According the Maria Pavlovna, commercial cosmetics were 'unheard of' in Russia at the time and particularly among the Imperial Family. She wrote that Ella made her own skin preparations of natural products (cucumber & cream) and it seems likely that Alexandra would have probably used the same natural preparations.
Whether Alexandra's symptoms were psychosomatic in origin, remains open to question but I am sure someone with Helen's & Belochka's medical knowledge could tell us that a very large number - far larger than is normally assumed to be the case - of illness are psychosomatic in origin (& I myself have witnessed this on many occasions where the initial illness cane be traced back to a traumatic or series of traumatic events and the mind reflects itself onto the body, as it were). This doesn't make the Empress any more 'disturbed' than any other person on the planet, nor does it make her illnesses less real.
She also suffered from frequent ear infections (which may have been genetic - since the Kaiser & his sisters also suffered the same problem). Other 'family' illnesses included gout and rheumatism, perhaps exacerbated by badly-heated rooms, and - in Alix's case - a climate to which she wasn't accustomed.
Considering the effects of Alexandra's background on her psychological state, I believe that not only the death of her mother and sister made her prone to gloom, but also the fact shortly after her birth Frittie had died which left her mother in a state of deep depression. A similar case can be seen in Moretta of Prussia (whose mother was in mourning for Sigismund in Moretta's earliest months of life and as a small child she had a great horror of women dressed in black).
Another often overlooked point is, I think, Alix's position in the family. She was 'mothered' by her elder sisters and as the youngest surviving child was doubtlessly more 'looked after' than the older ones. Then suddenly she found herself in a position of great power for which she was ill-prepared, and with a husband who, much as he loved her, depended upon her. To add to this, Ella, who had always been 'a big sister' was now her social inferior. Psychologically this must have been quite difficult for Alix to deal with.
If these were some of the difficulties she faced - not to mention the more glaring stress of not giving birth to an heir for over 10 years...and then to find him suffering from haemophilia - it is little wonder that at times her behaviour seems erratic. With responsibility for her son, and to a large extent for her husband, she was also exhausted. In such a state anyone might be prone to palpitations, and the myriad of other ailments from which she suffered. I am trying to make the point that her behaviour was really quite 'normal' for anyone in that situation. Even an eminent doctor might view it as hysterical - for outwardly that must have been on occasions how it appear. But even the most eminent doctor of the time did not have out hindsight to take all these factors into account. I believe she was simply in a very difficult position and the stress of that caused outward physical symptoms as well as psychological difficulties. Perhaps a better understanding could be gained not from 'outsiders' - even medical practitioners who knew her well - but from her own accounts, letters etc.
Perhaps Helen, who has great insight into this, could help us with some of Alexandra's own accounts of her difficulties.
