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Book Review: Under the Skin: A Psychoanalytic Study of Body Modification

Alessandra Lemma has written an interesting and timely book about the important subject of body modification; forms of which have become increasingly socially acceptable. She draws on her extensive experience in and out of the consulting room to formulate her psychoanalytic understandings of the motivations and meanings for the individual who compulsively engages in modes of changing the surface of their body through the use of tattoos, piercings or cosmetic surgery. Lemma begins the book with a vignette of a 15-year-old boy in a young offenders’ institution, whose body was covered in tattoos. Initially she felt assaulted by his appearance; subsequently in the course of therapy she came to know about a terrified young man, serving a sentence for manslaughter, who had grown up in a violent and abusive home. From early adolescence he had used tattoos to attempt to (re)claim his body as his own from an intrusive mother. This experience powerfully conveyed ‘the psychic importance of the body and the ways in which internal fragmentation and hatred can be managed through changing the body’s appearance’ (p. 2). Lemma proposes that the more compulsive and extensive forms of body modification reflect a difficulty in integrating the ‘basic’ fact of life – that we cannot give birth to ourselves: ‘the body is living testament to our interrelatedness’. She outlines three dominant unconscious phantasies which she has found to be present in such individuals: the reclaiming phantasy – rescuing the self from an alien presence felt to reside inside the body, the self-made phantasy – expresses an envious attack on the object, and the perfect match phantasy – creating an ideal body that will guarantee the other’s love and desire (p. 5). She suggests that these phantasies function tomaintain the psychic equilibriumof these individuals. However, as she points out, they are frequently present in the same individual at different moments in the therapeutic process, and thus are not diagnostically useful, rather they emphasize different elements of the underlying narcissistic disturbance. This also alerts us to the danger of confusing description with explanation, which I think is greater when the economic and temporal dimensions ofmetapsychology are not considered. In her particular focus on object relations Lemma runs the risk of overlooking the importance of the economic dimension in the regulation of anxiety, affects and desire, derived from the drives, and of the role of temporality in the structuring and functioning in the unconscious of unconscious phantasies. Lemma states that her psychoanalytic approach is object relational; her understanding of the patients she discusses is predicated upon a number of