Picture this: a person with psoriasis, standing practically naked in a cylindrical light box lined with vertical eight-foot-long ultraviolet light bulbs that form a complete enclosure. Her eyes are shielded by dark goggles to protect the corneas from UV damage, she is wearing a pillowcase over her head to protect her face. Her nipples are also shielded, as are the genitals in men. Fans whir, circulating stale basement-office air through the bowels of the medical center. When the lights come on, bathing not just the light box and the patient inside it, but also, because the top is open, the entire room with an eerie, violet glow, their intensity is ferocious, irradiating every surface of the body that is exposed to specifically chosen and particularly potent wavelengths of ultraviolet light.
The treatment is known as phototherapy. In order to prevent the skin from burning, the person comes for treatment three times a week for many weeks, and the length of exposure is gradually increased, from about thirty seconds at the beginning to maybe ten to fifteen minutes after a few weeks, depending on the patient’s skin type. Over time, the raised, red, inflamed patches of skin, which in severe cases cover large parts of the body, begin to flatten and change color, looking more and more like the person’s normal skin. When the treatment is complete, the skin looks entirely normal and clear. There are no more scaly patches.
The treatment is not a cure, however. The unsightly patches can return. Recurrent episodes are often triggered by psychological stress. Little is known about the genetic predisposition, the primary causes, or the molecular biology of the disease. It is an uncontrolled cell proliferation in the epidermal layer of the skin, but it is not cancer. The rapidly growing cells do not invade other tissues, nor does the disease result in ill health or death. It is, however, disfiguring in some cases, and psychologically debilitating. It can feel like having a plague.
I learned about psoriasis and phototherapy one day at a University of Massachusetts Department of Medicine retreat in the early 1980s. I happened to sit down for lunch with a young, cheerful-looking man who, as it turned out, was the chief of dermatology, Jeff Bernhard. We got to talking, and when he found out I ran the department’s Stress Reduction Clinic, where we taught Buddhist meditation practices to the patients (albeit without the “Buddhism”), he asked me if I knew the book Zen Mind, Beginner’s Mind, by Shunryu Suzuki.
I was amazed just to hear that he had read it and further amazed that he loved it. So we fell to talking about meditation and Zen, and about how we were offering the rudiments—and what we hoped was the essence—of just such training and practices to our patients. I saw the lightbulb go off in his head as he asked me if I thought we could train his psoriasis patients undergoing treatment in the phototherapy clinic to relax while they were in the light box.
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