PSORIASIS BLOG – Sensitive Skin
The mental health side effects of psoriasis can be quite profound, but treatment is there if you want it. Talk to your GP about it. The post below is extremely anecdotal and subjective because psoriasis treatment is so bespoke. I share it not because I am drawn to the idea of bearing some of my inner frailties because actually the opposite is true. In fact, it scares me a bit – part of me wants to post this but not Tweet about it because then no-one would come here and read it. But that would be to miss the point rather, wouldn’t it? So here you go, have a butcher’s at this. There is more about these issues at the See Psoriasis: Look Deeper website. There is much useful information there.
I have been discharged!
I have been seeing the derma-psychologist Dr Mizara for over four years. I was introduced to her when I was hospitalised with a painful and widespread outbreak of psoriasis after a throat infection. I was on immunosuppressants at the time so instead of a standard flare up I was knocked for six: psoriasis was Chris Gayle and my emotional and physical make up were the hapless and ill-equipped Zimbabwean World Cup cricket XI. Physically I was in a parlous state but mentally I was smacked straight out of the ground. Prior to that I had been doing so well: the medication had meant I’d been bump and crack and flake free for the first time since I was about 20. No pain, no ointments – my surface was flat and my sheets were clean.
(Alright – I’ll stop the cricket analogy now in case you decide to stick your bat into my crease).
See, actual cricket is more painful than the tortuous analogy I used. But only just.
I have always been rather dubious of psychoanalysis – not because I judged those who underwent it: whatever helps you, of course. Actually, I am lying. I did judge people. I judge people who share their medical and emotional woes on the internet too. I know! What a hypocrite. I don’t want to be one of those comfortable, middle class people who nods earnestly and bangs on about my councillor helping me through the latest hardships undergone by a relatively healthy white man with a home, a loving family and every episode of Doctor Who on DVD. Pass the bloody tissues.
And you know, I don’t have mental problems. Everybody who knows me would say that I’m a fairly jolly chap – yes, I get grumpy about ridiculous little things but only on stage or in dressing rooms and to hilarious (and sometimes “quite funny – three stars”) effect.
So it was with some trepidation that I went to see Dr Mizara. I’d never been very good in drama classes at that “opening up” stuff. You know, when we have to tap into our emotions and cry about something that happened to us. I’ve cried on stage, sure, found it easy, but crucially, because I was pretending to be someone else. I’m not one for bearing my soul in public (well, unless it is hidden behind the conceit of stand-up comedy – and perhaps we don’t need to get too complicated to work out the implications of that).
The first time I went we just talked – she was assessing me as I was getting acclimatised to the process. I was trying it out though – for it’d been suggested to me that it would help by a consultant whom I respect and I would give anything a go to control this scaly beast. If Dr McBride had told me to daub myself in marmalade and sing the Sailor’s Hornpipe on the roof of St Paul’s Cathedral every third Wednesday of the month I’d have had a crack. I have, in the past, spent a year taking Chinese medicine which is only marginally less ridiculous.
It’s difficult to describe Dr Mizara – considered without being distant, empathic without being touchy-feely, pragmatic without being cold. I guess the thing is, you don’t get to know your psychoanalyst : they’re doing a job, part of which is to know you. I decided early on that there’s no point in lying – a Doctor can’t fix you if you don’t tell them all of the symptoms. So of course when she asks that question “Anything else?” all those little niggles – things that have annoyed you, things that you feel guilty about, things that you don’t understand … come flying out. Total disclosure, even if it seems like it’s something irrelevant (which of course it isn’t).
That process alone has been extremely helpful. It’s a pattern of behaviour common in psoriasis patients – to bottle things up, to feel guilty about being angry about certain things because in the greater scheme they are minor. This is tied into the condition. It’s not life threatening nor is it cancer so we feel a bit burdensome complaining. The psychology of this condition is complex and it manifests itself into all other areas of our lives whether we realise it or not.
I’m my own harshest critic so it was always easy to deliver a litany of Things I’d Done wrong whenever I crossed the threshold of her small office on the first floor of the Royal Free Hospital in Hampstead. And I invariably went out feeling clearer about things : better. On some occasions I simply unburdened myself – on others I had an insight into why I had felt certain things at certain times or why I had reacted to others (and they to me) in certain ways. I cried. I got angry. But largely I tried to work out how to get less upset by this thing, or how to respond better to that one. This may sound daft to you – maybe you don’t spend hours going over conversations you had the night before, trying to spot the moments where you’d given the nice person you were talking to a reason to hate you (they didn’t give any sign they’d hated you, of course, but they still might have done). Maybe you don’t still get really upset about that stranger who said something cruel and thoughtless about the dry patches of skin on your face in 1996. Maybe you think doing that is a colossal waste of time and energy and a very silly thing to do. And you’re right: good on you and carry on not doing it. That’s probably why you’ve never been sent to a psychologist and I have.
I had a terrible year in 2013 – you don’t need to know the exact reasons why. There’s a difference between sharing one’s experiences and doing a humiliating dance dressed only in your dirty laundry. Just take it from me, it was terrible. Worse than the ending of “Lost”. I was a burden then, I know: to friends, to family. And I was in a parlous state. I went to see Dr McBride after one horrible day and she called Dr Mizara immediately and I was given a last minute session with her (she kindly flexed her schedule to accommodate me). When you are at your lowest ebb you expect friends to tell you that you are worth something but you don’t really believe it. When a medical professional tells you this and gives you coping strategies and insights it enables you to take bigger and bolder steps when all you feel like doing is curling up into a ball or drinking all the whisky in England (which I’m aware is probably not the best stuff but weepers aren’t inclined to be choosers). I am indebted to some very good friends for getting me through this period: but without the commendable empathy of those practitioners at the Royal Free I think I would have leant on my long-suffering chums to an even greater and more tedious extent than I did (so Peter, Caimh, Shauno, Dig, Susie, Mum and the rest, I think Dr Mizara and the dermatology team should be top of your list of People You Owe A Drink To For Saving You From Even More Nights Of Repetition And Tears With A Lachrymose Doctor Who Fan).
“Please say that I’ve been a good dermatology out-patient.”
I have been seeing Dr Mizara less frequently recently. So much in my life has changed. I think when someone works so hard with you there is almost a childlike, puppy dog need to tell them what you have achieved – and in doing so you see how far you have come. “I’ve been going to the gym”, “I haven’t had a drink”, “I’ve written a play!” I’d pant, dropping each metaphorical ball at her feet and waiting to be told I was a good boy. I mean, just as needy but so much better than “Why does nobody love me?”.
Last Thursday’s appointment was a formality – just to see how I was doing. I hadn’t been in for a while. To coin the correct phrase, I have coping strategies in place, for many of those things that used to (and still do) give me grief. I have made progress. Life will still never be easy (it isn’t for anybody), but so long as I can continue to not fixate on the past, to look at things from other people’s perspective and realise that not everything they do is about me, to take less destructive paths, and essentially just chill the fuck out (OK, that last one is mine, but it’s pretty much the gist of it) then maybe I can make this journey tough life – the only one we get folks – a bit less of a perilous ride. It would be ridiculous to go to my grave having spent far more of my time worrying about the bad things that might happen (another psoriasis patient meme) than enjoying the good ones that do.
When she told me that I didn’t need to come back I was a little scared but the biggest emotion I felt was one of massive gratitude. I know it’s her job but what a profession to choose. It’s the equivalent of seeking out that maudlin git in the corner of the pub who keeps whining about the bad things that keep happening to them when it’s clear to you that they just need to stop doing what they are currently doing and then maybe they’d be alright. But I needed help that I never would have asked for and I got it. And when she said goodbye I felt tears leaping from my eyes, and I wasn’t even on stage. Nor was I being someone else.
I was being Toby and, crucially, I actually didn’t mind.
There are patient testimonies about seeing Dr Mizara for a number of skin conditions here.
Dr Mizara talks to the Telegraph about the relationship between the mind and the skin here.