'Are You Bald By Choice?'

I was Sam, the badass dyke with the shaved head. What people didn’t see was the physical anguish that prompted me to pick up the clippers in the first place.

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Oct 31 2018, 9:25pm

Courtesy of Sam Manzella

During my sophomore and junior years of college in rural New York, I spent my weekends the way many college students do: working a minimum-wage job to pay the bills. I’d taken on slinging lattes and doling out baked goods at my neighborhood Dunkin' Donuts, and after months of this, few interactions I had with customers surprised me anymore. One exchange that did throw me for a loop, though, was an earnest question asked by one of my regulars, a woman in her 40s with kind eyes and a gentle smile: “Are you bald by choice?”

It was 7am on a Saturday, and I was half-asleep from the previous night out with friends, but the question made me jolt awake. My mind began to race: Was this woman looking for a lighthearted quip about me being a queer punk? Or was she asking me this because she genuinely wanted to know to the truth about why I shaved my head?

It was a simple question, but I didn’t have a simple answer. I didn’t owe her one, either, so I smiled, laughed it off with a “yes,” and handed her her latte.

Am I bald by choice? I mean, literally, I am. Months before the woman posed that question, I’d borrowed a friend’s set of clunky Wahl clippers and shaved my shaggy, grown-out pixie cut into an uneven buzz cut. It was part of my “look,” a friend told me later. I was Sam, the badass dyke with the shaved head. That was how everyone saw me.

What they didn’t see was the emotional and sometimes physical anguish that prompted me to pick up the clippers in the first place. I’ve struggled privately with trichotillomania, a compulsive hair-pulling disorder, for more than ten years. Strange as it may seem, the disorder isn’t exactly uncommon: The Trichotillomania Learning Center Foundation for Body-Focused Repetitive Behaviors (BFRBs) estimates that some 1 or 2 in every 50 people experience the disorder, also referred to as “trich” (but not to be confused with trichomoniasis, the common and curable STD).

The experience of pulling has an intrinsic reward to it for some, says Litsa R. Tanner, co-founder and clinical director of the Santa Rosa Center for Cognitive Behavioral Therapy in California. Patients she's treated for trich “often describe the pulling as pleasurable."

I was diagnosed with trich at around 11 years old. I started pulling out my eyebrows and eyelashes with my fingers or tweezers and later abandoned both spots in favor of the hair on my head. For me, Tanner’s words ring true: Pulling my hair out is pleasurable—self-soothing, almost, like biting your nails or twirling your hair when you’re nervous. I usually enter into a trance-like state when I pull, becoming almost completely unaware of what I’m doing. But the bald patches on my head quickly became something I couldn’t hide with the right haircut, and I wore wigs and headcovers—bandanas, caps, beanies, you name it—for years.

As a teen, I pulled so much and so often that my fingers were calloused, my scalp raw and red. Years of cognitive-behavioral therapy (CBT) and different cocktails of anti-anxiety meds helped, sure, but the pulling only ebbed and flowed. Tanner stresses that the population of people who deal with trich is extremely heterogeneous, meaning that different people experience the disorder in different ways. But she confirms that my experience—a persistent, uncontrollable urge to pull that endures despite ongoing treatment—is “very common.”


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My hair-pulling disorder traveled with me from middle school, to high school, to college. I went on to receive related diagnoses of generalized anxiety disorder and obsessive-compulsive disorder. I became super careful about only pulling in private, relying again on hats and headscarves to hide the damage, and the whole ordeal remained my biggest, most painful secret. So when I decided in a semi-drunken stupor to shave my head one night in college, my best friends, who’d earned the right to know my tragic backstory, cheered me on. “You’ll look great!” they screamed, slinging back shots of Fireball. My partner at the time even volunteered to shave their head in solidarity.

I am queer as fuck and extremely unapologetic about it, so being a woman with a shaved head wasn’t too much of a stretch. After all, it isn’t exactly wild for queer women to sport traditionally masculine haircuts.

What makes my experience as a queer woman with trich especially ironic is the drastic gender gap among trich patients. By adulthood, some 80 to 90 percent of reported trichotillomania patients are women. However, Tanner notes that those estimates might not convey the full story. “Men are able to do things like shave their head or keep their hair cut very short, all things that make it very hard or impossible to pull,” she explains. These conventions make it easier for men to manage trich without bucking gender norms or societal pressures, meaning that the number of men who experience the disorder could actually be much larger than the number who seek treatment.

I felt and continue to feel a sense of distance from the constraints of hetero-patriarchal gender norms. But that relative freedom still wasn’t enough to totally spare me from shame. Shaving my head felt like winning a battle and admitting defeat in the same breath. In a matter of minutes, I was freed from the ability to pull, the impulse that had ruled my life and instilled in me a deep sense of self-loathing for...well, for as long as I could remember. But I was also tired of fighting the urge to pull. And this seemed like a two-birds-with-one-stone kind of deal.

When I first shaved my head on that fateful night, standing in a raggedy towel with my ex and a few friends in the bathroom of our college dorm, my hands shook uncontrollably. Today, I shave my head once or twice a week. My hands don’t shake. I keep my buzz cut short enough that I couldn’t pull my hair if I wanted to, and I wear the haircut proudly. I don’t feel ashamed—I feel cool, empowered.

So really, am I bald by choice? Not exactly. I’ve come to realize that while I made the literal choice to shave my head, the decision was a direct result of my struggles with trich. But my queerness and my trichotillomania journey are irrevocably woven together, an entanglement of internal identity, private struggles, and outward presentation that’s as beautiful as it is messy. This is who I am. And I wouldn’t have it any other way.

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