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My appreciation of Alessandra Lemma's Under the Skin: A Psychoanalytic Study of Body Modification grew as I read the book. It has many impressive features: its relevance to understanding individuals who use and misuse their bodies to express and manage unconscious fantasies and needs; its relevance to psychoanalytic thinking and theorizing about the body and development of the embodied self; its helpful distillation of many theorists and clinicians past and present who have written about the body/mind in psychoanalysis.
Lemma brings considerable and varied clinical experience to her topic. It is apparent that she has studied and treated large numbers of patients who have felt compelled to act upon intensely felt feelings and fantasies by modifying their bodies in a variety of ways. These numbers include individuals who have subjected themselves to numerous plastic surgeries; individuals who might be classified as having body dysmorphic disorders; individuals who tattoo, pierce or scar their bodies; individuals who in general are intensively preoccupied with their appearance or display their bodies as canvases.
Before explicating the dynamics and psychic functions of these fascinating and often incomprehensible behaviors, Lemma carefully lays down a theoretical groundwork for understanding our experiences of being in a body. She begins with Freud (1923) by pointing out how the body is the starting point of mental functioning and citing his famous words about the ego that it is first and foremost a body-ego” (Freud, 1923, p. 27). Moreover, for Freud, the body is the source for the drives. Throughout the book, Lemma