Underneath your clothes, there's an endless story.

Shakira

Introduction

In the interest of full disclosure – I have three tattoos.

Although you are not the first to know this, you are certainly some of the few amongst my professional colleagues, my students, and my clients, many of whom may wonder why I prefer long sleeves in the summer.

As far back as I can remember, I always wanted a tattoo. Tattoos were off limits when I was growing up in New York City, owing to a ban by the Department of Health that associated tattoos with the threat of blood-borne Hepatitis B strains. Tattoos were exotic, deviant, and, by order of then-Mayor Robert Wagner, illegal. In fact, the only place to get them easily was in prison, where forensic psychiatrists conceptualized them as an “exoskeletal defense”: an artistic armor that telegraphs the wearer's toughness to peers but, to the trained eye, reveals a host of underlying psychopathologies (Manuel and Retzlaff, 2002).

The pathologizing of tattoos has a long history. In the 1930s, Albert Parry (1933) wrote that tattoos were unconscious representations of the penis that signified a trend toward sexual deviance. His book mentions, as supporting evidence for this theory, the criminal court's inclination to dismiss rape charges brought by females with tattoos, as the mutilating act undermined their credibility. (How times change! Contrast this claim with Mattel's release in 1999 of a “Tattoo Barbie.”) Parry, noting the regressive nature of tattooing, likened the painting of the body with ink to a child's smearing himself with feces and highlighted the masochistic desires exposed by engagement in the painful procedure. Even more specifically, Ferguson-Rayport and his colleagues (1955) proposed that diagnoses could be made on the basis of tattoo content (for example, a tumbling dice tattoo=psychopath); but others disagreed, believing that it was the very act of getting the tattoo, not its specific design, that indicated psychological instability. Indeed, more recently, psychiatrists were informed that the presence of a tattoo was “a warning sign” to examining physicians (Raspa and Cusack, 1990, p. 1841).

A survey by the Pew Research Center for the People and the Press (2006) indicates that 36% of Americans aged 18–25, and 40% of those aged 26–40, have at least one tattoo. That is 40 million Americans and, given Raspa and Cusack's warning, an awful lot of potential psychiatric patients. Worse, who knows how many of the afflicted are themselves practicing psychiatrists, psychologists, social workers, mental health counselors, psychotherapists or psychoanalysts?

I do not mean to compare the nascent popularity of tattooing to more seismic shifts in psychological taxonomy, like the removal of homosexuality from the Diagnostic and Statistical Manual of Mental Disorders or the depathologizing of women's desire to vote. After all, tattoos are by far more minor players in the psychiatric culture wars than other LombrosianFootnote 1 projects. However, even if the tattoo has not yet totally shorn its association with sexual and aggressive fetishism, it is moving more squarely into the realm of commodity fetishism, as Spitz (2000) defines it: the Marxist arena in which things are valued as merchandise rather than for any inherent value they possess.

If homosexuality and suffrage are guideposts, the degree to which the tattoo becomes more of a cultural referent than a personal one is the degree to which it is likely to be destigmatized by the mental health field. Consequently, once the tattoo loses it primary subjective relevance as a barrier-crossing communiqué of inner experience and becomes instead a sign of conspicuous consumption, its symbolism will be less interpretable in Freudian terms. More useful critiques might be made from the cultural schools of Harry Stack Sullivan (1937) and Erich Fromm (1954), who recognized something essential in the performative aspects of behavior, although I doubt either could have foreseen the ways in which postmodern society has turned the self inside out, the proliferation of tattooing being but one example of how the locus of desire, shame, and resistance is increasingly made available for public referendum.

Any relocation of the boundary separating deviance from convention begs an investigation of the moral dimension of our classification systems and raises technical questions about how clinicians, particularly those who find themselves astride the boundary, must revamp interventions to reflect newly articulated cultural realities and evolved definitions of the self. At the same time, the cultural Zeitgeist is distributed unevenly, with the most conservative and doctrinaire social institutions being the last to accept forms already well on their way to full cultural incorporation. Although it has its islands of flexibility, the larger mental health field is conservative in this way.

The psychoanalytic world, on the other hand, is generally peopled by those who see themselves as open minded, nonjudgmental, even free spirits of a sort; but we are all, of course, mired in the particular belief system of our era, our locale, and the teachings of our institutional gurus. Considering the persistence, in many mental health settings, of stereotypes that classify tattooed individuals as, well, a bit too individual, I wondered if tattooed therapists tended to hide their body art from senior colleagues and supervisors, maybe even from peers. More important, in view of the arousing quality of any self-disclosure – particularly one that reveals so much about the therapist's most cherished aesthetic (or provides embodied evidence of the therapist's puerility, eccentricity, or rebelliousness) – do therapists carefully cover their tattoos so as to supply an expanse of neutral, blank, ready-for-transference skin to their patients? As tattooing becomes more mainstreamed, and the likelihood of having inked patients increases, does the therapist's obligation to self-expose grow? What about inadvertent exposures and the discussions that follow them, particularly when tattoos reveal specific information (such as the names of loved ones) or contemporary predilections for, say, mermaids, skulls, or the waving tongue that graced the Rolling Stone's 1971 Sticky Fingers album? As Goren (2003) so beautifully articulates in her meditation on technology and conceptions of self, the current obsession with clinician self-disclosure in psychoanalysis itself mimics the commodification of self-expression, morphing personal, private, interpersonal, and public into one merchandisable sphere. Goren argues that, in the resulting indiscriminate admixture, distinctions between internal and external, object and subject, and animate and inanimate are lost, irrevocably changing whatever we believe constitutes the self. Once the self is redefined, so too must the intersubjective space between patient and therapist transform to reflect those diminished boundaries.

The study of tattooing situates itself in the crosshairs of multiple cultural discourses. Even the few narratives I present here expose the convergence of the true self and the false self (Winnicott, 1960), artful production and crass consumerism (Kosut, 2006a), autonomy and the capitulation to public norms (Rosenblatt et al, 2008). The narratives describe the “safe” externalization of desire and danger, the nexus of pain and memory (including collective memory), the representation of gender norms and, of course, the paradox of nonverbal communications.

Like so much of interest to clinicians, my curiosity began with my own story and what transpired when a terminating patient, unbeknownst to me, discovered one of my tattoos. My tattoo facilitated reflection about authority, hierarchy, disclosure, mutuality, the private and public self, the fortress of secrets, and the essence of shame.

A Woman Is Being Tattooed

An allusion to Freud's (1919) paper “A Child Is Being Beaten,” which explores the association of pleasure with suffering and the nature of memory versus fantasy.

Our sentence does not sound severe. The law which a condemned man has violated is inscribed on his body with the Harrow. Guilt is always beyond a doubt.

The officer, from Franz Kafka's “In the Penal Colony”

Although we did not have the opportunity to work together for a very long time, I felt a special closeness to Avi. That he had entered therapy knowing that he would be leaving the country before the year ended gave us both a heightened sense of purpose and, at times, what felt to me like a more fevered intimacy. As termination came closer, privacy (his) was dispensed with to a degree more usual in much longer treatments. Freedom was born of impending goodbyes, like the oft-acknowledged tendency to reveal to some stranger on a train a long-harbored infidelity. I prided myself on being human with him but not narcissistically preoccupied, either with what I revealed or what I withheld.

In the session prior to our last, he said that he had “Googled” me. It was the first time that a client had said this to me. Of all the things Avi might have mentioned finding out about me, he referenced a tattoo. Sitting there, for the life of me, I couldn’t think of a photograph I had taken that revealed it. So, not knowing exactly what he had seen, I simply asked what his thoughts were. He said that he wondered under what circumstances I had been made to get it. I thought it an odd locution and went on to explore briefly his fantasy about my getting tattooed under some sort of duress, which fit in with numerous dreams he had had of Justine-like characters who, through a combination of naiveté and obliviousness, came to tragic, violent ends. As I recall now, he quickly associated in another direction and the conversation moved elsewhere.

That night, I Googled myself and found the photo: a short sleeve covered my tattoo, but not completely. On my shoulder, I sported two hearts entwined, displaying the names of my children. None of this was visible in the picture. However, snaking out was a squiggle, measuring perhaps a quarter inch, which a less vigilant patient might have mistaken for nothing more than an unraveled thread from the shirt.

The squiggle was actually a part of my tattoo that I had not requested: the artist had added it as a kind of signature and a testimony to her partial ownership of my arm. Thinking about the exchange with my patient, I now associated more fruitfully. Of course, why had I not thought of it in the moment? His family had survived the Holocaust. Tattoos meant something completely different to him.

Thus, there was a particular transferential narrative that spun itself from the wisp of visible ink on my arm, one I would not get to pursue because he was leaving the country. The reason his interpretation of my tattoo acquisition as nonagentic had so confused me at the time (besides dissociating his generational trauma) was that contemporary tattoo culture posits that the very stylized and painful rituals of tattooing, far from promoting capitulation, cultivate an acute sense of agency.

The act of tattooing permanently reinscribes the living body-thinking, breathing, sweating, wrinkling – with a type of agency that is ongoing and inexhaustible, as compared with the consumption and display of sartorial body modifications that are, by their nature, ephemeral and disembodied. Tattoos invite a level of engagement because they become a permanent addition to the body/self. (Kosut, 2006a, p. 1042)

To me, tattoos were a kind of instant messaging – my body as billboard, a signal of affiliation with some and disaffiliation with others, a secret shame and a proud protest, and a way of being “both naked and clothed” at the same time (Blanchard, 1991, p. 18). My feelings reflect postmodern assumptions about selfhood: that each of my contradictory meanings has a kind of authority over my noncohered subjectivities, that each meaning privileges the hermeneutical over the essential and multiple realities over facticity. For my client, it appeared, the affect aroused by seeing my tattoo snippet had surfaced Foucaultian (1975) ideas of colonization and surveillance – the tattoo as a violation of integrity, and an annulment of the self.

Most amazingly, in an interpersonal sense, was that Avi had found the tiny part of my tattoo that I had neither requested nor desired, a permanent mark made, if not exactly under duress, certainly without my permission. I did not notice what was happening until it was too late; like the Jews of Poland and their progeny in my client's dreams, I had been oblivious to the treacherous intentions of others.

How had my client so intuitively reached across the intersubjective space and spied not only the very thing he needed to confirm his own view of the world but also something spot-on accurate about my own experience in it?

It was after Ari terminated that I became really interested in tattoos: on patients, therapists, and others.

Hiding in Plain Sight

In epistemology, the flesh cannot be dispensed with: it is an essential constituent of both intuitive and discursive systems; it constrains and obliges; its meanings may be made but it also makes meanings. Put more colloquially, the skin is where the rubber meets the road. Rather than dismissing the body as passively awaiting inscription, Biesta (1994) argues that the body can be a site of insurrection that resists or subverts the discourses that shape it. And so I interviewed a rebel clinician, Ruth.

When I asked to see her tattoo, Ruth said I was already looking at it. Until she pointed, though, I remained confused. Then there it was, curling around her arm, a vine on a trellis, peeking out among multiple bracelets but only if you knew what you were looking for and, even then, you couldn’t be quite sure what you were seeing. She had gotten it when she was in her 60s: “My cousin came from Israel and said, ‘Let's get tattooed,’ and I said, ‘Absolutely!’” She said the desire for a tattoo had floated, semiconsciously, in her psyche for a while. Ruth considered herself a free spirit, a therapist who worked intuitively and spontaneously, a healer who often spoke to her patients in artistic metaphors. The tattoo seemed a logical extension of this freewheeling persona and besides, she confided, “There's a touch of the histrionic in me. I wanted to show that it's never too late. I’m not too old.” Ruth wished to model this attitude for her patients.

The tattoo looked merely like a pretty design, something vaguely tribal perhaps, as is the current fashion. It turned out to be even more tribal than I had assumed: it was her name, in Hebrew. She said:

Twice, on the subway or bus, a guy yelled out my name and I turned, not understanding; it was an Israeli reading the Hebrew. I had a very interesting conversation with this one tall guy. He said to me, as I got off the bus, “Well, better that than this” and he showed me his tattoo from the concentration camps.

How do I feel about using the same area? The Germans were very functional, I knew about how they did it, always vertical, here [pointing above the area where she had her name emblazoned horizontally]. I thought, “It's not a number from them”; I’m proud, it's Hebrew.

And so, along with assertions about the eroticism of “putting something on the body,” the liberation of transcending one's generational Zeitgeist, the nod to exhibitionism, was this other kernel of rebellion that seemed to have sprouted through Ruth's skin rather than having been drawn on it. She had branded herself, where the Nazi's might have, but in choosing to do so had demonstrated a psychological undoing: a transformation of the meaning, if not the substance of a tattooed Jewish arm.

The tattoo was seeded in Switzerland. Ruth's children were still little but she had left them unattended while she tried to locate a luggage cart at the airport in Zurich.

My parents are from there so I speak German. I was looking for a cart and I started towards the door where there was a guard … he pushed me a little bit. I tried to indicate that I was going to get a cart, at which point he hauled off and said, “Fucking American Jew.” One part of me wanted to kick him in the balls; the other part was aware of my unattended children. I thought: discretion is the better part of valor.

Ruth, who had lived her whole life in New York City, had never encountered anti-semitism.

That's what made Switzerland so shocking. I feel a great association to transgendered people: their confusion. I identify as an American, but I am still an immigrant from Israel. I grew up speaking English, but it was complicated. Ever since Switzerland, it had been percolating. You can take the Chai [the Hebrew symbol for living that she wore around her neck] off, and I did for a while after that, but you can’t take this [pointing to the tattoo] off.

I noted the paradox of disclosing her heritage in another language. Her tattoo was a blanket statement of her Jewishness, a proclamation of Jewish life, a rebellion. Yet it also seemed a testament to the fundamental role of hiding in Jewish life, of passing oneself off as something more benign, of the pride taken in the cleverness of disguise. I remembered reading that, at the beginning of World War II, young Jewish schoolboys knew that only with their pants down could the Germans see their circumcisions, and so the boys took care to urinate alone. This was even better: I had looked right at Ruth's tattoo and not even known I was doing so. She went on:

The disclosure is interesting. In the fall, when I first got it, I wore long sleeves and it wasn’t noticeable. Then the spring came and I had to make a choice. I could have put it somewhere where disclosure isn’t an issue, but I chose an obvious place. Some patients noticed it right way and it could lead to some kind of discussion. I didn’t give the details (that it was my name in Hebrew). I don’t have to reveal what it is. Others never noticed, or mentioned it, or cared.

It's a statement of disclosure. But if I had an anti-semitic patient, he or she wouldn’t even speak Hebrew, wouldn’t even know to ask.

Ruth's tattoo seemed to function as what Greene called an “affective mneumonic” (cited in Namir, 2006), in this case one that carried memory through the collective, transhistorical space. Ruth could hide effectively the announcement of her origins when she needed to but could not erase it from her own vision of self; it was a link to Jewish wartime identity, tied intimately to annihilation, but also a link to continued existence. As Holocaust survivor Anna Ornstein (2004) has written, new arrivals at the concentration camp where she was imprisoned considered their tattoos to be “passports to life” because they signified the Nazis’ decision to send those Jews to labor rather than execution; Ornstein even sought out the best tattooist so that her marking would be neat and finely numbered. Ornstein's sense of agency (and even her vanity) is transcendent of the surreal surround, a reminder of the quotidian registers of humanity. Ruth's tattoo, woven among the bracelets at her wrist, cuffed her to these meanings and embodied pleasure's coexistence with the tragic.

Ruth felt that her tattoo disclosure had had a limited, but mostly positive, impact on her work with patients. She had said goodbye to earlier days when it seemed important to “sanitize” herself and her surroundings for the patients; now she felt comfortable with the person she was. Before leaving, she told a story about a patient, a story that could as well have been an apocryphal one about therapeutic disclosures in general.

A patient who had all kinds of tattoos went to study to be an EMT [emergency medical technician]. I pointed to her armful of tattoos and asked, “What about all that?” She said it didn’t seem to matter.

I guess when you are helping people in such dire circumstances, they don’t ask questions. They just go with it.

The Doctor's Flaming Heart

The sacred heart signifies the redeeming love of God as the source of illumination and happiness, hence the flames and the thorns representing the crown of thorns Jesus wore on the cross. … Saint Justin, the martyr, said that Christians were carved out of Jesus’ heart.

From the Sacred Heart Inspirational Tattoo Gallery website

Dr S is not a clinician. But my mind went immediately to him when I began writing this piece; he seemed to embody so many of my thoughts about the tattoo's power to reveal and obscure simultaneously. Dr. S always wears a suit. He has worked for some of the most conservative institutions in the country, overseeing historical archives and rare collections. He is covered up even in the summer. And it was during a particularly hot summer that I came to know what was underneath his clothes.

Because the weather was so warm and humid (and the hallways of my institution were empty; my colleagues, I thought, off on vacation), I walked down the hall without my blazer, exposing a tattooed arm. Suddenly, I saw the buttoned-up Dr. S approaching and fleetingly feared he might reprimand me. My anxiety increased when he motioned me aside. Dr. S seemed to look stern for a moment – or so I imagined – and then said, “I want to show you something.” He rolled up the cuff of his nattily tailored trousers high enough to reveal a large dragon tattoo. Leaning against the hallway wall, he shared an expansive knowledge of the history of tattooing and his personal journey through the skin art world over five decades. When I started this project, I sought out Dr. S again. He told me:

I showed you my tattoos. Most people don’t know I have tattoos. Maybe I did it as a rebellious act when I was a kid. I just remember that after I graduated from grammar school (8th grade) I decided to get a tattoo. When I was 14, my mother thought it was just a minor aberration … but the second, third, and fourth? Then it was too late for me. I was 12 when my father died. Most of that side of the family died young. Now I’m on borrowed time. My father was dead and my mother threw me out of the house with the second tattoo.

Dr. S considers his tattoos another kind of collecting and himself a documentarian of the form. He started getting tattoos decades before it was fashionable, when body ink designs were called “flash.” Dr. S says, “The collars” [the priests] in his Catholic high school made him keep them covered. “They were just martinets,” he scoffs. “In those days the tattoo was the mark of the criminal; guys would get them done with a piece of glass dipped in ink, you had to be able to take the pain. After the electric machine was invented, it got easier; it became the mark of the wayfarer because it wasn’t so painful.”

There is the image of a heart on fire on the right side of Dr. S's chest (he calls it “my modified sacred, flaming, bleeding heart”), a dragon on his shin from ankle almost to knee, and three lovebirds nesting in undisclosed locations. He has a bouquet of flowers on his right arm that covers up his very first tattoo from age 14, a floriated scroll with his name, because “I needed something larger on my arm.” He explains that he is a “lapsed and recovering” Catholic but still attracted to the iconography and romance of the images: “The energy comes from the cults of the medieval, and the mystical,” he explains. For the wide canvas of his back, Dr. S. has in mind the “Holy Ghost (in bird form) flying out of a burst of flames.”

Dr. S's tattoo choices seem a secular slap in the face to ecclesiastic notions of the inviolate body. However, since Andres Serrano won acclaim and a $15,000 prize for submerging a laconic Christ in urine in 1989, the popularity of crucifiction iconography has made sacrilege a respected art form. Judeo-Christian doctrines that equate tattooing with paganism have been weakened through the relentless postmodern insistence that the “self/body” is just another site of discourse anyway, a cultural artifact that, in turn, constitutes both the flesh and a nonagentic subjectivity (Biesta, 1994). Accordingly, Dr. S's Christ becomes an object d’art denuded of its original meaning but still highly desirable.

Perhaps, in an odd way, Dr. S agrees with this designification. When I ask about the meaning of the image of that incendiary airborne Christ he is considering for his lattimus dorsi, he says, “That's just the inspiration. … Who wants a pigeon on their back?” Indeed, he eschews any significance. He insists that “sometimes a tattoo is just a tattoo.”

We are always delving into the unconscious, but what if you just want one? I stopped getting them for three or four years. That shows it's not deeply embedded. It was just a rite of passage. I knew one guy who was drunk and we tried to talk him out of it. … He got a big tattoo of a devil holding a nude woman with his tail going into her vagina. He had to have it burnt out when he had children. He has a huge scar there now. It was obscene, and stupid. You have to take responsibility for your actions.

Gods, pigeons, and penetrated vaginas share a strange space in the tattoo world, where imagery and metaphor easily mix and a variety of different body markings can reach “exalted” status. My assumption has been that tattoos achieve importance in the wearer's eyes because they assert one's individuality and express some imagined truth about the self. According to Gaddini (1980), “The mind is extant through the body.” What is more personal and necessary than skin? Psychoanalyst Didier Anzieu (1993) and earlier theorists, like Esther Bick (1968), thought the skin analogous to the ego in its functions.

The functions of the skin-ego are to maintain thoughts, to contain ideas and affects, to provide a protective shield, to register traces of primary communication with the outside world, to manage intersensorial correspondences, to individuate, to support sexual excitation, and to recharge the libido. In brief, the skin-ego is an interface between inside and outside, and is the foundation of the container/contained relationship. (Anzieu, 2005).

Artist Catherine Obie, known for her portraiture of various kinds of scarification, contemporizes that view, prioritizing the skin's barrier function. She likens the painting of it to a kind of deceit, reminiscent of Winnicott's (1960) “false self” made to interface with the real world. She says that “body modification is a façade” – implying that the tattoo is sly frontage meant to obscure the wearer's true intentions and activities, even as it purports to reveal what is innermost (cited in Yablonsky, 2008, p. 218.) The idea of a tattoo as merely a masking device would render gods, pigeons and vaginas equivalent on the skin – even interchangeable, as artifacts – because the point is primarily the obfuscatory performance.

Dr. S. is an erstwhile Catholic who fetishizes the Church's symbols, and has replaced their rituals with his own: tattooing. In the tattoos he degrades and enshrines some early experience, perhaps at the knee of the priestly “martinets” he rages against. In the ancient world, tattooing was alternately forbidden as iconic adornment and embraced as a sign of religious devotion, although many evangelicals, who now consider tattoos a proclamation of faith, frequent parlors endorsed by the Christian Tattoo Association (Firmin et al, 2008). Dr. S. sees no blaring message in his body art, however: he merely loves the color, the beauty, the paint, as it were, on the aluminum siding. As with all levels of body modification, the recurring question is whether physical revisions are merely slapped on the physical container or something that has broken through its walls.

Culture in Transition

There is a computer game called Culture Shock, in which a licensed psychotherapist/tattoo artist named Sybil (what else?) runs a combination mental health clinic and tattoo parlor. Even in this age of unconventional pairings, one wonders if such a business proposition could actually flourish. Despite contemporary research demonstrating that the presence of tattoos does not necessarily signal severe personality defects, the majority of people who are unadorned still find those who are adorned highly suspect (Rosenblatt et al, 2008). People with body modifications, including tattoos and piercings, are still viewed negatively by the majority who do not alter their bodies in these ways. Moreover, the negative assessments are global and extend to all aspects of the tattooed person's character (Forbes, 2001). Thus, even in a time of changing mores, many question the motivations, both conscious and unconscious, of people who permanently alter their bodies in these ways.

The recoil evoked by Culture Shock’s juxtaposition of psychotherapist and tattoo artist is understandable, given the reparative skills ascribed to psychotherapists versus a mythic view of the professional tattooist as the “dark, sadistic partner who performs in an eroticized den of iniquity where the most perverted behavior takes place” (Aryan, 2006, p. 849). On second thought, however, considering the ways in which the analyst both vivifies and contains all manner of death wish, perhaps the consultation room and the tattoo parlor are not so disparate after all.

Even having been given the imprimatur of an academic establishment that recognizes its sudden ubiquity among the masses, tattooing has not yet penetrated the cultural “center of the gatekeeping system,” which connotes that tattooing has achieved only “quasi-legitimacy” (Diana Crane, cited by Kosut, 2006b, p. 75). This means that, although most of your fellow psychoanalysts probably do not attribute any generalized psychological meaning to a tattoo, it might still be problematic to parade the wingspan of your bald eagle openly at the annual American Psychological Association conference. The more conservative the profession, of course, the more circumspect you must be: I habitually tell my students who are trying to land internships with the Federal Bureau of Investigation that even their itsy bitsy butterfly is verboten to show. Even in settings where the tattoo does not shock, it is still considered inappropriate; a sign that we are only in a transitional phase – our major institutions have not yet validated the tattoo as a mainstream artifact.

Kosut (2006b) says that the academy has signaled its readiness for a “paradigmatic shift” in the way that tattoos are conceptualized, but the psychiatric establishment has been slower to cede traditional categories. Even as psychiatric parlance has changed, so that tattoos are not automatically taken as signs of masochistic personality, psychopathy or sexual perversion, many researchers in the field still are only a step removed. They frequently still assume that tattoos have traumatogenic origins (Romans et al, 1998), or they equate them with the same hormonal abnormalities rumored to fuel risk-taking behaviors, suicidality, delinquency, and adult crime (Favazza, 1996). Seemingly, “the notion of the tattooed deviant is an enduring construct” (Kosut, 2006b, p. 90) among psychiatrists. Even those who have them.

The Psychiatrist's Ram

Through regression, ideas are transformed into visual pictures; latent thoughts are dramatized and illustrated.

Freud, paraphrased, speaking of dreams, “New Introductory Lectures”

The psychiatrist, Ed, has a tattoo of a muscled ram with a Native American sunburst as back drop. “It's my astrological sign. As a kid I had a pendant of an Aries, too. My grandfather gave it to me so it has additional significance, being from my maternal grandfather.” He takes care to tell me that it is quite small and in a place where it could be revealed only with conscious aforethought. Ed is careful not to show it, although he has discussed the ram with his analyst, his supervisors, and, at times, with his patients. Ed was in a “bad place” when he got it and sees the image as representative of his struggle at that time, “a kind of battle scar; a dissociation onto the skin.” He found getting the tattoo “a significant process of identity change” because it shocked the people who knew him and, yet, Ed wore this radical identity uncomfortably and worried that others would think of him as merely a poseur.

In the end, Ed says, his identity change was really a “Pyrrhic victory.” His was a “pussy tattoo” compared with his uncle's (a forearm dagger that had to be surgically removed). Ed's father had earlier stopped him from getting a piercing; Ed thought maybe the tattoo was the compromised rebellion. “That piercing, it was like,” he pauses, “my whole life my dad wanted to get a Corvette. He felt it would be fun but it wasn’t really necessary.” The tattoo was a concession to his father's wish that he not be pierced, but I had the sense that it did feel quite necessary.

It seemed emblematic of where I was, pushing through it like a battering ram, determined. I was a psychiatry resident. I was struggling with the two [contradictory] aspects of my identity: being a professional and being more, being cool. I always felt like I was different, didn’t fit in, I was shy, not happy in high school. But not unrestrained. I didn’t get a bunch of tattoos or piercings in high school. I always had a sense of restraint. I was rebellious but not totally.

I saw the paradox of a ram, tightly controlled, but then remembered that a ram was also a male sheep, which raised the nested contradictions among aggression, compliance, and reprisal to exponential proportions. Ed explains how the struggle played out between him and his father, and how, surreptitiously, he won: “My dad was conservative, and older. When I got a tattoo, my dad said, ‘that's a form of self-mutilation’. When I shaved my head, my stepmother said, ‘You look like a neo-Nazi skinhead.’ I ask Ed if he thought about hiding the tattoo from his dad. The thought hadn’t crossed his mind: “I didn’t think about hiding it; if anything I was pleased.”

Later, Ed brings up a different kind of battle scar, a visible one on his neck, left from “a cancer that didn’t heal well.” Still later, he reveals that he lost his mother when he was 9 years old, also to cancer: a scar I cannot see. Both Ed's surgical scar and his tattoo supply external verification of internal traumas perhaps, one with a disease and the other with his father's perceived autocracy in his mother's absence. The scar and the ram make real to the observer an internal process that defies accurate articulation; they reify formerly unsymbolized traumatic events. On the other hand, these superficial signs can obscure internal life, particularly the shame attached to the very humiliations that triggered the scarring: a submission to both sickness and paternal dominance. “It's a secret life,” says Ed knowingly, “The information is most powerful when it's sequestered.”

Many tattoos are suffused with silent suffering. Ed says that, in the trauma work that he does, there are “hierarchies of suffering” and one needs “a membership card.” He tells me that his ram represents his “stubborn side: digging in, muscling through, keep my head down, and working it out: depression, relationships, loneliness, ennui, the usual stuff.” He worries, however, that his suffering is bourgeois. “Small and insignificant, like your tattoo?” I wonder aloud. “No, just right,” he laughs.

I think the tattoo is connected with self inflicted injury. For me, it is an injury. It hurts and has to heal. You cover it up, you look at it everyday; the way the wound heals and how it changes over time. I pay attention to that … how my skin changes once the tattoo is not fresh. That particular initial phase of wound healing. … But you can also keep doing it, like [self-] cutting. But people are ashamed of those. You can’t hide multiple cuts.

Discussing arousal and intimacy, Ed says that he might share his tattoo with a patient who is also tattooed, as a way to bond around participation in a subculture. “It helps people feel like you aren’t judging them. You could still be, though, judging them [sotto voce] ‘I have a small one, you have a huge one; mine is discreet, you have a big one that's not in your control.’” For the most part, Ed says, “It stays invisible; it's not creeping out of my collar. You know, professional decorum.” Ed makes a “thumbs up” gesture. He finds large tattoos, or ones that are prominently displayed, aggressive and hostile. “Tattoos on the side of your head, devils, eroticized cute girly tattoos on the back of a neck … my choice was more intellectual.” “I don’t know,” I say. “Rams also have a sexual connotation. And, despite the feelings of impotence conveyed by some of your story, being an MD is actually a pretty powerful thing.”

Yes, being an MD is powerful. I probably would have been an artist. Maybe being an analyst is the compromise. Maybe it's like my father's sports car. … I resist the urge to get another tattoo; I’ve been stopping myself. I don’t want another. Having one, in and of itself, is a sign of deviance.

Discussion

I started this project because I was curious about my own reluctance to reveal my tattoos to clients. My sense of it was contradictory: feeling intensely married to the idea of my tattoos as representing a special private truth, I didn’t want to share them; yet the “truth” was hardly private. In nonprofessional forums, I bandied my tattoos about indiscriminately, hoping they would be noticed. In treatment quarters, I was fearful of how their disclosure might abnegate my supposed neutrality and fill the room with an overabundance of me, to the diminishment and detriment of my clients.

As with any personal revelation, clinicians must consider whether sharing tattoos is too narcissistic, burdensome, or stimulating for their patients. On the other hand, there is also the possibility that a patient's discovery of something so authentic, and possibly even jarring, might wake up a drowsy analysis and facilitate the intersubjective engagement that gives treatment “traction“ (Grover and Dueck, 2010). Moreover, because clients these days often share something about their own tattooing experiences, clinicians’ silence or dissimulation on the topic begs issues of secrecy, authority, intimacy, and confession, as they conspire to deform dyadic communication. Hoffman (1994) and Greenberg (2001), writing about the analytic couple, have observed that therapists’ magical powers are enshrined in their anonymity. Thus, Maroda (2004), arguing in favor of greater transparency, urges that judicious disclosure not be considered a slippery slope into mutual analysis but a foray into egalitarianism that promotes a stronger working alliance. In this view, the clinician's show-and-tell of a tattoo might have particular meaning for a patient who finds it difficult to “expose” thoughts and feelings about his or her own body. Such a disclosure might temper shame or even model freedom, as Ruth tried to do in interactions with her patients.

Closely intertwined with decisions about whether or not to share their tattoos were subjects’ initial motives in getting them. Each person I spoke with still cherished some notion of the “mark” as separating them from others who were less maverick, permitting them entry into a hybrid subculture, where they could be deviant but not too much, as the psychiatrist Ed kept reiterating in his narrative of middle-class conflict.

The hiddenness of the markings allowed subjects to move facilely between their professional world and the “secret” world of their modified bodies. Funny how something so public can take on special poignancy as a referent of the unspoken and fill out a fantasy of deviance, guilt, and protracted punishment. Tattoos relieve the wearer of the obligation to explain himself or herself, as scarred wrists or right-hand wedding rings do for some others. A tattoo screams what we cannot, will not, should not say; it is an observable datum that telegraphs the very thing it censors. The contradiction engraves on the body a paradox similar to the one Winnicott (1963) cited when describing a children's game of hide and seek, “[It is] a joy to be hidden but a disaster to not be found” (p. 186). Winnicott observed that we must bear such paradoxes. In the case of tattoos, we bare the paradox as well.

Biesta (1994) urges us to consider that even these hedonistic pleasures of the body implicate capitalist chicanery; the mainstreaming of tattoos is sometimes offered as a strong case in point of educating the consumer about what is desirable. In this telling, our tattooed bodies are just social constructions made of flesh, as subject to the whims of the mass market as to any personal agenda. Contrary to this view, my data suggest that – rather than seeing themselves as capitulating to market forces – people think of their decision to get tattoos as an exceptionally deep expression of personal identity, as well as a dramatic declaration of autonomy.

The tattoo has sway to summon the most powerful imagery in the service of subverting power. Dr. S brought me squarely to the door of God, his heart tattoo collapsing the sacred and profane together, and his contradictory feelings about authority with them. Each subject, in fact, described the act of getting tattooed as defiant of some authority: religious, parental, or institutional. (These are the same oedipal stand-ins that populate most analyses, which perhaps argues for tattoos as a particularly good conversational conduit through which Oedipus can be invited into the consulting room.)

Despite their faddish acceptance, tattoos remain effective sites for self-affirmation, identity creation, and agentic reverie. Moreover, tattoos affirm the body's capacity to summon the concrete and fantastical simultaneously (Downing, 2004), and, in doing so, to provide a potent transferential landscape. That tattoos collapse the line between fantasy and reality has particular relevance, I believe, for two-person, interpersonal, and relational therapies, where negotiation of the reality–fantasy divide is exceptionally fraught.

As Constance Penley (1992) observed in another context, for psychoanalysis, fantasies revivify scenes where “crucial questions about desire, knowledge, and identity can be posed, and in which the subject can hold a number of identificatory positions” (p. 480). Such fantasies seemed to play out on my subjects’ skin, where what they wanted, had guilty knowledge of, and were made to endure was all made manifest in their branding, even as its exposure was highly controlled. Subjects embodied multiple roles: defiler, victim, exhibitionist, prude.

The tattoos themselves had a talismanic quality and, since they were so often concealed, I speculate that therapists feared the power they might have to hurt others in their treatment rooms. This was true even though all admitted that tattoos were so common these days that having a tattoo might merely brand one as the proud owner of a midlife crisis. The double belief that tattoos are simultaneously meaningless cultural artifacts and highly significant personal data persists for my young adult clients too. Two have told me that, despite the fact that almost everyone they know has a tattoo, they still feel marginally ashamed and excited by their own.

Tattoos are, on the one hand, so ubiquitous as to be voided of meaning, as much capitalist widgets as the designer bag. And still, therapists do not wear them as such, feeling that they are wearing their eroticism and aggression, so to speak, on their sleeve.