The hidden delight of psoriasis

BMJ 1997; 315 doi: http://dx.doi.org/10.1136/bmj.315.7123.1709 (Published 20 December 1997)
Cite this as: BMJ 1997;315:1709

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  1. Frans Meulenberg, General practitioner
  1. Dutch College of General Practitioners, Oudegracht 16, 3511 AN Utrecht, Netherlands

Introduction

In John Updike's novel The Centaur young Peter Caldwell has psoriasis.1 He is not sure whether to tell his girlfriend, but he is also aware of the power that the disease can involve, when he wonders: “Should he tell her? Would it, by making her share the shame, wed them inextricably; make her, by bondage of pity, his slave? Can he, so young, afford a slave?” And he does not conceal the fact that the disease also gives him pleasure. “The delight of feeling a large flake yield and part from the body under the insistence of a fingernail must be experienced to be forgiven.”

The visibility of psoriasis appeals to the imagination, perhaps because of the chronic, variable, and unpredictable nature of the disease, and has even led to literary language in the medical literature.2 For example, Ingram describes the plaques and colourful configurations as patterns that “may rival the heavens for beauty and design,” to which he adds with a sense of drama: “To leave a trail of silver scale about the house and blood-stains on the sheets and to fear the public gaze—this is a cruel fate.”3

The psychosocial dimensions of skin disorders like psoriasis have been described in the medical literature.4 5 6 7 But psoriasis has also been a theme in non-medical literature—autobiographies as well as fiction. Novelist Connie Palmen pointed out in The Laws that psoriasis seems to be “a perfectly visible, exterior, unhidden disease, but it is precisely the disease of the one who hides.”8 Autobiographical prose

Autobiographical prose

John Updike devoted the chapter “At war with my skin” to psoriasis in Self-consciousness.9 He argues that psoriasis keeps you thinking: “Strategies of concealment ramify, and self-examination is endless.” The patient constantly invents new ways of hiding the symptoms. …

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