Skin communication: early skin disorders and their effect on transference and countertransference

Eczema in the first year of life results in a basic disturbance of the earliest mother-infant relationship, a disturbance that is renewed with every transitional phase of the life-cycle. The pervasive fear of disintegration or loss of the self, and the need to be contained and held, affects subsequent character formation. Infants who experience extended periods of bodily soothing learn to translate psychic pain into visible bodily suffering and so arouse concern and care. This is illustrated by direct observation of women patients suffering from skin diseases and their interaction with women doctors in hospital. In the analysis of patients who have had such an infantile experience, whether they know it or not, a disturbance in concepts of the self linked with narcissistic difficulties and acute sensitivity to object relationships may be anticipated. The mother's human disappointment in her baby's appearance gives rise to an unsatisfying and unsatisfactory self image which remains unaltered in the true self. Transference and countertransference problems derived from the analysis of a female patient are described in order to illustrate these themes.