overtly measured, with the improvement clearly linked to the patient's new ways of coping. It becomes evident that taking the trouble is worth the effort. Habits are not only seen in overt behaviour: habit reversal is needed also in the ways of understanding and both by the patient, thinking about atopic skin disease and by others.
^ 0 £ Z
Attitudes — of others
G
Although feelings of impotence and pessimism come partly from the frustrating experience of long-term disability itself, the testimony of people with eczema points also to the relevance of attitudes of other people. These external influences include cultural factors generally, and views evidently originating in family life, especially during childhood. However, when some recollections of experiences of consulting professionals, including specialists, are considered, an important source of unnecessary difficulty becomes evident. Clearly the impotence felt by an advisor can be quickly transferred unwittingly to the person being advised; helplessness is contagious, and any useful advice that is offered will then end up quickly being forgotten as the patient leaves the consultation demoralised and depressed about their condition. In tackling this unhappy phenomenon with our patients, we take a first step by acknowledging that it is regrettably a real and relevant factor, and then go on to discuss how it needs careful handling. We explain how it is both possible and necessary to achieve a certain immunity to such negative influences, through both a greater personal understanding of what is required and also of how to get the best out of the professional help available. Each patient with atopic skin disease benefits from learning as much as possible about their condition, including the evident controversies that inevitably exist. Thus the patient can become his or her own expert, whilst working with the professional help available in a collaborative way. It is then possible to achieve the best possible results in the management of their own condition. For the professionals themselves there are two important issues. First, there needs to be a good understanding of the causes of long-standing atopic skin disease, and through that an understanding of a more rational and
« 5;
qc/3 > Q Q C M Jg r § S
73