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4
Why Now?

One thing just about all doctors do when they examine you is take a thorough history. They ask when the problem started, when it got worse, what similar difficulties you've had in the past. They often want to know about your health in general as well.

It should be obvious that I'm also vitally interested in history. Already, you've been asked to look backward for insights into your inner self and its turmoil. The point is that any past event that still affects your life is not just history:  it's alive in the present. The unresolved emotional tasks that complicate skin problems are chapters in your personal development that are relived over and over.

Here we're going to attempt to write history on a grand scale:  a reconstruction of the story of your life. No, I'm not suggesting that you take two years off and write your memoirs. More suited to our needs is something simpler:  a Time Line like the one in high school history books that extends from 1400 to the present, with points indicating the discovery of America, the Revolutionary War, the invention of the steamboat, World War II, and so on.

The Time Line is ideal for us for the same reason it was useful in high school history:  it not only lets us see all the important events at once but it also reveals relationships between them. The Time Line for American history suggested a pattern relating the invention of the cotton gin and the Civil War. Your own Time Line may show patterns in your history that have until now escaped your notice. When events are laid side by side, you may realize for the first time that your boils got much worse not long after your father left home or when your marriage deteriorated or that you first started flaking and scratching in the fourth grade, the same year that your family moved out to the suburbs and you had to change schools. The answer to "Why now?," why your symptom developed the year, month, day it did, may point to where it came from, just as knowing why the Civil War started in 1861 will tell you much about the political, economic, and social forces that made it happen.

Take a very large sheet of paper, perhaps something like the stiff construction paper you used to make posters in grade school, and draw a horizontal line about one-fourth of the way down. The left end of the line is the moment of your conception, the right end is the present, and in between are all the years of your life. Above the line, draw a vertical scale from one to one hundred and on it a graph of your skin problem that begins with its first onset, rises whenit got worse, and drops when it got better. One hundred on the scale is the worst it's ever been; zero is the best.

Below the line, list all the important events of your life just under their appropriate years. Basically, these include everything that has made you the person you are.

This definitely means family events, such as the birth of siblings, people moving in or out of the house, deaths, and a major illness of anyone:  parents, brothers, sisters, grandparents. If your mother or father was absent for a time or if a parent got a new job or was fired or promoted, include it. Put in even less tangible events, such as a shift in relationships for instance, if you remember drawing closer to your brother around the time you were fifteen.

As in the sample Time Line, add important events involving work and school:  starting school, changing schools, honors, dishonors, and graduations. When did you start and leave each job? List all transfers, promotions, and shifts in duties. If particular events on the job stick in your mind, such as a fight or especially supportive relationship developing with a boss or coworker, put it in. Include big moments in athletics and turning points in friendships. Things that disappointed you by not happening are as real as things that did happen, so don't forget to put in the time you didn't make the team.

Sexual events may be particularly important; jot down all the milestones. Going way back, note when you first discovered the difference between little boys and little girls, when you first played "doctor," when you first masturbated, or began to menstruate. Include your first boyfriend or girlfriend, first kiss, petting, intercourse. Any event that stands out in your sexual life deserves to be noted just because you remember it:  starts and ends of significant relationships, fights, high points, even orgasms you'll never forget. (Note:  here and throughout this exercise, don't skip topics that make you uncomfortable. These may be the most important. If you wish, use a code on the Time Line to ensure secrecy.) Childbirth and abortion are important parts of your sexual history.

Your medical history is highly relevant. Place in its appropriate spot any significant illnesses you've suffered, or any operations or major medical procedures. Needless to say, put in everything dermatological. If there's anything that impresses you with its emotional impact, give it space on the Time Line, such as pets, family fights, trips and travels, periods when you were depressed and didn't know why, any significant change or turning point. The rule is:  If it seems important, it is important.

This exercise is not the work of an afternoon. It's a personal research project that you will have to live with for weeks, perhaps months. In my experience, many people get impressive results quite quickly?in a few hours, they've gotten down to basics, perhaps twelve of the most important events of their lives. After that, there's often a long period where they return to the project from time to time, adding important events as they come to mind, touching up, filling in, and refining the Time Line.

Try posting the Time Line on your bedroom or bathroom wall so you can add details as they occur to you. Once you get your mind on the proper wavelength, information and memories gradually percolate and drift up to the surface. you'll probably discover a wealth of material that was in "inactive storage" ?accessible to your memory but not immediately accessible. As you sift through your memory bank, the most important things will emerge.

How can you discover what events, what needs, and what fears and emotional tasks inhabit the deep parts of your mind, where today, yesterday, and infancy sit side by side? It is here that your Time Line can yield the fullest dividends. Pressing relentlessly to reconstruct these years that are both dim and distant yet vibrantly alive, you are seeking to find out what makes you who you really are.

Constructing your Time Line is a lengthy task but one that will reward you with insights all along the way, and once you've gotten the first ten or so pivotal life events down, you've made a significant start. As you search for and wait for more details to bubble up to the surface, relax. You're your own biographer here but you needn't worry about the scrupulous standards of objective accuracy that bind most biographers, our goal is psychological reality. If you remember that your mother was out of town for six months when you were five years old and she tells you that in fact she took a two-week trip to Baltimore when you were seven, your version is the "right" one for your purposes. As a small child, you experienced her loss as prolonged:  the distortions of memory are a lie that tells the truth.

Help from relatives may be invaluable when you're trying to reconstruct early events, which deserve particular attention if your skin problem began when you were young. Find out what you can about the big moments of those years, tapping the memories of your parents, older brothers and sisters, and uncles and aunts. If you were born with a skin problem, find out whatwas happening in your family during the preceding year, this may have influenced the prenatal environment in which you developed.

The question is:  Where does your heightened reaction come from? Why is a business failure, say, distressing but surmountable for Robert G. but devastating for Horace T.? At every moment, in every situation, you react with a personality that comes in part from your genetic heritage but that for the most part has been shaped and molded by the experiences you've accumulated throughout your life.

To put it simply, your earlier years are not just part history. The emotionally vibrant events that you never came fully to terms with are live and active in your here-and-now life, vulnerable and sensitive, an emotional Achilles' heel. All the losses, frustrations, and confrontations of your life connect like the links of a chain; if you rattle one, all the others will rattle.

When you feel you're overreacting to an apparently unimportant event, it's because you're also responding to all the earlier events that the experience brings to mind, not one link in the chain but a dozen. The heart does not overreact. This will become clear as you understand the past events that survive, alive and kicking, in the parts of yourself that escape the laws of time.

For example, suppose a major skin flare-up appears to have been triggered by the breakup of a casual relationship, a rejection by someone who didn't mean very much to you. Why the devastating effect on your skin? An introspective look backward may reveal that loss and rejection loom large in your life story. Look back far enough and you may find a similar loss in the childhood days when you were most needy and vulnerable?the prolonged absence of a parent or a pronounced emotional withdrawal?that sensitized you to the losses you would experience ten, twenty, even forty years later.

To use an analogy, a person who is allergic to bee venom can suffer a violent reaction, even die, when stung, not the first time but after one or more stings have created a sensitivity. If such a reaction occurs, it is misleading to say that the "trigger" was the sting that occurred two minutes earlier, ignoring the earlier ones that made the person sensitive. To understand this vulnerability, you must look back over the years; the stings of ten, even twenty years ago are still alive in the antibodies that circulate in the bloodstream.

In reconstructing the events that inhabit the deep parts of your mind, your Time Line yields its fullest dividends. Pressing to recapture those early years that are both dim and distant and vibrantly alive, you are finding out what makes you who you really are. As you fill out your Time Line with all the significant events that have remained in your memory, be alert for motifs and patterns. Many of these events have stuck with you because they are connected to yourwishes and fears. Your Time Line, then, is a map of emotional hot spots; the prominence of events having to do with anger or rejection or loss or guilt may lead to a new understanding of emotional tasks that keep your skin disease hard at work.

One of my genital herpes patients, for example, noted how childhood events involving sexuality stood out on her Time Line. She recalled her parents' dismay and her own shame when they caught her and a little neighbor boy "playing doctor." The onset of menstruation was a moment of anxiety, a gain reinforced by parental reaction. As her memories of those years became clear, she came to appreciate how her early years had sensitized her to the whole issue of sex, how her parents' discomfort had silently taught the lesson that sex was an anxious business.

Her herpes, then, had stirred up a feeling of uneasiness that had been planted long before in her mind. Her genitals were now truly defective and unclean, as she had always suspected. Herpes for her was more than a physical illness, but also the focus of fears and anxieties with roots in the long-ago. Realizing the connection between her troubled sexual feelings and her herpes anxiety was extremely comforting:  the distress now made sense given the logic of her own psychology; she wasn't crazy to feel as bad as she did. She could begin to bring these feelings out into the light of day and release herself from their grip.

Why was the remembered shame and anxiety my patient experienced when discovered "playing doctor" important? This event, in itself, didn't shape her attitudes toward sex but it dramatically displays the forces of her upbringing that molded her personality and the uneasiness within that had already taken hold. Remembered moments like this are flashes of insight that reveal what life was really like in critically formative years and what it is like, still, in the timeless reaches of your mind. Her recollection points to sexuality as an unanswered question mixed up in her troubled skin.

The Time Line and the understanding of emotional tasks you've derived from other exercises complement each other. If you've come to feel that the expression of anger and the quest for control, for instance, are involved in your skin problem, devote special attention to Time Line events that got you angry and where you felt your freedom was threatened or trampled, a history of anger and autonomy. Seemingly trivial details may start to fall into place, such as how your mother or sister insisted on walking you to school while all the other kids were allowed to make it on their own or how you burned impotently when your sixth-grade teacher exposed you to public humiliation because you couldn't master fractions. Gradually, you may work back and forth between details and your emerging sense of the whole, as manyhistorical researchers do. As patterns emerge, they guide you to where it will be most profitable to look.

To put it most simply, the Time Line is also another way to focus in on the question of chapter 3:  Why you? Everyone has the same basic needs and deals with the same emotional tasks, so why did these particular needs and tasks come to be mixed up with your physical health? As we discussed earlier, many physical symptoms are ways of reliving the emotional past, valiant, doomed attempts to solve the same problem over and over. "Those who are ignorant of history are doomed to repeat it" is as true in psychology as in politics. In becoming less ignorant of your history, you may learn to unearth the buried past and its feelings and release your skin from its painful grip.

If your child has the problem 

People with particularly short memories may believe that childhood is an idyllic, stress-free land, but surely most of us can see through the myth. Children may not worry about fixing the roof or paying taxes but they have strains and anxieties of their own, no less tormenting than grown-ups', which play as significant a role in their skin disorders. By the same token, nearly all my exercises can be translated into child-sized versions. Children, in fact, are particularly adept at diagnostic and treatment exercises. They respond better than adults who have suffered with resistant skin problems for years. As the parent of a child with problem skin, you are in a frustrating situation. You may wish you could take on your child's pain as your own and stand willing to make any sacrifice, but you know of nothing you can do beyond taking him or her to the best doctor available.

Your feelings may be complicated by a vague sense that you are to blame; that your child's skin is a silent indictment of your parenting efforts. Let's face the issue squarely:  what's needed is responsibility without self-flagellating guilt. Every parent does the best job he or she can. Many of us, however, simply cannot be as good parents as we'd want to be; economics, personal crises, or pressing emotional problems of our own get in the way and such difficulties can contribute to a wide range of skin problems.

It is better to accentuate the positive:  you are in a powerful position to help your child by understanding his or her emotional needs, while searching for the roots of problems under the skin, perhaps bringing him or her the benefits of relaxation and self-hypnosis, with this book as a guide.

One key notion to remember is that children's skin conditions are often triggered or exacerbated by a normal crisis, an unavoidably stressful family event, such as the birth of a sibling, relocation, the arrival of puberty, or a death in the family. Use the Time Line to see what was happening when the trouble started and to pinpoint significant emotional issues.

Also keep in mind that working with your child on his or her skin problems is different at different ages. For the infant or small child who has not yet learned to talk, it's really yourself you must work on. Whatever helps you feel open, relaxed, and good about yourself also helps your child. If your needs aren't being satisfied, you won't be able to provide the rocking, soothing, stroking, and singing that your child and his skin need. Get the help you need, whether this means a laundry service, child guidance, or psychotherapy.

Can you act as a therapist for an older child? There's no simple yes or no. You might mention to your child that you've been reading a book about skin problems, like his or hers, and some games in the book sometimes help make troubled skin better. Many children really enjoy filling the Time Line and puzzling over "Why there?" (see chapter 5), to say nothing of the Animal Test in chapter 3. Keep the tone light but serious; you're working together on a puzzle or mystery. Don't push a hesitant child and avoid pressured approaches, such as the relentless "What if it got worse?" exercise of chapter 7.

You might share the Benson relaxation technique in chapter 8 with your child and then work out childhood versions of exercises such as the ideal imaginary environment in chapter 9. Most children are adept at this sort of game once they're ready to do it. (One hint:  a lot of youngsters prefer to keep their eyes open since closing their eyes reminds them of going to bed.)

The woman who tells her story of triumph over eczema in chapter 13 also had some important observations, based on her own experience, about how parents can help their children. She's talking specifically about eczema but much applies to other skin conditions as well:

Kids with eczema need extra indulgence at bedtime. During bad periods, parents may need to lie down next to the child until he or she falls asleep, then go back in the middle of the night to help him or her fall asleep again. Singing, stroking, and talking softly help. The child just needs to know that he or she is loved and not fighting alone, reassurance over and over again is crucial to the child's peace of mind.

He or she must also feel able to call on parents for help at any time during the night. The child needs some privacy, it's an embarrassing disease and he or she must be alone to cry or scratch or talk out loud, but must not feel too alone with his or her problem.

In addition to verbal reassurances, the child needs a lot of physical contact. Touching cannot be overdone. Massage is perhaps the best way to communicate a physical acceptance of the child's body while soothing at the same time. Take care to touch the parts of the body that have been most affected by the eczema, even if your touch must be extremely gentle to avoid irritation.

The Micro Time Line 

"Why now?" has another meaning for skin sufferers. Why did I have to have a hives outbreak today? Why is my eczema so much worse this week than it was last week? Why am I suddenly starting to itch? The same process that links emotional turmoil to illness operates on a small scale in the day-to-day, week-to-week ups and downs of your symptom.  Most of my patients find that tuning into these variations helps them get a good handle on the problems under their skin:  patterns are easier to see than the year-long contours of the Time Line.

Over the course of a year, dermatologist Robert E. Griesemer spent a few minutes talking to each of his patients about his or her life. He asked what upsets had occurred in the days or weeks preceding the flare-up that brought the patient in for treatment. Had there been quarrels at home? Pressure at school or on the job? With many skin conditions, a clear connection was evident in a high percentage of cases.

As cited in the Griesemer Index, which follows, 56 percent of certain eczemas were apparently triggered by emotional upset, for example, and 62 percent of psoriasis flare-ups. Emotions had a triggering role in nearly all cases of severe scratching, hyperhidrosis (excessive sweating), alopecia areata (hair loss), and rosacea. Emotional stress surely did not cause viral problems but it could set them off; the link was evident in 36 percent of outbreaks of herpes simplex (cold sores and genital herpes) and 95 percent of multiple spreading warts.


Diagnosis Percentage Biological incubation Emotionally interval between stress

Triggered and start of problem

________________________________________________________________________

                                               
Profuse sweating 100 Seconds

Severe scratching 98 Seconds

Focused itching 98 Days to 2 weeks

Specific hair loss 96 2 weeks

Warts, 95 Days

multiple spreading

Rosacea 94 2 days

Itching 86 Seconds

Lichen planus 82 Days to 2 weeks

Hand eczema 76 2 day for vesicles

Atopic eczema 70 Seconds for itching

Self-inflicted wounds 69 Seconds

Hives 68 Minutes

Psoriasis 62 Days to 2 weeks

Traumatic eczema 56 Seconds

All eczema 56 Days to 2 weeks

except contact

Acne 55 2 days for tender red papules

Diffuse hair loss 55 2-3 weeks

Nummlar eczema 52 Days

Seborrheic eczema 41 Days to 2 weeks

Herpes: oral, 36 Days

genital, zoster

Vitiligo 33 2-3 weeks

Nail dystrophy 29 2-3 weeks

Pyoderma 29 Days

Bacterial infections 29 Days

Cysts 27 2-3 weeks

Contact eczema 15 2 days

Fungus infections 9 Days to 2 weeks

Keratoses 0 --

Basal cell cancer 0 --

Nevi 0 --


Note:  These figures are quite conservative but useful for comparison (TG)

Adapted from Robert D. Griesemer, M.D., Harvard Medical School

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