Consoli Sylvie G
Med Sci (Paris). 2006 Feb;22(2):197-200. doi: 10.1051/medsci/2006222197.
To construct a coherent identity, humans must distinguish what belongs to the external, perceived world from what belongs to their own inner world and the inner world of other individuals. Based on the theory developed by S. Freud and on work by ethologists, a number of psychoanalysts (J. Bowlby, R.A. Spitz, D.W. Winnicott, etc.) have underlined the importance of early tactile exchanges with the mother if a child is to become an autonomous individual who feels secure within what he or she perceives to be sound and reliable mental and physical boundaries. More recently, other psychoanalysts (E. Bick, W.R. Bion, etc.) have studied the fantasized mental structures that form the limits between an individual's inner mental space and the external world (including other individuals). As part of this theoretical psychoanalytical movement, Didier Anzieu, a French psychoanalyst, started to develop the concept of the "Moi-peau" in 1974. The "Moi-peau" designates a fantasized reality that a child uses during its early development to represent itself as "me", based on its experience of the body surface. The child, enveloped in its mother's care, fantasizes of a skin shared with its mother: on one side the mother (the outer layer of the "Moi-peau"), and on the other side the child (the inner layer of the "Moi-peau"). These two layers must separate gradually if the child is to acquire its own me-skin. D. Anzieu's work allowed dermatologists and other specialists, such as pediatricians, to focus on the quality of early tactile exchanges between a mother and her child, including the child with a chronic skin disorder. It also helped dermatologists to recognize patients with "borderline" states, which are particularly frequent in dermatology (ereutophobia, dysmorphophobia, tattooing, self-mutilation, artefacta dermatitis). These borderline patients are adults who, as a result of their mental conflicts, adopt defense mechanisms derived from both neurotic and psychotic functioning. Their complaints reflect difficulties with the solidity of their mental and physical limits: their real skin is metaphorically linked to the fantasized mental structure that delimits the individual mental space. Among other clinical characteristics, they have a "pathology of action" and frequently attack their own skin, paradoxically, in order to test the solidity and reliability of their own limits. Finally, D. Anzieu's work encouraged dermatologists to use psychotherapeutic approaches in parallel to classical dermatologic approaches, when necessary, and helped them better understand how psychoanalysts work with patients who have not yet acquired their own "Moi-peau". As a result, D. Anzieu was among the first to reconcile dermatologists and psychoanalysts.
为构建连贯的身份认同，人类必须区分属于外部感知世界的事物与属于自己内心世界以及其他个体内心世界的事物。基于S.弗洛伊德提出的理论以及动物行为学家的研究成果，一些精神分析学家（J.鲍尔比、R.A.斯皮茨、D.W.温尼科特等）强调了如果孩子要成为一个在其认为合理且可靠的心理和身体边界内感到安全的自主个体，早期与母亲进行触觉交流的重要性。最近，其他精神分析学家（E.比克、W.R.比昂等）研究了构成个体内心心理空间与外部世界（包括其他个体）之间界限的幻想心理结构。作为这一理论精神分析运动的一部分，法国精神分析学家迪迪埃·安齐厄于1974年开始发展“皮肤自我”的概念。“皮肤自我”指的是孩子在早期发育过程中基于其体表体验用来将自己表征为“我”的一个幻想现实。被母亲照料着的孩子幻想有一层与母亲共有的皮肤：一边是母亲（“皮肤自我”的外层），另一边是孩子（“皮肤自我”的内层）。如果孩子要获得自己的“我 - 皮肤”，这两层必须逐渐分离。迪迪埃·安齐厄的研究使皮肤科医生和其他专家，如儿科医生，能够关注母亲与孩子之间早期触觉交流的质量，包括患有慢性皮肤病的孩子。这也帮助皮肤科医生识别出“边缘性”状态的患者，这种情况在皮肤科尤为常见（恐痒症、畸形恐惧症、纹身、自残、人为性皮炎）。这些边缘性患者是成年人，由于他们的心理冲突，采用了源自神经症和精神病功能的防御机制。他们的症状反映出他们在心理和身体界限稳固性方面存在困难：他们真实的皮肤在隐喻意义上与界定个体心理空间的幻想心理结构相关联。在其他临床特征中，他们有一种“行动病理学”，并且经常攻击自己的皮肤，自相矛盾的是，目的是测试自身界限的稳固性和可靠性。最后，迪迪埃·安齐厄的研究鼓励皮肤科医生在必要时将心理治疗方法与传统皮肤科方法并行使用，并帮助他们更好地理解精神分析学家如何治疗尚未获得自己“皮肤自我”的患者。因此，迪迪埃·安齐厄是最早调和皮肤科医生和精神分析学家关系的人之一。
