PS45 Dermatosemiotics: moving towards person-centred care in psychodermatology

Abstract

Present psychodermatology and psychoneuroimmunology paradigms tend to stick to the dualistic and reductionist paradigm, where mind and body are different entities coupled with linear connections. Not only does this fail to account for clinical phenomena in which skin pathology is a direct expression of an untellable story of a patient, which is known as symbolic diseases, but it also hinders practising authentic person-centred medicine. This medicine demands a biopsychosocial approach that is more holistic in respect and values relational aspects of life, health and clinical encounters. The objective of the review paper is to indicate how dermatosemiotics therapy (DST) can be used to offer a transformative model to enhancing the quality of care and achieving the objectives of person-centred medicine in psychodermatology. This research covers (i) the theoretical foundations of DST, in conceptualizing healing as an enskinment, grounded into phenomenology, biosemiotics and complexity science; (ii) clinical evidence on psychoneuroimmunology in symbolic diseases and (iii) experience with experiential psychotherapies (e.g. internal family systems and schema therapy) in the dermatosemiotic perspective. Conceptual analysis shows the positioning of the skin as the main relational and communicative organ in DST, where disruptions are manifested by failures of an attempt to transfer the subjective experience into a verbal form and lead to translation into skin manifestation. DST holds that a significant number of chronic skin disorders can be considered symbolic diseases, that is, a translation of emotional inhibition or alexithymia. In this case, the skin in itself turns into a social medium, when other means of expressing feeling and thoughts become inaccessible. Dermatosemiotics as a paradigm and a therapy can provide a paradigm shift to psychodermatology that operationalizes nondualistic relational and person-centred care. Dermatosemiotic practices placing the skin as a coemergent zone of meaning, empowering the clinician to understand the communicative role of the skin.