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Excerpt
We have received a couple of communications regarding our article “Stigmata: Part I. Shame, Guilt, and Anger,” which appeared in Plastic and Reconstructive Surgery (104: 65, 1999). We hope that you publish these letters and, likewise, our response.
(1) We greatly appreciate Dr. Steven Levenkron’s kind comments regarding the article. There is no doubt that our initial engagement with these patients was a lucky combination of naiveté and patients who were well along in their own recovery. We agree with the criticism of the reviewers who felt that more thorough psychoanalysis was needed in these individuals. On further consideration, We realize that, in these particular patients, we were extremely lucky in that they were well along in their recovery. I certainly would encourage all plastic surgeons to establish a strong working relationship with a psychotherapist and to be sure to have these types of patients seen in formal psychiatric consultation before surgery.
To those interested in this area, we highly recommend Dr. Levenkron’s book Cutting, which is published by the W. W. Norton & Company of New York. (We would note that we have no financial connections in any way with Dr. Levenkron or with this publishing company). This book is an excellent exposition of the psychodynamics that occur in these extremely complex and challenging patients. In our clinic, we plan to move forward with further evaluation of patients who have been abused as children. We believe that the number of patients we are seeing is far beyond anything we could have ever imagined and that they come not only for relief of self-inflicted scars, but for relief in many other ways, as described by Dr. Levenkron and outlined in our article.
(2) We appreciate the interest of Drs. Elmore and Frank and we concur that a formal consultation with a psychotherapist is definitely indicated in treating patients with self-inflicted injuries. Note, however, that we continue to believe these self-inflicted injuries are not “suicide gestures,” but rather the result of ritualistic cutting. We would again implore our plastic surgical colleagues to abandon these pejoratives.
We look forward to participating with psychiatric and plastic surgical colleagues in the treatment of these extremely complex patients. “Stigmata: Part II. Nurses, Plastic Surgeons, and the Police” will deal with the recovery process and how plastic surgeons may better identify and help patients with a history of abuse.
