Illness is a socially constructed phenomenon based on the value of life and health. It represents a deviation from what we hope for and expect . However, some illnesses are imbued with additional cultural meaning that results in a “spoiled identity”, or a stigmatization of the individual . Previous studies have shown that individuals with hair loss experience a stigma that they must deal with during social interactions. In turn, these stigmatizing experiences may lead to additional physical and mental health problems. Their stigma—an attribute which is socially discrediting —is instantly visible when the hair loss is apparent, but hidden when they conceal their hair loss, for example, by wearing a wig . We have selected the major diseases that are associated with hair loss, either as a direct result of the disease itself (e.g. AA) or by the medical treatments related to the disease. Nevertheless, although the three groups included in the present study share the same physical blemish, their illnesses have distinct social constructions, and they are associated with distinct cultural images.
AA is a benign inflammatory autoimmune disease prevalent in 2% of the population, which is characterized by the loss of hair without scars . The etiology and subsequent development of alopecia are not fully understood, but it is an autoimmune disorder that arises from a combination of genetic and environmental influences . Although it is not life-threatening and creates no significant pain, ache, or itching, it has been associated with notable emotional stress, low self-esteem, depression, and anxiety . Women with AA reported a worse quality of life compared to men with AA . Patients with AA have reported higher levels of self-stigmatization than patients with mental illness .
In Israel, there are currently 323,751 AA patients (110,929 men, 212,822 women) according to the Department of Quality Measures and Research of Clalit Health Services, which is the largest health services provider in Israel (Arnon Cohen, Chief Physician Office, General Management, personal communication, January 17th 2019). Despite this large number of patients with AA in Israel, the disease is not well known among the public. Therefore, a person with AA is typically perceived as a person with cancer that underwent chemotherapy. One of the health services available covers special populations and provides assistance in financing various rehabilitation devices. However, despite assistance for common aesthetic rehabilitation devices, like dentures and stump socks, no assistance is available for an aesthetic rehabilitation device for baldness. Only in 2019, after 4 years of repeating requests, wigs for patients who cope with AA were approved by the Health Services Basket Committee, in addition to new drugs and technologies,
Ringworm of the scalp (tinea capitis) is a highly contagious fungal skin disease that primarily affects children. It tends to start out as a bump or small sore, it might turn flaky and scaly, and it leads to patches of hair loss. For centuries, ringworm was treated by manually plucking out the infected hairs of children. In 1910, following the discovery of X-rays by Roentgen, ringworm began to be treated with low dose radiation, which eliminated the infected hair. Currently, ringworm can be treated with a prescription medication.
From ancient history, ringworm was a stigmatic disease, due to the ugly wounds and scars it caused on the head; it was often called ‘scald-head’, and children with ringworm were often excluded from schools and society. In Israel, there are nearly 6000 women with partial or complete hair loss due to irradiation for ringworm in childhood . Radiation therapy has been the standard care for children with ringworm, since 1925 in Israel. In the 1950s, during mass immigration to the country, the Ministry of Health sent individuals with ringworm (mostly children, but also immigrants, veterans, Jews, and Arabs) to public X-ray clinics, where they received radiation therapy . The treatment resulted in baldness, which was considered shameful. All irradiated children experienced temporary baldness after treatment (for a six-week period); 5% remained completely bald for the rest of their lives; and about 14% remained partially bald for the rest of their lives . In 1974, Baruch Modan, then a prominent Israeli epidemiologist, led a research team that studied the high prevalence of head and neck tumors among people which, as immigrant children in Israel, were irradiated for ringworm in the 1950s . This seminal work had two consequences: first, it placed the issue of ringworm treatment on the public agenda in Israel; and second, it was followed by political activism that led to the 1994 Ringworm Victim Compensation Law, which stated that people that had been treated for ringworm in the 1950s were entitled to monetary restitution from the state.
In addition to the social stigma, radiation therapy for ringworm appeared to have dire psychosocial consequences and severe health outcomes,. A recent follow-up study of women in Israel treated with radiation for ringworm in childhood found a high prevalence of social abuse social anxiety, depression and migraines . That study also revealed high rates of psychiatric medication use and hospitalizations in mental health institutions.
In Israel, about 4500 women are diagnosed with breast cancer each year , with many experiencing chemotherapy-induced alopecia. In contrast to the mechanisms of the stigma associated with ringworm and AA, the stigma associated with cancer is thought to be driven primarily by fear of the illness. Cancer has been described as the most feared of modern diseases [24, 50, 51]. Fear has led to the stigmatization of individuals with cancer, and they are isolated from social life [38, 50]. This stigmatization has given rise to concerns about the reluctance to disclose patient medical histories for occupational and social purposes. Occupational stigmatization frequently arises from the myths that cancer is a death sentence; that cancer survivors are unproductive, and thus, a drain on the economy; and that cancer is contagious . The social stigma of females with cancer is also driven by treatment-induced hair loss. Women across cultures often report that hair loss is one of the more troublesome results; it makes them feel like they look unattractive, sick, or dying. Furthermore, they often feel stigmatized by others .
Although cancer is associated with severe physical limitations and negative experiences, it is not associated with social groups considered to be morally guilty. On the contrary, media portrayals of individuals with cancer often describe them with “imagined superpowers,”  which illustrates the common goal of self-willed victory over cancer and any limitations of the body. In fact, women with breast cancer are openly honored as “survivors”  and heroic .
Although individuals with the three diseases that cause baldness must cope with a similar physical flaw, they received different levels of compensation for their baldness. Patients with ringworm are compensated by the Israeli 1994 Ringworm Victim Compensation Law, when they have a disease listed in the addendum to the law. Patients with cancer receive assistance in buying wigs during their treatment period, through many dedicated associations. Although more than 50,000 people are diagnosed with AA in Israel, only recently, 23 years after the National Health Insurance Law came into effect, the Healthcare Basket Committee has decided to include financial assistance for purchasing wigs for patients with AA in the healthcare basket. Nevertheless, the Israeli healthcare system continues to ignore the psychosocial aspects of hair loss, as it is mainly classified as an aesthetic issue.
Taking a broad view of the epidemiological, historical, and social meaning of each of these three causes of hair loss, it is important to understand the way the media—a major source of health information for health professionals and the public at large—defines, frames, and represents the three diseases. Therefore, the present study used the agenda-setting and framing theories to examine and compare the media coverage of ringworm, AA, and cancer in Israeli newspapers. In the tradition of inductive research, we gleaned understanding and meaning by carefully reading and analyzing the text and images of diseases, as described. Thus, the specific aims of the current study were to: (1) identify the dominant frames related to ringworm, AA, and cancer in Israeli newspapers; (2) examine the dominant media portrayals of patients with ringworm, AA, and cancer in Israeli newspapers; and (3) examine the salience of hair loss experiences reported in Israeli newspapers in describing patients with ringworm, AA, and cancer. Understanding media portrayals of diseases that cause hair loss is crucial, because these portrayals serve as a window into how society understands induced hair loss, its causes, and its social implications.