Hair pulling in the writings of Shakespeare

In the works of William Shakespeare hair pulling appears quite a bit.  It is performed to:

(a) reveal grief
(b) demonstrate madness (mental illness)
(c) show despair

It appears in the following works by Shakespeare:

The Rape of Lucrece (poem)

    "Let him have time to tear his curled hair,  [line 1120]
    Let him have time against himself to rave,
    Let him have time of time's help to despair,
    Let him have time to live a loathed slave,
    Let him have time a beggar's orts to crave,
    And time to see one that by alms doth live
    Disdain to him disdained scraps to give."

Much Ado About Nothing (2.3)

 Claudio:
    Then down upon her knees she falls, weeps, sobs, beats her heart, tears her hair, prays, curses--'O sweet Benedick! God give me patience!'


Romeo and Juliet (3.3)

Romeo:
    Thou canst not speak of that thou dost not feel.
    Wert thou as young as I, Juliet thy love,
    An hour but married, Tybalt murdered,
    Doting like me, and like me banished,
    Then mightst thou speak, then mightst thou tear thy hair,
    And fall upon the ground, as I do now,
    Taking the measure of an unmade grave.

Troilus and Cressida (4.2)

Cressida:
 Tear my bright hair and scratch my praised cheeks,
 Crack my clear voice with sobs and break my heart
 With sounding Troilus. I will not go from Troy.



King Lear (3.1)

Kent:
I know you. Where's the king?

Gentleman:
    Contending with the fretful element:
    Bids the winds blow the earth into the sea,
    Or swell the curled water 'bove the main,
    That things might change or cease; tears his white hair,
    Which the impetuous blasts, with eyeless rage,
    Catch in their fury, and make nothing of;
    Strives in his little world of man to out-scorn
    The to-and-fro-conflicting wind and rain.

King John (3.4)

Constance:
I am not mad: this hair I tear is mine;
My name is Constance; I was Geffrey's wife;
Young Arthur is my son, and he is lost:
I am not mad: I would to heaven I were!
For then, 'tis like I should forget myself:
O, if I could, what grief should I forget!
[snip]

King Philip:
Bind up those tresses. O, what love I note
In the fair multitude of those her hairs!
Where but by chance a silver drop hath fallen,
Even to that drop ten thousand wiry friends
Do glue themselves in sociable grief,
Like true, inseparable, faithful loves,
Sticking together in calamity.

Constance:
To England, if you will.

King Philip:
Bind up your hairs.


Constance:
Yes, that I will; and wherefore will I do it?
I tore them from their bonds and cried aloud
'O that these hands could so redeem my son,
As they have given these hairs their liberty!'
But now I envy at their liberty,
And will again commit them to their bonds,
Because my poor child is a prisoner.
[...]

King Philip:
You are as fond of grief as of your child.

In the final example given above in King John (3.4), Constance defends her hair pulling as an expression of her grief for her son, rather than a sign of her madness.  But whatever meaning the audience is supposed to place upon hair pulling in Shakespeare's plays (and in the poem) the underlying purpose of the action is to reveal the sincerity of the feelings, emotions, heart ache and frustration that underlies it.  This reveals hair pulling to be an action that is not something that people feign or pretend to perform.  It is a behaviour that is painful under regular circumstances. No one does it for fun!  But in the face of genuine grief and anxiety it becomes a reaction that reveals itself to have benefits.  It helps take some of the pain away by, paradoxically, increasing the intensity of a person's pain through the yanking of hairs.  Maybe hair pulling is akin to self injuring in some way? However, whether self injuring behaviour is as automatically performed as hair pulling is hard to say.  I find it fascinating that references to hair pulling in English literature are so plentiful. I just wish there were more references to it in psychology too!

My research interests

If you haven't already figured, my interest is in what happens when people are in some way caught in two minds.  It can be a strange sensation that we all experience at various moments and it leads to behaviour being directed towards ourselves.  So, chin rubbing or head scratching are the most common manifestations.  Now some people might ask, so what?  Such behaviours are so natural and simple they might wonder, what is there to research?  The reason I think these behaviours are interesting is because they are so close to what we are as human beings that we barely notice them.  They are automatic and occur without conscious intention.  This fact alone reveals something startling: self-grooming reflects our ancient ancestral behaviour patterns.  Scratching or rubbing or stroking ourselves is behaviour so linked to our primate past that these are the actions that we are! It is the fact we overlook these actions because they are so normal that makes them so fascinating when they are highlighted. 

     In terms of research my aim is to better understand the benefits or advantages these kinds of behaviours have for us and in turn this will help explain why we developed them in the first place.  Soothing oneself by touching, rubbing, smoothing, stroking, scratching or pulling actions means that we feel better in some way for doing it than if we didn't do it.  So, rubbing your chin when weighing up the pros and cons of a decision somehow assists in the decision making process by allowing you to tolerate the discomfort of being in two minds about something until you can resolve the dilemna one way or another.  But what would happen if you had to make an important decision that placed you in a dilemna and you couldn't self-soothe (let's say your hands were bound in some way)? Would you make more hurried and less prudent choices as a result?  

     Another behaviour that interests me a lot is when footballers or fans clasp their hands above their heads when a goal has been missed.  Usually it happens when they expect the ball to go into the net but it diverges or swerves away or gets saved at the last moment.  I regularly do it when I watch my team  (West Bromwich Albion) narrowly send a ball over the bar or past the post.  But I don't do it when I can see from the first moment that the ball is not on course for the back of the net.  It requires the expectation of a goal and then the sudden thwarting of this hope to produce the response.  But why?  Why can't I just sigh or groan and let that be enough?  Why do I have to raise my hands to my head and pass my fingers through my hair?  What is that about?  Again, there must be benefits to the behaviour that help reduce the sudden discomfort and stress when two opposing impulses are activated simultaneously or when a cued behaviour (celebration) is suddenly deselected.

     My other interest, hair pulling, is a behaviour that I feel may be a stereotypical action that occurs when tension or stress is prolonged by being in an unnatural situation.  Imagine being caught in two minds about something not just for a few seconds but for hours, days or even years!

     I would like to undertake research into what the benefits of these behavours are to, as I said, find out how they benefit us.  Do they reduce stress or the heart rate?  Do they affect metabolic rate?  What happens if these behaviours are prevented in some way so the discomfort of being in two minds is not relieved?  These are the kinds of questions I would like to answer.  This week I added a paypal button to my site to receive donations to this site.  With any money these are the questions I would aim to research into further.

Lack of research into trichotillomania

It is not easy to research displacement behaviour - for a few reasons.  The main one is that not many psychology departments or schools focus on it.  This is surprising when one considers that hairpulling, for example, may affect up to 13 per cent of the population (by some estimates). In regards to trichotillomania (aka hair pulling), another problem that I discovered all to well, is that it is hard to find hair pullers willing to come and be subjects of studies.  In most cases hair pullers will not even go and see their regular doctor, let alone volunteer to take part in an experiment. People with trichotillomania may feel very ashamed of what they do and cover up bald patches with hats, wigs etc.  But because hair pulling does not detrimentally affect their overall state of physical health and because the behaviour is pleasurable and may even lower ongoing stress, they don't report it.  After all, why try to cure yourself of something that has clear benefits?  One area of research I would have liked to engage in (and maybe will in the future) is to try and assess what those benefits to a hair puller actually are.  For example, does pulling out hair lower stress (cortisol) levels?  Does it lead to endorphin release into the bloodstream (painkiller)?  My intention was to create a pain test to establish a person's pain threshold.  This might be done simply, such as seeing how long a person can stand having an ice pack placed against their skin.  Then the test would be done again to see if pain tolerance is higher after a bout of hair pulling.  A mouth swab could aslo be used to check cortisol levels.  A very simple experiment but unfortunately it was not performed.  Other things I would have liked to examine include:

Do hair pullers prefer certain types of hairs over others? e.g. wiry, kinked or curly hairs over and above straight, smooth, fine ones.

Can hair pulling be affected by ensuring the head and neck remain in an erect position and so the head bowing that makes hair pulling possible can not take place?

I believe that simple experiment that focus on direct observations can me most useful and helpful.  Of course, using an fMRI scanner to observe brain areas related to hair pulling is valuable too.  But, and I might be wrong, the technology is not yet in place to do both together - undertake a scan of someone in the process of hair pulling!  I think when that day comes some serious new data will emerge.  Hopefully.

Hair Pulling in Art

It is fascinating to think that the association of madness and hair pulling goes back to medieval times.  The fool or the madman in earliest artistic representations of madness was marked by a dishevelled appearance, and chiefly by wild unkempt hair.  This image is most likely derived from the fact that people with mental illness would have led socially isolated lives outside of the local community.  They may well have become forest dwellers, where they would have been left alone to forage for berries and other freely growing morsels.  If and when they emerged in society they would have been instantly recognisable by their tattered, dirty attire and, of course, ungroomed appearance.  Another fascinating fact is that the classical image of the court jester, a professional fool appointed at court, is of a man wearing gaudy unmatching colours and wearing a three-pronged hat with bells.  What we have here is the image of the forest madman but in an ornate , costume - the colours signify a madman's lack of taste and dress co-ordination and the three-pronged hat invokes association with twisted clumps of upstanding unbrushed hair.

    Images of madness appear aplenty in art, but hair pulling per se is more rarely depicted.  But one example can be found in Artus Quillinus De Oude's sculpture called The Women From The Madhouse from the 17th century (Gilman, 19, 1996).  A seated woman, naked for only a cloth around her waist area, yanks with her left hand at at a thick and entwined handful of hair.  She is pulling at far too many hairs at once for them to become extracted, so self-inflicting pain seems to be her object.  And with her right hand she is twisting tightly another thick bundle of hairs and pulling them downwards.  On her face is a mixture of both agony and pleasure (or relief), as if the mind and body are somehow split; her emotional and physical needs so neglected that automatic grooming behaviours have become more exagerated and self-directed than normal.  It is as if her soul seeks relief from the otherwise lack of control she has over her immediate environment, and obtains it via hair manipulation.

     A second interesting presentation of hair pulling can be found in Thomas Rowlandson's and Augustus Pugin's drawing of the interior of St. Luke's Hospital in 1809 (Gilman, 146, 1996).   Four women in the forefront clearly have very dishevelled hair. One seated in the left corner appears to be holding up in each hand a clump of extracted hairs.  A second seated woman in the middle of the picture is clutching at her hair, possibly seeking to extract some fibres.  Two other women walk together and although their hands are not engaged in pulling activity their hair is clearly of uneven lengths indicating sporadic and unco-ordinated growth - resulting perhaps from hairs having been plucked out at diverse times.  In this scene the forementioned patients reflect, 'standard images of Bedlam, raving mania and melancholy' (Gilman 1996).  The artist divides the image into two halves - the left side where the hair pullers dwell represents the old style Bedlam or unreformed asylum where inmates are abandoned and left alone.  The hair pulling may then be symptomatic of the hospital environment itself.  On the right side, hospital life is organised and ordely with inmates performing useful chores and where no self-directed behaviours are being indulged in. The implication is that healthy minds require healthy socially functional lifestyles - an affirmation of the christian sentiment that the devil makes work for idle hands.  

   Again we can see that references to hair and hair pulling are core to the commonly held images that we all carry with us but which are so close to us that we often overlook them. 

 References:

Gilman, S. (1996), Seeing the Insane (University of Nebraska Press)

Hair Pulling in Medical Literature

The first ever reference made to hair pulling in a medical context was by the father of modern medicine, Hippocrates around 400 B.C.  In Epidemics, Book III he lists hair plucking as one of the many signs and symptoms a doctor must consider when assessing a patient in order to identify the disease.  I very much doubt if such an item would be on many doctors’ checklist today!  Most interestingly he gives an account of a patient in Thasos, referred to as the wife of Delearces.   She is suffering with a high fever that involves shivering.  Her illness is thought by Hippocrates to be brought on by grief.  Her hair pulling is accompanied by her falling silent and scratching too.  She also cannot sleep and is constipated.  

      Amazingly, it will be almost 2000 years later before another mention is made of hair pulling in the medical literature.  In 1777-8 a French surgeon named Baudamant finds masses of hair in the stomach of a teenage boy indicating hair pulling and hair ingestion.  But it is not until 1889 in a medical report by the French physician Francois Henri Hallopeau that hair pulling receives its first formal diagnostic label.  Hallopeau gave it the name trichotillomania, from the Greek words thrix (hiar), tillein (to pluck or pull) and mania (an abnormal love for).  This name remains today, though mostly it is referred to simply as hair pulling disorder.  Hallopeau’s first report in 1889 described a young man who pulled out all of his body hair.  Another more detailed report by Hallopeau in 1894 identified the key features of hair pulling as:

1) itching sensation extending to all the hairy parts of the body
2) a “type of insanity” that drives the patient to seek relief from pruritus via hair pulling
3) normal appearance of skin and hair
4) long duration
5) lack of cure

Hallopeau had sought to cure hair pulling by applying mentholated camphor and wrapping the patient in rubber.  But when the method proved ineffective he declared the disorder incurable.
     Since this time, doctors have found establishing a diagnostic criteria for hair pulling very problematic.  It remains a poorly understood disorder and it varies in its particular manifestations which include:

(a) hair can be pulled from different sites of the body
(b) hair may or may not be chewed and the root eaten and/or the hair ingested
(c) there may or may not be a tingling itchy sensation prior to pulling etc
(d) pulling may occur consciously or unconsciously.  

To date trichotillomania evades a fully inclusive medical definition.  But according to DSM IV (American Psychiatric Association, 1994) the criteria for hair pulling includes:

A. Recurrent pulling out of one's hair resulting in noticeable hair loss.
B. An increasing sense of tension immediately before pulling out the hair or when attempting to resist the behavior.
C. Pleasure, gratification, or relief when pulling out the hair. [- but not always the case]

D. The disturbance is not better accounted for by another mental disorder and is not due to a general medical condition (e.g., a dermatological condition).
E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

It is currently classified in the category Impulse Control Disorders Not Otherwise Specified though this may change in time (for the very latest current definition see DSM V).

     Considering that records of hair pulling go back as far as the writings of Hippocrates, not to mention featuring in the Bible, Homer’s Iliad and in Shakespeare (more on these references in future posts) it is extraordinary to reflect that in the 21st Century psychologists and psychiatrists continue to struggle to find a meaningful diagnostic category that might help to shed light on an age old enigma of psychology.

References:
American Pschiatric Associaton, DSM IV, (1994)

Christenson, G.A. and Mansueto, C.S. (1999), "Trichotillomania: Descriptive characteristics and phenomenology". Chapter in the book "Trichotillomania", edited by D.J. Stein et al. 1999.

Hair pulling in ancient literature - Part One: The Bible

Hair pulling in various forms features heavily in the works of ancient literature and also in later English literature too.  In the next series of blog posts I will cover some of these references to pulling hair and attempt to comment on how hair pulling is depicted, the situations in which it occurs and what this possibly reveals to us about human nature.

    Since the Bible is a text at the very heart of Western culture it is fascinating to extract instances of hair pulling from it, considering that hair pulling is a behavior that is largely unrecognised in modern society.  

    In fact, biblical references to hair are not hard to find.  In the King James Bible there exist eighty references to hair - both in relation to animals and humans. (There are also 11 separate references to locks of hair.) However, there is only a single primary reference to actual body directed hair pulling itself, and this appears in the Book of Ezra, 9:3-7:

When I heard this news, I rent my robe and mantle, and tore my hair and my beard, and I sat dumbfounded; and all who went in fear of the words of God of Israel rallied to me because of the offence of these exiles.  I sat there dumbfounded till the evening sacrifice.
   Then at the evening sacrifice, I rose from my humiliation and, in my rent robe and mantle, I knelt down and spread out my hands to the Lord my God and said, ‘O my God, I am humiliated, I am ashamed to lift my face to thee, my God; for we are sunk in our iniquities, and our guilt is so great that it reaches high heaven.

The background to this odd behaviour, which entails tearing his clothes and his hair, is when Ezra (a very devout man) learns that people returning to Israel have not kept themselves sexually apart from non-jews during their time in exile.  Fearing the wrath of God for breaking His covenant Ezra has some kind of fit that involves yanking out his hair and this is then followed by some kind of trance state or unconsciousness.  The episode seems to be brought on by an extreme internal conflict whereby the God fearing man suddenly feels contaminated by the sins of his people. The sudden manic tearing of his clothes, and the self-directed pulling out of his head hair and facial hair would on one level appear to be an attempt to rid himself of contamination, to pick off or groom away unwanted particles adhering to his body.  And yet we know that what ails him is not physical contamination but a sense of a tainted spirit.   From this, Ezra's sense of true helplessness is conveyed by  (a) using a contaminated part (his hand) to attempt to clean the whole (body) and (b) using a misapplied physical grooming strategy to achieve spiritual cleanliness.  In other words, not only is Ezra’s hair pulling an inappropriate method to achieve a spiritual effect but it is also symptomatic of a state of mind in which no adaptive solution can be found the problem he faces.  

   The emergence of grooming behaviour during this internal conflict is perhaps revealing.  The Bible is not a work that exemplifies psychological realism but in Ezra's case the hair pulling seems to produce a beneficial effect or neuro-chemical change.  It precedes a state of calmness, which is inkeeping with the notion that endorphins have been released into the blood stream as a direct result of inflicting pain on himself.  Interestingly too, the people around him express no surprise or alarm towards his hair pulling and impute no case of demonic possession to him; hair pulling would seem to be within the normal realm of their common experience of human social behaviour.  Following the incident no further reference is made to Ezra’s hair pulling episode.  Perhaps it marks the continuation of a habitual behaviour that has persisted for years. 

        Rather than viewing his manic episode as a moment of divine interaction between a holy prophet and his God, viewed psychologically it may instead reveal an organism caught in two minds, or two states.  On one hand he yearns to feel righteous and holy but on the other he knows that he shares the sins of his people in the eyes of his God.  The co-existence of these two incompatibles in the same moment therefore negate each other and produce a third alternative state - hair and beard pulling.   In this respect Ezra's case possibly supports the theory that trichotillomania is a stereotypical displacement behaviour.

Interview questions raised on hair pulling...

A student this week asked me some questions about hair pulling for a project she was working on.  In trying to answer her questions it hit me just how little we really know and investigate this condition.  She asked firstly:

What do you think triggers the beginning of trichotillomania in someone? 

 

My answer to this question was that different fields of psychology have different perspectives on it.  The neurobiologist might point to dysfunction in the basal ganglia and cerebellum which implicate the role of serotonin.  The behaviourist might see it as a random behaviour that results when an environment inadequately enforces normal behaviours so that unintended behaviours develop.  Evolutionary psychology (in which camp I place myself) might view it as a 'mental program' or an innate behaviour derived from man's ancestral past which is triggered under certain conditons.  Those triggering conditions are most threatening during a sensitive period when the young developing organism's brain is becoming wired to its environment.  If the environment is unnatural or inadequate and thwarts, prevents or does not reciprocate and support species specific behviours then a self-directed behaviour might emerge.  But I could not say why hair pulling develops over, say, nail biting or thumb sucking etc.  One of the reasons I could not say is because so little research has gone into this question, if any!  So, I want to put forward some suggestions of my own here for what they are worth.

1. no research has gone into why the lipid fat root is so valued by hair pullers.  This eating behaviour that forms part of hair pulling is often completely omitted from considerations of the condition because the focus is placed instead on coping with the social embarrassment of hair loss.

2. no research has gone into the effect of hair pulling and lipid fat hair root eating on a person's metabolic rate.

3. no research has gone into why certain kinds of hairs and certain areas of the scalp are preferred over others.

I believe that the eating component of hair pulling is an attempt to control or homeostatically regulate in some way the metabolic rate, i.e. that rate at which the body conserves or spends energy.  The implication here is that hair pulling is triggered by environmental conditions which are stressful and which the brain may interpret as conditions in which resources and social support are scarce.  Hair pulling and root eating may be an activity that aims at preserving resources and reducing exposure time to a disadvantegeous situation because it is an activity that: (a) is a form of self-feeding as well as self-grooming (b) is mode of foraging applied to the body (c) is a form of tolerating exposure to an environment in which the indivudual feels powerless by triggering behaviours that utilise grooming and feeding brain circuitry implicated in survival (d) is a way of focusing attention towards the body and away from the world because the act of pulling involves bowing the head and obtaining an object that fills the foreground.  Of course, without research pointing in this direction this is but conjecture on my part. 

The student's second question was:

How would someone with the condition overcome it?  

I suggested that unless hair pulling is engaged with early on and during the developmental period when the brain is becoming wired to its environment then it could well become a lifelong condition.  In other words, the environment needs to be altered as soon as the problem surfaces to address the triggering circumstances.  Maybe family system therapy would be the best place to start.  In short, some sort of environmental enrichment is required - a method successfully employed with captive animals that fur pull.

Maybe the moral here, is that unless we see ourselves as organisms that have developed to be sensitive to environmental signals - as animals are - we cannot hope to understand hair pulling fully.