“How His Hair is Growing Thin!”: On the Emotional Significance of Male Pattern Hair Loss

Hair Loss: A Survey of the Literature

Hair loss causes many men significant psychological distress. In one survey, men between eighteen and forty years of age expressed concern about looking older due to hair loss and feeling less satisfied with their appearance (Budd et al. 2000). In another, many admitted that hair loss affects their self-esteem, evokes concerns about personal attractiveness and getting older, and occasions social anxiety and depression (Alfonso et al. 2005). In a third, increasing degrees of hair loss were associated with loss of self-esteem, depression, introversion, neuroticism, and feeling unattractive (Wells, Willmoth, and Russell 1995). Although the subjective experience of hair loss is undoubtably dependent on sociocultural factors, its significance has been remarked throughout history. The oldest recorded medical prescription is a treatment for baldness, noted by the Egyptians five millennia ago (Parrotto 1961). Today medical treatments for male pattern hair loss abound, promoted with a wide range of promotions, including TV and print advertisements and websites, transforming this once ordinary and benign ailment into an illness, reconfiguring it as a treatable disorder for commercial gain (Harvey 2013). The hair loss industry is, circa 2018, worth 2.8 billion dollars annually (Pantelireis and Higgins 2018).

Comparatively little has been published on the evolution of baldness as a sociosexual signal. Although early on it was suggested that baldness might signal social dominance (Guthrie 1970, 1976), empirical support has tended to contradict this. In one study, which examined the influence of male pattern baldness on the initial social perceptions of men by both sexes, male pattern baldness led to less favorable initial impressions, including lower ratings of physical attractiveness, judgments of less desirable personal and interpersonal characteristics, and misperceptions of age (Cash 1990). In another study, balding figures were rated as less potent, active, and attractive (Roll and Verinis 1971). In yet another, using manipulated facial stimuli, baldness was associated with increased perception of social maturity, appeasement, and age and a decreased perception of attractiveness and aggressiveness (Muscarella and Cunningham 1996).

Adult male pattern baldness may also signal increased “social maturity”: enhanced social status but also decreased physical threat, increased approachability, and a propensity to nurture. Age is a necessary component for the occurrence of male pattern baldness (Hamilton 1942). In men, closely related to a decrease in testosterone production, aggression and sexual vigor decline with age, and caretaking behavior increases. From an evolutionary perspective, it has been suggested that male pattern baldness may have facilitated interaction between older and younger males, by making the former seem less intimidating and more approachable. Adult male pattern baldness exhibits the same pattern of baldness seen in infants (Hamilton 1951), and in male pattern baldness the follicles of the scalp revert back to the type that produce the vellus hair characteristic of infants (Butcher 1951). In infants this vellus hair serves as an appeasement signal (Guthrie 1976). This view receives support from the observation that male baldness is associated with male philosophers, teachers, and priests: figures combining social status and nurturance (Vallis 1982).

Despite the considerable emotional distress it causes, hair loss is undertheorized in the psychoanalytic literature, with a few notable exceptions. As Lemma (2015) points out, the emphasis on hair as a phallic symbol is congruent with the fact that hair has often been culturally associated with strength, virility, and sexual potency. Barahal (1940) writes about the association between hair and “ideas of strength, virility, manliness, and power” (p. 296) and how hair cutting, evidenced by numerous folk tales throughout the world as well as real historical incidents, signifies a loss of power, potency, and even death. As one of many examples Barahal offers, it was held as an honor among the Gauls to have long hair, which is why Julius Cesar forced them to cut their hair as a symbol of submission. Freud (1910), in a footnote, linked the cutting of hair with castration; unsurprisingly, later conceptualizations have tended to describe hair as a phallic symbol (Berg 1936; Barahal 1940). Berg (1936) describes the displacement upward from pubic hair to hair on the head and the associations between baldness and castration in several clinical cases. Andresen (1980) identifies three symbolic meanings of hair loss: castration, loss of the mother, and restitution to an aggrieved object. Sperling (1954) emphasizes hair as a bisexual symbol and, again, links hair cutting with castration and, for some, giving up of the feminine part of the self. In a chapter on baldness, Hirsch (2011) emphasizes three significant elements: confrontation with mortality, the loss of youth so closely associated with physical attractiveness and physical and sexual prowess, and the conceit of competitiveness with other men along those dimensions. (He suggests, provocatively, that having less hair and the competitive inadequacy that accompanies this may in fact more profoundly capture what the concept of castration anxiety has been taken to symbolize in the history of psychoanalysis than anxieties about genital endowment.)

Building on the few contributions in the psychoanalytic literature, Lemma (2015) suggests that hair, in its broadest sense, is deeply linked with the earliest relationship to the mother’s body and how separation from the mother’s body was experienced. Unlike most other parts of the body, with the exception of nails and skin, hair can be cut and regrown, making it a particularly pliable medium through which to express difficulties around separation and individuation. Drawing on Hermann (1976), who emphasizes the centrality of our desire to cling to the mother’s body in early life and the profound impact of the dissolution of this early dyadic union (which for him always entails a measure of trauma), Lemma suggests that hair cutting—and hair loss, I would add—may not simply be framed as a form of displaced castration but may also resonate with early experiences of disruption and detachment in this clinging to mother. Our relationship to hair, then, reveals an emotionally colored internalized object relationship that unconsciously shapes our experience of separation-individuation. Patients’ relationship to their hair provides an entry point for approaching early conflicts and deficits around their differentiation from the maternal object.

Hair as a Locus of Maternal Desire

Lionel and I begin meeting shortly after the Covid outbreak, so our three-times-weekly sessions have been conducted over a computer-mediated screen service from the beginning of our work. In our first meeting, I am struck by how he seems to use the screen as a mirror, as a way of inspecting his own face, during our conversations. The screen service platform I use displays a full-screen image of the person the user is speaking with and at the top right of the screen, a smaller image of the user. Though I can’t tell if he is aware of doing so, Lionel occasionally looks into the screen and rearranges the bangs of his straight brown hair, especially in moments when, it seems to me, his anxiety is heightened. As I observe this behavior, I reflect on an earlier patient of mine, a young boy of short stature, or dwarfism, who at first experienced the use of computer-mediated screen services as narcissistically injurious, in that he was confronted with a reflected image of his body (Wooldridge 2017). After some time, I mention my observations.

From time to time, you seem to adjust the bangs of your hair, I say gently, concerned about catching him off guard. His eyes widen and I can feel his anxiety increase, confirming for me that he is not aware of the repetitive gesture. Yes, I suppose I do, he admits. And what do you see when you catch a glimpse of your hair in the screen? With a sigh, he responds, I’m worried that I’m losing my hair. I think that my hairline is receding and I see that in the picture of me that shows up on my screen. I try to recall Lionel’s age: he’s in his mid-twenties, I believe, which, I am startled to realize, now seems incredibly young to me, though I also recognize that this is when I first started to notice my own hair beginning to thin. ³ I recall asking my barber for her assessment of the situation, appreciative of her efforts at reassurance at the time; alas, though, in hindsight I now know she was wrong. Returning from my reverie, I ask him to tell me what this means to him, as best he can, and without hesitation he answers, That I won’t be desirable to women anymore. That I’ll be ugly, unattractive. They’ll laugh at me.

Like Lionel, Prufrock imagines the society women mocking him in just this way: “They will say: ‘How his hair is growing thin!’ And near the end of the poem—an ending I have always found particularly moving—he imagines mermaids singing to each other (throughout the poem, images of the ocean appear as offering respite from the claustrophobic, often crushing, pressures of society), yet, as he says, “I do not think that they will sing to me.” Though we are quiet for several moments, I can feel, viscerally, the long-drawn-out fear that has taken up residence in the back of his mind as he waits to see whether he is, in fact, losing his hair and how much time he has before its loss becomes more generally noticeable. Actually, he breaks the silence, pulling out his phone and showing it to me, as if the device were needed to convey his point, I take selfies of my hairline . . . sometimes dozens every day. . . . And look at them, zooming in here or there, comparing today’s to last week’s and last month’s. It drives me crazy sometimes. This obsessional defense is, we come to feel over many months, an attempt to manage a deep substrate of anxiety evoked by the possibility of hair loss that he is confronting.

Building on Lemma’s contributions, I am suggesting that hair loss evokes our earliest experiences of childhood vulnerability, of the early, relatively undifferentiated self-other matrix: the “nursing couple” (Elise 1998, 2001; Winnicott 1952). As I have mentioned, adult male pattern baldness follows the same pattern of baldness seen in infants (Hamilton 1951), and the follicles of the scalp revert back to the type that produce vellus hair: the short, thin, light-colored hair characteristic of early childhood (Butcher 1951). As Elise notes, the nursing couple is a form of potential space allowing for many imaginative possibilities regarding the development of erotic capability. Here I wish to highlight the role of hair in these intimate exchanges. The preverbal interplay between mother and child—an intricately patterned communication of pain and pleasure, excitement and relaxation—lays the foundation of the child’s developing sense of self, and in particular his erotic self. As Lemma correctly points out, the head and hair are the physical location for many of the earliest tactile exchanges between mother and baby. The experience of handling and holding mother’s hair, of caressing and rubbing against it, are central to these exchanges. Elise (2006) evocatively describes how in this early period the mother is an “aesthetic object” for the infant, including her “sensuous swirls of glossy hair” (p. 209). Similarly, the experience of the mother stroking the baby’s head and hair is also a fundamental expression of the mother’s desire for the child, of her libidinal investment in his developing body.

On a Friday afternoon, Lionel spontaneously tells me about some of the “hair” memories of his childhood. He recalls how before school he would often find his mother in her dressing room, a large, spacious room where she sat before a wall-length mirror each morning as she applied a curling iron to her long blonde hair. He describes a special intimacy in being allowed to use her hairspray or various combs to style his own hair. My hair was so thick then, like little kid’s hair always is, and blond like my mother’s. I can remember the way the hairspray made it sticky and, once it dried, a little hard. I think I was putting on too much. I loved that morning ritual: she paid attention to me, was interested in what I was doing with her. There weren’t many times in the day like that. We discuss, too, how the dressing room was a place to which his mother would retreat when she became angry with him, locking the door and leaving him in the living room, upset and alone. She took to that room and left me on my own. I can still remember the pit in my stomach.

Building on Freud (1914, 1930) and Chasseguet-Smirgel (1975, 1976, 1984), Manninen (1992) suggests that the basic trauma of infancy is the loss of the ideal (and perhaps, I would add, idealized) state of narcissistic fusion with the mother. This basic trauma is the bedrock of the masculine psyche, and the effort to reestablish it gives rise to compensatory maneuvers, including the fantasy of “phallic supremacy,” of regaining unity with mother by conquering and possessing her by penetrating her body. In this vein, the oceanic imagery of Eliot’s poem—the “chambers of the sea,” for example—is used to convey Prufrock’s longing to return to this “paradise lost” (Manninen 1992, p. 2), which resonates with Freud’s descriptions of the “oceanic feeling” (1930, p. 64), akin to love, a defiance of death, a rejoinder to our mortality.

Hair loss in men is, as I have noted, associated with a diminished sense of sexual attractiveness and potency. Resonant with Lemma’s emphasis on hair as a locus of conflict and deficit around differentiation from the maternal object, hair loss may evoke anxieties, and even terrors, that this ideal, and likely idealized, state will be forever unavailable, insofar as it is felt that it might somehow have been recaptured vis-à-vis the other’s desire, perhaps through the establishment of oneself along the lines of a phallic masculine ideal that hair loss is felt to have diminished or foreclosed entirely. In this sense, early analytic writers equating hair loss and cutting with castration (Berg 1936; Barahal 1940) were speaking to this issue, in that castration would indeed put an end to the possibility of establishing that ideal.

This brings to mind a session in which Lionel is describing a sexual encounter from the previous weekend, where his hair figured prominently. Only a few months earlier, he began dating a woman he met through a mutual friend. Although he has enjoyed spending time with her, he has struggled to maintain an erection during their first few sexual encounters, a fact that distresses him greatly. This time I asked her to straddle my face—“face sitting” is the term, I believe. He looks at me furtively, as if to assess my reaction. I really love it. While it was happening, as it was picking up pace, so to speak, she started to run her hands through my hair and that seemed to somehow really turn her on. He pauses, waiting for me to respond and, when I don’t, he continues. There’s something about being covered like that . . . it’s like, you couldn’t possibly get closer to another person, you know? And it really calms something deep inside me.

Hair and the Helplessness of Early Infancy

Then, well, things went in the wrong direction. We were kissing again, and I knew that she was waiting for me to make a move in the direction of sex. As we were kissing, she started to run her hands through my hair again. And this time, all I could think was, “What if she’s making it thin out even more quickly?” And I couldn’t stop thinking about that. Lionel and I have discussed similar scenarios several times now when, it seems to me, experiences of merger and union, which he at first experiences as intensely pleasurable, transform into experiences fraught with anxiety, often exactly at the moment that he is “expected” to penetrate his partner. He is, I suspect, frightened by the evolution of the sexual encounter toward intercourse, leading his attention to shift from a sensate to a cognitive focus, which is quickly populated by his anxieties about hair loss and leaves him unable to give himself over to the unfolding encounter and the experience of penetration. The feared loss of his hair, I believe, is unconsciously equated with the loss of maternal interest, which then leaves him identified with his father, whom he experienced as impotent. His fear of merger with his partner may in fact be a reaction to a deeper yearning to lose himself in his partner’s pleasure and to avoid the pressure of (and anticipated failure in) assuming a phallic position.

Indeed, hair loss evokes feelings of impotence, weakness, and vulnerability for many men. As Lemma (2015) notes, in ancient cultures, in the hands of unknown others, one’s hair became one’s weak and unprotected self and, thus, ancient warriors often buried their hair to avoid it falling into enemy hands (Simon 2000). Samson, one of the last judges of the ancient Israelites, upon losing his hair, also lost his strength. His hair, notably, was cut when he lay sleeping, his head upon his lover Delilah’s knees (Lemma 2015). Prufrock poetically describes himself as “pinned and wriggling on the wall” by the gaze of the society women, utterly without agency in relation to these maternal figures, and compares himself to John the Baptist—“my head (grown slightly bald) brought in upon a platter”—who was beheaded by Herod at his stepdaughter Salome’s insistence, head presented to her on a platter. Prufrock finds himself sorely lacking in comparison.

In the next session, Lionel begins on a different topic, which I read as a commentary on these matters. Last night I watched Die Hard. I haven’t seen that movie in a long time. Bruce Willis still had his hair back then, but he was already losing it fast. And then he shaved his head and people think he’s more attractive than ever. I think I might do the same thing, you know. . . . I hate being so passive about it, just waiting for it to happen. His words remind me of Freud’s view (1896a,b) that an active masculinity originates as a defense against the pleasures and perils of a passive femininity (Christiansen 1996). The empirical literature suggests male pattern baldness signals an increased propensity to nurture and caretake (Vallis 1982), which is congruent with femininity as Freud conceived it. Now I have an urge to run my hands through my own hair, which I have trimmed short myself, a Covid do-it-yourself haircut that, in spite of my ambivalence about it, seems a better option than reverting to my teenage shoulder-length hair. That night, I google Willis and find that he has spoken publicly about his baldness. “I’ve seen all those little digs where they try to make you feel less of a man because you’re losing your hair. I’m a man, and I will kick anyone’s butt who tries to tell me I’m not a man because my hair is thinning” (Outsons 2020).

Turning passive into active, a basic building block of the ego and a versatile mechanism of defense throughout the lifecycle (Corradi 2007), plays an important role in managing anxiety associated with feelings of helplessness that, to be sure, hair loss evokes for many men. In imagining proactively shaving his head, Lionel (in fantasy) imbues the experience of hair loss with a felt sense of activity and control where it would otherwise be absent. In this fantasy he fabricates an experience of agency (Woodridge 2021)—an idea discussed at length in a later section—by aggressively “pushing back” against standards of conventional masculinity, as Willis does in his opposition to anyone who would claim that his baldness diminishes his manliness. At least three studies confirm that men who choose to shave their heads tend to be perceived as more dominant and, in fact, that men who are perceived as losing their hair may improve their social standing by shaving their heads (Mannes 2013). ⁴ On a related note, reflecting on well-known men who are both bald and widely regarded as attractive, Synnott (1987) suggests that their choice “expresses a transcendence of conventional views of masculinity and . . . thus these individuals become symbolically more alive and more virile” (p. 402).

Hair Loss, Old Age, and Death

I think it’s about death, really, Lionel begins a session, gesturing at his hair. I mean, at the root of it. We both smile, aware of the play on words. I consistently appreciate Lionel’s verbal wit. Last week we were talking about my ankle injury and it got me thinking. The previous week, I recall, we discussed an ankle injury sustained while jogging—he is a dedicated long-distance runner—that hasn’t healed for nearly a year. I voiced the possibility, which I suspected was at the edges of his mind, that it might not heal at all, entirely, but could be a chronic vulnerability that would require his ongoing attention. This disturbed him, for it was the first sign of “wear and tear” in his otherwise youthful body. His voice draws me back to the immediacy of our conversation. My hair loss is like that . . . it’s something that’s changing, deteriorating I guess, about my body—for the worse—and that will never be repaired. And that is really depressing, isn’t it?

Returning now to Eliot’s poem: “And I have seen the eternal Footman hold my coat, and snicker, / And in short, I was afraid.” Faced with death—the eternal Footman—Prufrock feels he has accomplished nothing of significance in his time thus far, but rather is utterly ordinary, signified by his baldness, and time for meaningful action is quickly running out. At the poem’s end, he imagines himself old and still timid and self-conscious:

I grow old . . . I grow old . . .

I shall wear the bottoms of my trousers rolled.

Shall I part my hair behind? Do I dare to eat a peach?

I shall wear white flannel trousers, and walk upon the beach.

Synnott (1987), likewise, affirms that baldness is a symbol of age and death. For many, hair loss is a profound narcissistic injury. In contrast to hair cutting, typically chosen by us, hair loss happens to us. It shatters our illusions of omnipotent control in relation to our own bodies. For many young men, hair loss is the first direct challenge to this illusion in their lives up to that point. As Becker (1973) emphasizes, in healthy development a child is able to experience himself as omnipotent and indestructible; from this base of secure support, he increasingly develops a sense of his own power. Death, which hair loss signifies, is the ultimate challenge to this narcissistic illusion. Old age and impending death also evoke, I believe, the helplessness of infancy, often starkly highlighting once again our dependency on others for support and care and the waning of our capacity to sustain illusions of our autonomy and self-sufficiency.

As I listen to Lionel speak about his fear of what is to come—What other components of his bodily self will break down and how soon? This is, he says, the first time he has seriously contemplated his death in concrete terms—I think of my son and how, in the early moments, weeks, and months after his birth I was frightened about the fontanelles, the soft spots, on the top of his skull. I worried over the vulnerability of them, imagining despite myself how some impact to his fragile skull might injure, even kill, him. I reflect upon Bion’s description of the “baby’s fear of dying” (1962): those moments when an infant’s mind and body are consumed by distress with no object aware of or containing that distress on his behalf. It is, of course, a speculative thought: some babies’ earliest terrors are forgotten through infantile repression, whereas for others those terrors become woven into the fabric of their personalities (Proner 2013). I imagine Lionel, with his painful anxieties and obsessions, falls in the latter camp.

Although I do not think, as Freud and many who followed him did, that the fear of death is merely a displacement of the more fundamental fear of castration as punishment for oedipal competition (Razinsky 2013), many of my patients suffering with this issue have often come to describe considerable guilt about their oedipal rivalries with their fathers and accompanying fear that they will be “cut down to size,” which hair loss seems to threaten. Lionel remembers elaborate childhood fantasies, often as he waited for sleep to overtake him in the evening, of being a powerful superhero: Spiderman, who, after his parents fall asleep, roams the streets and fends off villains, invulnerable to their attacks. Yet during his waking hours he is plagued by hypochondriacal anxieties, worried even by run-of-the-mill bumps and bruises and timid in the schoolyard.

Lionel’s father developed multiple sclerosis in his early forties, when Lionel was only six. By the time Lionel was fifteen, his father was barely able to walk and spent most of his time in bed, assisted by a live-in nurse. In the conversation I have in mind, Lionel, seeming quite pained, remarks: Sometimes I think about some of the ways I felt about him, especially when I was younger. I was so ashamed of his illness, of my friends’ seeing what he looked like or how he moved. I even remember once making fun of him to a friend who was at my house for a sleepover. . . imitating the facial expressions that he made. And how sometimes I’d imagine that he would just die and leave my mother and my sisters and me alone, to live our lives. And now I’m watching him crumble. As we discuss this further, he recalls surreptitious, guilt-ridden fantasies, which he places at the time of early grammar school, that his father would die and he would marry his mother, becoming the “man of the house.” Though he loved his father deeply, his deteriorating condition inflamed his unconscious oedipal rivalry with him. And now his hair loss feels like punishment for these competitive wishes: a deserved diminishment of his body and a sign of further loss to come.

Hair Loss and the Paternal Figure

In my male patients who worry over hair loss, I have noticed a striking trend: most recount memories of experiencing their fathers as weak, passive, damaged, or dangerously vulnerable. Lionel’s father developed multiple sclerosis in middle adulthood, while other patients tell of fathers who are crippled by obsessional pursuits, unable to effectively engage with the outside world, or who frequently seemed comically overwrought in moments of frustration or anger, or who allowed themselves, seemingly without protest, to be mistreated by their wives or parents. Describing the vulnerability in his father as he experienced it, Lionel, in a conversation not overtly related to hair loss, comments: I can remember helping him stand when I was only ten, trying to lift him up from one side and with my mother on the other, and looking down at his legs . . . they were so thin, the legs of an old man. And then I looked over and saw that my mother was looking at them too, frowning. It was an expression I’ve never seen before.

The mother’s face is the child’s first emotional mirror (Winnicott 1967). In healthy development, the mother’s loving gaze takes in and receives the child and serves as the beginning of an intact body image, further consolidated over time. As Elise (2015) notes, the mother is primary, her sensual care mapping the child’s sexual body within their relatively undifferentiated self-other matrix. Lemma (2009) helpfully accounts for body dysmorphia in terms of the mother-as-mirror in this early developmental situation. Did the child experience the mother as opaque, inaccessible—a one-way-mirror mother—or as intrusive and hostile, a distorting-mirror mother? As analysts, we listen for the patient’s most compelling anxieties, conflicts, and deficits. While I have found Lemma’s ideas invaluable, for the young men described here, for whom hair loss is the central, and often the only, preoccupying aspect of their body image, the most salient emotional experiences often seem to me to be constellated at a later developmental stage.

For development to proceed from this early, dyadic “nursing couple” (Elise 1998, 2011; Winnicott 1952), an emotionally relevant third, someone (or something) competing for the mother’s attention, must enter the scene. Over time, of course, the little boy frequently identifies with this third, often the father. Through a father’s establishing a loving, trusted bond with his son, his “attractive function,” which also stands for a “nonmother space” (Diamond 2017, p. 307), encourages the child’s capacity to explore the outside world (Abelin 1971). Manninen (1992) describes how the young boy’s masculine ego ideal develops through an identification with the father and through an expansion of his own bodily capacities. “Passivity is replaced by activity . . . the possibility of increasing . . . the separateness from the powerful mother appears as a new, more effective and narcissistically safer means of mobilizing the relationship with her once more in the service of recovering the lost early ideal state” (p. 3). But what happens when the father is experienced as weak, passive, or damaged, and the maternal gaze upon him as critical or disappointed? For Lionel, and for many other young men with whom I have worked, anxiety about hair loss emerges in moments when this identification with the father is heightened.

As our work unfolds, we discuss the shape of Lionel’s shame about his hair loss: It makes me feel like I’m not a real man. And eventually: My father. . . he was so broken, really. I don’t know how else to describe it. And when I experience myself as weak or vulnerable, when someone else looks at me and sees those parts of me, it makes me feel a small piece of what he must have felt . . . unable to stand, even to go to the bathroom without help. The discussion culminates after a date with someone he’s just met online; throughout their walk, both masked because of Covid, he can’t stop thinking about his receding hairline. What do you imagine she saw? I ask. Sometimes when I get out of the shower and look in the mirror, I see my father: skinny legs, thin arms, a bird chest, and a balding head. Other times, I like what I see. But sometimes it’s terrible. And what do you imagine your mother saw, in that moment the two of you were lifting your father up? I imagine that she was heartbroken, disappointed. . . . I know part of her blamed him for being broken.

No! I am not Prince Hamlet, nor was meant to be;

Am an attendant lord, one that will do

To swell a progress, start a scene or two,

Advise the prince; no doubt, an easy tool,

Deferential, glad to be of use,

Politic, cautious, and meticulous;

Full of high sentence, but a bit obtuse;

At times, indeed, almost ridiculous—

Almost, at times, the Fool.

Unlike Hamlet, charismatic avenger of his dead father, Prufrock imagines himself as a mere attendant, ridiculous, a “tool.” In his indecision, which emerges from this sense of himself as ineffectual and unimportant, he lacks a sense of his own agency. I believe that Lionel’s similar feeling about himself is not only a result of his identification with an image of his father as damaged and vulnerable; it also stems from the ways in which his father was unable to provide an important paternal function because of his vulnerabilities during his son’s early development.

Elsewhere (Wooldridge 2018) I have developed the notion of the experience of agency: the phenomenological experience of oneself as having an impact. Hoffman (1998) describes a similar idea with his active mode of experience, in which “there is a ‘space’ between the source of influence and its impact, a gap in which I am present as an agent, as a choosing subject” (p. xi). The experience of agency is intended to highlight the agent’s feeling that his choices have an impact on his thoughts, feelings, actions, and relationships. This phenomenological experience is not an accurate marker of objective freedom. On the contrary, in some states, such as passive-to-active or manic defenses, we feel immensely potent though our objective agency may be diminished (Caston 2011). In that paper I also suggest that the experience of agency is grounded in the infant’s earliest experiences of motility and, further, that motility, and hence agency itself, has an aggressive aspect insofar as it takes pleasure in, and eventually involves seeking out, opposition in the environmental surround. Resistance from the environment is what makes the experience of agency meaningful; the experience reflects the agent’s deploying his aggressive energies to overcome opposition. Through exerting an impact on the environment, which by its very nature resists that impact, the child develops a sense of himself as a subject who is causing or generating an action (Knox 2011).

In another paper (Wooldridge 2021), I describe how the paternal function, which is often carried by the father but should not be equated with him, makes an important developmental contribution to the capacity to experience agency. There I elaborate rough-and-tumble play as a metaphor for the kind of experiences with early objects carrying the paternal function that, over time, become psychic structures facilitating or foreclosing a child’s capacity for the experience of agency. These experiences, importantly, involve the expression of aggression with a dyadic partner who assists in the modulation of that aggression, both by regulating his own aggression and by supporting the nascent capacity for self-regulation in the child. But what happens when the father is experienced as dangerously vulnerable? Unless the paternal function is effectively carried by other important objects, the young boy may not have access to the rough-and-tumble dyadic experiences needed to foster a sense of himself as agentic. In fantasy if not in reality, he may experience his dangerously vulnerable father as unable to withstand his aggressive impulses. When the child overwhelms his father, encountering too little resistance, he may understand his aggressive impulses to be dangerous and, over time, defend against this guilt- and shame-ridden experience. Guilt and shame are among the central affects that modulate a child’s behavior, with the former referring more to the specifics of what one has done and the latter a more global feeling of deficiency about who one is. Lewis (1992) highlights the totality of the psychic collapse that accompanies shame. Repeated over time, these experiences of self-with-father move beyond discrete affects and are consolidated as ego states involving highly complex compromise formations including impulses, defenses, and inner ideals and prohibitions (Sugarman 1997).

In fact, I repeatedly notice Lionel’s curiosity, coupled with anxious concern, about his impact on me. He seems relieved whenever there is some indication that I am sturdy enough to withstand the intensity of his feelings. We often talk about how his aggression and frustration toward his father is intimately bound up with guilt and shame given his father’s tragic fate and how he yearns for a father figure who can show him how to be a man (Herzog 2001). I worry, he comments with striking boldness, in the final moments of our session, that all of this talk about losing hair is affecting you. I mean, I’ve noticed that you’ve run your hands across your head a few times over the past hour. I smile and acknowledge to myself that yes, these conversations have made me more self-conscious about my own receding hairline. And what if they are affecting me? I ask. Well, he responds slowly, I guess it would depend on how, but I worry that I’m making you self-conscious too. For a few moments we are both silent, as I reflect on how best to respond. You know, I say slowly, I have been more aware of my own hair since we’ve started talking about this and, yes, slightly more self-conscious than I was before. After a pause, I continue. But I can handle it. We both laugh and I can sense his relief. In an apt final comment on our session, he replies. I guess we’ll have to figure out a way to withstand the loss together.

Conclusion

I sometimes imagine Prufrock as a patient in analysis. After all, the first line of the poem—“Let us go then, you and I”—is an invitation issued to a “you” that is never named. Permit me, then, to imagine that this “you” is Prufrock’s analyst, beckoned to join Prufrock amid the reveries and anxieties, even terrors, of his mind. If so, perhaps the poem has a hopeful aspect: in inviting another to join him in his lament, in his mourning, for the life in which he finds himself, he engages, perhaps for the first time, a companion who can offer him emotional understanding and, with luck, help him find a way to encompass his experience without drowning in it. I also seek this with Lionel: to help him understand, and experience, the loss of his hair as a loss that can be borne and, to some degree, shared with another.

As an analyst, I have been honored with the opportunity to accompany numerous young men, akin to Prufrock and with Lionel as an example, as they give voice to their experiences of fear and confusion, shame and loss, and, fortune permitting, a measure of hope as they face the challenges of early adulthood and middle age. I have articulated four interlocking perspectives on hair loss in men: (1) hair as the locus of maternal desire and hair loss as signifying the loss of that desire, (2) hair as evoking the helplessness of early infancy, (3) hair loss as a symbol of aging and death, and (4) hair loss as evoking paternal identifications and experiences with the paternal function. These, of course, are not the only relevant perspectives on this topic but instead the most emotionally salient I have encountered in my work with young men. Hair can also be, for example, a symbol for feminine identifications (Sperling 1954) and hair loss, thus, may be experienced by some, including Lionel, as a loss of important feminine identifications. This and other ideas are certainly deserving of further elaboration. Indeed, although hair loss may seem less significant than many of the catastrophic losses analysts are confronted with on a daily basis, it is in fact, as I hope to have shown, a deeply poignant and evocative experience for the young men who struggle with it and a struggle with which psychoanalysis can be of immense assistance.