Photo by Josh Massey / Unsplash
It is evening, the last weekend in August, and I am trying to remember what it is like to wear shorts. Sundresses and bathing suits too. I sit on the granite-studded shores of Lake Wahwashkesh in northern Ontario, stretched atop the gray wooden dock of my boyfriend’s family cottage. I study clusters of lanky conifers across the bay, tracing the ebb and flow of their cragged boughs and admiring their resemblance to the trees in Emily Carr paintings. Summer does not end before September anymore. My joints swell in the dry heat; my long track pants warp from an afternoon’s worth of sweat. The polyester pools around my ankles, sticks to my knees.
I am reaching for a time before scars but cannot find one. How did it feel, baring my legs? Inviting the evening up around my thighs? The picking started before memory. In old family Christmas cards and elementary school yearbooks, they are always there: pink and red spots riddling my cheeks, spattering my legs and arms.
I am in the first grade. My parents beg me to leave the ones on my face, just for the week — just until after class photos have been taken. When Picture Day arrives and I am coaxed into a frilly dress, there is a deep, blood-filled circle on my forehead, halfway up and just left of center. In the thumb-sized square picture proofs that I find a decade and a half later, the spot glints like a small crimson gem.
I am in grade four, possibly five. I have moved to a farm, an hour northwest of the city, and my limbs are covered in horsefly bites turned open flesh wounds. As he watches me peel off thick cotton socks and shin guards in the passenger seat after soccer practice, my father suggests, gently, that there might come a time when I will want scar-free skin.
He means well. Still, I bristle. I tell him I do not care how my legs look and never will. My words are hot and breathy, meant to impress upon him the embarrassment of his own vanity.
Now, I play that scene over in my head, teasing the recollection apart as though it is, itself, a flaky, purpling scar. Would things be different if I had listened? Could I have stopped, then, if I had wanted to?
In the years since, I have found myself often ashamed by the evident weakness of my rational brain, the failures of intellect stamped along my skin like the hoofprints of some baser steed. I explain to a new therapist how jarring the split has become — how I sometimes feel half woman, half animal. Can they really both be mine, these feral fingers and the brain so ostensibly in control? Can anyone — friends, professors, tourists on the street — possibly guess that I fall asleep each night between bloodied sheets? In my attempts to stop, I feel like the old woman in Anne Carson’s poem “The Glass Essay,” lying awake, angry, lost, and alone, flicking a switch for bulbs that refuse to turn on. I clamber along to find the source, yelling, I want an explanation. Also: I want to be beautiful again.
I often voice my desire for understanding. A therapist reassures me that my questions are common among people who engage in “ego-dystonic behavior,” or thoughts, impulses, and actions at odds with their values and self-conceptions. She explains that ego-dystonicity distinguishes disorders like OCD from others like anorexia; in the former, people are aware that what they are doing is strange, obsessive. As a result, she tells me, they may feel compelled to find explanations. To transform their impulses into something reasonable. Articulate.
I am intrigued by the possibility of discussing it — out loud or on the page, granting it the dignity that language affords. Even so, early attempts to articulate my spots are sterile in their simplicity. I am a freshman in college when I first hear the word dermatillomania — a sterile formulation that fails to capture what, predating memory, seems impenetrable to me. I read Sontag at seventeen, and her warning resonates into my twenties: Illness is not metaphor.
What I rarely voice is that I do sometimes think my spots hold beauty. You never know how a given one is going to heal. Of course, the body forms fresh collagen fibers every time damage is inflicted on skin, but each manifestation of that process is as exhilaratingly idiosyncratic as the formation of a mountain range. Some scabs surge upward, seeping amber pus like sap through the bark of a maple. Others sink into ovular depressions, like those left in long grass where deer have curled up and slept.
In June, I move back to Toronto, my hometown. There, my spots grow into gashes the size of shelled pistachios. When I run into a friend from high school, I tell her I slipped and fell on the sidewalk.
In June, I get high after dinner and roll up my left pant leg in the bathroom, willing myself not to tear the scab from a particularly deep opening on my desiccated calf. A minute or two passes — or maybe they are seconds — before I do, driving into the sticky hem of the sore with the nail of my pinkie finger, closing my eyes at sister surges of pain and relief. Why relief?
In June, I am aware of the marks on my skin from the moment I wake until the moment I sleep.
The question becomes increasingly urgent: If my free-willing self is not driving this, what is? If, as Leslie Jamison writes in her “Grand Unified Theory of Female Pain,” a “wound is where interior becomes exterior,” what have these small indigo circles brought to the surface?
The etiology of pathological skin picking is not well understood. The disorder was first documented in 1898 by Louis-Anne-Jean Brocq, a French dermatologist whose adolescent patient could not stop itching her acne. Still, “Excoriation Disorder” only appeared in the Diagnostic and Statistical Manual of Mental Disorders, the DSM, recently, in the fifth edition, published in 2013.
Since then, the neurobiological nature of picking has been up for debate. Some doctors link picking to multiple pathophysiologies, including genetics, family history, diet, comorbid dermatological conditions, and socioeconomic factors. The DSM-5 classifies picking under “Obsessive-Compulsive and Related Disorders,” alongside other “Body-Focused Repetitive Disorders” (BFRDs), such as nail biting and hairpulling. But other experts believe that pathological skin picking bears greater similarity to addiction and substance abuse disorders than it does to OCD. In this way, skin picking may be about habit formation: neurons firing in the same patterns, over and over, to create synaptic pathways that support certain behaviors.
One article tells me to think about these pathways like ruts in a dirt road that become wider and deeper — and therefore harder to avoid or get out of — each time I drive in them. This is a helpful image. To break down the ruts, I have to drive elsewhere.
Drive elsewhere, I tell myself at two in the morning, my fingers scrabbling at my forearm.
New psychologists always start by giving me glossy pamphlets and drawing simplistic cognitive diagrams on screeching whiteboards. Some warn me that my spots are manifestations of suppressed emotional injuries. Others suggest my picking is a misguided attempt at self-soothing, the deliberate instigation of local, controlled sensations to distract me from more profound pains.
One psychologist recommends that I try to construct a timeline. The idea is to plot the major events of my life against the periods during which I have picked and have abstained from picking to see if I can approximate a pattern. Picking, I title the page in my journal. Starts: age 3(?) Stops: age 14. When I started middle school, I had to strip down into my gym uniform alongside my classmates three times a week. Perhaps I became increasingly conscious of the marks on my limbs and torso as I began noticing the skin of other girls and boys — wanting to touch theirs, to have them touch mine too. Was it vanity, then?
Begins again: age 21. I do not know why.
They all spout phrases: pathological fixation, body dysmorphia, obsessive-compulsive disorder, generalized anxiety disorder, panic disorder. Any of these terms could, plausibly, apply. Yet none resonate completely.
Hidden and bleeding, my body turns twenty-three. My body, which, for two fortunate decades, has been given everything it could need to keep moving, to grow and find pleasure. My body, which has retooled those things and done this.
The anthropologist Enid Schildkrout has written of the long interest in the skin as a boundary phenomenon between self and society, noting that Claude Levi-Strauss characterized it as “a surface waiting for the imprintation of culture.” Compulsions can, in some instances, manifest in response to social demands and fetishes, like the Western idealization of impossibly thin, white, blemish-free female bodies — and our failure to protect bodies that do not, cannot, conform to such impossible standards. Similarly, compulsions can be born of a concept Émile Durkheim called anomie, or the collapse of collective societal values and the resultant sense of meaninglessness or alienation.
On the other hand, the body experiences impulses that predate any awareness of society or culture. These desires and related behaviors simply are: they may exist when we are too young to be anxious, much less to experience panic or harbor trauma. This is not unlike the ancient Greek concept of akrasia, behavior which forgoes reason or rational explanation, and which is certainly not a response to external systems.
In Ethics, Aristotle identified two kinds of akrasia: weakness (astheneia) and impetuosity (propeteia). The opposite of akrasia is enkrateia, or mastery over urge.
I type “pathological skin picking, dermatillomania, and excoriation disorder” into my browser’s search bar. I skim Wikipedia articles and follow links to increasingly obscure medical and psychiatric journals. I scroll through online chat threads where people celebrate the number of days since they last picked, or upload photos from particularly bad excoriation episodes.
At some point, I realize I am obsessive, unassuageable — consumed not only with picking my skin but also with finding an appealing interpretation of my behavior, a language for picking, however convoluted or precarious.
As the years pass, the medical establishment’s attempts to develop a comprehensive semiotics of my scabs and scars ring increasingly hollow. They are all irritatingly tidy, operating with a fundamental lack of imaginative space for variance or complexity — what Jamison, in The Recovering, rejects as the “simplicity of syllogism,” or any “neat one-to-one correspondence between trauma and addiction.”
The histories of the rise of psychiatry and psychology, the revival of Freudianism, and the evolution of the DSM tell a story of the necessity of medical expediency. As part of a series of lectures delivered at Trinity College in 1919, the English philosopher Alfred North Whitehead characterized the “aim of science” as “seek[ing] the simplest explanations of complex facts.” He went so far as to caution that “we are apt to fall into the error of thinking that the facts are simple because simplicity is the goal of our quest.” This prioritization leaves systems of emotional and neurobiological understanding that, when faced with anything mysterious, amorphous, or partial, run for categorical cover, retreat back to the shelter of narrative neatness. Dispassionately, they say: You hate your body, and therefore you drink. Your parents split up, and therefore you pick.
Jamison references another memoir of alcohol addiction by Charles Jackson, who, Jamison recounts, insists that one can’t always trace self-destruction back to a tidy psychological myth of origins. Picking is not metaphor. Very possibly, it is neither a passionate, organized response nor an abstracted act of boredom and fatigue. Perhaps it is beautiful — I sometimes think of my own legs, pockmarked like coral reefs, as otherworldly in their allure — or even profound. Perhaps it signifies nothing.
In July, I worry that my boyfriend’s family hates me because I decline invitation after invitation to spend summer weekends at their cottage on the lake. It is not about them — it is about what becomes visible if I wear shorts or a bathing suit — but I do not offer an excuse.
My boyfriend tells me that the picking itself does not bother him. That he does not notice the spots. I do not believe him, and he admits that he notices them but insists they are not important. He claims that he is as attracted to me as he was when we started dating seven years ago, long before my picking got bad again. Part of me wonders if he, too, finds magnetic energy in my spots.
Mostly, I wonder if he is sympathetic because he also picks. Not his skin, his beard: the cropped auburn bristles along his jawbone and lower cheeks that, if they grow long enough, redden at the tips. He picks these while we watch movies he has seen before, while he muses over case readings for law school, or while I am taking an especially long time to make my next move in an especially slow game of chess.
Once, over text, he admitted that he is often overcome with a bizarre but overpowering urge to eat these hairs. At the time, I did not ask whether he wants to eat them individually, placing each eyelash-like tendril on his tongue and swallowing it whole, or whether he has the desire to collect the hairs and chew them all at once, breaking their thin, slimy spines with his molars.
Still, I imagine it must be different for him. Whenever his picking gets bad, he can shave. I imagine it must happen just like that: two minutes with a razor and the temptation is gone. I think about how liberating that must be — not having to resist the ravages of impulse — and the unfairness of this is inexplicable to me. I am jealous — so jealous that, when he emerges from the bathroom with clean, only slightly inflamed cheeks, I tell him he looks like a toddler.
When I am unable to stomach the DSM but still seek something like interpretation, I find more liminal, human alternatives thumbing through family bookshelves. Carson’s old woman, who keeps switching and switching her unanswering light bulbs. Behind Carson rests Mary Oliver, whose overly familiar “Wild Geese” reads like an exhale.
You do not have to be good.
You do not have to walk on your knees
for a hundred miles through the desert repenting.
You only have to let the soft animal of your body
love what it loves.
How can I not repent?
What does my body, streaked and scored like a pink birch tree, love?
In his journals, the distinguished poet and lifelong alcoholic John Berryman listed his reasons for drinking. In her writings about him, Jamison is sympathetic — Berryman, of course, was an addict, and also a writer: “What else could he do?”
Jamison also records Jackson’s simultaneous observation that “it had long since ceased to matter Why. You were a drunk; that’s all there was to it. You drank; period.”
Sometimes, I think I am getting closer. Not to a blueprint for getting better — “if there’s any illness for which people offer many remedies,” Chekov wrote, “you may be sure that particular illness is incurable” — but to a more comprehensive explanatory framework, a more satisfactory vernacular. Despite our wiser instincts, we remain desperate for language to capture what our bodies experience. Maggie Nelson reports spending a lifetime devoted to the idea that “words are good enough,” even as she worries that “once we name something, all that is unnamable falls away, gets lost, is murdered.” Language falls short, yet still we crave it — to make sense of ourselves, to articulate why — even when, seemingly, it has long since ceased to matter.
The last weekend in August, my picking is as bad as it has ever been. Yet finally, afraid that my boyfriend will leave me, I agree to spend four days with him at his family cottage. His brother is elsewhere, his parents in France.
My butt is so inflamed that it hurts to sit. Especially on the aluminum seats of the family boat when the water is rough. Especially on the hard wooden slats of dock chairs. I wince, pulling down my blood-spotted pajama pants in front of the bathroom mirror. I trace the various local infections with my index finger, the raised bumps with their yolky, pus-filled centers. There are nine bad spots on my face, and unable to sleep, I dig into them again and again over the course of the long weekend nights. As I wait for the coffee maker to finish each morning, I tease dried blood and bits of skin out from under the rims of my short nails, which I have bitten down in an attempt to make picking harder, less efficient.
On Sunday, I sit on the dock trying to write about it — to unearth some adequate mode of articulation, maybe an effective method of resistance.
In The Collected Schizophrenias, Esmé Weijun Wang writes: “How did this come to be? is another way of asking, Why did this happen?, which is another way of asking, What do I do now? But what on earth do I do now?”
To be consciously embodied, I think, is to undertake an endless project of watching and wondering. How can one refrain from asking, often obsessively, about the why of skin, marrow, and tendon — alternately angular and fleshy; scraped or battered, often by one’s own hand — with whatever vocabularies they have available?
What do I do now? But what on earth do I do now?
A calendar notification slides into the top right corner of my laptop screen, reminding me to schedule a first laser scar removal session with my dermatologist. When we met for a consultation in early July, she informed me that, so long as I refrained from picking over the summer, my wounds would be healed enough to begin laser therapy by fall.
Now, I click on the calendar reminder and reschedule it for two months in the future. I reassure myself that I will keep searching, writing. That eventually, when my scars have faded, I will get my first tattoo. The one I have wanted for years but refuse to get until my skin is clear. Over time, the idea of getting this tattoo has begun to figure in my mind like a kind of conclusion. Just as writing begets understanding and intentional narrative, reassertions of ownership of story, tattoos produce intentional marks, reclamations and celebrations of skin.
The tattoo I want is an allusion to “Wild Geese.” It is an expression of faith in the world going on, in honoring and admiring the body as a soft animal. The geese will start around the back of my right hip and follow the curvature of my ribs, driving up along the front of my stomach and in a line under my collarbone. They will fly across the clear sky of my skin, smooth like the surface of Lake Wahwashkesh: homebound, embodied, and free.