Under the Skin ─ A Psychoanalytic Study of Body Modification

Under the Skin considers the motivation behind why people pierce, tattoo, cosmetically enhance, or otherwise modify their body, from a psychoanalytic perspective. It discusses how the therapist can understand and help individuals for whom the manipulation of the body is felt to be psychically necessary, regardless of whether the process of modification causes pain.
In this book, psychoanalyst Alessandra Lemma draws on her work in the consulting room, as well as films, fiction, art and clinical research to suggest that the motivation for extensively modifying the surface of the body, and being excessively preoccupied with its appearance, comes from the person’s internal world – under their skin. Topics covered include:


body image disturbance
appearance anxiety
body dysmorphic disorder
the psychological function of cosmetic surgery, tattooing, piercing, and scarification.

Under the Skin provides a detailed study of the challenges posed by our embodied nature through an exploration of the unconscious phantasies that underlie the need for body modification, making it essential reading for all clinicians working with those who are preoccupied with their appearance and modify their bodies including psychotherapists, counsellors, psychiatrists and psychologists.

Alessandra Lemma is a psychoanalyst and a clinical and counselling psychologist. She is a Member of the British Psychoanalytic Society, a Senior Member of the British Association of Psychotherapists, and Associate Fellow of the British Psychological Society. She is the Trust-wide Head of Psychology at The Tavistock and Portman NHS Foundation Trust and Honorary Professor of Psychological Therapies at the School of Health and Human Sciences, Essex University. She has published widely on psychotherapy and psychoanalysis.

The Body as Canvas. As You Desire Me. The Symptom of Ugliness Mirrors. Being Seen or Being Watched. Occupied Territories and Foreign Parts: Reclaiming the Body. Copies Without Originals: Envy and the Maternal Body. The Botoxing of Experience. Ink, Holes and Scars. An Order of Pure Decision.