5
Why There?
Mapping Trouble Spots

In introducing the Animal Test in chapter 3, I talked about how the inner self often communicates best through symbols, objects invested with emotion and meaning. (The deer is more than just a shy animal, it seems like shyness come to life:  the symbol of shyness.) Such symbols are common in art, poetry, and everyday figures of speech.

We live with and through our bodies, and in them we find symbols for the whole range of human experience. Body parts become identified with what they do, embodying abstractions such as deceit ("giving lip service") and devotion ("I only have eyes for you"). A person who refuses to be moved from the spot, intellectually or emotionally, is "putting her foot down." Body symbols are embedded in the language of daily life; we manipulate and control objects with our hands, so there's poetic logic in a word denoting how we handle ourselves, others, our jobs, our lives.

Through body symptoms, the inner self expresses its needs, wishes, and fears. These are often pragmatic if misguided efforts to accomplish emotional tasks, like the woman whose outbreak of genital herpes literally resolved her "should I or shouldn't I? sexual conflict. Symptoms, though, may also be symbolic expressions of these needs and tasks. The early literature of psychiatry is filled with cases of " hysterical conversion"? men and women who become blind, deaf, or even paralyzed for no physical reason. Their eyes, ears, and whatever were in perfect working order but ceased to function normally in order to express emotional conflict in an extreme form of body language. Here the location of the problem was an essential part of the message, like the noun in a sentence. The woman who became blind after catching a glimpse of a parent's infidelity, an expression of her shock and horror at what she'd seen, was not going to become deaf instead.

A similar kind of symbolism may be less dramatic; a persistent tense ache in the upper back, for example, might express the feeling that one is "carrying the world on one's shoulders" and needs relief. There may be similar revealing logic in the place where your skin symptom chooses to appear or intensify. The answer to "Why there?" is often a key phrase in the message your skin is struggling to convey.

The question sometimes seems pointless; your contact dermatitis developed there, on your hands, because they were in contact with a noxious chemical. A rash developed there, on your feet, because they provided a warm, moist climate ideal for a fungus or irritation. Certain skin diseases have a predilection for certain parts of the body; acne is most likely on the face or back, for instance. Even here, however, asking "Why there?" may clue you in to your symptom's hurting and staying power, what keeps it holding on.

To ask "Why there?" profitably, you need an open mind willing to make creative connections. Why did your eczema choose to appear around your eyes? What difference does it make to you that your arms are afflicted with hives rather than your legs? The physical scene of the dermatological crime may point, via metaphor, to where the action is emotionally.

One of my patients was driven by an uncontrollable urge to scratch her arms, a nightly scourge (excoriation is the medical term) that left them swollen and bleeding. In therapy, it became clear that many of Maggie D.'s problems involved her feelings about her mother, who seemed loving but was actually a constricting, manipulative person. Not only wasn't Maggie able to express the anger she felt at her mother's manipulations, but she felt intensely guilty over the fact that she'd been angry at all.

That her arms were the target of Maggie's self-attacks was not accidental. These are the classic instruments of aggression as well as affection. Unable to strike out at her mother in anger, she attacked the instrument with which she would strike out. In scratching her arms, she was metaphorically expressing her anger? and also punishing herself for it.

Note that I used the word metaphorically to describe how Maggie's skin was expressing itself. A metaphor usually means a figure of speech, the kind of thing that poets use to convey complex emotions in concrete form. In Shakespeare's play, "How sharper than a serpent's tooth it is/To have a thankless child!" evokes King Lear's lacerating sense of his daughter's betrayal better than paragraphs of logical analysis ever could. Maggie's inner self was perhaps speaking like a poet in the language of emotions, with a complex, evocative metaphor:  "I'm striking out and keeping myself from striking out and punishing myself for even thinking of striking out." To clarify the point, let's look at two specific ways in which "Why there?" may link physical symptom and emotional action:  metaphors before the fact and after the fact.

When it is a metaphor before the fact, the place where the skin symptom appears is integral to its meaning. Like hysterical blindness, there would be no point in its appearing elsewhere. The dermatologists Obermeyer, Wittkower, and Edgell, pioneers in the field of emotions and skin, describe one young woman who was kissed against her will by a suitor she found repugnant. The next day, she developed a skin irritation around her mouth, an expression, in skin language, of how she felt about the kiss!

They describe another patient who developed a rash on a single finger, one she used in sexual play, after she began a guilt-ridden extramarital affair. Here the affliction was a physical expression of her guilt. On a more "innocent" part of her anatomy that had not been involved in the misdeed, the message of the symptom would have been lost.

In these cases, there was a literal connection between the body part, the actual event, and the symptom that followed. A metaphor before the fact may arise from a more figurative connection. The same authors describe a man who developed a rash on his navel shortly after the death of his mother. This was the point where he was "cut off" from his mother at birth, and it was at this part of his body that he metaphorically expressed his sense of loss now.

When a skin symptom happened where it happened because of physical factors, such as irritating contact, for example. "Why there?" won't tell you its psychological underpinnings, but it may help you to understand the emotional resonance that makes it particularly upsetting and gives it power to hang on. Once established, a symptom can become a metaphor after the fact:  it gathers strength from the meaning of the afflicted body part.

The power of a metaphor after the fact is clear in the case of herpes. Biologically, oral and genital herpes are similar. They are caused by viruses so nearly alike that it takes an electron microscope to distinguish between them. In fact, 20 percent of genital herpes is caused by the virus that usually causes oral herpes. Psychologically, however, these are very different disorders:  oral herpes is generally dismissed as the nuisance of "cold sores" while the latter can become the focus of devastating emotional turmoil.

No one would argue that psychological factors per se determine whether you develop a herpes infection on your lip or genitals; this is a straightforward matter of exposure, the infection appears and generally recurs at the point where it entered the body. The two types of herpes affect people so differently because they tap into the very different meanings attached to the mouth and the genitals. Much suffering that accompanies genital herpes arises from the interaction between the disease itself and feelings of anxiety, guilt, and confusion about loving that we symbolically attach to the genital area.

Understanding "Why there" won't cure genital herpes, but understanding the complex emotions related to "there" may help you explore the emotional tasks that the herpes virus may be performing with frequent recurrences. This awareness has helped some patients end their recurrences.

Distinctions like "before the fact" and "after the fact" aren't always clear or important, but answering "Why there?" will sometimes provide the essential clue to the symptom'psychological underpinning or just add useful information to the clues you've been amassing with earlier exercises. If your skin problem has concentrated on one or several parts of your body, it's a question that no doubt has already occurred to you and is well worth asking.

Answering "Why there?" means asking yourself what the afflicted body part means to you. We use our bodies in common ways, so we share associations that give body parts a common meaning. Everyone talks, kisses, and eats with the mouth, so a rash here may suggest emotional conflicts involving communication or affection. Because our lives are different, though, we also develop our own set of personal, private associations:  a rash on my arm may not mean to me what a rash on your arm means to you. The unique details of your life will give your body its unique symbolism. To a person who was often slapped across the mouth by an angry parent, a rash on the mouth will have a special meaning.

Answering "Why there?" doesn't mean translating body parts into emotions using some kind of code book. It means thinking freely about your own experiences with, feelings about, and associations with the afflicted parts of your body. It means considering how you use your body in concrete, practical terms, as well as what your body means to you, what connotations and associations arise when you think of your hands, genitals, or whatever areas carry your symptom. It means thinking of your body in the context of your life and problems.

Mary G., for example, had a shy, lonely childhood. She had more than enough to cry about, but her stern, moralistic parents disparaged tears as a show of weakness. Now Mary was working with severely retarded, emotionally disturbed children, kids with profound problems of their own.

She came to me when her dermatologist could do little for a persistent rash that developed around her eyes. In therapy, it became clear that Mary empathically shared the sadness of the children she worked with; in their struggles, she saw the pain of her own early years. It was enough to drive anyone to tears, but  Mary's own tears were still dammed by her parents' injunctions. So the sadness expressed itself symbolically, in a rash that took the place of tears. As we explored the suppressed crying beneath the rash, Mary became able to confront her sad feelings directly. As she learned to cry real tears, her rash disappeared.

I want to stress again the personal nature of such body symbols; in another person, a similar rash might have a totally different meaning. The literature of psychopathology records the case of one woman who inadvertently witnessed her mother's infidelity. She developed a rash around the eyes that nearly closed them, an expression, perhaps, of the guilty feeling that she'd "seen too much," similar to the hysterical blindness we discussed earlier.

To appreciate the spectrum of meanings that attach to a single body part, let's consider several people who had trouble with their hands. We use our hands constantly, and a skin symptom there may reflect on any of these uses. We express anger with our hands; we fondle and masturbate; if we are "light-fingered," we steal with our hands. Metaphorically, we "handle" our lives, jobs, and relationships the way we handle objects, carefully, gracefully, tentatively, or awkwardly. If we have more than we can handle, we "have our hands full." If our needs are left unfilled, we come away "empty-handed."

Elsa D., a woman in her early twenties from a close-knit European family, aspired to be a concert violinist, but duty, according to her family's old-world values, demanded that she stay home to care for her elderly grandmother. She left for the conservatory anyway, but within a semester she was back home, forced to give up her studies by severe eczema on her hands.

Elsa's hands were caught in the squeeze between duty and personal aspiration; she felt guilty if she sought fulfillment on her own terms and angry at being trapped if she didn't. She could not allow herself to experience these "unacceptable" feelings.

The conflict between her own and her parents' values was all the more unresolvable because of Elsa's own conflicts about growing up and becoming independent. Her hands? which would play the violin but should tend grandmother, became the battlefield of contradictory needs and demands.

Tom J. was a super executive, a troubleshooting expert hired by ailing companies to solve problems and bail them out. This time, however, it was clear he'd taken on a sinking ship; nothing he tried would pull off his customary miracle. Tom's trouble was compounded by turmoil at home:  a stepson was going through a particularly troubled adolescence.

The rash that developed on Tom's hands was mysterious. Dermatological testing suggested he'd suddenly become allergic to common inks and papers, but even when he avoided them, the rash remained and even worsened. His hands, it seemed to me, were expressing a deeper problem:  Tom's frustrated feeling that he'd failed to handle difficult situations in both his professional and personal life. Rather than take this blow to the ego directly, this man who was supposed to be able to "handle anything" took the rap symbolically.

Janet N. had been in psychotherapy for several years when she developed a strange eczema that afflicted only the first finger of her right hand and the third finger of her left hand. As often happens in therapy, this woman had transferred to me strong emotions originally directed toward others. She wanted to be part of my real life, close to me in a way she'd never been allowed to be with her father. It seemed to me that the rash on her wedding finger and trigger finger pointed to the emotional hotbeds that had been aroused, her wish for closeness along with anger at its frustration. Part of her wanted to marry me; another part wanted to shoot me.

All three were quite successful in clearing their skins once they discovered the metaphor.

Like these patients, you will only find the answer to "Why there?" in your own experiences and problems, but the human condition that we share gives certain body areas a common ground of meaning, as widely understood figures of speech attest. This list of body associations is intended to stimulate, not replace, your own introspection. Think of it as an emotional map that suggests some places to look and some things to look for.

The face is the most visible organ. It is here our emotions are most flamboyantly displayed, voluntarily or despite our efforts to conceal them. Humiliated, we "lose face."  Salvaging our pride, we try to "save face. The original stigma of guilt, the mark of Cain, appeared on the forehead.

The mouth is at the center of much emotion-laden experience, such as speaking, eating, and kissing. It is a sensitive, expressive organ, deeply involved in sexuality, but the mouth is also an instrument of deception:  the "lip service" we pay to ideas and feelings we don't truly believe in or the false smiles and frowns with which we deceive.

As an orifice, an opening, your mouth is a border station between you and the world. You take food in through your mouth, you breathe in and out. Consequently, it often has a symbolic role in emotional conflicts surrounding interactions with others, particularly when giving and getting are involved. This includes times when we "get" more than we want, when we're being unduly influenced and having things "rammed down our throats." Other orifices?ears, eyes, genitals, and rectum are also frequent symptom targets when these issues are involved.

The eyes are the source of tears and the organs with which we see?sometimes what we'd rather not. "Sight" is a frequent metaphor for perception and insight:  we "lose sight of things" when we forget what's important and what's not. If we're greedy, overambitious, or wanting more than we feel we have a right to, we have "big eyes." Gazing fixedly or deeply, we drink in the world with our eyes.

The head is where we think and is thus a symbol of both intellect and disordered thought, brains, and craziness. Overly intellectual types are said to live "from the neck up." Stubborn people are "headstrong, or " pigheaded"; the reckless go "head first" ; to be overly proud is to have a "swelled head." Skin problems that focus on the head may suggest difficulties with self-esteem, with accepting intellectuality or keeping it from taking over.

The hair is the part of the body most easily lost, and feelings about loss are frequently expressed here. The biblical tale of Samson illustrates how hair can be a metaphor for potency. The whitening of hair is associated with wisdom but also with aging, decline, and severe shock. The quick loss of hair can follow severe emotional stress.

The chest is the home of the heart, and when one's heart is breaking, the skin above it may actually break out. We associate the chest with the essential self, so getting something off it is a metaphor for confession, the expression of guilt. Sticking one's chest out is a confident assertion of self.

The breasts have sexual connotations as well as strong associations with nurturing and mothering. Our cultural obsession with breasts makes them symbols of attractiveness. Their usual concealment charges their display with emotion.

The stomach is below the chest, softer and more vulnerable, a "soft white underbelly." It, like the chest, may be the metaphorical heart of the person. Many cultures call the pit of the stomach the home of the soul; to the Japanese, it is the center of the vital life force ki. When we can't stomach something, literally or figuratively, the revulsion may be expressed on the skin of the stomach. The navel may symbolically maintain a lifelong link to the mother.

Strong emotions, strong conflicts, and strong confusions are associated with the genitals. Unresolved feelings about loving and being loved may express themselves in genital skin problems. The genitals symbolize sexuality itself and its echoes in assertiveness, attractiveness, and creativity. They may suffer when we have trouble exercising power. Many of us still have feelings of guilt associated with the genitals; this remains, in a corner of our minds, a taboo area.

Skin troubles around the anus or buttocks can express difficulty dealing with irritation (witness the expression "a pain in the ass" ). Childhood feelings about dirtiness that we develop at the time of toilet training still cling to this area, in our minds, along with the emotionally tinged issue of self-control. Problems here may relate to sexual identity conflicts, such as homosexual fears or impulses we find too distressing to acknowledge. (One patient had recurrent warts in and around his anus, which served to symbolically protect him against the homosexual assault one part of him wished for but another part feared with revulsion.)

Symptoms at the anus or farther up on the back may suggest conflicts about activity and passivity. Should we "back out" of our responsibilities? Bear burdens gladly? Go after what we want or just "sit on our ass" ? A person hung up between active and passive, who resents his habitual passive role but cannot break out of it, may experience symptoms on his back.

We kick aggressively with our legs and feet. They are also the organs of locomotion and standing firm:  they root us to the ground and give us the means to travel on, and they may break out in a rash when we're unable to do either with ease. For one of my patients, movement was a key feature of life. She never really planted herself firmly anywhere but would move restlessly from one project or one relationship to another. Painful warts on her feet made it literally impossible for her to stand still and firm and focused attention on this unresolved issue.

Putting one's foot down is an image of decisiveness, and foot problems may accompany difficulties in making decisions. The fact that they're "lower organs," pointy, moist, and sometimes odorous, can make them a symbol for the genitals, expressing conflicts and difficulties surrounding sex.

In asking your own "Why there?" no guide can be better than your own associations, imagination, intuition. What does this part of your body, spotlighted by troubled skin, stand for? How does illness there feel different from illness elsewhere? All the great storehouses of metaphor and symbol, art, dreams, the language we use daily, may offer clues to the "thereness" that has become part of your troubled skin.

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