Skin That Has No Roots

The ego is a heuristic term, rather than an entity, which we employ to indicate the location of our sense of who we are. This sense has two main aspects: tactile and verbal, or sensation and sensibility. In the unconscious these ambiguities interact and may be inseparable. There is a dynamic process whereby we learn to feel ourselves; the ego is owned within the confines of the body, taking the similarity of limits for granted, while, in health, maintaining sufficient flexibility for psychological exchange between outer and inner.

The surface of the body is of tremendous importance. It is the site of physical sensations which once defined a psychological event, the beginning of the ego, and it continues to be the bodily counterpart of the sense of identity. Skin can be both a signal and a source of emotions (and I would include here a negative spectrum from blushing to self-mutilation with a positive one from hugging to sexuality) central to the sort of person we feel ourselves to be. In one way, what we might call the sensation-ego is a boundary to the verbal-ego as well as each being a component of the other while, in another way, it can provide a site for manifestly abnormal actions or ideas.

There follows an account of the treatment of an adolescent girl with a long history of gross obsessional-compulsive symptoms which had culminated in a set of phobic behaviours centred on AIDS. These were making normal life impossible. As in all psychotherapy, words were used to alter what was felt. We can be touched by what is spoken. In this case it was her sense of skin that made sense and led to change.

Presenting Problem

Jane was referred with a dramatic range of obsessional-compulsive thoughts and behaviours which circled around her dual fascination with AIDS. She was certain that she either had it and was a danger to others, or that she was permanently at risk of contracting it. She thought of little else and behaved accordingly.

She was also aware that her outl