Why happiness is skin deep

Skin disorders are not just a physical issue, their psychosocial impact can have tragic consequences, Linda Papadopoulos tells Anne Sebba.

When "Nasty" Nick was expelled from the house in the hit television series Big Brother, the story made tabloid headlines. But for Linda Papadopoulos, a psychologist employed by the show to interpret the behaviour of contestants, the way the group reacted to Nick's transgressions was civilised. "They were very firm and managed to act like good parents. In fact, the group healed itself very well," she says.

Papadopoulos, a clinical counselling psychologist based at London Guildhall University, says the most surprising aspect of the programmes was not what was going on inside the house but the reaction from outside, especially in the media. "Many people said how terrible it must be to be watched all the time," she says. "But, to an extent, in everyday life we are watched all the time: phone calls are monitored and there are closed circuit TVs everywhere. That is the reason we only do certain things in our own house. We double check we are alone beforehand. So thinking we can get away from 'Big Brother' is quite naive. The series had many parallels with the outside world."

Papadopoulos believes that popularising knowledge-based psychology on television is important. "There are so many shows such as Oprah (Winfrey) and Jerry (Springer) that say so much that isn't research-based: in those cases, a little knowledge is a dangerous thing. But what psychologists say is research-based, which is the only reason we can say it. There is a real place for explaining psychology through the mass media."

Papadopoulos, a glamorous 29-year-old, concedes that many clients who consult her in her private practice are surprised by her appearance. "They expect me to be a bearded old man like Freud, who will take a 'tell-me-about-your-mother' sort of attitude," she says. "I think the demystifying process is important because it allows people to look at what psychologists do and to see that therapy could help their personal development and growth without having a taboo attached. We live in such a coping culture but sometimes it is important to admit that you need help."

It was partly a recognition of the way contemporary culture emphasises appearance and blights the lives of many who fail to live up to a glossy magazine ideal that led Papadopoulos to research the psychology of skin disorder. She is course director of London Guildhall's MSc in counselling psychology, a course she developed and set up and that has received a special commendation from the British Psychological Society. She hopes to set up a National Research Institute, which the university would run in conjunction with St Thomas's Hospital, London, to look into all aspects of psychodermatological illness, particularly the effects on the families of sufferers.

Born in Canada to Cypriot parents, Papadopoulos says she was aware from an early age of comments about the suitability of a couple dating according to how they looked. She also had a cousin who had the disfiguring disease vitiligo, a progressive condition involving loss of pigmentation in the skin for which no effective cure or treatment exists. Papadopoulos says that although psoriasis and eczema have been studied for years, she was one of the first to look at the psychological implications of vitiligo. She published the results of her preliminary investigation into coping with the condition in the British Journal of Medical Psychology last year, but her research with larger groups is ongoing.

"Skin disease is one of the most minimised conditions you can have," she maintains. "Although patients who visit their GP may say 'my skin is flaking, my wife won't touch me and I'll never whatever again,' they get told, 'Get a grip, you won't die.' That's what you'll get from the medical profession, which is largely concerned about quantity not quality of life. Few GPs are trained in dermatology, so often people will present with conditions that they could have treatment for but won't be referred because the GP doesn't see it as serious. However, skin diseases often lead to depression and feelings of withdrawal and, in severe cases, to suicide."

Papadopoulos is now involved in a research project examining whether people commit suicide because of acne or as a result of the skin getting better. "Acne is a great way to cover up all your problems by saying, 'I haven't got a job and I haven't got a girlfriend because of the acne,' but once the acne goes you have nothing left to blame," she says. Recent figures have shown that more than one in six young people with severe acne has felt suicidal as a result of their complexion and half say that they suffer from anxiety.

Papadopoulos tells of patients with acne asked to work in the back room of stores, of one asked to leave a restaurant because his severe facial burns might be upsetting to other customers; another was even spat at. Because skin disease, unlike most internal illness, is immediately visible, many people feel themselves being stared at, or worse. Complete strangers feel they have the right to comment and ask what the problem is. "What I try to do is displace that type of behaviour by asking, What does that say about them and what does it say about you?" Papadopoulos has long been aware that the psychological impact of skin disease has been under-researched and that little attention has been paid to the psychosocial problems experienced by people who suffer from skin conditions. "Any research in this field has tended to focus more on the loss of bodily function and physical handicaps," she says. She hopes her National Research Institute, which could be operating by January if she can raise the Pounds 400,000 needed, will redress this imbalance. The unit, of which she would be director, would initially have a staff of four. One function would be to set up a referral system because many clients are afraid to ask for psychological help and many doctors, unaware that professional counselling is available for these issues, do not offer it. The institute would also set up a register for bona fide researchers seeking willing participants for trials.

Papadopoulos is evangelical about the need for such an institute. "This was my idea and there isn't anything similar anywhere. If people could think every time they have just one pimple on their face how bad they feel walking down the street, then imagine what it is like to have an illness running out of control. There is so much more we need to learn."