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Because of the apparent psychological significance of the skin as a means of intercommunication between the inner and the outer worlds, skin diseases obviously deserve the attention of psychoanalysts. Yet, the examination of the literature discloses little systematic application of psychoanalytic technique to skin manifestations. Barinbaum (1) has pointed out the significance of psychoanalysis to dermatology. “In adjudging psychogenic skin diseases,” he says, “psychoanalysis merits first place, because this method alone among all methods of psychotherapy is able to reveal the sources of the energy bound up in these diseases. It is only this knowledge that makes possible a rational therapy. Every psychogenic skin disease is a symptom of a psychoneurosis, specifically a conversion hysteria, providing physical release of repressed impulses.”
Numerous writers since Kreibich and Doswald (2), to whom we owe the first demonstration that skin blisters can be produced hypnotically, have established the existence of psychogenic skin diseases. Dunbar (3) lists 120 communications bearing directly on the subject. Recently Schilder (4) reported quite extensively on the psychology of the skin. However, the literature in general seems barren of detailed psychoanalytic case histories of psychogenic skin diseases. Jelliffe's early paper stands alone.
Perhaps the primary reason for this may be, as Sack (5) points out, that “without psychic analysis, the diagnosis ‘psychogenic skin disease’ cannot be established. There are no skin manifestations that can be recognized by inspection as psychogenic.”
In the same paper Sack stresses the point, that the skin affords an especially favorable field for the study of psychosomatic relationship, particularly since here all voluntary innervation seems to be excluded. The same author, in an earlier communication (6), stresses the importance of the skin as an organ of expression which has a twofold significance: reflex, springing from the deep strata