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As psychotherapy began, he demonstrated notable difficulty discussing his emotions and was resistant to the therapist’s attempts to delve further into past and current relationships and his symptoms of PTSD.Īn online search of PubMed and PsycInfo databases was performed using the search terms “tattoos”, “tattooing”, “tattoo”, “skin art”, “epidemiology”, “stigma”, “psychiatric disorders”, “psychology”, “perception”, “self-perception”, “removal”, “depression”, “anxiety”, “self-harm”, “deviance”, “psychopathology”, “prison”, “military”, and “veterans”. At the time of enrolling in treatment, he was living with a long-time girlfriend while maintaining partial custody of two children from his previous marriage. However, he ultimately completed his military service and after an initial period of instability that included intoxicated fighting and divorce, he obtained sobriety and decided to go to law school. During deployments, he accumulated extensive combat experience where he expected to die. Although he claimed to have thrived within military culture, he often clashed with superiors when he felt disrespected. When asked about his motivation for joining the military he replied, “I needed to find a way to maintain masculinity without being a convict”.
One tattoo referenced the names of fellow soldiers who were killed in action during the wars in Iraq and Afghanistan. Other tattoos, including women in bondage, wizards, and skulls, were described as “filler”, while others displaying religious symbols, weapons, references to Greek philosophy, and military themes seemed to be more personal. His first tattoos declared affiliation with his ethnic background, depicting themes of racial affiliation and violence that reflected long-time engagement with racially-based groups for the purpose of enhancing survival on the dangerous streets of his childhood home and within the juvenile corrections system.
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Later, he revealed that most of his body was covered with tattoos.ĭiscussions in psychotherapy revealed that he started getting tattooed at the age of 11, when his father forced him to learn how to fight, subjecting him to physical beatings in order to prepare him for the violent realities of his neighborhood.
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At the age of 31, he presented for treatment of PTSD with bilateral full arm tattoos along with visible tattoos on his hands, knuckles, and the back of his neck. A was considered a gifted child with an intellectual capacity well beyond his years and background. Despite these developmental barriers, Mr.
While medication titration was attempted during that hospitalization, he was never followed consistently by mental health as a child or adolescent, nor did he take psychiatric medication. A tumultuous childhood, including neglect and trauma at the hands of his mother and within the foster care system, led to several suicide attempts as a pre-teen and one psychiatric hospitalization where he was diagnosed with intermittent explosive disorder, bipolar disorder, and obsessive compulsive disorder. He is a divorced father of two, currently in law school, with overall high functioning despite significant life challenges. A is a 31-year-old Caucasian United States Army veteran with post-traumatic stress disorder (PTSD) based on military combat experiences while deployed to Iraq and Afghanistan. We suggest that as a kind of augmentation of the physical exam, looking at and talking to patients about their tattoos can provide a valuable window into the psyche, informing clinical practice.
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We then review psychological and psychiatric aspects of tattoos, with a goal of revising outmoded stigmas about tattooing and helping clinicians working with tattooed patients to facilitate an exploration of the personal meaning of skin art and self-identity.
This paper aims to review the more recent epidemiology of tattoos in Western culture in order to establish that tattooing has become a mainstream phenomenon. Within modern Western societies through the 1970s, tattoos represented a cultural taboo, typically associated with those outside of the mainstream such as soldiers, incarcerated criminals, gang members, and others belonging to marginalized and counter-cultural groups. Accordingly, the symbolic meaning of tattoos has evolved over time and is highly individualized, from both the internal perspective of the wearer and the external perspective of an observer. Tattooing the skin as a means of personal expression is a ritualized practice that has been around for centuries across many different cultures.
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