I think almost everyone with eczema will notice that stress makes it worse. With J. I can see it clearly. We moved to Germany about a year ago and when we left the US we thought that we had almost overcome eczema, so nice and smooth was his skin. Of course it helped that we had a couple of months vacation where he could spend much time outside.  Then both, my husband and I, started to work and J. started daycare. His skin got much worse over the next few months. Several factors might have contributed:  there was the new environment and the excitement about our move. J. stared to go to daycare and we couldn’t control his diet as well (even though we are not sure about the milk, we still don’t give him cow’s milk and only goat yogurt). That all might have put much more strain on him as his usually happy and cheerful nature might suggest. Besides the general and obvious excitement (good and bad) that worsens his skin, I have the feeling that he also reacts very sensitively to stress around him. Whenever I have much work or are otherwise nervous or there is some change in our daily routine, I have the impression that he is immediately itching more. The name for atopic dermatitis in German is Neurodermitis, suggesting a neuronal connection. While the name Neurodermitis has a rather historic than scientific basis, I still believe based on my own experiences with J. that eczema do have a psychological component.

When I recently searched the internet for some more information about eczema I came across the site of the psychologist Dr. med B. Frederich who is treating the psychological component of eczema through psychotherapy.  I happened to meet him many years ago on an occasion unrelated to eczema. His collaborator Dr. Niels Birbaumer is a well known psychologist. We live too far away from Dr. Frederich to use his services, but I think the information on his website is quite insightful and at least gave me something to think about. Unfortunately this website is only in German, but I will try to summarize the main points:

Dr. Frederich does not deny a genetic predisposition. He rather suggests that whether genes are switched on (and eczema break out) depends to a large extend on the person’s psychological circumstances. He claims that the mind is able to eventually switch off again the gene and to make eczema disappear (“healing starts in the head”). His main hypothesis is that a person (or child) with eczema is very much afraid of the phrase “you have to!”  and is afraid that he 1. has to do something (he does not want to do) and  2. does mistakes, for example disappoints others or loads guilt on him [check. that is my son]. The therapeutic approach is then to learn to deal with this “you have to”.

But what is the reason for this “allergy” against “you have to”? Dr. Frederich’s observations suggest that in many cases the mothers (or parents) of children with eczema are insecure and therefore inconsistent, which leads to a lag of the feeling of security for the child. The child can’t fully let go, relax and recharge. (check. I do see myself here to some extend. I wasn’t a so natural first time mom). Dr. Frederich says that very often insecure and inconsistent parents create an atmosphere that loads to much responsibility onto the child which causes a constant strain, which eventually can lead to itch attacks and eczema. The child “has to do” to much starting in earliest childhood. The child basically says: “I have to do a lot for others (take responsibility), but one should not ask it from me (I just don’t want to “have to” even more!)”.

The therapeutic recommendation of Dr. Frederich is to learn to deal with “you have to”, and to evaluate to which extend it really is a “you have to”, before opposing it. It is important to learn to not automatically oppose everything but to first listen and then evaluate what to do with the demand and eventually be in favor of things. But the main point is to learn that it is ok to make mistakes and to eventually disappoint others.

For families with a small child he recommends: be loving but consistent. Create a framework for your child which is predictable. Don’t allow exceptions from the rule. Parents don’t always agree about education and thus generate inconsistencies and insecurity for the child.  But because there is in general no “right” or “wrong” education, it is better to do something “not-so-useful” but consistent than having both parents disagree.

Dr. Frederich gives me some ideas to think about. J. is allergic to “you-have-to”, even the educators at the daycare told me several time. He can’t handle criticism well. He tries very much to please everyone. My husband and I are both involved in his education and don’t always agree. I wonder how I can put Dr. Frederich’s advise into action….

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