Can you pull it off? Appearance modifying behaviours adopted by wig users with alopecia in social interactions

Highlights

• Using wigs to cover hair loss underestimates social obligations not to be “fake.”

• Different categories of people have rights to see, notice, and comment on the wig.

• Alopecia wig users need to adopt appearance-modifying behaviours in social settings.

Abstract

In the academic and medical literature on alopecia, wigs (hair prostheses) are typically recommended as a coping strategy: a device to camouflage, conceal, or cover hair loss, and cope with the psychological impact of a dramatic change in body image. This paper used Goffman's (1959) theory of impression management to demonstrate (a) the social significance of self-presentation, and (b) how adults with alopecia managed their wig use in their daily lives. Data from 14 interviews, two focus groups and six video diaries with 22 Caucasian adults (19 females, 3 males; 29–74 years, SD = 13.75) with alopecia in Scotland were analysed using discursive psychology. The analysis detailed how participants managed their wig use and behaviours in relation to social interaction with different categories of people. The paper raises concerns about health and medical discourse about wigs as a coping mechanism, and provides practical suggestions for wig users in social settings.

Introduction

This paper examined the social consequences of wearing a wig for individuals with medical hair loss conditions such as alopecia areata, totalis, universalis, lupus, trichotillomania, and androgenetic alopecia. For the sake of brevity, all of these conditions are referenced under the common term, alopecia, unless stated otherwise. We focused specifically on the interactional impact of medical recommendations and social and cultural obligations to camouflage, conceal, or cover hair loss with wigs. Throughout this paper, wigs are referred to as the common term for a device used to conceal full or partial loss of hair from the head. While there are anecdotal accounts of wig use (Culvert, 2009, Lewis-Browning, 2005) and historical or practical guides on wigs (Cheesborough, 1989, Draelos, 2011, Woodforde, 1971), there is no known research to date on the social implications of wig use. This paper begins to address this omission and highlight the importance of wigs (and hair) for body image in social settings.

Goffman's work (Goffman, 1959, Goffman, 1972) provided a theoretical framework for understanding the social obligations that people have to present themselves as they are. Knowledge about using a wig for medical reasons becomes a socially accountable issue: there may be a social obligation to tell close friends and family about the wig and thus manage one's identity, as not deceiving loved ones. On the other hand, this obligation has its limits; practically, one would find it almost impossible to go through daily life telling everyone about the wig. This paper examined how people with alopecia managed these obligations, under the premise that current medical recommendations about using wigs as an aesthetic coping mechanism underestimate the individual preparatory and emotional work, and the constraints on social interaction, that this demands.

Alopecia is unpredictable and can affect any individual at any time, once or repeatedly (Hunt and McHale, 2004, Hunt and McHale, 2005, Hunt and McHale, 2007). Individuals can experience different severities of hair loss including small circular patches on the scalp or body (alopecia areata), total hair loss from the scalp (alopecia totalis) or total scalp and body hair loss (alopecia universalis). Androgenetic alopecia and lupus-induced hair loss can result in systematic patterns of thinning or partial hair loss, while Trichotillomania results in traction alopecia, caused by an individual pulling out their hair follicles, leaving isolated patches of hair loss. While there are many physical complications due to alopecia (for example, loss of eyelashes and eyebrows can lead to dirt particles and sweat irritating the eyes), the condition primarily has social and psychological consequences such as a reduction in self-esteem and confidence (Cartwright et al., 2009, Cash, 2001, Cash, 2009, Tucker, 2009) and a negative impact on identity and body image (Cash, 2001, Hunt and McHale, 2004, Hunt and McHale, 2005, Hunt and McHale, 2007, Hunt and McHale, 2012, Welsh and Guy, 2009).

The unpredictable onset and prognosis of alopecia has prompted primarily questionnaire-based or interview-based research into coping strategies (Kranz, 2011) and an individual's quality of life (Tully et al., 2010, Van der Donk et al., 1994). Wearing a wig to camouflage or conceal hair loss is typically treated as an important coping strategy in academic literature (Cash, 1999, Cash, 2001), medical reports (Bunting et al., 2005, Draelos, 2011, Messenger et al., 2012) and personal accounts of hair loss (Lewis-Browning, 2005, Wheeler, 2010). Even the literature on chemotherapy-induced alopecia (typically short-term, and with a fairly predictable onset) indicates that there are social pressures to conceal hair loss (Hilton, Hunt, Emslie, Salinas, & Ziebland, 2008). Wearing a wig is thus often positively portrayed, presenting people as “normal” rather than a “sick patient” (Rosman, 2004, Zannini et al., 2012), and with a focus on aesthetics and individual choice.

Goffman's work on the presentation of self in everyday life (Goffman, 1959) provides a theoretical framework for understanding the social and interactional implications of daily wig use. Treating social life as a performance, Goffman (1959, p. 28) argued that individuals “are asked to believe that the character they see actually possesses the attributes he [sic] appears to possess.” Wearing a wig thus requires individuals to conceal their true attributes (hair loss) and to present a false front (“that part of the individual's performance which regularly functions in a general and fixed fashion to define the situation for those who observe the performance”; Goffman, 1959, p. 32). This is what Goffman (1959, p. 141) referred to as a “double or dark secret”; the wig looks like hair (secret 1) and it is not known to be a wig (secret 2). To do so – and on a daily basis – requires considerable effort and skill on the part of the individual wearing a wig.

While Goffman (1959) argued that all social life involves impression management, the aspects of the self that people reveal or conceal will vary according to the audience (known as “audience segregation,” p. 57) and setting (or “regions,” p. 109). Front region performances refer to the space or place where people perform; back region (or backstage) is where the performance is prepared, out of sight of observers. The performance individuals create includes what Goffman (1959, p. 34) referred to as “expressive equipment” or “personal front.” These are the items that are most closely associated with certain individuals: from their gender and racial characteristics, to their clothes, posture, and hair. An important part of Goffman's theory of impression management is that revealing or concealing aspects of one's self is a social norm and embedded in everyday social practices, rather than concerning the behaviour of individuals.

It is reasonable, then, to apply Goffman's (1959) theory to understanding how wig users “pull off” the presentation of themselves as having real hair. The focus here was specifically on concealment and performance around wig use, and the management of front and back regions. Adult alopecia wig users in Scotland took part in the present study that aimed to understand more about the everyday experiences of wearing a wig, including social interactions and modified behaviours.