Trichotillomania interruptus v. forme fruste

Awhile back I blogged a bit about cell death as the body's way of policing itself, to protect itself, sacrificing one or a few cells to isolate damage to the rest of the body. Those are pathological forms of cell death, mostly in response to injuries. There are also physiological forms of cell death; examples include cells between digits dying so that we don't born with web hands, like ducks, or later in life, where hair follicles degenerate under the influence of testosterones, commit quiet suicide, little bits, dying slowly.

The morphological hallmark of physiological cell death is the quiet disappearance of these cells without triggering inflammation; which I will blog about in the future (I know, don't get too excited). There are also frustrated forms of physiological cell death. By that, I mean the process is interrupted. The best example would be skin cells. Technically, they have committed suicide, yet the cell soma is still here, serving as a barrier to prevent the hostile environment outside from invading the sterile environment inside. Another would be red blood cells, they are so specialized, so well trained, in their mission in life, in sustaining life, that they don't even have the heart and soul of a cell, the nucleus. In the case of keratinocytes (skin cells), they are dead; but that's not the case with red blood cells, they don't die until they are gobbled up by other cells in the liver. Yeah, don't get me started on how you swallow, eat, and digest your own cells and proteins on a daily basis. So all these cells are what we called terminally differentiated. They don't become anything else, their fates have been determined. At an earlier point in their lives, they could have the potential to become anything, as we are currently trying to coax stem cells to do, but these cells at this stage, however, are fated to serve a limited set of functions then die. They have, in essence, petered out.

Yes, I know I'm anthropomorphosizing the process. This is how we all relate to the world, using what we know in order to acquire, incorporate, and organize information. One can only imagine the frustration if a normal process is disrupted, or in this case, interrupted. How does this frustration manifests itself? In the case of keratinocytes, they just slough off and become the dust in our house, as waste. In the case of erythrocytes (red blood cells), their content, such as hemoglobin, is recycled.

The distinction of whether something is useful or not is difficult. It's almost as bad as trying to figure out the cause and effect. For example, if you see someone who is bald, does s/he have trichotillomania (and possibly trichophagia, a "zebra") or just another case of alopecia areata (the horse)? Sure, there are clinical signs that we can look for, but to a lay person, who is reading online medical books without training, how would that person figure out without clinical experience? It's almost like trying to figure out what I am saying in my blog without knowing who I really am and what I'm really saying. What inspired all this? Subcommunication.

Something I leave you with, you know the expression about people who are frustrated, they pull their hairs out. What happens to those who are already bald? Where do they find an outlet for their frustration?