. 133; 1909a, p. 111)
• The instinct of contrectation (impulse to establish contact with another, or need for skin contact) (1905a, p. 169 [footnote]; 1909a, p. 111)

For the reader unfamiliar with psychoanalysis, we should clarify that all the aforementioned experiences become a source of sexual excitement because they cause an increase in excitation that Freud called erotogenicity, which does not manifest itself in the exclusive domain of biological needs. Although this increase in excitation does not have a genital goal, it nevertheless participates in what Freud called the general current of the sexual impulse.

STUDIES ON HYSTERIA

The concept of the erotogenic zone stems from what Freud once called the “hysterogenic zone”, a zone of the body which, on being stimulated, unleashed a hysteric attack. “The significance of the erotogenic zones as apparatuses subordinate to the genitals and as substitutes for them is, among all the psychoneuroses, most clearly to be seen in hysteria; but this does not imply that that significance is any the less in the other forms of illness” (1905a, p. 169).¹ In hysteria, the pressure or pain experienced by the skin can correspond to thoughts awoken or stimulated by physical contact. Either a feeling of contact or a part of the skin can be the focus and the starting point of hysterical pains by virtue of its association with memories and feelings “interpreted” (Freud, 1883–1895), that is, linked to a sexual desire which can be either the individual’s own or someone else’s. This could be one of the causes of its consequent repression. Owing to this “interpretation” of the feelings of contact which remain stored in the memory, an equivalence is established in the unconscious between contact in general and sexual contact or contact with the genitalia (Freud, 1883–1895). In this way an attack of hysteria seems to be the direct effect of contagion, because when we touch a hysterogenic spot we provoke an unintended reaction: we awaken a memory which can in turn evoke a whole series of events and ideas associated with sexuality (Freud, 1896).

Erotogenic zones, and in particular the mucous membranes which correspond to them, can behave like genitalia, and under sexual excitation can be the source of new sensations and “changes in innervation” or processes which can even be compared to erection. Although this can be better recognised in hysteria, the phenomenon is not exclusive to this neurosis and can also be seen in others; “it is only that in them it is less recognisable [than in hysteria], because in their case (obsessional neurosis and paranoia) the formation of the symptoms takes place in regions of the mental apparatus which are more remote from the particular centres concerned with somatic control” (Freud, 1905a, p. 169).

María, a patient who had been admitted to a general hospital, was suffering from a chronic ulcer on one of her limbs. I was called on an inter-consultation because the doctors treating her were concerned at how badly her condition was developing. The patient was 46, a virgin, obese and had an infantile character. She had always wished to become a ballet dancer. Her father was a pharmacist who took care of her health, testing on her some of the new medicines that came onto the market. On one occasion, when she was 13, she hurt her leg while she was dancing and her father had healed the wound trying out new antiseptics and dressings on her.

The nurse came into the room in the middle of the interview to apply a dressing, and I decided to stay and watch her do it. At the moment when she put on an antiseptic that stung, the patient threw her head backwards and with an evident expression of pleasure and pain exclaimed: “Ahhhh! What a thrill!” I then remembered Freud’s definition of hysteria as a pathology in which the reversal of affect predominates. Although he was referring to the fact that revulsion appears where sexual excitation should, we could also consider the appearance of an orgasmic reaction in the place of pain as a reversal of affect. In other words, it was evident that the ulcer was a lesion on the skin which was behaving like the female genitals.

OBSESSIONAL NEUROSIS

In obsessional neurosis the importance of the erotogenic zones as surrogates for the genitals is not as evident as it is in hysteria. However, the anal zone has a preponderant role. Regarding the rest of the skin, the new aims created by the drives are the most singular. We know that the pain and cruelty components of the sexual instinct, for which the corresponding erotogenic zone is the skin (Freud, 1905a), are of the utmost importance.

PSYCHOSIS

Schreber finds in his own skin the smoothness and softness which are typical of the female sex and, by means of applying pressure to any part of his own body, he can feel the feminine “nerves of voluptuousness” under his skin, in particular if he is thinking about something feminine while he is applying the pressure. This means that by applying pressure or performing any other action upon the skin, that action can gain the significance of a change in gender. This is important as men with skin diseases have to apply creams as women do while women, in order to hide the lesions to their skin, tend to stop using feminine clothes and wear “men’s clothes” (for example with psoriasis: trousers, long sleeves, collarless shirts, etc.).

EXPRESSION OF THE EMOTIONS

The skin is also intimately related to the expression of the emotions. Freud states that among other physical changes which are part of the expression of emotions, the ingurgitation of the skin is an example of the mind’s action on the body (1905b, p. 286). Moreover, as can be seen in the following list, there are several expressions which allude to the skin in order to refer to emotions. Here multiple references to the skin or to the feelings caused by the skin to express ideas have been summarised:²

The skin used to express affective moods:

• Fear, emotion or shock: I got goose pimples (piloerection)
• Perplexity: “I was frozen”, I was struck dumb (vasoconstriction and paleness)
• Embarrassment: I blushed (vasodilation in the face)
• Rage: I was red with rage (vasodilation)
• Hypersensitivity and irritability: To have a quick temper
• Nervousness or fear: My hair stood on end (piloerection)

The skin to express contact:

• Abstract contact: “To caress an idea”, to cherish, or toy with, or relish an idea
• Affective contact: It touched my heart
• Aggressive contact: “Touché” (used in fencing); to lay a finger on somebody
• Sexual contact: To snog, to get off with someone, to make out with someone, to canoodle, to cuddle
• Social contact: To be tactful, to have social graces, to avoid any brushes (with the law)

Expressive function of sweat:

• To sweat over something (to work hard, or to succeed in doing something with a lot of effort)
• To sweat your guts out (to work very hard)

Expressive function of the hands:

• To have a firm hand (to control things strictly)
• A hand (as in a hand of cards)
• To get your hands on someone (catch someone you are angry with)
• Hand to hand combat (an encounter in equal conditions or when opponents are very close)
• To fulfil a wish, “to touch the sky with your hands”, “it was a dream come true”

The skin as a symbol of identity:

• To like (or dislike) a particular person; to rub someone up the wrong way
• “To be the skin of Judas”, a Judas; “He is the skin of the Devil”
• To be skin and bone (to be extremely thin)
• To save your skin (to save your life)
• To tear somebody to shreds (to gossip about someone in a very severe way)

The skin to express identification:

• “I would like/would not like to be in your skin”, to be in somebody’s shoes

Expressive function of the hair:

• “He loses his hair but not his tricks”; You can’t teach an old dog new tricks
• “To throw a grey hair to the wind”, to throw caution to the wind (to do something forbidden or dangerous as a treat, generally used in a sexual sense)
• It gave me a few grey hairs (something causes problems or trouble)

The skin to express protection and lack of protection:

• “One needs to harden”, or “to tan” (to acquire experience, not to be sensitive or vulnerable)
• “She is so fragile that you can look at her but you cannot touch her” (to refer to someone who is fragile and always complaining about things, a highly-strung person)
• Near the knuckle, close to the bone (to refer to something the other finds very painful)
• To be devastated, “raw” (to be extremely sensitive, to feel skinless, to feel wounded)

To conclude, here are some quotations from Freud referring to the skin as an erotogenic zone and to the erotic function of contact, which may be useful to the reader interested in these subjects:

Thumb-sucking appears already in early infancy and may continue into maturity or even persist all through life. It consists in the rhythmic repetition of a sucking contact by the mouth (or lips). There is no question of the purpose of this procedure being the taking of nourishment. A portion of the lip itself, the tongue, or any other part of the skin within reach—even the big toe—may be taken as the object upon which this sucking is carried out. [1905a, pp. 179–180]

The sexual activities of this erotogenic zone, which forms part of the sexual organs proper, are the beginning of what is later to become “normal” sexual life. The anatomical situation of this region, the secretions in which it is bathed, the washing and rubbing to which it is subjected in the course of a child’s toilet, as well as accidental stimulation (such as the movement of intestinal worms in the case of girls), make it inevitable that the pleasurable feeling which this part of the body is capable of producing should be noticed by children even during their earliest infancy, and should give rise to a need for its repetition. If we consider this whole range of contrivances and bear in mind that both making a mess and measures for keeping clean are bound to operate in much the same way, it is scarcely possible to avoid the conclusion that the foundations for the future primacy over sexual activity exercised by this erotogenic zone are established by early infantile masturbation, which scarcely a single individual escapes. The action which disposes of the stimulus and brings about satisfaction consists in a rubbing movement with the hand or in the application of pressure either from the hand or by bringing the thighs together. This last method is by far the more common in the case of girls. The preference for the hand which is shown by boys is already evidence of the important contribution which the instinct for mastery is destined to make to masculine sexual activity. [ibid., pp. 187–188]

It is, however, a fact that a number of people report that they experienced the first signs of excitement in their genitals while they were romping or wrestling with playmates—a situation in which, apart from general muscular exertion, there is a large amount of contact with the skin of the opponent. [ibid., pp. 202-203]

The eye is perhaps the zone most remote from the sexual object, but it is one which, in the situation of wooing an object, is liable to be most frequently stimulated by the particular quality of excitation whose cause, when it occurs in a sexual object, we describe as beauty. (For the same reasons the merits of a sexual object are described as “attractions”.) This stimulation is on the one hand already accompanied by pleasure, while on the other hand it leads to an increase of sexual excitement or produces it if it is not yet present. If the excitation now spreads to another erotogenic zone—to the hand, for instance, through tactile sensations—the effect is the same: a feeling of pleasure on the one side, which is quickly intensified by pleasure arising from the preparatory changes [in the genitals], and on the other side an increase of sexual tension, which soon passes over into the most obvious unpleasure if it cannot be met by a further accession of pleasure. Another instance will perhaps make this even clearer. If an erotogenic zone in a person who is not sexually excited (e.g. the skin of a woman’s breast) is stimulated by touch, the contact produces a pleasurable feeling; but it is at the same time better calculated than anything to arouse a sexual excitation ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• ACKNOWLEDGEMENTS
• ABOUT THE AUTHOR
• PREFACE
• Introduction
• 1 The skin in the work of Freud
• 2 Didier Anzieu's Ego-skin
• 3 Contributions by other psychoanalysts and psychiatrists to the subject of skin and psychoanalysis
• 4 The skin and the levels of symbolisation: from the Ego-skin to the thinking-Ego
• 5 "It works for me": symbolic efficacy and the placebo effect
• 6 Reflections on attachment
• 7 The case of Mr Quirón
• 8 Body image and the psychosomatic patterns of childhood. Medical publicity regarding the skin
• 9 Pathomimias: self-inflicted lesions on the skin
• 10 Franz Kafka's In the Penal Colony: Superego and the skin
• 11 The relationship between what the psychoanalyst hears and what the dermatologist sees
• 12 Psoriasis: Father, don't you see I'm burning? (The skin and the gaze)
• REFERENCES
• Index