Hair pulling (trichotillomania) IS a displacement behaviour

image by Steve Doria

Categorising hair pulling behaviour seems to be something that psychologists struggle with.
Of course, no one can make strong assertions without evidence. But from people who do pull out hair and have an 'inside take' on the problem, phenomenological information can be obtained.

From speaking to people who pull their hair out certain common feelings seem to be apparent.  A rise in anxiety prior to pulling, a relaxation following the extraction and an automatic sequence that is repeated which seems to restore some sort equilibrium until the anxiety passes.

This is exactly what displacement behaviours exist for of course.  In nature, animals demonstrate displacment behaviours when they are caught between

two behaviours, such as fight or flight.  The displacement behaviour lasts until the situation changes and the organism is no longer experiencing a conflict of mutually exclusive tensions.

In our household pets self-biting is common among dogs who are distressed.  This self-directed behaviour seems to offer a classic view of what displacement behaviour is.  Such a poor animal's distress might take the following course.

1.  a need to escape a threatening situation - but no escape is possible!

2.  instead of escaping, avoidance is attempted - but there is no away to

     avoid the stressor either.

With two key survival strategies frustrated the animal can find no control over its environment. Whatever it does, it cannot solve the problem and find comfort or safety.  The self-directed behaviour emerges as a final act by which the dog can exercise some control over its physiological state.  Self-biting is a means of disengaging from its environment (i.e.from the source of its stress) via an action which achieves some measure of equilibrium but by maladaptive means.

I believe that hair pulling in humans serves the same effect. The hair puller's environment is causing stress that the person cannot escape or avoid or findany solution to.  In young developing people where the brain is still wiring itself, such pressures can lead to lifelong hair pulling because the child is not psychologically strong enough  to cope with its situation.  Once the behaviour begins it becomes part of the intrinsic behaviour pattern of the individual concerned  and is hard to break - but not impossible if the conditions in which the child was embedded at the time the disorder developed can be uncovered and the original anxiety identified and worked through.

To say there is a cure is a bit of a misnomer.  Hair pulling can be stopped, but the original anxiety that led to its emergence is something that can never be taken away.  But it can be faced and coped with, so that the adult hair puller does not have to be a prisoner of the childhood environment in which hair pulling served as the self-comfort of last resort.

Instinct - Hollywood on the effects of captivity

There are not many movies that try to tackle truly big themes, such as why is civilisation so brutal and make a clear link between civilisation and life in captivity.  In this blog the idea of captivity is prominent because certain behaviours in animals emerge in captivity that do not appear in animals living wild.  And, for me, behaviours like hair pulling can be traced to environmental deprivation in both animals and humans.  So, it was a big thrill to watch a Hollywood movie that tries looks at how environments can undermine species specific behaviours and how these environments can turn people crazy.  

Dr. Ethan Powell (Anthony Hopkins) has been arrested and returned to the USA after committing a murder in Rwanda, where he has been living amongst a group of gorillas, who have accepted him as part of their family. He returns and appears violent and refuses to speak until a psychiatrist, played by Cuba Gooding, Jr takes on his case as a way of furthering his own career.  He hopes to maybe write a book based on this curious case.

In the high security section of the jail where Powell is kept with other 'psychotic' patients, there is a lot of brutality from the prison guards who have their own ways of keeping the prisoners in line. Due to staff and funding shortages only one prisoner is allowed out each day into the exercise yard.  They randomly award each inmate a card from a standard playing deck and the one holding the ace of diamonds gets to see the sun and sky whilst the rest have to stay inside.  However, in reality the same person gets to go outside each day because he is able to bully the ace out of anyone weaker than him...until Powell arrives.  He fights to keep his ace and establishes a new pecking order, which arouses the dislike of the senior guard.

Meantime, the psychiatrist has started to win Powell's trust and got him to slowly open up.  We begin to understand why he killed someone.  He was living in peace with the gorillas and they had accepted him - not as one of their own (i.e. a gorilla) - but as a member of another species they accepted into their ranks.  This, as the film points out, is an amazing act.  Eventually, soldiers come to find Powell who has been reported as missing.  They open fire and kill all the adult gorillas believing them a threat.  Desperate to protect them Powell attacks them and kills one.

Understanding his patient better, Gooding's character tries to get him out of prison but further fights break out and it looks as though Powell will never be let out. Powell also makes him understand how we all live in captivity and how all our behaviours are distorted by this because we lack control over our environment.  Powell, profoundly explains how civilisation is a form of trap because we can never get outside of it and how it rewards destructive behaviours such as hoarding and profit seeking.  

Towards the end Powell is able to escape captivity with the assistance of Gooding and some of the other prisoners and returns to life outside society in the African jungle.  Meanwhile, Gooding realises that his career path is all wrong and that his striving to reach the top means he can never truly be free from the objectives that civilisation set for him, but which he does not choose for himself.

Although there is no stereotypical behaviour featured in the movie it aims to get to the heart of why people and animal behaviour can become distorted by an environment that is not one that the organism evolved within and is an adaptation to. Hopkins and Gooding are great and carry the film, which could so easily have failed with a lesser cast.  So, well worth a look by anyone interested in behaviour and in need of some entertainment.

Caught In Two Minds - happy birthday!

image by Graceful Cake Creations

It is one year since I started this weekly blog on self-directed behaviours and 52 posts later and 2500+ hits on I would like to thank those of you who have visited or followed the site.

From talking about hair pulling, to chin rubbing, animal behaviour in captivity, hunter gatherers and evolutionary psychology - it has been a lot of fun discussing and sharing these topics.

The aim is to carry on with the blog, though in the future posts will be every 2-4 weeks rather than every week.  This is because of time and energy constraints in part, and the fact that it gets ever harder to cover new angles.

The purpose behind this blog has been to keep my interest in self-directed and displacement behaviours alive whilst I aimed at doing more research in the future.  However,  problems with funding have blocked this ambition unfortunately.  But maybe one day more work on hair pulling and other behaviours can be undertaken.

Thanks for visiting and don't forget to check the back catalogue to read some interesting articles on self-directed behaviours.

Will S.

Hair pulling as indicator of emotional dislocation

a dislocated elbow...but what about emotional dislocation?

 To me hair pulling behaviour points to a dislocation between an internal impulse (physiological) and its physical expression (behavioural) so that the impulse is constantly repressed or negated.  This ongoing tension may be compared to a rocking to and from between two states.  For example, a child will feel the need to approach a parental adult for comfort seeking needs, yet if this parent is unreliable and provokes a withdraw response the child is caught between two stools, so to speak.  If this situation is ongoing and no alternative adult is available the child will develop coping or maladaptive behaviours and hair pulling fits this category.  This is because hair pulling is a displacement behaviour, in my view, which emerges when two opposing impulses such as approach and withdraw are simultaneously activated.  The pulling is the nervous system's way of deactivating this short circuit and finding some resolution to the ongoing tension.

Hair pulling reveals that there is something wrong with the hair puller's environment.  They are unable to settle or feel at ease.  They may feel constantly agitated and hair pulling is a form of relaxation.  For example, they may not want to be alone and yet find themselves alone, desire to find some form of relief but unable to do so.  So, hair pulling is a form of homeostasis whereby physiological tensions that cannot be mediated through normal social avenues (e.g. approach behaviour) can find some outlet.

I have no direct evidence for this in human studies unfortunately.  This is the kind of research  I would like to do.  But animal studies where fur, feather and hair pulling have been noted do back up the idea, particularly in artificial or captive environments where species specific needs are not supported.  This means the animal is striving to attain some internal goal state but cannot achieve it through interaction with its sterile laboratory environment.  For example, it may lack materials to build a suitable nest or place of safety and so its attempts at doing so are constantly frustrated and aborted.  Body directed behaviour follows, whereby the animal's normal behaviour is shown to have been utterly derailed and its environment utterly unsuitable to allow its behaviour patterns to develop normally.

This line of enquiry is harder to prove with people but there are some key signals I would look for.  I would predict that some who pulls hair will be in a state of agitation or feel unsettled to some extent whereby they should be able to report some anxiety towards their environment either before or after the hair pulling episode. 

Too much therapy is focuses on the puller and not enough on its environment - by which I mean the environment in which the hair pulling first emerged.  This is the situation, along with the developmental needs of the person at the time pulling first took place, that needs closest analysis.  Too often we treat the symptoms rather than try to find underlying factors. 

foraging behaviour and hair pulling?

Which one would you choose?

A basic survival behaviour since the dawn of human existence has been food seeking or foraging.  Humans have long had to make mental calculations about how much time and energy to devote to food seeking.  In those days it was calories rather than money that were the real currency.  If it took you all day to find food that provided only a meagre number of calories then you would not live very long before starvation would set in.  To survive one would have to find food that took less time and effort to find by seeking out a better alternative food - one requiring less time and energy to find and prepare before eating.

So food seeking, food finding and food selecting are behaviours key to who and what we are.  An obvious example is berry picking.  When picking berries one is automatically drawn to pick those which are largest and most ripe.  The choice is simple - the bigger and riper the berry means the more calories they possess.  Efficiency of effort is served by selecting these over smaller and less developed berries.

For anyone who has ever pulled hair to obtain hair roots some of these notes on berry picking should be familiar.  Hairs are selected from certain favoured parts of the scalp where the likelihood of extracting a fatty root is most high.  Commonly this is from the vertex or crown region.  As hairs in a favoured region become depleted the puller will start to pull from new areas.  This again makes sense in the context of food foraging because once one area becomes depleted of food the forager moves on to where berries are more plentiful and can therefore maintain a high rate of return in relation to energy expended. 

It would seem that the same mental algorithms that serve foraging may well serve hair pulling too, suggesting that trichotillomania is a behaviour that utilises key mental processes that normally serve to promote our survival.

For me, hair pulling is a behaviour that is ancient and which can be traced all the way back to the earliest medical records penned by Hippocrates.  It is a behaviour from which hair pullers derive great comfort and involves selecting the 'right' hair - one that will yield a satisfying texture and a healthy fatty root.  The final process of eating the root makes the comparison with food seeking (e.g. berry picking) natural to make.

By seeing a disorder as a distortion of normal behaviour rather than a behaviour that has no relevance or value within the normal repertoire allows us to recognise it as fundamentally human and comprehensible.

Darwinian psychiatry

Charles Darwin - whose theory of evolution has influenced psychology

My approach to self-directed behaviours is largely influenced by Charles Darwin whose theory of evolution focuses on natural selection and sexual selection.  Natural selection relates to how well organisms are adapted to their environment in terms of being able to obtain food, fend off predators, develop immunity to diseases and grow to adulthood.  Sexual selection is how well organisms can attract mates and produce offspring.  The two things are separate but inter-related.

A darwinian approach to medicine aims to see whether strange behaviours or mental states have positive benefits.  For example, having a high temperature is the body's response to fighting off invading viruses - contrary to popular belief which sees the high temperature as caused by the virus. Invading micoorganisms cannot breed as quickly when the body is hotter.  Of course, the danger is that a temperature that goes too high can be life threatening also.  Or take vomiting - it is the body's way of ridding the gut of harmful contents and so has a beneficial function.

Similarly, Darwinian psychiatry aims at understanding the potential benefits of behaviours and mental states commonly viewed as harmful or a problem to be cured.  Let's take hair pulling for our example.  It can be viewed not as an adaptive action (one that promotes growth and well-being) but a maladaptive one.  A maladaptive behaviour is one that is manifested in an unnatural environment (e.g. a cage) and helps the organism cope better with its unnatural environment.  It may help lower stress levels but at the cost of hair or fur loss (i.e. bald patches) - but the point is that it is not all bad.

Viewing seemingly negative behaviours in this way stands the common wisdom on its head.  Rather than being behaviours that are bad for you and damaging, they instead may make you feel better whilst you are engaged in them.  Hair pullers positively enjoy yanking hairs and obtaining roots.  It is only the guilt and shame that follows brings them down.  

Another example is self-harming.  People may cut themselves or scratch at their skin and this is commonly seen as an act of self directed aggression.  But from a Darwinian viewpoint the self-infliction of pain may lead to dopamine release in the brain and from this the self-harmer can feel uplifted and elated.  This is not as contradictory as it may seem.  For thousands of years humans had to cope with injuries without anaesthetic, surgery or doctors.  The body developed mechanisms whereby pain at a certain level either leads to unconsciousness or can lead to endorphins (natural painkillers in the body) being released.  These endorphins are extremely powerful natural drugs and would have helped our ancestors keep moving despite their injuries.

Applying a Darwinian approach to psychology is long overdue and much needed if we are to make real sense of, and truly understand the reason we develop the behaviours we do.   

Regulating emotion via the body

my self-grooming cat

Self-directed behaviours are all about regulating what is going on inside us by manipulating our external physical body.  It happens when normal channels for handling our relationship to our environment are blocked, frustrated or unavailable. 

All animals - and this certainly includes humans too - learn to survive by interacting in a purposeful way with their surroundings.  Take an insect and put it in an empty glass jar and you can soon see how when taken out of its environment it has no way of using its innate abilities to serve its own needs.

People can live in glass jars too.  They can find themselves in sterile surroundings that offer them little or no chance to express themselves, obtain loving responses from others,  finding security or comfort and feeling the way they need to feel to be content in their own skins.

I have written about this topic before.  It is called homeostatis - the way an organism controls its internal state by interacting with its environment.  Animals demonstrate it very clearly.  For example, if not fed at the appointed hour my cat will yelp and cry.  If perhaps I am busy for some reason and it does not get the response it requires (i.e. to be fed) it will eventually quite meowing and start grooming itself e.g. licking its fur.  Unable to successfully manipulate its environment (me) through attachment evoking sounds and unable to stop the feeling of being hungry it is between something of a rock and a hard place.  It can only endure this state of tension for as long as it feels able to exercise some control over its personal destiny.  When its efforts at attracting attention go unheeded for a time the grooming behaviour offers a way of switching off or self-calming until either the situation changes and it is able to try again, or its hunger increases and prompts a renewed attempt to elicit the response it seeks (to be fed).

I should add, I love my cat and do not go out of my way to make it sing for its supper.  But its grooming behaviour is regular enough for this observation to be made.  Humans are similar too.  Observations of people playing with their hair whilst waiting or bored, rubbing their skin or scratching are signs of being in an inbetween state - of aiming to attain an internal state whilst in a environment over which control is limited so that manipulation of the situation in a desirable way is not immediately possible.

This sort of predicament is so common that one might say it reflects the human condition of being in the world.  What interests me is when this situation is prolonged unnaturally and what happens when it is. 

But don't worry, I won't be experimenting on the cat!

More on bad environments

image by JustcallmeBethy

Sometimes environments fail to give a person what they are seeking. Most people adapt to these kinds of conditions if they arrive in them as adults because they already have had prior experience of their needs being met and they are able to manage their needs by seeking fulfillment elsewhere.  Younger persons can cope too with, for example, difficult home lives if they can find some form of sanctuary with relatives (aunts, uncles etc.) or with close friends.  But if the environment being relied upon is all a person has and it fails them the consequences can be terrible.

We have all met people who exude calmness and emotional balance - they are usually the people we would most like to resemble or the ones we envy secretly.  They are people who we wish to be close to so that we can share in the equanimity that they possess.  But in fact, it is not them one should envy necessarily but the system of relations of which they are part - i.e. their environment.

The problem of being brought up in a disturbing environment is that it prevents a person from directly experiencing themselves in relation to a loving other.  There is no response that can be relied upon to allow a confident self-image to be based upon.  Lines of communication may be twisted and direct communication that is open and honest seem impossible without fear of misunderstanding or arousing an unwanted reaction.

Mental problems such as paranoia can develop in such situations, where one may feel of no importance and feel jealousy towards those who are held to be more significant or loved.  In some cases protective delusions are built up to allow a person to feel important.  In schizophrenics the environment may be so distorted they lose any sense of who they are, who others are and what situation they are in.

In incestuous situations the child may experience a real conflict between keeping a symbolic relationship with the parent alive and keeping their own individuality intact.  Confusion stems from the parent relating to the child in two ways - as parent and lover.  Incestuous feelings can be aroused too where a child is not allowed adequate privacy, is smothered and is treated as a 'darling' rather than a son or daughter.

My main interest is in self-directed behaviours.  An environment that does not recognise or respond to the needs of a person risks producing these because the individual will continually be seeking a certain relationship to its world (to be heard, recognised, comforted etc) but be continually knocked back or frustrated.  This continual process can, in young developing children (and animals in captivity), produce behaviours such as hair pulling which reveal that the body has become a source of satisfaction in order to deactivate the behaviours that can find no outlet.

One of the reasons that hair pulling may be so little reported is because for the people who do it it is a very comforting and helpful way of mediating their emotional frustrations.  In short, they feel better doing even if there are the unwanted consequences of bald patches and social embarrassment.

Thumb sucking

image by Megabu7

Thumb sucking is a self-directed behaviour that for the most part is viewed as perfectly normal and natural within a certain age range.  It is usually performed by children after weaning - and its emergence suggests that the weaning process has occurred too quickly and ended before the child was ready.  Thumb sucking reveals that the mother's body was once the child's living environment and that its (the child's) physical functions remain rooted in the mother.  

Persistence of thumb sucking beyond early childhood suggests the child has not been able transfer comfort seeking to an age appropriate behaviour.  Freud referred to such regressive tendencies as fixations and this related to his idea that there were stages of development or specific phases and sometimes children could get stuck at a certain stage.  The notion of stages is not so adhered to these days - normatively children will go through behaviours at certain points but there is nothing arbitrary or inevitable about the mode of expression that will be manifested.  

Having a physical function rooted in the mother's body implies separation has not been managed in the interest of the child but probably been imposed arbitrarily on the child by the parent who has decided that it is TIME for the next stage of growing up to be reached.  It is important that we get away from the idea of fixed stages in order to prevent the kind of thinking imposes change for no good reason.  I believe that if a child is allowed the freedom to behave in accordance with his wishes and needs then in time s/he will move on in his/her development soon enough.

Ultimately, thumb sucking is a healthy thing because it shows that oral behaviours have developed,  and that the child has attained an important level of physical functioning.  The child whose oral development is disturbed might never suck his thumb - nor dervive comfort from other things such as blankets or soft toys.   But more on these comfort behaviours in another post. 

 

Why write about self-directed behaviours?

Whenever people learn about my blog they ask me, 'why?'  It is a fair question.  I got interested in self-directed behaviour whilst studying psychology courses at Helsinki University.  It started out as an interest in attachment theory (e.g John Bowly, Mary Ainsworth) and then extended into evolutionary psychology (e.g.Cosmides and Tooby).  Afterwards I became interested in ethology (studying animal behaviour - particularly primates) and what studying animals could reveal about human interactions.  From that I developed an interest in how animals respond to captivity and from there the parallels with human self-directed behaviours became evident.  

My PhD studies are on hold right now, so this blog is partly a means to preserving my interest and also a public record of my work.  

Writing about this stuff is very satisfying.  It is a minority interest of course, and not one that will ever appeal to most internet surfers but that is part of why I like it.  

There is a political aspect to this blog too.  As humans we are constantly having to adjust to rapid changes in the social world around us.  But humans are not limitlessly plastic (flexible) and nor are we blank slates who can put up with anything and everything - as animals raised in barren conditions of captivity frequently reveal.  Unfortunately, politicians and corporations often overlook this fact as they seek to promote their interests over the social well-being of others and ignorant of knowledge of human history and evolution base decisions upon ideologies serving short-term profits.  Where humans are embedded in environments that do not properly respect those conditions characterising our evolutionary history  problems will emerge.  And by this I mean self-directed behaviours. 

Humans need to feel rooted in their environments; they need social support; they need to feel they have control over their lives to the extent that they can remain cognitively flexible and avoid psychological inertia. They have a strong sense of what is just, moral and fair and react strongly when these principles are not respected.  They can accept inequality just as long as they have the same opportunity as another person to make something of themselves so that any status difference is the product of hard work rather than social privilege or cheating.  Ultimately, we are creatures of light, I believe, rather than ones of darkness for who would choose the latter over the former if given a free choice.  In the absence of choices people find alternative ways of coping - sometimes body-directed ones - as a way of regaining control over their hostile environments.  Ultimately, we and our environments are one and anything that seeks to place human beings in glass jars or social vacuums will create destructiveness that is aimed inwards (body-directed) or outwards (hurt to others).

So, this site may only be of minority interest but the studying self-directed behaviours touches on universal concerns: how to live and stay mentally healthy in a social environment that can be frustrating and seemingly opposed to human needs.  In writing this blog I get to connect to those concerns that make me (and you) a human being and in this respect it is a worthwhile exercise.

True or false? self-directed behaviours that give away liars!

image by J. Coutinho

Lying is not easy......there are conflicting emotions involved - fear, guilt and shame - which need to be controlled or the lie will become apparent.  But the conflict also reveals that we value honesty and truth because they usually bring peace of mind and to contradict this creates anxiety.   Self-directed behaviours often emerge unconsciously when we tell a lie and in some cases they may be viewed as displacement behaviours because they reveal that the teller is in two minds about the lie he is telling.  Here are some possible examples:

1. The 'Self-Squeeze' - this is when a person holds or hug themselves tightly.  This may look as if they are giving themselves a group hug or may also involve clamping their hands between or underneath their legs.  The self-squeeze is a way of steadying the body or keeping the body locked into a pose so that it cannot interfere with lie in progress.  In this respect, the person may appear as if frozen into an ice statue pose or be like a rabbit hypnotised by headlights.

2. Eye contact avoidance indicates is a common when lying.  In this blog we have discussed displacement avoidance and lying may generate the same phenomenon. There is also some evidence that looking up and to the right is also a sign of lying because in this action the brain is seeking to access that part of itself that stores imaginative data, rather than real memories or facts.  Indeed, it is well know that the act of thinking and imagining is a private one and to do so on the spot in front of people involves an attempt at protecting one's personal space from others.

3. Touching nose - aka 'the Pinocchio Effect'-   is when the person finds it necessary to lay a finger aside their nose, making it appear they have a longer nose than normal, hence the term 'Pinocchio'.

4. Covering the face/mouth reveals an amateur liar at work because they are attempting to 'obfuscate by muffling', (the O.B.M. Effect).

5. Lipbiting, which may accompany a face pull or a grimace is a self-directed action that gives liars away.

It would be interesting to do some research into these behaviours and see whether the do qualify as displacement actions or not.

Interview with a female hair puller

image by zsoolt

Some time ago I interviewed people as part of my PhD and I was very lucky to talk to a young woman whose story and insights are revealing for anyone who has had hair pulling disorder.  Here is the interview...

"I can't remember the first time [I pulled my hair] specifically.  However, I do remember the first few months of the behaviour. Most of the time I was in bed or on a couch, just sitting there and pulling the hair out of my head. When I was five I began skin picking on my head specifically...nothing that I can recall really triggered the beginning of it, I guess I was just an anxious little girl. It was definitely calming for me though, that's the main feeling I recall. 

Pulling was first directed towards my head, then later on towards pubic hair but still mostly my head hair. Then the behaviour went away for the most part and now I will occasionally pull eyebrow hair but not nearly to the extent I used to."

The interviewee was asked to consider a range of possible environmental factors that may have contributed to her hair pulling, with the emphasis on feeling trapped, isolated or confined.  Here is what she said:

"I was abused by someone a little older than me who used to ride his bike around our neighborhood, and because I was afraid of him I spent the majority of my childhood hiding inside, even after he moved away. Therefore, I did feel confined. I also felt abandoned by my parents, specifically by my mother, because the first time my abuser babysat me, I told them I didn't want him over because I was scared of him and they left anyway. Sadly, the clearest picture I remember during that part of my life is looking out the window and seeing them drive away." 

What other factors might have contributed to the hair pulling?

 "As far as environmental factors, when I was 11 my mother bought me a large, lighted magnifying mirror for my skin or something. This is when I would lock myself in my bathroom for hours picking at my face. For hair pulling, I can't really think of any but I know my maternal grandmother also had the disorder at one point. Also, when my hair pulling really began, a few months prior I had disclosed the sexual abuse I had suffered three years prior, so anxiety most likely played a big role in that.

 My mother was also a factor. Her emotions were very unpredictable and she was really mean and nasty a lot of the time. Because of this, I have a lack of an attachment to her. I think a lot of her issues with me had to do with viewing me as an extension of herself. She would call me names, lie, demean me and pretty much ravaged my self esteem. I have noticed that since moving out of my house, besides my nail biting all of my repetitive behaviors like self-cutting and hair pulling stopped cold. I felt my world was completely out of my control living with my mother - I was constantly attacked and I didn't know when the next rage would happen. Because of this, I felt under her constant control. She grounded me constantly, wouldn't let me see friends, wouldn't let me journal (she would find it and then rage at me for the things I wrote), would pull me out of therapy, etc. Basically she cut off any support I could have had...I felt a lack of personal space because of things like my journalling. I distinctly remember her "cleaning" my room but she was really going through all of my stuff and I felt incredibly violated, even as a child. A nanny recalled that my mother described me as "adult like" when I was 3 because I would just sit quietly at the table during meals. Most 3 year olds I've come across are more emotional and excited than quiet."

I asked how the hair pulling behaviour was currently manifesting itself:

"Now, I no longer pull and haven't for seven years I believe. When it first stopped, I had begun habitually self-injuring and I think that took over my need to pull. I had self-injured a little bit prior to the onset of the hair-pulling but not in the addictive phase. Then when the more addictive phase began I stopped. I self-injured off and on until about a year ago and I haven't since, and the pulling has not returned. I have been biting my nails since age 4 or 5 and still do, unfortunately. My skin picking was at its worst when I was 11 years old and has tapered off significantly."

 

Some really interesting themes emerge from this interview.  One is being in a symbiotic relationship with the mother or where the child may feel s/he has no way of regulating their internal emotional state via interaction with the parent.  Hair pulling may emerge where the child may feel thwarted in attempts at attaining comfort or safety and self-grooming emerges out of the ongoing frustration.  Another theme is the way hair pulling may diverge into other modes of behaviour over time - or find expression via different trajectories.

My thanks to the interviewee for her kind permission in sharing this interview.  I hope readers out there have also found these comments useful.

Interview with a hair puller

I was lucky to interview someone recently who developed hair pulling behaviour as a child and they told me about the first time they pulled out a hair and examined the lipid fat root.  Here is what they said:

"It is weird that I can remember the first time I ever pulled out a hair, but I can.  I remember sitting watching TV,  I must have been about 9 years old.  I had just had a bath and was sitting wrapped in a towel.  My mother and father were also in the room.  Not sure what was on TV but I remember some urge possessed me to pull a hair.  It happened automatically.  It was like some force was driving me to do it.  The body just had a will of its own to do it and once plucked I was surprised to see the glistening white root fatty root.  I plucked a second hair just to see if I could repeat the same result as I had the first.  And I did.  And I just kept on plucking after that.

My family must have seen me do it and I recall my dad told me to stop it on a few occasions, but they never took me to a doctor.  I suppose they viewed it as a bad habit that I would grow out of.  But I wish they had understood the nature of trichotillomania - that it is a real condition and not a passing phase.

The more I plucked the more other changes occurred.  As a child I had very fine, glossy and straight hair but when the plucked hair grew back it grew back thicker, curlier and more dull in colour. 

I plucked consistently until I was into my mid-teens and developed very thin hair on the crown of my head.  To avoid over plucking in a single area I would pluck from alternative places - the sides of my scalp.  Again, thinning occurred.  Over time my hair pulling developed into skin picking as I tried to find alternative ways to avoid direct hair pulling without giving up on the comfort I got from this behaviour. 

To this day I will still dig my nails into my scalp and eat the skin I can scratch off.  It doesn't happen often but I know that the same impulse that affected my as a kid still affects me today. "

These interesting insights reveals the strange trajectory that hair pulling can go in, with manifestation of hair pulling behaviour changing over time.  It also reveals how this condition is very hard to cure outright.  Genetic changes, such as hair quality altering, are also a part of trichotillomania, with changes in hair quality a common phenomenon.  I wish to thank my interviewee.  I hope you found it interesting too.

Human 'captivity' may precipitate hair pulling?

Self-directed behaviours affect animals raised in captivitiy - fur biting, hair pulling, feather plucking...so it is fair to say that environmental disruption is a strong link with these behaviours.  So, can self-directed behaviours in humans also be traced similarly?  The psychoanalyst R.D. Laing famously pronounced that man is a captive animal - which I take to mean that his social boundaries are ones imposed by modern society but are not ones that characterize humanity's evolutionary history.  

When environments go wrong it means that some essential behaviour is being frustrated or unsupported.  For example, the conditions for rest and relaxation require a level of comfort and sense of safety from danger.  But what if drowsiness arouses fear of attack or the loss of control over the proximity of others?  Where the need to maintain wariness and the need to achieve sleep are in prolonged conflict it could mean that the onset of drowsiness could become a trigger for displacement behaviours.  These might serve to resist the transition to unconsciousness until a window of opportunity - where risk to safety is tolerable - arrives.

There are many ways too that people can feel 'caged' by their environment.  Maybe they are being brought up in a home where parents are enforcing certain rules or boundaries too strongly.  Or maybe one of the following situations has arisen:  judging a child by adult standards of behaviour; limiting physical movement; restricting vocal expression; disapproval of touching and grooming behaviour; preventing free playfulness; imposing social separation and isolation for prolonged periods; creating power imbalances; affording limited or unsuitable living space.  With all of these situations there lies the risk that, as with caged laboratory animals, the species specific conditions that behaviours rely upon to get their cue or derive their setting point are undermined. The organism may retain the propensity towards a particular action or state, but  the environment continually fails to allow its expression.  This creates a stop-start-stop-start experience which eventually becomes resolved through a third behaviour which deactivates this whole uncomfortable process but produces a new and unwanted chain of events.

Many parents fail to perceive or understand their offspring as children - but impose the same conditions that were imposed on them.  Any parent who demonstrates behaviours such as nail biting, hair pulling or self-directed symptoms is, in my view, revealing signs of being poorly embedded in their social environment.  The danger here is that if the parent is poorly adjusted the child may be even more extremely affected because the parent IS the child's environment!  In the most extreme of cases, the parent creates a barren cage for its offspring.

World Cup 2014 & displacement behaviour

Hands on head after a missed open goal- displacement behaviour

Keep your eyes open this world cup for displacement behaviour.  It is such a common phenomenon that you may never have really paid attention to it before but in almost every game at certain key moments you will see it.

Those key moments relate to missed goals.  Now, anyone who watches or plays football knows that some missed goals are more painful than others.  The shot that misses the goal by a large margin and which, from the moment it leaves the boot, never looks like going close to goal is never as disappointing as the one that only just misses the target.  When we fully expect the ball to go into the back of the net but at the very last moment the ball veers away or goes past the post and not inside it, an automatic reaction occurs.  

This automatic reaction is one we all know well.  Consider this: excitement builds as the expectation of a goal rises, only to be suddenly and forcefully opposed by the realisation that it has missed and the sense of elation is simultaneously contradicted by one of disappointment.  This process is marked by the hands of the player (or often spectators too) suddenly being raised to the head and the fingers used to comb the hair or scalp in a smoothing or caressing action.  

But why does this happen?  Well, it marks disappointment and a defeated expectation but there is more to it than just this.  Physiologically speaking it indicates that two contradictory impulses are being experienced and producing a behaviour that has in fact no direct relevance to the situation in which it occurs.  I mean, how could raising your hands and passing them through your hair or resting them on your head be of any real use?

Most people fail to really pay attention to this action because it is so common or automatic that we take it for granted as a natural phenomenon of no significance.  But when one stops to think that it occurs at those specific moments when the tension between excitement and disappointment is at a certain point of balance, it assumes new meaning.  It is a classic case of a displacement behaviour, the purpose of which is to deactivate overloaded circuits and act as a reset so that the processing of fresh incoming sensory data can be resumed.  

As well as this act of self-grooming behaviour we often see players grooming each other too.  A player who has missed a goal and looks disappointed will often have his head touched or stroked by a team mate.  Grooming is just an automatic and innate human behaviour derived from our ancestral heritage.

You will see many cases of self-grooming (and mutual grooming) during this World Cup so keep your eyes peeled - especially for those specific moments when celebration behaviour and realisation of failure are at a point of balance and produce displacement actions.

Thwarted again!

When ethologists, who study animal behaviour, looked into the weird behaviours that are typical of many animals raised in captivity they were puzzled.  For example, they witnessed animals biting at their own fur, feathers or hair or at those of other co-caged animals. The range of animals who expressed this sort of thing included parrots, sheep and mice to name but three.  They were puzzled because they could see no relationship to the weird behaviour and the environment in which it took place.  In short, the behaviour could not be directly said to be related or caused by the situation.  It was from this puzzlement that the concept of displacement behaviour emerged.

Three mechanisms are believed to be responsible for these weird displacment behaviours: (1) early environmental deprivation (2) the disruption of habitat-dependent processes and (3) the thwarting of behavioural response rules.  

Firstly, cases of environmental deprivation include animals reared in isolation or away from maternal care.  Secondly, the disruption of habitat dependent processes may include not giving animals the right kinds of foods or nesting materials so that behaviours dependent upon these environmental aspects cannot be properly expressed. Thirdly, animals in captivity are often physically prevented from behaving in natural ways such as a cage that restricts movement or which prevents it from achieving an ongoing goal.

The basic idea is that when an animal is continually frustrated or where the environment means that it cannot find an adaptive solution to an environmental problem the brain wiring is disturbed and these odd behaviours come to the surface.  But why, for example, hair pulling and not a different behaviour emerges is, as yet, unknown.  However, the link between animals in captivity showing this kind of a problem and people who pull out hair seems one too big to overlook in my opinion.

If there is one thing I would hope to get from this blog, it is that more and more people consider these aspects when they seek to understand hair pulling.

References:

 

Akgul, Y., Agaoglu, Z.T., Kaya, A., Sahin, T., (2000) The relationship between the syndromes of wool eating and alopecia in Akkaraman and Morkaraman sheep fed corn silage and blood changes (haematological, biochemical and trace elements). Israel Journal of Veterinary Medicine 56: 23-37.

 Bordnick P.S., Thyer B.A., Ritchie B.W., (1994) Feather picking disorder and trichotillomania: an avian model of human psychopathology, J. Behav. Ther. Exp. Psychiatry 25 (3) (1994), pp. 189–196.

Dias R, Robbins T.W, Roberts A.C (1996) Disassociation in prefrontal cortex of affective and attentional shifts. Nature 380: 69-72.

Kalueff, A.V., Laporte, J.L., Bergner, C.L. (2010): Neurobiology of Grooming Behaviour (Cambridge University Press)

Schrijver N.C.A., Wűrbel, H.: (2001) Early social deprivation disrupts attentional, but not affective, shifts in rats. Behav Neurosic 115: 437-42.

Wűrbel H (2001): Ideal homes? Housing effects on rodent brains and behaviour. Trends Neurosci 24:207-11.

Observations On Young Children

Watching children play or simply behaving in an environment in which they feel relaxed is very informative - as anyone who knows of Piaget's work can testify to.  It is informative in two ways.  Firstly, it is a point of reference to one's own early childhood and secondly it is possible to see in these early stages the way children try to navigate their environment, make decisions, seek comfort and affirmation from others around them. The family environment is the one in which the children will learn the rules of social behaviour, what can and cannot be performed and how to interact with others. 

I spent a few days with my nephews this week - aged 1 and 6 respectively.  They are happy, lively children but not immune to tantrums when their simple desires or wants are thwarted in some way or another.  But on the whole this is quite rare.  It was particularly interesting to see the younger one roaming freely about the house and exploring the nooks and crannies of the lounge and kitchen spaces.  When a child explores its space it does so without inhibition or assumptions towards what it should or should not do.  This open curiosity and undisrupted approach to the world contrasts well with children and animals not raised in such accepting and welcoming environmental conditions.

Children and animals in captivity do not get the chance to explore the world in such a free way.  Their species specific behaviours are constantly interrupted or interfered with.  They are not able to fully express themselves towards their environment and with this comes a retardation of their powers to engage with the world.  This means physical performance and physiological setting points are non-optimal.

Captivity means that an animal or human will feel constantly thwarted, as if the world is continually refusing to permit them to be themselves - or simply saying 'no' at every twist and turn.  The conditions that support successful engagement with the environment are not there and loss of confidence may become pathological.  In such cases the organism's behaviour will no longer be directed towards objects in the world around it but towards itself.

Disengagement with one's environment is a sure precursor to the appearance of self-directed behaviours like hair-pulling.  It constitutes a form of disturbance whereby continuity of expression and interaction has been disrupted.  A child able to roam freely and approach family members without fear of rejection or avoidance of eye contact or touch is much less likely to feel thwarted or displaced.  Fortunately for my nephews, their upbringing is one that allows them the freedom and affection they need to become healthy human beings.  Sadly, this is not the case for everyone.

Zen Buddhism and displacement behaviour

Korean symbol for Zen

There are many psychiatrists who feel that the perspectives offered by Eastern philosophy are helpful and support the efforts of Western practitioners in mental health.

Whether it be in promoting meditation or yoga or simply utilising basic breathing techniques - eastern exercises that assist coping, focusing and relaxing are all useful tools.

Behind these approaches is an eastern philosophy that takes a very different stance from the Western scientific tradition.  In the West the only valued perspective is the objective one.  To understand something one must take a detached viewpoint and aim at removing oneself - one's feelings, emotions, biases and prejudices - from understanding the world.  In contrast, the Eastern tradition upholds that nothing can be truly know or understood without engagement, feeling and immersing.

Overcoming detachment is important to feeling more engaged with the world and with one's emotions, so it is unsurprising that eastern philosophy was so approved of by Jung, much to Freud's annoyance.  He believed in the hard scientific notion that psychology should stick to hard facts and not align itself with ideas and concepts that threatened to take it beyond the realm of science.

Detachment means that one places oneself outside what one is focused upon.  The object - that which is focused upon - must be held distinct from subject - that which is doing the focusing.  This goes to the heart of western scientific understanding that was philosophically enshrined by Rene Pascal's 'I think, therefore I am'.

This object-subject distinction is something that is part of the human experience.  We always feel a certain reflective distance from the world which means that in certain exceptional circumstances we speak of 'letting ourselves go', or 'forgetting myself '.  Usually this implies we have had a good time and this forgetfulness has allowed us to lose self-consciousness or detachment and allowed us to enter into the world with less reticence, shyness or embarrassment. In fact, we may long to feel that freedom all the time!

The problem for people with mental disorders is where the object-subject relationship between world and self becomes fraught with problems.  Freud wrote about the super-ego (or basically, conscience) that imposes an ideal morality upon the ego.  This torturing voice of self-criticism means that the individual cannot relax or feel at peace and my develop compensatory behaviours in order to achieve this.

This lack of harmony between the object (how we perceive ourselves) and subject (that which does the perceiving) is surely important to understanding self-directed or displacement behaviours too.  Automatic behaviours aim at bypassing the subject-object character of consciousness.  People lose themselves in automatic hair pulling, for example, and derive a sense of wholeness from it.  In short, they derive release from it but when they regain their subject-object awareness they later regret it whilst still longing for the peace that hair pulling brought them.  This viscious circle can go on for years!

Maybe Eastern approaches can and are being brought to bear on hair pulling and other unwanted behaviours.  Offering people alternative ways to switch off their minds, of attaining mental peace and a relief from the pain of subject-object detachment is important.  And in this stressful environment of modern living such relief may be ever harder to find for many people.

 

Mother always knows best...er, maybe not!

Sweet Dreams, by Belgian artist Firmin Baes

An interesting study was undertaken by Galski (1983) which noted that unhealthy symbiotic relationships may partially account for hair pulling. A symbiotic relationship is one where the boundaries of separation and independent functions become blurred. For example, where a mother makes her child dependent on herself as its primary need gratifier, so that all needs must be met through her, then learning that leads to mastery over the environment and independent functioning is prevented. As a result important stimuli are not presented at appropriate times and necessary types of interactions do not occur.

It is very possible that a child in such a situation will find itself over-stimulated by such a parent’s constant supervision which it may have no adaptive means to prevent, neither by a show of aggression (saying 'No!') nor proximity withdrawal (leaving home). Access to external objects in order to meet personal needs or solve personal problems may require protracted emotional engagement with the mother, who may also assume control over the use and handling of objects. As a result innate mechanisms that would be engaged under normal conditions are inhibited in their development. In Winnicott’s terms, the mother has failed to support the child as a suitable transitional object so that the child is unable to make the transition towards independent functioning within its cultural context.

Reference: Galski, T. (1983) Hair Pulling (Trichotilllomania), Psychoanal Rev, Vol. 70, 3, 331-46.

Hair pulling in the movies: Young Adult

On TV this week I caught a movie called Young Adult, starring Charlize Theron.  Mostly, movies and psychological realism do not go well together which is why I was suprised (blown away in fact) that hair pulling featured.

Theron plays the character of a rather disturbed woman called Mavis Gary, who moves back to her hometown to win back an ex-boyfriend.  The trouble is he and everyone else in the town have moved on in their lives, whereas her development is stuck in the past and like an angry teenager she spends most of her time berating others and putting them down. 

Hair pulling appears when she is sitting in bed, watching TV (see the previous post on pulling cues).

We watch as Mavis toys with her hair, searching for something until she eventually finds a suitable hair and plucks it.  She then studies the strand and root befor laying it on the table next to the bed where there are a collection of other hairs pulled earlier.  The camera pans to reveal a small bald spot on the back of her head.

In another scene Mavis visits her parents and whilst sitting at the table she goes to pull at her hair.  Her father asks, “Are you still doing that?” before her mother chimes in with, “It’s just that your hair is so beautiful…”

 

Trichotillomania doesn’t make another appearance in Young Adult, and it never features as anything more than an add-on behaviour to Mavis' complex personality.  But the fact that it was included in the movie is worth recording.  I know some bloggers have expressed dismay that hair pulling should be associated with a character (played brilliantly by Theron) bearing such serious personality issues but I do not.  I think Mavis' borderline personality problems, her extreme perfectionism and social isolation in adulthood reveal that these were her issues as a teen too. If so, her desire to escape her hometown and her extreme dissatisfaction with her own status in life reveal adaptive failures that might well lead to body directed behaviours. 

Mavis is caught in two minds throughout the film - she hates her hometown, but returns there; she wants to be viewed as a success by the world, but doesn't feel like one; she dreams of perfection, but her life is flawed.  At the very end she completes a narrative in which the protagonist achieves a happy ending - but her identification with such an ending jars with the film's own ending which sees Mavis scrutinizing her damaged car in a roadside carpark.  This dislocation towards one's environment is important to understanding hair pulling in my opinion. Hair pulling is what emerges when a prolonged environmentally rooted contradiction can find no resolution.

 

Hair pulling cues

ready, set....pull?

Cues for hair pulling in humans have been studied, most notably by Christenson et al. (1993).  Two distinct types of cues were recognised.  These are as follows:

Type 1. negative affect e.g. anger, embarrassment, shame, depression , anxiety, emotional hurt.

These type one cues point to extreme frustration, where a situation is leading to an emotion or state of mind that the individual cannot cope with and nor can s/he escape from it.  In other words, the situation cannot be transcended and the mind becomes trapped or stuck in an undesirable state. 

Type 2. sedentary contemplative situations, e.g. feeling alone, tired, relaxed, getting too little sleep.

In these type two situations a natural state of transition - whereby feeling alone or tired should lead to seeking social contact or sleep - has not been achieved.  Indeed, such a transition may be being avoided or negated.  Maybe a loss of continuity is feared; a loss of temporal identity.  The bottom line is that the organism falls back upon the body to offer comfort and exercise control over its immediate environment.

Cognitive behaviourists when dealing with hair pulling will try to remove pullers from those situations that seem to cue the behaviour.  They might tell the person to sit in a different chair than they would normally, as if the problem had something to do with the room's furnishings!!  This kind of lack of professional understanding is rather shameful in my view.   Instead, they should be focused on the function of displacement behaviour and how its stereotypical manifestation indicates the presence of a real problem in the patient's history which relates to their earlier environmental adaptation.  Psychology can only have credibility to the extent that it fulfills itself as a true science and does not confuse band aids for cures.

When Mental Algorithms Go Wrong...

Evolutionary psychologists tend to view the mind as a kind of computer that runs algorithms that help us make decisions based on sensory input from the environment and an internal assessment of our physiological condition.  These are called tradeoffs and we make them all the time.  For example, do you continue safely in a job you hate, even though it gives you security? Or do you quit and pursue your dream to be a Hollywood actor with a massive payoff if you succeed - but the poverty line if you don't.  I am being a bit facetious here, of course.  But time/resources/energy/risk tolerance are all factors in decisions that have been made by our ancestor's since human history began.

Hunter-gathers make tradeoffs in terms of how much time they will give to hunting, to spending time with family, to forming social alliances...(sound familiar) and the mind has evolved to allow us to compute these things.  In modern day life businessmen do the same, allocating company funds for investing in research and development, marketing etc.  Indeed, capitalism is all about employing algorithms to maximise financial surplus.

But what has all of this to do with psychology?  Well, if the human mind is a sort of computer that uses its own form of algorithms to make decisions then 'normal' behaviour can be defined by how well those calculations suit the circumstances in which they are employed.  'Stupid' behaviour fits within a normal range, and after a few glasses of wine we are often apt to make decision we regret because we do not properly take in all the information or consider all the angles or give equal weight to various considerations.  But even daft decisions can be intelligible in the context they are made, so that we might forgive someone who offers the excuse, 'But I was really drunk at the time!'

So, what about 'insane' behaviour?  Well, this would mean that a decision someone made or an act they performed would be hard to fathom.  No rational basis might be discerned for it.  Indeed, the action may be one that seems totally ill-suited to the context in which it occurs or is one where the algorithm used may be an inversion of one which would normally serve survival.  For example, what if someone was making business decisions that maximised expenditure and minimised profit margins as much as possible?  Or what if someone decided to use time as inefficiently as possible to achieve an objective that could be achieved much faster?  Well, you might argue these people were aiming for these purposes - perhaps trying to ruin the company or dragging their heels to procrastinate and put off doing something that they wished to avoid.  Fair enough.  But what if this algorithm of inefficiency were applied to all their actions?

It is interesting to view all behaviours, including ones which are in the realm of abnormal psychology, as algorithms gone wrong.  Hair pulling, for example, is a kind of hunting for lipid fat roots whereby the puller aims to maximise the fat gained by selecting the most profitable hairs.  Viewed this way hair pulling constitutes an algorithm normally applied to resource finding but which is being misapplied to the body.  One reason this might occur is because the individual finds itself in an unstable or unpredictable environment and to combat this the mind rechannels an algorithm that is normally directed towards the world towards the body instead.  And after this calm can be achieved because a reward can be reliably obtained from specific manipulations, i.e. control is restored.

 By viewing abnormal behaviours in terms of the reward versus time/energy consumed/context applied to, it may be possible to view abnormality in terms of mental calculations which have gone awry in some way.  This may mean they are compensating for environmental instability in which no clear and reliable optimal strategy for obtaining resources or social attachments can be identified. 

Unless someone intercedes and helps supply new environmental information that changes a person's perspective on their world, or provides cognitive support so that an adaptive application of the algorithm can be found, the problems may persist.

 

is hair texture a factor in hair pulling?

Are fine, straight hairs less pulled?

Before people pull out a hair it is common for them to go through a process of searching for the right one to extract. I call this 'the audition'. Auditioning for the right hair means locating one that 'feels right'. Hair pullers seek out a strand that is satisfyingly kinked, or wiry or curled. This preference means that there must be hairs that are clearly less attractive to them and which remain unextracted. These tend to be fine, straight hairs that do not pass the audition process.

The favourite area to pull from for people who pull out head hairs is a region of the scalp called the vertex, which is at the top of the head and where most men naturally manifest hair loss.  However, less common areas for pulling are at the very front or those areas close to the sides where the hairline meets the skin regions. Why is this?

One answer I would suggest is that straight, fine hairs on the border of where hair meets skin do not produce fatty roots. The oily sebum yielding roots come from more central areas of the scalp and this is a major reason for pulling from those areas. Indeed, Mansueto (1990) has noted that procurement of hair roots provides a strong incentive for pulling, with 43% of TTM subjects acknowledging that they manipulate the hair/hair root.

It is only my theory, but one experiment would be to use water or gel in order to smoothen the hair and give it a straighter, finer texture than usual. This might interfere with the auditioning process by removing the kinks and wiry texture from hairs which trigger the pulling. Maybe someone has tried this already. If so, get in touch and say how it went.

What the ancient Greeks teach us about hair pulling

Hair pulling behaviour features quite a lot in ancient Greek literature - as anyone checking out this blog will know - and it is interesting to note that two forms of hair pulling are revealed.

One form of hair pulling is ritualistic - hair pulling that would have been conducted at funerals or at times of intense grief as a consciously performed social act. Indeed, as the body of the deceased was paraded or displayed family and loved ones would have yanked and pulled out hairs as an expression of their grief and inner pain. In many respects such behaviour served as a sincerity signal, whereby the pain of yanking out hair would reveal the genuine nature of the grief being felt as it is not something you would do for the sake of someone you didn't feel strongly about.  

Of course, this raises the question as to why a public display of hair pulling would emerge as an expression of grief?   In my view there are two reasons.  Firstly, inflicting pain on oneself releases endorphins, the body's own natural pain killers.  So on some level the mourner is attempting to inflict intense pain on himself as a way of triggering endorphin release and reduce the pain of his grief.  Using hair to do this does not involve causing any real damage to the body, but does produce a dishevelled appearance that socially marks him as a mourner to onlookers.  The second reason is that hair pulling is a behaviour that humans have always manifested, and is recorded in Hippocrates writings (see this site for more information on Hippocrates' notes on hair pulling).  In this respect, the mourners can be viewed as enacting a behaviour that is associated with intense distress and psychological frustration.

These days people do not pull out their hair at funerals because hair pulling itself is very little known and has lost its cultural significance.  However, it remains far more common than the statistics of official reported cases would have us believe.  Indeed, it has always been part of the human repertoire of body-directed actions that the Greeks were the first to record.  I like the fact that what is so little known of today was once a common spectacle among the ancient Greeks.