HX26 Her skin and the skin: Mary Shelley and a work of fictitious disorder?

Abstract Mentioned in all her major works, not just Frankenstein, for which she is most famed, the theme of ‘the skin’ in Mary Shelley’s writing often represents a boundary: between the real and the imaginary, between the beautiful and the frail, and also between human vitality and the body grotesque. The skin of her most famous creation, ‘the creature’, as life giving as it is horrifying, is ‘translucent, stretched and yellow’ and ‘scarcely covered the work of muscles and arteries beneath […] he was ugly then’. Shelley herself may have had deeply personal reasons for the skin appearing as a recurring theme in her writing. Between the years of 1810 and 1814, aged just 13–17 years, Shelley suffered extensively with a ne’er diagnosed painful skin condition affecting, curiously, only one arm, but by record its entirety. Mary was treated with poultices, a topical wet concoction of natural matter intended to purify and soothe, but which, of course, could also have worsened the problem. Wrapped in place with cloth and sometimes stitched closed, the rudimentary bandaging evokes the imagery of the stitched skin of the creature himself. Of the differentials proposed in the literary world for Shelley’s affliction, inflammatory dermatoses, particularly dermatitis and psoriasis, have been forerunners; connective tissue disease and infectious causes have also been suggested and garnered argument. Stress is a viable but not well-explored suggestion, but crucially, within this diagnostic category is the hitherto neglected possibility of a psychiatric disorder of the skin, namely dermatitis artefacta, which this paper proposes. First described as a distinct dermatological condition in 1877 by Dr George Morgan, dermatitis artefacta was not an entity that would have been well conceptualized in the time of Shelley’s youth, but certainly as a young girl she possessed many of the risk factors we now recognize for the disease. These included loss of her mother at a young age and a resulting difficult family life, possible low mood and prolonged periods of separation from her home. Following a change to her circumstances in 1814, the malady did not afflict her again. Thus could the sudden onset of a unilateral, localized, skin disorder that persists for some years in a vulnerable adolescent, and that resolves as mysteriously as it appeared, compel the modern dermatologist to consider dermatitis artefacta? Shelley’s life, her great works and indeed her suffering with her own skin demonstrates the importance of the complex interplay between psychological distress and dermatological disease that we now understand to be so central in the practice of modern dermatology.