Sergio del Molino was 21 years old when he first experienced symptoms of psoriasis, a chronic autoimmune condition that causes an overproduction of epidermal cells, resulting in scaling on the surface of the skin. These scales appear in red blotches that sometimes crack and bleed. For the next 20 years Del Molino endured considerable physical discomfort – arthritis, back pain, chronic fatigue – and bodily shame; he avoided wearing T-shirts and shorts, and even in the height of summer he would have his shirt buttons done up all the way. Medical interventions provided only limited relief until a medicine called adalimumab bought the disease under control.
Del Molino came to literary prominence in his native Spain with an award-winning memoir about the loss of his baby son, who died of leukaemia before his second birthday. La Hora Violeta (2013) – published in English as The Violet Hour (2016) – was an erudite essay on grief and mortality. In his latest book, published in Spain in 2020, and translated into English by Thomas Bunstead, the story of his illness is a springboard for a wide-ranging meditation, in which the author revisits the lives of several notable psoriasis sufferers – from notorious thugs such as Joseph Stalin and Pablo Escobar to literary doyens John Updike and Vladimir Nabokov – to explore the nexus between the skin and the psyche.
That Stalin’s great purge of 1936-38 was orchestrated by two fellow psoriasis sufferers – secret police chief Nikolai Yezhov and public prosecutor Andrei Vishinski – strikes Del Molino as a coincidence worth examining: “What is the likelihood of a dictator with psoriasis recruiting two henchmen with the same illness to carry out his most ambitious extermination plan?” He playfully suggests that we might view the campaign of repression as pure psychodrama – an industrial-scale revenge fantasy: “It was all down to a skin irritation, rheumatic pain, shame.” Conversely, on a happier note, Updike credited his psoriasis as the driving force of his talent, remarking in his memoirs that: “Whenever in my timid life I have shown some courage and originality it has been because of my skin.”
A running theme is the chicken-and-egg question of whether ill health determines mood and character, or the other way around. The onset of Nabokov’s psoriasis during his French exile in 1937 happened to coincide with his extramarital romance, which was enough to convince him that it had been brought on by stress and guilt, and that he should end the affair. Perusing Nabokov’s letters to his wife, Vera, Del Molino observes that Nabokov’s tone shifts markedly after he wangles a free skin treatment from a fellow émigré: “As soon as the psoriasis is dealt with, the irritation in the person’s words also disappears, an ebullience enters the things they say and their adjectives become unscaly.”
The great strength of the themed essay-memoir – the sheer elasticity of the format, which allows for all manner of disparate things to be tethered to a central concept – can also be a weakness: if the hook is too tenuous, the reader begins to feel patronised. Del Molino’s chapter on the pop singer and psoriasis sufferer Cyndi Lauper, in which he celebrates her 1983 hit Girls Just Want to Have Fun and makes a persuasive argument for a radical politics of leisure, is a case in point. The connection to Lauper’s psoriasis – which materialised more than two decades after her 80s heyday – is flimsily contrived. Likewise, a chapter on skin colour and racism, though cogent and insightful, sits a little uneasily alongside the rest of the material.
In fairness, del Molino’s digressions are usually good value. There’s a touching anecdote about the time he unwittingly gave a cigarette to a lung cancer patient on an oncology ward, prompting a sober reflection on the platitudinous, quasi-militaristic rhetoric around terminal illness: “Society has all the time in the world for the optimists putting up a fight, and none at all for the cantankerous old men bumming cigarettes in hospital wards.” The sentiment calls to mind Anne Boyer’s powerful cancer memoir, The Undying (2019), which dissects this issue at length.
The idea of a correlation between physical and moral ugliness takes us into tricky ethical terrain. When Del Molino speculates that “those who are made into freaks by skin conditions have a desire to pass on their blemishes, eruptions and wounds to everyone else”, he draws on an age-old preconception. Pop culture abounds with malevolent baddies who are embittered and vengeful due to some disfigurement or disability. The trope plays on, and reinforces, ableist prejudice, but its psychological plausibility makes it enduringly seductive. Skin embraces this contradiction between our better impulses and our innermost anxieties: none of us, however enlightened, is entirely immune to this stuff. Two decades of illness shaped Del Molino’s sense of himself as a monster. When his symptoms finally cleared up, the shame persisted: “In some way that I can’t explain, I am still a leper with a cowbell around my neck.”
• Skin by Sergio del Molino, trans Thomas Bunstead, is published by Polity (£20). To support the Guardian and Observer, order your copy at guardianbookshop.com. Delivery charges may apply.