map Psychiatry 101

by Holly Tri

Published in Issue No. 255 ~ August, 2018

The process of skinning a human being is similar to that of skinning any mammal. Of course, our goal is more medicinal, and therefore, we’ll be following the certain procedure that will be most beneficial to the patient. Remember, there may be more than one way to skin a cat, but there is only one proper way to skin a human.

The first difference, as you will note from today’s volunteer, is that the human patient is still living, breathing, actually aware. Human skinning has been an approved medical practice since the mid-twenty-first century. Developed by leading neurologists and psychiatrists at Oregon Health & Science University, skinning has the purpose of releasing pressure within the human body, as no other procedure can.

Early studies showed that live skinning increased complete recovery chances for patients diagnosed with PTSD and other forms of severe anxiety to nearly 62%, well over the results of psychotherapy, medication, or any combination thereof. These results brought the technique to the forefront of twenty-first century medicine, and decades later, the treatment has been nearly perfected, with full recovery numbers just below 90% of patients. It is one of these important techniques that we will focus on in today’s demonstration: removing the skin in one piece.

Today’s volunteer is a thirty-four-year-old female who’s been suffering from acute anxiety due to trauma in her formative years. The patient has been under the care of psychologists and social workers off and on for the past fifteen years. Traditional treatment methods have had limited success, and over time, stress within the brain has led to damage elsewhere in the body, namely the head, lungs, and reproductive organs. The success of today’s procedure is expected to be high.

Live skinning is generally not performed on a patient until all other forms of treatment have been exhausted, though today’s researchers are working to show the procedure is worth the high expense if it relieves the symptoms of nearly all patients who participate. I expect we’ll see a change in the law sometime in our lifetime.

We don’t sedate the patient at this time, as it is imperative to the success of the procedure that the patient is aware of the release that is occurring throughout the body. Instead, we are administering a procaine-family anesthetic that will take the edge off the pain and discomfort, allowing the patient to concentrate on the sensations she’s experiencing.

Now, the number one thing to remember is that for proper success, the skin must be removed as a single, unbroken sheet. Other methods have been experimented with, with only limited results. What I’m about to demonstrate is the most current AMA/APA-approved method, guaranteeing that almost 90% success rate.

Once the patient is anesthetized and relaxing, we can begin the incisions, which we will complete before starting the process of actually removing the skin, as it will make the job simpler in the end.

Using the scalpel, we begin with a long, smooth incision running from the bottom of the chin; down the neck, chest, and stomach, and finishing just above the genitals. Be sure to cut only through as far as the hypodermis, as deeper could cause severe hemorrhaging. Note how the skin at the incision quickly puckers, pushing against its counterpart in the early stages of healing. It’s necessary to work quickly so the removal process can begin before too much healing has occurred. If the tissue does begin to rejoin, fresh incisions will need to be made, and the process will need to begin anew. This is occasionally necessary.

Once the central incision is complete, we work our way outward. Legs, then arms, then the head. All incisions will be made on the anterior of the body. This will allow the skin to be more easily removed from the body in one piece. Straight cuts are used for the appendages; however, we get to the trickier areas, the finger and toe joints, the eyes, nose, mouth, and ears, the genitals, we’ll curve our incision line, winding around the joints and better-fused areas, so that during removal, we aren’t pulling back from the center of these sections, but beginning with the more pliable skin.

Note how at the phalange joints some incisions must wrap nearly around to the posterior side of the knuckle. It is delicate work, but once again essential that the incisions do not cut below the hypodermis. Research has shown that due to the large number of nerves in the fingers, disturbing the layer beneath too early in the procedure has the potential to limit the success of the skinning. The patient may begin to exhibit symptoms of distress too early, lessening all benefits of the treatment.

Around the facial features, researchers have found that actually weaving the incision from side to side produces better results than making a straight, asymmetrical incision down one side of the face. Instead, we come up straight from chin, curve around the mouth to the patient’s left, across the upper lip, to the right around the cartilage in the nose and then back in to the center, cutting straight between the eyes. From there, we continue in a straight line to the top of the head.

The final incisions are a series of lateral cuts at certain areas to enable a smoother removal of the skin. Namely, the hip and shoulder joints, along the chin, and from the corners of the eyes to the ears.

Remember to communicate continuously with your anesthetist, ensuring that the patient is as comfortable as possible throughout this part of the procedure.

Now for the removal of the skin. This is where the truly therapeutic benefit of the treatment begins. The skin is thick, as they say, protecting the organs, skeletal system, and muscles from damage from the world outside. Unfortunately, damage can also occur on the interior, in the form of mental illness, and the skin, so skilled at keeping bad things out, can hold that damage in, where its effects continue to grow within the body. Today’s procedure will release the tension and ill-effects of that damage.

We begin peeling at the center of the torso, as this skin will come free more quickly and easily, and work our way out to the most difficult areas, namely the hands, feet, genitals, and face. Skin removal is where a well-trained assistant is necessary. The skin must be pulled distally at the same rate on both sides of the body.

The process is simple. Insert fingertips at the center of the chest and curl back the edge of the skin. If you’ve worked quickly enough with the incisions, this should be easy. Your assistant will face you and do the same, as such. Now we firmly grip the skin between thumb and fingers and pull away from the midline. Be aware, that most patients will jerk at the beginning of this step, as the skin starts to tear away from the body.

We pull the skin outward until intersecting with the lateral groin and shoulder incisions, then repeat the process on each appendage, using the scalpel to carefully cut the hypodermis away from the layer beneath whenever it seems reluctant to release on its own.

Notice that the patient’s heartrate is beginning to increase. This is normal. Remember, we are releasing mental illness that has been locked inside for years, in some cases a lifetime. Patients are going to feel discomfort at this sensation. That’s normal. The best thing to do is to keep working at a steady pace so as not to disturb the patient’s concentration.

Torso, legs, arms, and the top of the head come first. Your scalpel will get more use when you get to the joints in the feet and hands. Be sure not to sever any ligaments, causing undue stress for the patient. You’ll need to be the most careful around the joints you left covered, peeling very small amounts before cutting the connections. The same technique will be used at the genitals and on the face. Peel, slice, peel, slice.

Once we’ve turned the body over, the last challenge is the spine. By now the patient is fully stimulated and the release of mental illness is in full progress. If the heart monitor has a steady, fast-paced beeping, treatment is proceeding as expected.

The skin on the back will pull away fairly easily, with some cutting necessary at the ribcage. However, the tissue around the spine is a sticky area that will need to be handled with great care. Because of the enormous number of nerves here, mistakes are not allowed. Using the same peel and slice method as with the phalange joints, be extremely careful not to damage the sheath beneath the hypodermis. Work medially, beginning at the top and working down until the only skin still attached is at the sacrum. Once that final piece is severed, the skin can be removed from the body and discarded, and the skinning is complete.

You’ll know the procedure has been successful when the beeping of the machinery becomes one long, steady, piercing sound. Like a permanent ringing in one’s ears. This is assurance that the release of mental illness is complete and the patient is finally at peace.

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Holly Tri is a full-time editor for a book publisher in Portland, Oregon, and has an MFA in Creative Writing from Goddard College. She also edits for various non-profit literary journals. Her short fiction has appeared in The Rejected Writer. Born and raised in northern Minnesota, she and her family now live in a small town near Portland.