Psychosomatics and Psychiatry

Abstract

I really scratched myself, and I can say here that whoever has not known uninterrupted itching knows very little about hell…

Lorette Nobécourt, La démangeaison [Itching], Editions J’ai lu, Paris, 1999

Defined as “an unpleasant sensation that provokes the desire to scratch oneself”,¹ pruritus is one of the main functional signs in dermatology, specific to this speciality.² Lying on the skin and some mucosa, it disturbs the functions of these organs without creating a necessarily observable lesion on it. And in the end, it is always in the brain that the sensation is or is not perceived. As a conscious perception, it unites skin and brain - without “the brain, no itch.”³ Hence, there is a subjective side. The sign exists at the cerebral, physiological, psychological, and verbal levels. It is from this plurality that a link between soma and psyche can be formed. The use of the terms “displeasure” and “desire,” and notions with a dual interpretation (physical and mental), to define pruritus express this complexity well. It is why the skin can be the starting point for a somatic and psychological expression of the subject, as well as the destination, a dead end where it becomes impossible to exist outside the itching. As a result it becomes a vicious circle, a suffering that can hold such a central position that it affects social, professional, emotional, and mental life. The subject becomes the pruritus: “…at the edge of one’s self, on one’s skin, the subject acts out not only his identity, his connections to others and his relationship to time, but his humanity as well.”4