On skin

I was sitting in with a dermatologist one day learning about skin conditions of the type that are severe enough to make it into hospital. Before I went in to sit with him (as an observer) I had to wait out in the waiting room with his patients. I noticed a red man there with lots of fine scale on his blue work shirt and around his chair. There was also an older lady who I could not discern anything of note from where I was sitting. Then I went in to the dermatologist’s room to sit in the corner as any good medical student.

The man I had seen in the waiting room came in. He was quite animated and greeted both me and the specialist with a handshake and a big smile on his face. He was having another flare up of his psoriasis because he had been working out on a roof (he was a painter, I believe) and didn’t wear his usual long-sleeve shirt that in the Brisbane summer is only best described as torture. He was bright red (beyond what I had learnt the word erythema meant) and was shedding layers of skin everywhere, even as he talked and sat. He had come in his work clothes and he offered to remove it so that I, the medical student, could see and learn just how bad psoriasis can get. He was not a bit embarrassed, and he thought he owed to show me at least the worst spots of the disease, which extended literally from his feet to his face. After his treatment was sorted out and different work strategies were discussed to prevent such frequent exacerbations, he left with a smile even bigger than the one he came in with. The dermatologist explained to me afterwards that he was an extreme example, that he was the worst even he had seen, and that the man was remarkable to continue on with his employment and in such great spirits. I must admit, until that day, I had never even seen any psoriasis at all except in books – and that was not ‘typical’.

The second patient we saw was the other lady I had seen out in the waiting room. She came in, sat down, pulled her skirt up above her knees, and started crying. There were two small psoriatic plaques on her knees, about 4cm long by 1cm wide. The plaques were raised and had some scaly skin on top. There was no redness. This was devastating to her because this was the second or so time this had happened to her in the last four years. One knee, two small spots, and not inflamed. She apologized for having to show us such “disgusting” things that were on her knees; she was clearly embarrassed. The dermatologist treated her as if he had not just seen actually bad psoriasis and tried to dissipate her concerns and offer medical therapy for her skin. I was stunned to see how incredibly emotional she was and how humiliated she seemed to be!

One day I was out walking with a friend and she was telling me how she had always struggled to feel comfortable in her skin because she had a skin condition since she was very young. I had of course noted her skin appearance, but it had never occurred to me that she felt self-conscious about it. She told me how she imagined people thought of her because of her skin. They might think she is unhygienic and her skin is disgusting, that she is ugly and possibly ‘retarded’ or suffering some greater disorder. She said she imagined people would speak of her and comment on how ugly and disgusting she looked, and they would laugh and make fun of her. Just then a group of adolescents with skateboards went past us and were laughing amongst themselves. She said episodes like that made her think it was her they were laughing at. I felt at that moment not pity for her for having a skin condition, but rather offended as a human being not of what she thought people said of her, but what she thought of us, us people other than her.

I had one question to ask her: what did she think when she saw a person with a skin condition like hers? Did she think they were ugly and disgusting? Would she laugh and mock them? She responded no, of course not! I asked her then if she was special, was there something about her that meant she was a good person and the rest of humanity were judgemental, spiteful human beings? She said no, she wasn’t special. Of course she would never think she was special, her problem was one of low self-esteem not a heightened arrogant one! Well, I said, if she is not special and she would never think that way of anyone, what made her think anyone else would think that of her? Here she was accusing strangers, others, of being spiteful, judgmental, arrogant people with vicious mocking thoughts in their minds. Freud called it projecting, the act of ascribing to other attitudes and feelings you personally have. I believe no medical condition, handicap, special ability, money, or other advantage or disadvantage entitles you to cast judgement on other human beings!

There’s an early movie by Pedro Almodóvar called ‘Dark Habits’ in which a group of nuns take on the names such as Sister Manure, Sister Rat, Sister Damned, and Sister Snake. The aim is to humiliate themselves and remind people how even the “good” ones of us are despicable; they believe that “man will not be saved until he realizes he is the most despicable being ever created”. By the end of the film all the nuns have become either prostitutes, drug addicts, drug dealers, and other such “sinners” befitting of their adopted names. At the end, a higher-order cleric visits them to shut their order down and reminds them that sometimes “humility” can be the worst kind of arrogance when you wear it for a badge. Nothing that attracts pity entitles you to act carelessly or exonerates you from being responsible for what you say or do.