Biological skin and psychic skin: rethinking the connection through “Tact-Pulsion”

The skin constitutes the primary interface between the organism and its environment. Serving not only as a protective barrier and a sensory organ but also as a psychic support, it goes beyond its biological functions to become a foundation of the self, a surface where tactile and relational experiences are inscribed. In the 1960s, Esther Bick showed that when the skin fails to fulfil its role as a psychic container, the individual constructs a “second skin”: an early defensive structure, protective against primitive anxieties but later limiting affect expression and connection with others. Then, in 1972, Didier Anzieu developed the concept of the “Skin-Ego,” defining the skin as a psychic envelope supporting the emerging self and ensuring continuity between body and psyche. In 2022, Régine Prat identified an intermediate zone between biological skin and psychic skin, which she named Tact-Pulsion, explaining that tactile stimulations from conception—contacts with the uterine wall and the fetus’s exploratory movements—constitute a form of early libidinal investment. Thus, from the emergence of cutaneous sensory receptors in utero to the cerebral release of neurotransmitters involved in emotions, attachment, mood, and relationships (oxytocin, dopamine, serotonin), touch appears as both a sensory and psychic phenomenon, linking sensory perception, bodily sensations, and libidinal life, transforming physical contact into affective and relational experiences. This article aims to raise awareness among medical students and clinicians about the importance of contact and touch, which are crucial for the development of the self in early childhood and later essential in caregiving relationships. Touch, far from being a mere technical gesture, carries relational and symbolic value at the heart of clinical encounters.