The letters of Vladimir Nabokov highlight the psychological impact of psoriasis
A new research letter published in the British Journal of Dermatology has hypothesised that Vladimir Nabokov, the famous 20th century author best known for his novel ‘Lolita’, suffered from severe psychological distress due to his chronic psoriasis.
The condition, while never referenced in his fiction, is a recurring theme in his letters to his wife Vera between 1923 to 1977. At the time when Nabokov was writing and long after his death, psychodermatology, the management of psychosocial impact of skin conditions, did not even exist as a discipline.
Psoriasis is a long-term condition that affects one in 50 people and may come and go throughout a person’s lifetime. The condition presents itself as well-defined pink or red (depending on skin colour) areas with silvery scales. These areas can be very flaky and crusty and may be sore and exceedingly itchy. Although psoriasis appears normally in smaller patches, known as ‘plaques’, these plaques can cover large parts of the body in cases of moderate to severe psoriasis.
The link between psoriasis and psychological distress has been researched before, with the rate of psychiatric distress and depression from psoriasis being around 10 per cent to 58 per cent and suicidal thoughts in psoriasis patients ranging from 2.5 per cent to 7.2 per cent.
Nabokov himself struggled with suicidal thoughts, writing in 1937:
“I’m so tortured by my Greek”*… “now I can tell you straight that […], I’d reached the border of suicide”.
Nabokov’s psoriasis made him extremely itchy, causing insomnia, and worsening his mood, something that is not uncommon amongst people with psoriasis.
“I don’t sleep at night because of its furious itchy – and this greatly affects my mood”.
Also:
“Sometimes I simply thought I was losing my mind”.
Embarrassment of his condition also seemed to burden him, he wrote of “…constant thoughts about my bloody underwear, blotchy mug** and the scales pouring down on the carpet”.
The researchers also hypothesised that a particularly severe flare of psoriasis that occurred during his time in France may have been linked to the stress of being unfaithful to his wife. Adultery is a theme addressed in Nabokov’s work, notably in novels such as ‘Lolita’ and ‘Pnin’.
The psychological effect of psoriasis on this prolific 20th century writer serves to highlight the usefulness of psychodermatology in the treatment of patients of skin conditions, especially in severe cases such as with Nabokov.
Dr Laurie Rousset, one of the researchers from the Dermatology Unit at the Hôpitaux de Paris, France, said, “Nabokov’s psoriasis is known about, but the psychological impact of his condition is not discussed enough. His letters paint a vivid picture of a man who was often tormented by the symptoms, social anxiety, and who struggled with shame. Nabokov’s experiences highlight how important it is that patients feel in control of their condition and are happy with their treatments.”
Daragh Rogerson of the British Association of Dermatologists said, “Treatments for psoriasis have come a long way since Nabokov’s time, as has the availability of psychological support. The itching, the insomnia, and the emotional toil of the condition are still common themes raised by patients. This is one of the reasons why we launched our support website, Skin Support. I hope this powerful testimony will highlight to both doctors and patients the importance of managing the mental aspects of this condition, as well as the physical.”
The British Association of Dermatologists’ Skin Support website is available at skinsupport.org.uk. The website brings together, and links to, patient information leaflets, support groups, self-help materials and help-lines.
