Psoriasis is a CHRONIC AUTOIMMUNE DISEASE, which is to say the body cannot recognize which cells are part of the body and which are not. In a healthy body, the immune system turns on when it detects foreign and unwanted cells, such as viruses or germs from cuts and scrapes, moving quickly to eliminate them from the body. In a body with psoriasis, the immune system becomes a workaholic warlord, sending the body into a defensive inflammatory response even when there is no enemy to fight. The result is the production of RED, SCALY PATCHES on the body that can cover anywhere from the back of the left knee to the entire torso. In other words, psoriasis is a body unsure of what belongs and what doesn’t. In other words, a body ignorant of what it is, and what it isn’t.
I am a year old when my family immigrates to the United States. My parents had lived in America once before while my father was in college, but it was another five years before he obtained a work visa to return. Our first house is in Irvine, a small apartment on the second floor, accessible only by a set of spaced out metal stairs that terrified me as a child. In the mornings, after my father left for work in Monterey Park, a nearby Taiwanese enclave, my mother and I would walk to the neighborhood park, where she would flip through fashion magazines while I tried to find the optimal position for pushing myself on the swing set. It is there, in our small apartment with its metal stairs and widowed neighbor that sings all day, that my body first begins to show signs of my disease, flaking rashes erupting on my cheeks after wiping too hard with a napkin, a call from the preschool nurse about my chicken pox when my arms were really covered with another sort of red blotch. For months my skin slowly turns volcanic and ash, but my mother does not go to the doctor. Instead, she rubs my skin with mint and tea leaves, bathes me in oils sent from relatives in Taiwan. When that doesn’t work, she takes me to the park in June with long pants and a sweater. It was during one of these visits to the park that I push a younger girl off the swing set. Both of our mothers rush over after she begins to cry, and whenever my mother tells this story, she starts with her dread, the way her tongue forgot itself in a language it did not know. In her story, my mother musters out an apologetic half sentence; her voice thick with accent, and the other mother looks up from her daughter’s scraped knee. My mother sees a face like hers, almond eyes and pale golden skin. The woman replies in Mandarin. Beijing Mandarin, my mother likes to add, but Mandarin nonetheless. This is the story of my mother’s first friend in the United States. This is the story of a body learning to recognize an ally body, of two bodies made similar in a world of other bodies.
While psoriasis may appear to be similar to a number of highly infectious rashes, it is in fact NOT CONTAGIOUS. You cannot get psoriasis from looking at it, or touching the arm of someone who has it. Despite this, psoriasis often still appears frightening to those who have not seen it before, and may induce apprehension and discomfort from who notice it on someone else. Never mind the discomfort of the one who has it. Never mind the discomfort of a body that makes other bodies want to leave. Psoriasis is CYCLICAL DISEASE, and there will days when the body looks completely normal, and days when the body is as raw and tender as a skinned grape. The medication for the rashes creates discoloration and scarring, and so on most days, the body is part old battlefield, part volcano.
The first time I hear the word psoriasis, I am nine. My mother doesn’t trust Western doctors, with their manufactured pills and heavy jargon she cannot understand. She despises the long and confusing registration forms in the waiting rooms. It is only after I come home from school one day in tears, after a boy named Alexander refuses to hold my hands during PE swing dance class because he sees my rash covered arms, that she finally makes an appointment.
The doctor asks to touch the small eruptions of skin and plaque on my stomach and back. She hums to herself as she looks, runs a thumb over a patch on my arm and watches the dead skin crumple and fall away. I am reminded of fish skin, of the Safeway butcher scraping scales off our salmon dinner. When my father was in college in Chicago, someone left a rotting fish on his car windshield, along with a note that said, “Go home.” He did, eventually, but not because of the note. The doctor scribbles something on a notepad, talks in low tones with my mother. My mother follows along slowly, shaking her head more and more as the doctor speaks, and suddenly the doctor turns to talk to me. She tells me I have psoriasis, which makes plaque grow on my skin. She pauses, and I realize she is waiting for me to translate for my mother. I do. Ten minutes later, we leave with a prescription, a disease name scribbled on a business card.
There are numerous things in the world that are hereditary: eye colors, alcoholism, noble titles. Psoriasis is not one of them. Children with psoriasis-inflicted parents are NO MORE LIKELY to develop the disease than any other child. On the other hand, when my mother became an American citizen, the same year I was diagnosed with psoriasis, that citizenship passed down to me by default, and I knew nothing of the anthem, or of the Constitution and its equal treatment of all bodies. On the other hand, my mother, whose body did not create the psoriasis on my body, who knows nothing of this disease except for the way it covers her child’s body, spends years getting up early to rub my feet with lotion so that I do not wake up with cracked, bleeding soles.
When I am twelve, my parents decide to move back to Taiwan. They grow tired of America, of the way the waiters snicker when they order at Olive Garden, of commuting two hours to work at the only Taiwanese company in the area. I am outraged, both with the move itself, and with the fact that they call it “moving back home” when I had been to said “home” a total of three times in my life. In an attempt to placate me, my parents remind me of our family’s American citizenship, the blue palm sized books that deemed us un-foreign, un-invasive. You can always come back; my parents say when I begin to cry on the plane. Which is to say, they have to let you come back.
In Taiwan, I am neither invasive nor native. Street vendors speak in Mandarin when I first stop by, switch to English after they hear my American accent. My relatives greet me warmly and say nothing when I forget to greet an aunt’s daughter in law or a great-uncle’s first grandchild by title, a grand offense in most settings. They are quick to forgive because they remember where I am from, how moving back to Taiwan wasn’t really moving back for me at all. In Taiwan, the wet summer humidity, smoky warm honey in my lungs, makes me miserable, makes the psoriasis worse.
For the next six years, I wear long sleeves to school in tropical July, get to PE class fifteen minutes early so that I can change before anyone sees my legs. When my friends joke about the dark red patches on my neck and call them hickeys, I play along. I have creams for sunburns, creams for covering up scar tissue, creams for elbows and creams for feet, creams for the good days that I want to prolong into good weeks. I buy my prom dress four months in advance so that the tailor can sew extra fabric into the sleeves to cover my arms. There is NO CURE for psoriasis. It is a disease that is buried deep within your body’s coding, emerging when triggered and retreating when not. Treatments for psoriasis HELP WITH SYMPTOMS, deal exclusively with mitigating the damage that has already been done. It’s a disease you can only fight when it shows up.
In the 1800s, thousands of Chinese laborers show up on the shores of California, shipped over by American tycoons eager to use their labor in the mines and on the railroads. The Chinese work hard, and those who do not die in accidents send money back home to their families, to keep bodies on another continent fed and alive for another month. Many return to China after their contracts end, but some stay, raise children and start businesses in Chinatowns that will survive for the next five generations. For years, the Chinese workers are lauded as the solution to America’s labor shortage. By the middle of the 19th century, attitudes toward the Chinese turn hostile, and petitions to get rid of the yellow foreigners, with their strange hair and smelly food and penchant for taking jobs away from hard working Americans, are drawn up. In 1882, the Chinese Exclusion Act is passed. A paper is signed, a group of bodies are deemed foreign, deemed invasive. For the next six decades, all immigration from China, Taiwan, and Hong Kong is halted.
Yet the railroads stayed. The Chinatowns stayed, modern day tourist destinations for white bodies that want to feel foreign for a day. Stanford University stands, built from a fortune built from Chinese labor. To say America is separate from its Chinese workers, that they were temporary and invasive, would be inaccurate. I already know all this, because to exist in a foreign body in America is to know all this.
The first time I heard of psoriasis, the doctor described it as a disease that will grow on my skin. But to say psoriasis grows on the skin is inaccurate. Psoriasis is skin, is your body producing too much skin because it believes there is something out there from which the body must be protected. Psoriasis is a CHRONIC DISEASE, a lifelong companion, and to say I am separate from my psoriasis, that is it foreign to my body, is inaccurate. I am learning to understand my disease and my body, to understand how body and disease are one and the same. To fight an invisible enemy, to return again and again, against resistance, against dread; how can I not recognize my psoriasis for its own kind of resilience, for doing what I have always done? At the same time, how can I?
I want to wear shorts. I want Alexander to hold my hands in dance class. I want soft skin, like baby cheeks, like a body that doesn’t know better than to be soft.
**All phrases in caps are taken from various medical descriptions of psoriasis as a disease