Consultant Psychiatrist




Life transitions, like leaving high school and starting college, and transitions in t, like birthdays, and the start of a new year, are sometimes seen psychologically as “crises”. They are cross-roads, and can be times of heightened awareness, and arousal. They are sometimes stressful. They are times of potential change.

In Chinese “crisis” is written 危机 , which translated literally back into English is “dangerous opportunity”.

The psychological approach linked with crises is “crisis intervention”. During the run of normal life we are literally “in the habit” of getting on with things. Relatively speaking day-to-day life is “business as usual”. But in a crisis, when there is a disturbance – expected or unexpected – the usual equilibrium is upset. With this comes a sense of things being “up in the air”. There is now uncertainty, a potential for change. How things have been can be reviewed and plans made to change things for the better. So a crisis can be a good time to give, or to get help. In a crisis we are more accessible to learning new ways of being.

In clinic, when meeting a new patient who is asking for help with a longstanding condition like chronic atopic eczema, it is usually important to ask: “Well, why now?”. The Combined Approach to atopic eczema requires changing habitual behaviors, and motivation to change is important for success.

Recently a nineteen year old with chronic eczema explained that, as she was going to college and starting a new life, she wanted to improve her skin condition, and she had heard good things about habit reversal. We thought this bode well for her treatment outcome: she was changing her life, and changing her attitude to her skin.

Time will tell. Happy New Year!



Dr Christopher Bridgett (DrB) is a specialist in Adult General Psychiatry who has also worked in Dermatology since being first introduced to Psychodermatology by Arthur Rook in 1971. Together with dermatologists Richard Staughton (London) and Peter Norén (Uppsala) he co-authored Atopic Skin Disease - A Manual for Practitioners, which sets out a behavioural approach for the successful management of atopic eczema. Now retired from both NHS and private practice, he continues to teach and advise at Chelsea & Westminster Hospital, London and runs an online community for both practitioners and patients interested in The Combined Approach to the treatment of atopic eczema:

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