The meaning of baldness and implications for treatment.

From the Lkpartment of Anthropology, University of MichiganDearborn, College of Arts, Sciences, and L.&D-S, Dearborn, Michigan Use of therapies to improve an individual’s appearance is not a new medical concept. Androgenetic alopecia has been recognized as a disorder since the time of Hippocrates,’ and since that time, a variety of preparations and surgical procedures have been used as treatments. Recently, both the popular press and the professional literature2 have given much attention to the antihypertensive agent minoxidil for treating androgenetic alopecia. Treatment of alopecia raises a number of interesting questions regarding the definitions of “disease” and “illness,” some of which have implications for practitioners as they define the limits of proper medical practice. Whether androgenetic alopecia is a disease remains debatable. Quite likely, most people would agree that alopecia areata, especially in its more severe version (universalis), is a disease. But why should alopecia areata be perceived any more a disease than androgenetic alopecianeither is life-threatening nor occasions physical pain. Consider this passage from a standard medical reference? “In many patients with [alopecia areata], systemic corticosteroids produce regrowth of hair, but their use, with its attendant risks, to correct a cosmetic defect, is not justified.” In this view, alopecia areata is not a disease but rather a “cosmetic defect,” which might be treated only if there is no risk involved. Introspection suggests that patients with this condition might not agree, and experience shows that individuals with various conditions affecting the growth of their hair regularly seek treatment, which may be of some risk, even with only a modest promise of results. Some of the reasons why individuals with “cosmetic defects” may feel compelled to take such risks are addressed in the experiment reported herein. Subjects answered specific questions about the personal characteristics of the same individual, rendered both bald and with hair. Underlying this experiment is the general anthropologic notion that with “body completions” such as hair style, cosmetics, and clothing people communicate aspects about themselves. For example, for many centuries in the western world, monks and priests communicated to others a certain sexual asceticism by means of the tonsure; other much