Liz Atkin is an artist and an advocate for the destigmatisation of mental health. Having suffered from excoriation (also known as skin picking disorder) since she was a child, Atkin now uses art to work through her condition, creating intimate pieces and performances that explore the body-focused repetitive behaviour of this particular mental illness. Statistically, 4% of the population — one in 25 — suffer from skin picking or its sister illness, Trichotillomania, a hair pulling disorder. Many hide it from even those closest to them out of shame or the inability to stop. There are no clear causes for the disorder nor is there a cure and athough it often affects people in their youth, it can also be triggered later in adulthood.
We caught up with the effervescent artist while she was in town for the M1 Fringe festival, where she gave away free charcoal portraits to commuters riding the MRT in a project called #CompulsiveCharcoal. Confident, eloquent and full of positivity, Liz couldn't have been a better spokeperson for the importance of talking about mental health and how can art can help.
When did you discover you had a mental illness? I grew up in quite a turbulent home with an alcoholic parent. I think the disorder probably began when I was six or seven years old, but like many people who have this, I had no idea what it was. I hid it from everyone in my life for decades! It has many names, Compulsive Skin Picking, Dermatillomania, Excoriation Disorder.
I think I probably lived with it for more than 25 years before discovering this was a recognised disorder. In 2005 I did a Google search for skin picking and thought 'this is me' and realized other people lived with the same thing. Around that time, I completed a self-assessment at my GP which led me to meet a Cognitive Behavioural Therapist at the Maudsley Hospital in London. In more recent years, I have had problems with Severe Depression and Chronic Anxiety, so it was a nervous breakdown in 2014 which led to a more formal diagnosis of mental health problems.
How did you cope before you found art? For more than 20 years, Compulsive Skin Picking was something I was doing in private to cope with some of the challenging experiences I'd had in my life. Compulsive Skin Picking became a way of coping with feelings of anxiety, but of course it was extremely distressing to live with. The disorder is very complex, it's much more than just a bad habit. Picking at skin is a very normal human behaviour, but CSP is categorised by the repetitive picking at skin to the extent that damage is caused. It's not known why humans develop this disorder. For some, environmental factors influence the development of skin picking or hair pulling disorders, others have hereditary links where family members may pick. CSP may start by picking at an existing blemish, or even at healthy skin, in an attempt to smooth it out or make it feel more 'normal' but of course the picking leads to scabs, infections and eventually scarring which causes an awful vicious cycle where the behavior loops and you just can't stop. Often it was quite a pleasurable or relaxing thing to do. I'd experience an urge to pick, and this would lead to endlessly picking at different parts of my body, my face, my hands, by back and shoulders, my arms, my feet. Many people think it would hurt, but actually it's the opposite. That urge to pick could be overwhelming, and although the damage could be very severe, the gratification to pick could cause me to carry out the behavior over and over again. Sometimes I'd 'zone-out' and lose hours picking in front of the mirror. The effects were extremely hard to cope with, not just the marks and wounds and eventually scars, but the guilt and shame of the disorder dominated my life. It also developed into something I did subconsciously, some nights I would pick until the early hours of the morning, I would even pick in my sleep.
I masked and covered the illness from those closest to me, wearing clothes that concealed the parts of my body covered in scabs and scars, and even using make-up to mask it. I really did suffer in silence for a very long time. I got to a point where I didn't want this illness controlling me anymore. There were just perpetual cycles of shame, embarrassment and anxiety and I had no choice really but to try and help myself because it was destroying me. So what do you do with a disorder that is both a conscious urge, and an unconscious behaviour...? That's where I had to find out what this was, and that's where the journey with art began.
Tell us more about the artwork you make. With the disorder rattling along in the background of my life, I had always had a fascination for the body and performance, so from my early teens, I studied theatre. This led me to complete a BA in Drama and then ten years later a Masters in Dance. So these expressive disciplines had been in my life for a long time, I just hadn't been using them to look at the Skin Picking.
It was a class exercise that prompted me to make one of the boldest choices of all. We were recommended to look at our own pedestrian movement, and I filmed my body one day, that was where I saw my skin picking for the first time. I only lasted a fraction of a second before I started picking at my face on film and I decided to study it, to confront the illness head-on. Very slowly over two years I began to turn my illness into something else. Through dance I found I was able to express things I didn't have language for and began to channel the illness into something positive. I began making artwork directly about my skin, rethinking it through photography. A new understanding began, that there has always been this inherent physicality to the illness; it led me to look at repetitive movement patterns, to rethink my skin as a kind of soft canvas, and I found an imaginative transformation and healing process through photography.
I now explore the body-focused repetitive behavior of skin picking in my art practice and it's become a daily way to recover. I work with textural materials like latex, clay, acrylic paint to transform the skin. And much more recently, drawing has become one of the best ways of all to channel the illness away from my body... drawing is a tool for me to manage the physical urges of disorder every day. Art is now my biggest tool for recovery.
You were here in Singapore as part of the M1 Fringe Festival to do talks and give away free charcoal art drawings on the MRT for an art project that you do in the UK too.How has this project shape your work and advocacy for the destigmatisation of mental illness? #CompulsiveCharcoal began 18 months ago by accident. A friend gave me a box of charcoal sticks as a present and to stave off panic attacks and keep me focused during long commutes on the London Underground. I started drawing in sketchbooks but during one of those trips, I ran out of pages, so I decided to draw on a discarded free newspaper that was on a seat in a carriage beside me. There are often free papers littered all over London's trains after the morning rush hour. After I posted an image of the drawing on Instagram, it garnered a lot of positive reactions. It's a kind of graffiti recycling; grabbing newspapers and upcycling them. The next time I got on the Tube, I did the same thing and now, it's a thing I do wherever I am in the world. I draw on planes, trains and buses. This isn't just some kind of art project for the sake of it. Whenever I am sedentary, skin picking is something my hands will do automatically so to stop that from happening, I draw.
I had no idea what an incredible tool it would be to stop the CSP, but it's become the greatest solution. Someone here said the drawings I create even look very itchy! They are very quick, each one takes one minute, the speed of the mark-making is absolutely akin to the skin picking. Since I don't really need the drawings, I just need to do them, I began handing them to curious passengers who'd caught my eye and obviously wondered why I was furiously drawing at that speed in the middle of a packed carriage. An act of kindness for someone? Yes, but I also realised that many people would chat to me, little conversations about mental health were happening with strangers about these drawings. I do a huge number, up to 60 a day. I realized that for every drawing, this was a moment of connection, of advocacy for mental health, and a chance to let others know I am drawing because of Compulsive Skin Picking.
"In a year, I've given away up to 10,000 free drawings, and I now carry free postcards to explain the disorder. One encounter could cause a powerful ripple effect. That's 10,000 mental health conversations and from that, many thousands of people who may live with, or know someone who lives with CSP"
What were the Singaporeans' reactions to your work? Did you encounter anyone with your mental condition? On an average day I will speak with maybe six to 10 people who know what this is, or at the very least will talk a little about mental health. In Singapore, although passengers were a little more private and reserved, those conversations did happen. I had a Singaporean beside me quietly admit while I was drawing that she suffered from panic attacks and was a musician, so she played music to cope with her difficulties. A number of people at my talks during the Fringe Festival came up to me at the end and said they lived with Skin Picking disorder. I also had many others mention they knew others with the Hair Pulling disorder called Trichotillomania, this is the sister disorder to Dermatillomania, so I would say that there were parallel moments with the public in Singapore to the moments I have in London!
Singaporeans are really no different to Londoners in those initial moments seeing me drawing. I feel the flicker of someone's eyes looking at me drawing, the initial curiosity- and that's all I need for me to pass a postcard to them explaining why I'm drawing before handing them the completed drawing and starting another one. The expressions of joy and surprise are the same the world over! We don't expect to be given something for nothing.
In your case, you were already interested in art before you knew it could be a form of therapy. How and when did you discover that art could be the tool to help you best with your illness? Much of this has been a happy accident. I didn't train as an artist, I certainly had no idea how transformative art was going to be in my life. Much of it has evolved organically through the act of doing it. I only started drawing 18 months ago — and I don't think it was a remedy a doctor might have suggested for skin picking... but that's where the other part of my life has become important. Because of the transformative experiences I have had with art, it is now a fully connected part of my life. I teach art and drama in hospitals, hospices, prisons, universities and schools, approaching creativity as a hugely important tool to help others.
What is it about art that you find so therapeutic? Art gets in there without language and provides a channel to express some of this stuff. It can be very hard to put into words what it feels like to live with Skin Picking. But I can perhaps find a way to express this through a photograph, and that becomes very cathartic. Art is a powerful tool for us to also focus our minds — I find it to be extremely mindful, soothing, evocative and emotional, all in the same moment! That's a terrific thing, and it has become something I am passionate about offering to others. Teaching has become a very important part of my life now.
How does one diagnose if they have your condition and what are the current known remedial therapies? Is there a cure? There is currently no cure for Skin Picking and Hair Pulling disorders. But a lot of important research into these illnesses is currently happening in the US. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the diagnostic criteria includes: recurrent skin picking that results in skin lesions, repeated attempts to stop the behaviour, the symptoms cause clinically significant distress or impairment, the symptoms not being caused by a substance or medical, or dermatological condition and the symptoms not being better explained by another psychiatric disorder.
Have you faced much discrimination because of your illness? The discrimination of skin picking I'd experience was very subtle, I would see someone's gaze catch sight of a wound or scar on my body and the shame and guilt would flood through me because I'd think they'd know what it was. Sadly, I experienced a lot more discrimination when I got ill with depression and anxiety. I had almost a year off work, and I lost a lot of friends and colleagues at the time. People I'd known a long time, left my life. That was extremely painful. But as I started to get better I realized I could voice things to make a small change for that.
Recovery has given me the chance to advocate for mental health and work to reduce the stigma surrounding these conditions. Our brain is the most important organ to manage our bodies and our lives, but when it 'goes wrong' or we have problems that are to do with our mental health, it's stigmitised. That is something that needs to change.
"One in four will experience a mental illness in their lifetime so I am now committed to reducing stigma and shame each and every day about these disorders and mental illness. It's a personal and a professional journey!"
How important do you think is inclusivity in the arts? I'm really proud and grateful to have come to Singapore for the M1 Fringe Festival Supported by the British Council. There's a big push happening at the moment for the British Council to champion inclusivity in the arts in Singapore. It's about raising awareness for people with mental or physical disabilities to be able to feel welcomed in the art community. Be it through using art as a cathartic healing tool, to being able to embrace artists of such backgrounds. Sort of to build an equal opportunity playing field for everyone. Art is also not simply for those in that scene but is something which I believe is intrinsic in all of us. The ability for art to provoke thought and emotion in everyone can be used as a great tool to reach out to people out there who can use it as a form of therapy.
As an artist who is exploring mental health issues but also finding creative approaches to looking after ourselves, it feels like I'm riding a good wave here, in terms of putting my art to good use.
Do you think your illness has made you a better artist? Pretty hard to answer that! The art and the illness are intricately connected in my case — I think of it as a collaboration, a conversation between skin picking and the act of making. It has become what keeps me well. But art filters into other aspects of my life — I work in set design and teaching, where art is not specifically connected to the skin picking. I think the health connection in my artwork and practice has given me a lot of empathy to want to work with others who might be experiencing difficulties in their lives.
Considering that one in 25 have this disorder, where can people get more information this condition? The leading provider world wide of information, research and community for those of us living with Body Focused Repetitive Behaviours like Compulsive Skin Picking and Hair Pulling disorders is The TLC Foundation. No one treatment is affective and people respond to different approaches. Treatments include Cognitive Behavioural Therapy, Habit Reversal Therapy, some SSRI medications and psychotherapy.
You came during Singapore Art Week. What do you think of the art scene here in general? I managed to get to Art Stage on the Saturday just before I left Singapore. Some extraordinary work was on display there. I was really inspired to see such diverse sculpture, painting and drawings from Asia's visual art scene. I came away feeling very inspired to continue some of the large wall drawings that are occurring in my own art practice recently. I was particularly taken with the repetitive work of Yoko Choi from Singapore who is also working with mountainous images and mark-making. We met at the exhibition and had a really fantastic chat about our mutual interest in the monochrome/meditative act of drawing. I wish I had had more time to meet with other artists whilst I was there, but I do feel a great influence and I have returned to the UK deeply inspired.
Is there a dream project that you would like to do? I'd love to take my #CompulsiveCharcoal free drawings to other cities around the world! It would be amazing to draw on trains in different countries, giving art away and advocating for the disorder at every stage!
Liz Atkin was in Singapore for M1 Fringe Festival from 4 to 15 January. To find out more about her work, click here.