Feature: The Bio-Psycho-Social Effects of Eczema on Zelda Fitzgerald

by Dr. Karen E. Tatum

Although Zelda Sayre Fitzgerald had experienced allergic symptoms (such as asthma and eczema) before in her lifetime, the most excruciating of these occurred, not coincidentally, during her first hospitalization for “nervous exhaustion,” at Prangins Clinic in Switzerland, in the Spring of 1930.  “By mid-June” of 1930, as biographer Nancy Milford describes, “Zelda had developed a severe eczema that covered her face, neck and shoulders . . . the eczema was virulent and painful.  None of the medicines tried at Prangins were effective against it.  For the rest of July, all of August, and early September, Zelda suffered its debilitating pain” (Milford 1970, 169).  In September, her psychiatrist, Dr. Forel, hypnotized Zelda.  When she awoke after a thirteen-hour deep sleep, the eczema had somewhat disappeared, but as Milford writes, “When she felt normal and realized the danger in her conjugal conflicts, the eczema appeared.  It came, [Zelda] thought, as a sort of warning device” (Milford 177).  Although this particular flare-up eventually cleared, eczema’s manifestation as symptomatic of impending psychological destruction would remain with Zelda for the rest of her life, until her death in an Asheville, North Carolina asylum in 1948.

“Eczema,” write Kathryn Zug and Marilynne McKay, “is derived from the Greek term ekzein, ‘to boil out.’ This term aptly describes the swollen, wet, oozy, bubbly appearance of acute eczema.  When itchy skin has been rubbed and scratched for weeks, it lichenifies into dry, thick, scaly plaques of chronic eczema” (Zug and McKay 1996, 1243)[1]. Although a variety of forms and causes exist, eczema is basically an inherited, allergic skin disease, often stemming from immune deficiencies.  Not only are there environmental and genetic triggers for this allergic response, but doctors often attribute flare-ups to stress which can exacerbate the condition.   Precise statistics on the numbers of people affected with eczema are difficult to come by due to the still somewhat generic use of this term to describe many types of skin irritation as well as the difficulty in determining causes (allergic or contact dermatitis).  However, the following factors are clear: more women than men suffer from eczema by a ratio of 2:1 (Williams and Wüthrich 2000, 43) [2]; although eczema is more likely to develop in childhood than adulthood, fifty percent of infants with eczema will continue to suffer all of their lives (“Eczema/AD” 2000); and, lastly, the incidences of eczema cases reported in the last thirty years has increased by twenty percent (Youngson 1995, 5; “Environmental Hazards,” World Health Organization, 2003). 

All of these factors make this disease worthy of our critical attention and understanding, particularly in terms of the ways in which gender, society, psychology, neurochemistry, and eczema outbreaks are so deeply intertwined.  Because eczema is so prevalent among women in contemporary society, it approaches in significance the now well-known problems that cause eating disorders in women.  The psychological causes and effects of dermatological illness have largely been overlooked in medical humanities and gender studies, particularly those focusing on disability and trauma, despite the fact that issues of body image, self esteem, gender norms and male medical authority are all central to the problems that women with eczema face.   By examining Zelda’s works in terms of her eczema flare-ups, their accompanying psychological disorders and treatments, in addition to her feelings of entrapment and frustration with gender roles, we can better understand the labyrinth of social, psychological, and physical stressors in women with chronic eczema. 

Zelda and Scott’s letters demonstrate that they both had keen insights into the links between anxiety and eczema.  In January 1931, before sailing to America for his father’s funeral, Scott wrote Zelda’s doctor, Oscar Forel, at Prangins that he believed Zelda’s eczema was caused by either an increased or insufficient amount of “poisons” in Zelda’s system.  As he puts it:

Mrs. F. encourages her nervous system to absorb the continually distilled poison.  Then the exterior world, represented by your personal influence, by the shock of Eglantine, by the sight of her daughter causes an effort of the will toward reality. She is able to force this poison out of her nerve cells and the process of elimination is taken over again by her skin. . . . The eczema is not relative but is the clue to the whole business.  I believe that the eczema is a definite concurrent product of every struggle back toward the normal.  (Bruccoli 1993, 365) [3].

As a writer, Scott’s insights into human beings, their bodies, and their often troubled relations to the world in which they must live, allowed him to intuit the connections between chemicals (poisons), nerves, and the skin, which would take years for medical science to verify.

Esther Sternberg’s recent book The Balance Within: The Science Connecting Health and Emotions presents convincing arguments for the definitive links between the immune system and the central nervous system.  Histamines are the all-too familiar poisons released from the Mast Cells (white blood cells) during an allergy attack (Sternberg 2000, 178).  Unfortunately, however, this knowledge was not available to Zelda’s doctors, because it would take Daniel Bovet in Italy another six years to develop the first antihistamine substance, and another five years (1942) before the first antihistamine drug for humans would be available on the market (“Daniel Bovet” 2004). 

Furthermore, psychiatrist Peter Kramer notes that “the first modern psychotherapeutic medicine, Chlorpromazine, was an antihistamine.”  Also known as Thorazine, Chlorpromazine “was introduced in 1952 [and] constituted a breakthrough in the treatment of schizophrenia [because it] . . . had some efficacy in depression, calming agitated patients” (Kramer 1997, 50).  Esther Sternberg relates that the Mast cells, which release histamine, gather around the nerve endings that release serotonin, one of the two main chemicals responsible for anxiety and depression.  If the Mast cells release histamine around these nerve endings that release serotonin, a mis-fire can occur, causing nerve cells to activate Mast cells and vice versa (Sternberg 2000, 178-9).  This suggests that allergy flare-ups and anxious and/or depressive episodes may chemically coincide.  Further research has confirmed this suggestion.  A 2005 study published in The British Journal of Dermatology found that, as the title of the article states, “Anxiety Accelerates T-Helper 2-Tilted Immune Responses in Patients with Atopic Dermatitis [eczema]” (Hashizume, H. et al. 2005, 1161).  The combined efforts of allergists, immunologists, and psychiatrists (such as those cited here), provide compelling evidence in favor of the chemical communication (or miscommunication) between allergies and nerves, which Scott forecasted (unfortunately they were just about seventy years too late to help Zelda).

Zelda also insightfully attributed her eczema to psychological causes in addition to recognizing that the outbreaks caused psychological distress in her life.  On February 12, 1932, upon entering the Phipps Clinic at Johns Hopkins, she told the doctors blatantly “It’s this eczema and asthma that’s just disrupted our home when it was running so well” (Milford 1970, 210).  She complained of the strain of her father’s death, of having to hold down the fort in Montgomery during this time with Scott screenwriting in Hollywood, and of being alone with her daughter.  But although Zelda’s doctors entertained both her and Scott’s linking of these emotional stressors to her eczema, they did not pursue them much farther, apparently not taking them very seriously. 

Although allergy research has assumed a more interdisciplinary approach, practitioners in both dermatology and psychology remain somewhat uninformed about the psychological effects of this debilitating skin disease.  In a letter to the author dated April 6, 2005, allergy-immunology specialist Dr. John F. Dishuck writes: “Little attention has been given to the impact eczema has on the mental health of the patient or the impact of medical and non-medical treatment of psychological diseases on the treatment of eczema.”  Not only does eczema cause physical pain, it is also frequently accompanied by varieties of anxiety and depression.  Given its chronicity, unpredictability, and traumatic impact, a negative self-image, if not a disturbance in body image, where the patient perceives her body as more grotesque than it may be, is quite likely to develop.  Dr. Dishuck writes: “Eczema is increasing in prevalence and severity.  Body image disorders are also quite common, especially among women.” As Zelda came to terms with herself, with Scott, with her past, and with her surroundings, she depicted the nightmare of those early experiences with mental and physical disruptions in her figures, which reveal, in the words of her granddaughter, Eleanor Lanahan, “a series of painfully distorted figures” (Lanahan 1996, 14), figures that shock and defy even the Expressionist mode of art that may have influenced her.

Examining Zelda’s collected writings, literary critic Mary Gordon writes:  “Love and fear and horror mix themselves as well . . . . Her use of ands and commas to create a strung together, litany effect accentuates the pile up of dissimilar elements, and the reader is taken on an exhilarating ride that brings together glamour, terror, wit, and the seductive fog of the unconscious set loose” (Gordon 1996, xix).  Gordon’s description of the “love and fear and horror,” which Zelda’s work evokes, can partially be accounted for by Julia Kristeva’s theory of abjection [4], a simultaneous fascination and repulsion with sick or imperfect bodies, which are ousted from the clean and proper boundaries of society, not because they threaten mortal death; rather, sick bodies, particularly those with skin lesions, threaten to dissolve the boundaries on which identity and civilization depend.  As Leviticus states: “For whatsoever man he be that hath a blemish, he shall not approach . . . a man that is brokenfooted or brokenhanded, or crookbacked, or a dwarf, or that hath a blemish in his eye, or be scurvy, or scabbed . . . . he shall not come nigh to offer the bread of his God” (Leviticus 21:18-21) [5]. This commandment stems from the fact that, as Kristeva explains, “The body must . . . be clean and proper in order to be fully symbolic.  In order to confirm that, it should endure no gash other than that of circumcision . . . . Any other mark would be the sign of belonging to the impure, the non-separate, the non-symbolic, the non-holy” (Kristeva 1982, 102).

Certainly Leviticus’ commandment and its underlying fears of contamination by broken skin remain with us today and are most troublesome to eczema patients who often feel like lepers.  Dermatologist Robert Youngson explains:

Many people with atopic eczema and other obvious skin diseases have, whether they acknowledge it or not, a fear of being considered unclean or infectious and thus being socially rejected. This is not surprising. The skin is by far the most conspicuous of all organs and it is an almost instinctive tendency to react unfavorably, or even aggressively to perceived abnormality.  There are plenty of instances of this throughout history.  The biblical attitude to leprosy is a case in point.  (Youngson 1995, 55)

Given this religious and cultural history, which dictates that skin diseases are unclean and therefore ungodly, it is not surprising that Zelda’s drawings of red, raw, disfigured, and painful bodies provoke an abject response.  Zelda’s grossly imperfect figures disturb us because, as Kristeva writes, they “show me what I permanently thrust aside in order to live” (Kristeva 1982, 3).

Additionally, in her recent cultural history of the skin, Nina Jablonski points out that chronically broken skin promotes a great sense of vulnerability for an individual (Jablonski 2006, 4), and, consequently, a need for the protective covering of some sort of surrogate skin.  For the more creative-minded, writing or painting, as French psychoanalyst, Didier Anzieu, puts it, “has the power to function as a skin” (Anzieu 1989, 231). A painter’s canvas can be seen as a second skin; the painting on the canvas may provide a more complete skin, and thus, a more complete sense of self. As Zelda herself said, “I don’t think I could paint anyway if it weren’t for the fact that it’s my way of communicating with someone.” Such communication is the essence of understanding, compassion, and thus, humanity, which can be the greatest healer of all.

Human beings are spiritual as well as biological entities. As long as medicine and humanity remain strangers, as long as we continue to treat physical symptoms in isolation from the psychological or spiritual realms, we continue to confuse the side effects of medications with symptoms of physical disease, and more insidiously, to perpetuate both physical and mental distress. For, as Vienna psychiatrist, Viktor Frankl wrote in his book, The Doctor and the Soul “Man lives in three dimensions: the somatic, the mental, and the spiritual.  The spiritual dimension cannot be ignored, for it is what makes us human . . . . The proper diagnosis can be made only by someone who can see the spiritual side of man.” With this holistic approach in mind, Frankl alleviated his patients’ dis-ease by helping them find meaning in their suffering.  These multi-faceted approaches to medical treatment as prescribed by Frankl and the other psychiatrists and allergists cited here are the solution to the vicious cycle of physical and psychological trauma from which eczematic women unnecessarily suffer now more than ever before.

Endnotes

[1] According to Robert Youngson’s Coping With Eczema, lichenification involves a “hardened and thick skin epidermis caused by abnormally persistent scratching” (Youngson 1995, 94).

[2] Original study reported in Aberg, N. and Engstrom, I. 1990. Natural history of allergic diseases in children.  Acta Paediat Scand 79, 206-11. 

[3] Scott’s letter to Dr. Forel, dated January 29, 1931, is in the F. Scott Fitzgerald manuscript collection of the Princeton University Library.  The excerpt quoted here is taken from Matthew J. Bruccoli’s Some Sort of Epic Grandeur: The Life of F. Scott Fitzgerald (1993, 365). 

[4] Here, in general, I draw on the chapter called “Semiotics of Biblical Abomination,” in Julia Kristeva’s Powers of Horror: An Essay on Abjection.  1982.  Trans. Leon S. Roudiez.  NY: Columbia, UP.  90-112.

[5] Kristeva cites these verses in Powers of Horror, 102.  I have cited from Leviticus 21: 18-21 in the King James’ version of the Bible (Nashville: Holman, 1989), 199.

References

Aberg, N. and I. Engstrom. 1990.  Natural History of Allergic Diseases in Children.  Acta Paediat Scand.  206-11.

Anzieu, Didier.  1989.  The Skin Ego.  Translated by Chris Turner.  New Haven, CT: Yale UP.

Bruccoli, Matthew J.  1993.  Some Sort of Epic Grandeur: The Life of F. Scott Fitzgerald. NY: Caroll and Graf.

“Daniel Bovet.”  Encyclopaedia Britannica.  3 August 2004  [Encyclopaedia Britannica database on-line]; available from http://search.eb.com/eb/article?eu=16218;  Internet; accessed 3 August 2004.

“Eczema/Atopic Dermatitis.” American Academy of Dermatology.  2 November 2002.  [database on-line]; available from http://www.aad.org/pamphlets/eczema.html; Internet; accessed 15 July 2004.

“Environmental Hazards Trigger Childhood Allergic Disorders.”  World Health Organization, Europe.  4 April 2003.  [database on-line]; available from http://www.euro.who.int/childrenhealthenv/Publications/20020725; Internet; accessed 14 July 2004.

Frankl, Victor. The Doctor and the Soul. NY: Vintage, 1986.

Gordon, Mary. Introduction to The Collected Writings of Zelda Fitzgerald.  1997. Edited by Matthew J. Bruccoli  Tuscaloosa, AL: U of Alabama P.  xv-xxvii.

Hashizume, H. et al. (2005). “Anxiety Accelerates T-Helper 2-Tilted Immune Responses in Patients with Atopic Dermatitis [eczema] The British Journal of Dermatology. 1161

Jablonski, Nina. Skin. U of California P, 2012.

Kramer, Peter D. 1997.  Listening to Prozac.  NY: Penguin.

Kristeva, Julia. Powers of Horror: An Essay on Abjection.  1982. Translated by Leon S. Roudiez.  NY: Columbia UP.

Milford, Nancy. 1970.  Zelda: A Biography. NY: Harper Perenniel.

Sternberg, Esther. 2000. The Balance Within: the Science Connecting Health and Emotions.  NY: W. H. Freeman

Youngson, Robert. 1995.  Coping with Eczema.  London: Sheldon.

Williams, Hywell C. and Brunello Wüthrich. 2000.  “The Natural History of Atopic Dermatitis” Atopic Dermatitis: The Epidemiology, Causes, and Prevention of Atopic Eczema. Edited by Hywell C. Williams. Cambridge, UK: Cambridge UP, 2000.  41-59.

Zug, Katherine and Marilynne McKay.  1996.  “Eczematous Dermatitus: A Practical Review.” American Family Physician 54:4  (September):  1243-53.

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