Psychiatrist calls for new mindset to overcome psychological burden of atopic dermatitis

With the advent of effective treatment options like biologics and JAK inhibitors, many patients have been freed from the suffering of severe atopic dermatitis.

However, some still struggle with the memories of enduring horrific daily symptoms such as nurning rashes and oozing lesions, as well as the psychological pain of social isolation caused by severe atopic dermatitis.

A forum was organized to comfort these patients and offer solutions.

Dr. Lee San, director of Yonsei Mountain Psychiatry, delivered a special lecture at the “Beyond Skin, Our Story” forum held at POSCO Tower Yeoksam in southern Seoul last Saturday to commemorate World Atopic Dermatitis Day the following day. Lee conveyed the message that “mental itchiness also requires treatment," advising attendees to shift their awareness, let go of negative thoughts, and explore various activities that engage the body, which is strongly linked to the mind.

Lee explained that becoming trapped in negative thoughts leads to being swept up in bad emotions, and as the emotional waves grow larger, one can develop a “disease of the mind.” Therefore, changing the “thoughts” that cause these emotions is crucial for mental health. To achieve this, a conscious effort is needed to let go of negative thoughts whenever they arise and to cultivate positive emotions.

Dr. Lee likened negative thoughts to a pink elephant, stating, “If you keep focusing on and repeatedly bringing to mind a pink elephant, it becomes hard to push away and leaves an afterimage. When negative thoughts accumulate, they can lead to ‘thought disease.’”

He continued, "If we diagram the flow of thoughts, emotions, and actions, we see that thoughts exist, those thoughts lead to a mood state, and that mood manifests as behavior. While artificially improving mood is difficult, pushing away the preceding thoughts can be somewhat easier. Therefore, regulating thoughts is considered crucial as a therapeutic strategy."

Among the myriad negative emotions, Lee cited “self-blame” as deserving particular attention.

“Among various negative thoughts, self-blame, such as ‘I'm inadequate’ or ‘I'm getting treatment because I'm worthless,’ deepens negative perceptions. One of the nine diagnostic criteria for major depressive disorder is self-blame or self-deprecation,” he noted. "You must stop habitually directing blame at yourself without realizing it. Self-blame is a habit. Consciously or unconsciously, persistent self-blame reinforces itself. It can become habitual, like a pink elephant gaining weight and growing larger. It's necessary to reflect on this at least once."

Negative emotions stemming from negative thoughts lead to a negative self-perception and foster a pessimistic view of the present situation. Dr. Lee defined this as a “cognitive error.”

“Even if you haven't been diagnosed with depression or reached that level, if negative thoughts take shape and solidify within you in this way, it's a sign you need self-development,” he explained.

Lee noted that when cognitive errors lead to misguided choices and focus, they can blind people to positive changes even when circumstances improve. Therefore, they must consciously seek out positive stimuli. Lee diagnosed this state as requiring improvement, stating, “If you ask a depressed patient to name their strengths, they'll say ‘none,’ but if you ask them to list their weaknesses, they'll name about a hundred. This is because a biased, negative view of themselves has formed.”

Director Lee San added this advice: just as wearing “black sunglasses” makes the world appear dark, wearing “depression sunglasses” can make everything seem negative. Therefore, one must make an effort to remove these depression sunglasses and view their current situation and environment with an objective perspective.

“Even without my actions, there are many people who treat me harshly, and the world is full of difficulties. Do I really need to add to that and make things harder for myself?” he said, urging people not to be harsh with themselves, to objectively recognize the situation, and to treat themselves kindly, just as they would treat others.

So, how can one escape negative thoughts and emotions?

Dr. Lee stated, “Since pushing away conscious thoughts isn't easy, the strategy we need isn't focusing on shifting them but redirecting our attention elsewhere. Instead of pushing, we should let them flow away. Maintain awareness while redirecting your focus to something else, like shifting your attention away from the pink elephant.”

Various methods are needed for shifting consciousness, and moving the body is an effective strategy. Director Lee advised, “Moving is naturally necessary for shifting consciousness. People say they don't feel like moving, but the order needs to be reversed. If you move, your mind will follow, so create things to move and shift your attention. There's another reason why moving is an effective strategy. If you stay still, you continue to think. Moving is also necessary to break those patterns.”

Another reason is the connection between body and mind. Director Lee said, "The body and mind are more strongly connected than we realize. If it doesn't work well at first, move with the thought, ‘I should make my body feel better.’ Moving will ultimately drive out negative cognition. At first, negative images can be overwhelming, and pushing them away may not be easy. But if you keep at it, you can eventually break free from those negative thoughts."

This is why the term “Mind Run” was coined. It signifies that physical activity, such as running, can nurture mental health. Director Lee San introduced Japanese author Haruki Murakami's memoir ‘What I Talk About When I Talk About Running,’ noting that when asked, ‘What do you think about while running? Murakami replied, "When I'm happy, I think happy thoughts; when I'm sad, I think sad thoughts. But most of the time, I think about nothing. But thinking about it, in a way, it seems like I run to enter that state of having no thoughts at all. In terms of the ‘disease of thought,’ activities that lighten and reduce thoughts are necessary.

Keeping a ‘Praise Notebook’ also helps.

Director Lee advised, “Write down five things to praise yourself for each day to shift your perspective,” adding, “It allows you to see yourself more positively.”

When struggling, leaning on someone to share warmth is also necessary. Director Lee San pointed out, “It's difficult if you think, ‘This is my own battle, my own feelings, my own hardship.’ Find someone to walk that path with you.” He noted that through companionship, rough edges can be smoothed out.

In conclusion, Dr. Lee emphasized that people can choose their thoughts. He introduced a passage from British author Charlie Mackesy's “The Boy, the Mole, the Fox and the Horse.”

“How we deal with things, that is our greatest freedom,” Lee said, quoting the book. “We can choose whether to hold onto thoughts about the pink elephant and let them grow, or simply let them pass.”

He continued, “Rather than clinging to the pink elephant and making it grow, we should let it go, comfort ourselves a little more, and find someone to walk alongside us. That is our greatest freedom. Rather than clinging to the pink elephant and feeding it, I hope we can let it go, comfort ourselves a little more, and gain more experiences of walking alongside someone."