Applying Self Psychology to a Research Project: Hair-Pulling as a Language of Death

I had two reasons for deciding to set out on a research journey to study hair-pulling. The first was a long-standing professional interest in how the body encodes traumatic self-experience; the second was a desire to understand my own history of hair-pulling which began when I was twelve years old. I had long been aware that no clinical studies on hair-pulling have been conducted and that the prevailing belief in the psychiatric field was that hair-pulling or trichotillomania is best understood as an obsessive-compulsive disorder-the result of an unfortunate neurological glitch. Much psychiatric literature claims that depression among hair pullers, a frequent finding, results from social repercussions related to their missing eyebrows or eyelashes, or from their being bald. The recommended treatment involves fostering self-acceptance of the "condition" by means of cognitive-behavioral therapy and psychopharmacological intervention.

Not only have I found this understanding of hair-pulling a poor fit with respect to my own hair-pulling, but there is evidence that this approach has been largely unsuccessful and that the pulling out of hair remains an intractable, mysterious disorder (O'Sullivan et al., 1997; Christenson et al., 1999; Diefenbach, 2000; Elliott et al., 2000; Gretchen et al., 2000; Penzel, 2003; Kress et al., 2004; Woods et al., 2006).

At the outset of my research, I had no idea what, if anything, I might find. My study consisted of three unstructured interviews of seventy-five people who were chosen on a "first come" basis among those who responded to an advertisement I placed in a local newspaper, To this day, I am still astounded at the extent to which my research partners, who were all hair-pullers, shared similar organizing patterns. In their first interviews with me they invariably reported viewing their hair-pulling as a habit. To my surprise, not one considered that he or she had experienced any trauma. However as our research relationship developed, what emerged were intergenerational histories filled with repeated and often catastrophic losses and deaths, which had invariably been met with silence and disavowal. Consequently, these deaths had largely gone unmourned. Indirectly, their loved ones seem to have conveyed to them that they must not know, they must not ask. Nevertheless, their terrible losses haunted them. Death was everywhere and nowhere and felt far more certain than life.

When deaths occurred in the hair-pullers' own lives, they reported feeling terror and overwhelmingly guilt at not be able to keep their loved ones alive. Like mourners of yore who pulled out their hair as an important part of a death ritual, hair-pulling, for my research partners, seems to have become a dissociative death ritual in a family and culture where death had to be denied at all cost.

In previous writings I have told many of my hair-pullers' stories (Lewis, 2002, 2003, 2004, 2006, 2008). However, this piece focuses on the research process of coming to know-what I have come to call my self psychology/intersubjective research methodology. Intrinsic to this methodology is my awareness that my own subjectivity inevitably influences the research process. Whatever I say or do not say, ask or do not ask, feel or disavow, depends on all of who I am. The process is one of mutual influence in which there is no such thing as a lone research partner.

Although acknowledging my hair-pulling had, heretofore, been intensely shameful, after embracing an intersubjective sensibility, I knew I had to open myself to all the feelings and memories that this study would evoke. Nevertheless I was shocked to find that research could be such an extreme sport. I had no idea that I would become flooded with memories and feelings relating to death and loss that I had never experienced before. They were so unrelenting, at times I thought I would lose my mind. I know I could not have finished this study if I had not been seeing my analyst. However, equally intense was my relief and joy on discovering the strong bonds of twinship that emerged for me with each and every one of my research partners.

The relationships I developed with many of my research partners were similar in many important ways to my relationships with my patients. I became aware of the selfobject experiences my research partners yearned for during our time together, and the selfobject experiences I needed from them. I often became aware, at times after the fact, that a rupture had occurred which required repair before the process could move forward. And, I became aware that dissociative experience was as context-sensitive in the research relationship as it was in the psychotherapy relationship. When a feeling of safety and trust was present, memory could emerge. When a feeling of endangerment or potential retraumatization felt imminent, memory and meaning-making would freeze. Perhaps most importantly, I realized that bi-directional healing processes began during the three times that my research partners and I met together. So, often, we became fields in mourning where memories of death and loss could exist for the very first time.

This research journey radically changed how I now look at most research. I am forever questioning when I read about research findings: "Where is the researcher in his or her research?" Just as we have exposed the myth of neutrality with regard to psychoanalysis, I believe we could say that a "God's eye view" with regard to "the research subject" is also a myth. With this said, my question remains: "Isn't all research inherently intersubjective?"

I must add that my research study created an uncomfortable dilemma for me. In this postmodern climate where so many of us stand firmly in opposition to Cartesian essentialism, I found that the commonalities my seventy-five research partners and I shared could not be dismissed as simple coincidence. What to do then about reconciling this with an intersubjective sensibility? More specifically, for almost two decades my clinical work and writings focused solely on the thoroughly fluid and dynamic intersubjective field codetermined by me and my patients. To a great degree, my emphasis was on the uniqueness of the interplay between our two subjective worlds.

With the advent of my research project, I suddenly found myself looking beyond the researcher/research partner dyad. When I became aware of all that my research partners and I had in common, I felt I had to acknowledge that we were a distinct group and that, perhaps, there were many more hair-pullers out there who also shared our similarities. Ultimately, I found myself questioning if our present focus on the particularity of each patient/analyst dyad might be just as extreme, in its own way, as any psychoanalytic theory that seeks to universalize human psychodynamics. It is my hope that human sameness and the uniqueness of our own subjectivities can exist side by side. It is also my hope that another researcher will do a hair-pulling study. I would very much like to see whether he or she would find different themes. It is certainly a possibility.

Jane Lewis, L.C.S.W. is a training and supervising analyst at The Training and Research Institute for Self Psychology (TRISP). She has presented papers on the connection between transgenerational trauma and hair-pulling at numerous conferences. She was also founder and director of the Eating Disorders Program at the Karen Horney Clinic in New York City. She is currently in private practice.

References

Christenson,G., Mansueto, C., Trichotillomania: Descriptive Characteristics and Phenomenology (1999), Trichotillomania, ed. Stein et al., (American Psychiatric Press: Washington, D.C.)

Diefenbach, G., Reitman, D., Williamson, D., Trichotillomania: A Challenge to Research and Practice, Clinical Psychology Review, Vol. 20, No. 3. (April 2000), pp.289-309.

Elliott, A., Fuqua, W., Trichotillomania: Conceptualization, measurement, and treatment, Behavior Therapy, Vol. 31, No. 3. (2000), pp.529-545.

Himle, J., Perlman, Lokers, L., Prototype awareness enhancing and monitoring device for trichotillomania, Behavior Research and Therapy, Vol. 46, No. 10. (October 2008), pp. 1187-1191.

Kress, V., Kelly, B., McCormick, L., Trichotillomania: Assessment, Diagnosis, and Treatment, Journal of Counseling and Development, Vol. 82, 2004.

Lewis, J., Hair-Pulling: A Dissociative Disorder?, 19th International Society for the Study of Dissociation Conference, (2002).

Lewis, J., Hair-Pulling: Dialogues of the Body, National Association for the Advancement of Psychoanalysis (NAAP) "Gradiva Award", (2003).

Lewis, J., The Therapeutic Value of the Research Relationship in a Dissociative Study, 20th International Society for the Study of Dissociation Conference (2003)

Lewis, J., The Dissociative Experience of a Psychoanalytic Researcher, 21st International Society for the Study of Dissociation Conference (2004).

Lewis, J., Hair-Pulling, Culture and Dissociation, Varieties of Dissociation Conference, (2006).

Lewis, J., Hair-Pulling and Intergenerational Loss and Death, 25th International Conference for the Study of Trauma and Dissociation Conference, (2008).

Woods, D., Flessner, Franklin, M., Wetterneck, C., Understanding and Treating Trichotillomania: What we know and don't know, Psychiatric Clinics of North America, Vol, 29, No., 2. (June 2006), pp. 487-501.