Psychotherapy with people who smell

This paper stems from psychotherapy work with patients who ‘neglect personal hygiene’ in homelessness and chronic mental health settings, and consultancy to staff groups tasked with patients’ ‘social inclusion’. Psychoanalytic theory has largely eschewed exploring internal psychic states communicated by odour and, equally, the meaning of marked societal hostility towards malodorous individuals. The paper looks at historical and anthropological notions of ‘dirt’ and the construction of the ‘unwashed’ as a social category in the formation of bourgeois society. Psychoanalytic ideas of unconscious bodily and psychic communication are described. Case examples explore how troubled relations between body and mind result from early abuse/neglect, where the internal world is suffocated by trauma and ‘dread’ which cannot be contained and processed. From a psychosocial perspective, taking up a role as ‘unacceptable’ is the paradoxical condition of belonging for many members of the social whole. The paper suggests that invasive smell confronts us with our repressed knowledge of that which is ‘rotten’ in the emotional and sociopolitical environment in which ‘the unwashed’ exist. An example from organisational consultancy traces profound disturbance in institutional dynamics that occurs when the malodorous individual seeks to claim shared social resources. The author questions the prevalent view that ‘being smelly’ is an attempt to withdraw from social and psychic contact, rather than a meaningful communication which is within the scope of psychoanalytic thought to understand.