to those boundaries are references to medical “necessity,” a term that has mutated from an obscure insurance designation to the focus of national debate. Although suffering might be understood as a scalar attribute (a complaint might move up or down the ladder of “seriousness”), the concept of medical necessity acts to fence “real” suffering, allocating or withholding social and financial resources in a binary fashion.15 Medical necessity compels for-or-against decisions. Contested diagnostic categories, such as fibromyalgia or Chronic Fatigue Syndrome, drive patient advocates as well as medical providers to seek reproducible tests of “legitimate” disease. New drugs and devices, such as memory-enhancing pharmaceuticals, demand decisions about their appropriate application. State and federal health care reforms force questions about precisely which services ought to be considered “basic” or “essential” (e.g., kidney transplants, in-vitro fertilizations, gender-reassignment surgeries). And, even as distinctions between elective “enhancement” and necessary “therapy” acquire fresh importance, accountability for the determination of these distinctions is obscured, veiled by the spread of integrated private insurance plans with capitated payment systems. As critics rightly point out, insurance companies are rarely called on to justify their exclusions.16
The United States is hardly exceptional in witnessing the extension of medical authority: the “biomedicalization” of everyday life has been charted across the affluent industrialized world. With time and resources, a more exhaustive comparative study—a global history of sciences of hair—would be ideal.17 But given the disproportionate influence of U.S. definitions of “necessity” in the early twenty-first century (evident in the ICRC’s report on Guantánamo), sustained reflection on American habits seems a useful place to start.
BUT FIRST, A few notes on terminology may prove helpful. Because this book seeks to emphasize the contingency of ideas often treated as timeless, I take some care to employ the terms of identity and difference used by period writers themselves (e.g., “Indian,” “lunatic,” “man of science”). Relying on what might be called “actors’ categories” carries the obvious hazard of being misinterpreted as condoning the activities under discussion; I hope that readers will not mistake my intent in this way. To take but one example, I follow the U.S. government in using the word “detainee” to refer to the men held against their will at Guantánamo, not to convey support for indefinite detention but to stress the consequences of seemingly minute terminological decisions. “Criminals” would need to be charged with specific crimes; “prisoners” would be endowed with specific rights.18 Elsewhere, too, I resist the impulse to simply extend idioms backwards or forwards anachronistically: the nineteenth-century “invert” is not synonymous with the twentieth-century category of “homosexual,” nor “man” with “people,” nor “Mongolian” with “Asian.” The introduction of new words, or familiar words invested with new meaning, often signals subtle, consequential changes in thought.
I TAKE A similar approach to what might be called the “basic science” of hair and hair growth (figure I.2). Today, the terms of that science are often presented as straightforward and uncontroversial. Mammalian hair is said to grow from follicles in the dermis (the layer of skin between the epidermis and subcutaneous tissues) into a long shaft that extends above the skin surface. The root of each hair ends in an enlargement, called the bulb, that fits like a cap over the dermal papilla. Hair fibers are further made up of three layers (medulla, cortex, and cuticle). The cortex, shaped by the follicle, helps determine the shape of the fiber and resulting texture: round fibers result in relatively straight hair, oval fibers result in relatively curly or wavy hair. Follicles also contain special stem cells, unique to the skin, that regulate the cycle of hair growth.19 These claims, like other assertions about nature, are not arbitrary; they must respond to the material world or they will fade away. But, like all facts, they are bound to specific conditions of production—conditions that, upon closer inspection, often reveal more complexity and discord than are presented in most textbooks.20 Take the very term “mammalian,” for instance. As historian Londa Schiebinger has argued, Enlightenment taxonomists wrestled with multiple classificatory schema before landing on the category of Mammalia; Linnaeus chose to focus on the breast (mammae) rather than equally valid terms, such as Pilosa or Lactentia, in response to broader cultural and political struggles.21 Subsequent chapters address other key scientific and medical taxonomies, including classifications of hair structure (such as distinctions between hair and feathers), type (such as Negroid or Caucasoid), and growth pattern (male or female).22 Throughout, I refrain from placing derisive quotation marks around those words or concepts no longer seen as “scientific.”
Figure I.2. Diagram of a hair follicle, from the 1918 U.S. edition of Gray’s Anatomy of the Human Body.
Several previous readers of this work have taken issue with this agnostic approach, asking instead for straightforward declarations of what an outdated disease category “really means,” or who members of some now-defunct racial category might “actually have been” according to twenty-first-century parlance. Such requests seem to miss the point. The chief virtue of body hair as an object of historical study is that it wreaks havoc on established partitions, rendering their scaffolding unusually transparent. This book seeks to describe that scaffolding.
Many of the book’s sources were produced by highly educated Anglophone writers of European descent. Many of the claims made in those sources advance specific racial, national, economic, sexual, and religious interests at the expense of others. This is not to suggest that there are no other perspectives on these matters, no alternatives to dominant attitudes and practices; again, given time and resources, a more exhaustive exploration of subcultural, subaltern, and oppositional attitudes and practices would be ideal. Here, I focus on privilege, its distortions and silences. Considered in this way, history becomes a tool of cultural critique: a way to emphasize the conflict, uncertainty, and possibility present in realms too often taken for granted.23
IN THE CONTEMPORARY United States, few practices are as taken for granted as the deliberate removal of body hair. (This study does not address the involuntary loss of hair associated with toxic exposures, alopecia, trichotillomania, cancer treatments, or male pattern baldness.)24 Recent studies indicate that more than 99 percent of American women voluntarily remove hair, and more than 85 percent do so regularly, even daily. The usual targets, for the moment, are legs, underarms, eyebrows, upper lips, and bikini lines. Those habits, furthermore, appear to transcend ethnic, racial, and regional boundaries.25 Over the course of a lifetime, one 2008 survey indicated, American women who shave (a relatively inexpensive way to remove hair) will spend, on average, more than ten thousand dollars and nearly two entire months of their lives simply managing unwanted hair. The woman who waxes once or twice a month will spend more than twenty-three thousand dollars over the course of her lifetime.26 Most American men, too, now routinely remove facial hair, and increasing numbers modify hair elsewhere on their bodies. Research indicates that as of 2005, more than 60 percent of American men were regularly reducing or removing hair from areas of the body below the neck.27 Although generally ignored by social scientists surveying hair removal trends, transsexual, transgender, and genderqueer people also express concern with hair management, and employ varying techniques of hair removal.28
The ubiquity of personal hair removal in the United States is particularly striking given its relative novelty.29 To be clear: forcible hair removal is not new. The use of hair removal to control or degrade, as with the beard removals at Guantánamo, has been imposed on inmates, soldiers, students, and other captives for centuries. Despite the recent treatment of U.S. detainees, American courts have tended to frown on the forced removal of hair by agents of the state.30 In an influential 1879 decision, U.S. Supreme Court Justice Stephen J. Field held that the San Francisco officials who cut off the long queues of Chinese men confined in county jails
