When I was 14, my sister told me a secret. “I pull out my hair,” she said, laying in the bed across from mine in our little room. “I don’t know why I do it, but I can’t stop.”

She had developed trichotillomania, a Body-Focused Repetitive Behavior characterized by uncontrollable urges to pull hair from the body. Her hair had always been something to admire: lustrous and bright blonde. My mother had fawned over her hair since she was born. Once, my sister stole a pair of scissors and snuck into the bathroom early in the morning before anyone was awake. She sheared off four curls from the back of her head. When my mother found her standing in the bathroom, she grabbed those curls from the white plastic of the sink and screamed over that dead hair while we watched.

Back in our little bedroom, many years later, my sister purged all her secrets. Her hair was long and flat over her pink scalp. There was no curl. She had even lost her blonde-ness. All that time spent ignoring the issue, looking away, avoiding the stray hair in the bathroom and bedroom and carpet, was now before me like those curls on the sink. They’d been cut. I couldn’t ignore them.

I was the one to tell our father. Our mother was no longer around (not dead, just elsewhere), and my sister was afraid Dad would get mad at her if she was the one to tell him. I walked into the back bedroom and fumbled over my sister’s secret. He couldn’t understand, and I honestly couldn’t either. I just repeated her words in my own way in front of him, hoping he’d listen.

Mental health on the news is one thing; a loved one with mental health issues is another. When my sister told me about her trich, I struggled to comprehend the issue altogether. My sister was pulling out her hair, and from my limited viewpoint, all she had to do was stop. At first, I couldn’t – or rather didn’t try to – understand from her perspective. Mental health disorders are not controllable, which is precisely why they are disorders. This is what I refused to see. When I thought I was helping my sister by telling her to stop as she was pulling, I was hurting her. I didn’t understand her struggle. For awhile, I didn’t even try.

The next few years were hard. My sister was suddenly living in a new world apart from me. She had been dropped into a city without a map, and I was sitting in my own selfish comfort, watching her struggle to navigate buildings and roads that fought her and welcomed me. Simple things became hard. Brushing my hair was an insult. A complaint about a bad hair day was insensitive. She was lost and so was I, and we weren’t even lost together. That was the worst part of it all. As sisters, we had never been separated so painfully, and now, there was an entire city between us. For the first time, I didn’t know how to help my little sister.

After a few months, it became clear her hair wasn’t growing back. She had no control over her pulling, as it’s called, and she soon made a decision: she was going to shave her head.

Our dad has had a shaved head since his twenties. When my sister and I were younger, we used to run his clippers over his head. It was like holding a spitting snake with silver teeth. It shook and became hot with anger the longer you held it. The entire kitchen always smelled like hot baby oil afterwards as Dad swept up the clippings. The short, prickly hairs clung to our hands, sticky with oil.

My sister shaved her head when she was fourteen without our help. When she unveiled her work, we rubbed our hands over her bald head like she was a golden statue of the Buddha. My dad commented on how round her head was, the perfect curve of her skull, the birthmark on the back of her scalp. He called it an “Angel’s Kiss.” I have one, too, according to him. It was another thing connecting me and my sister, even though we felt so separate.

Once, my sister and I were spending the night with family friends during some of my sister’s most difficult days. Before we arrived, our dad called them and warned them about her new haircut. He wanted to make sure they told their kids, preparing them for their friend to show up with a clean scalp. Every time we were going to see someone, he made this phone call. I could tell my sister hated it.

As we were spending the night with those family friends on their pleather couches, I woke up to my sister’s tears. She was crying in the middle of the night. I went over and sat on her couch, and she told me about how othered she felt. She said words like “freak” and “crazy” and “bald girl.” To me, she was the same sister I’ve always had, but she thought everyone saw her as she saw herself, including me. This was when I realized that my treatment of her and this view of herself were not mutually exclusive. Older siblings have a special kind of influence over their younger siblings, and we usually don’t recognize it until we’ve abused it.

After that night, I worked towards understanding. It’s so much easier as someone who is privileged in mental health to discount others who are not, but it isn’t right. I became – I hope – the older sister I should have always been.

My sister was medically diagnosed with trichotillomania when she was sixteen along with unspecified depression disorder and generalized anxiety disorder. With therapy, she started to cope and heal. Today, she still battles with trichotillomania. Patches of skin show where her hair no longer grows. She wears wigs outside of the house. However, she hasn’t pulled in 55 days. She calls to update me on her success every once in a while. We’re closer than we’ve ever been.

My mental health has never been impacted by something like this, but my sister’s struggle has impacted my understanding of mental health greatly. Through her, I’ve learned to navigate her city with her beside me. I’ve met others with depression and anxiety, and everything my sister has taught me has helped me connect with them. My sister will struggle for the rest of her life with her mental health, but I intend to be there for her the entire way.

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