"Under the Skin: A Psychoanalytic Study of Body Modification".

By Alessandra Lemma

Published by Routledge 2010. ISBN 978-0-415-48570-8

Reveiwed by Brian J Muir

This is an interesting and valuable book, and, to my knowledge, one of the few (or perhaps the only psychoanalytic one) devoted to the subject of the body and its relation to the mind, since Paul Schilder’s classic “The Image and Appearance of the Human Body”.

Over the past two decades or so, psychoanalysis in Australia and Britain has moved further and further away from the body into the inner world of phantasy. We seem to have lost sight of Freud’s statement that “the first ego is a body ego”. By this I mean that we have been more interested in focussing on anxiety and defence, psychic conflict, destructive phantasy, obstructions to creativity and so on – issues generally related to psychoanalysis as an ethical activity. We seem to have lost sight of the human mind as embedded in bodily sensation and experience. This book is a salutary reminder of the primary importance of our bodily existence as it influences our states of mind and sense of self. Lemma writes of the ubiquity in our society and culture of a Cartesian mind/body split, giving rise to a psychic retreat with mind as self and body as other, to protect the self from the inner meanings of the body-self. The book is well written and of an orientation that will be familiar to analysts and therapists of the British Kleinian and Object Relations tradition.

The chapter headings are a good guide to the themes discussed and Lemma opens with an account of the affirming impact of the mother’s admiring gaze (or depriving lack of it) on the baby’s earliest sense of body-self. Being looked at and admired is a universal human wish and well attested to by our interest in fashion, cosmetics etc. and being “seen” socially. But so also the converse, - fear of being seen as ugly, and vulnerability to social phobias, shyness and extreme self-consciousness. Being the impact of someone’s gaze (or the camera’s lens) is compellingly tempting and can lead to exhibitionism or a yearning for and entitlement to an idealized mother, along with a need to attack a failing object mother, or one unsupported by a sheltering and concerned father. Lemma’s discussion takes account of how being seen is almost never isomorphic or congruent with the way the subject sees herself. The body is both subject and object, and this dichotomy is a dilemma that can lead to an unpalatable asymmetry. A similar asymmetry exists early in life for the baby who is seen and known but from her vertex sees and does not know – or rather knows only in small part in primitive phantasy. Lemma refers to Meltzer’s notion of aesthetic conflict arising from this situation, and leading to envy of the providing object mother or other. She gives two illuminating quotes from Proust and Sartre, which I shall reproduce here.

“I might caress her, pass my hand slowly over her, but, just as if I had been handling a stone which encloses the salt of immemorial oceans or the light of a star, I felt that I was touching no more than the sealed envelope of a person who inwardly reached to infinity. (Proust 1972 248-249)


“The other looks at me and as such holds the secret of my being, he knows what I am. Thus the profound meaning of my being is outside of me, imprisoned in an absence.” (Sartre 1943, 207, Lemma’s italics)

And so, the impact of the mother as mirror reflecting the body-self as admired – “you are the apple of my eye” - or, the neglected and unwanted converse. In chapter 3 the author amplifies an account of this dynamic and of what can go wrong such as the projection into the object of a damaged and hated other and a re-introjection of a retaliatory and hating object mother. The wish to be the only maker and origin of oneself leading from this state of affairs goes on to a discussion of Mary Shelley’s “Frankenstein” and S. Gold’s account of the pathological narcissism as a consequence. These and other dysmorphic body disturbances (like feeling ugly) can motivate attempts to re-make oneself by means of body modifications of various kinds.

In the following chapters, Lemma offers a full and informed discussion of the various forms of body modification and the unconscious phantasies of love and hate, autonomy and dependence, motivating them. Her accounts are informed not only psychoanalytically and from her extensive clinical work, but also by her reading of sociological works by respected authors such as Giddens (Modernity and Self Identity 1991), who suggests that the increasing complexity of modern life in the West and the individual isolation this can lead to in the modern world, fosters a retreat into more manageable self improvement projects focussed on the body.

Topics covered in the book include body piercing, cosmetic surgery, limb removal, gender change surgery, tattooing and the influence (often deleterious) of the fashion and cosmetics industries and their massive advertising campaigns. The unconscious phantasies along with conscious body dysmorphic states of mind and their accompanying feelings of shame and fear are fully explored in terms of early mother-child relationships and the disturbances thereof such as rejection, neglect, over-intrusiveness, posessivness and parentification and their accompanying disturbances of dependence/autonomy conflicts, many of which lead to psychotic solutions. Coming from an author of Kleinian orientation there is a refreshingly open minded approach to the relevance of trauma and privation with regard to the development of the embodied mind. This is an impressive work by an author who is clearly well experienced in her topic and it is a pleasure to read. I can strongly recommend it, especially to analysts and therapists who are working primarily with adolescents. The book is well researched and there is and extensive reference list.