Tattoos -a window to the psyche?

Ruwan M Jayatunge M.D. PhD ( in progress) 

The word “tattoo” derives from a Polynesian word. Tattooing is an ancient, ritualized practice and a decorative form of body modification.  Tattoos are defined as the introduction of exogenous pigments into the dermis in order to produce a permanent design (Islam et al.,2016).

Tattoos are a form of self-expression. Mostly tattoos are applied for the sake of fashion. tattooed people consider themselves more adventurous, creative, artistic, and individualistic. Sometimes tattooing indicates sexual identity, masculinity, and sexual orientation.  Tattooing represents a bodily expression of uniqueness. In Sri Lanka there is an upward trend in the practice of tattooing. Tattooing has become popular among the X and Millennial Generations.

In the early 60s and 70s tattoos represented a cultural taboo in Sri Lanka. The most tattooed people were criminal elements.  During that era, tattooed people were considered as gangsters and social outcasts.   Many incarcerated criminals, gang members, and counter-cultural groups (unorthodox artists) had skin tattoos. With tattoos on their body, they looked more aggressive and rebellious.  For long years tattoos carried negative associations.  However, this trend changed significantly after 2000. Although stigma associated with tattoos appears to still exist tattoos have evolved into a mainstream phenomenon.  

Tattoos are symbolic marks.  What are the psychological and psychiatric aspects of tattoos? Can tattoos provide a valuable window into the psyche? Demographic and behavioral correlates of getting tattooed indicate psychosocial health. Some experts speculate that tattoos appear to be a marker of risk-taking behavior in adults.

According to the psychoanalytic perspective, tattoos have implicit meanings and suggest that tattoos may also serve a defensive function when associated with themes of destruction. Tattoos have psychological meaning and symbolism. For Psychoanalysts skin represents the fragile border of the self. Sigmund Freud in his Totem and Taboo (1913) narrates how tattoos were used as totem clans in the ancient tribes.  Tattoos have metaphorical symbolism. As Freud commented people carve the image of a totem animal into themselves by tattoos. The totem animal must not be killed or consumed, and this taboo forms the core of totemism. Lacan underlines the drive of erotogenic masochism in tattooing. 

Pozgain and collogues (2004) examined the association between the tattoo(s) and human personality traits and concluded that tattooed subjects have less social conformity. Mortensen and team (2019) suggest that individuals with tattoos are more likely to engage in risky behaviors relative to their non-tattooed counterparts. Raspa and Cusack (1990) highlight those psychiatric disorders, such as antisocial personality disorder, drug or alcohol abuse, and borderline personality disorder, are frequently associated with tattoos. However, Roggenkamp et al., (2017) elucidate that tattoos should be viewed not as signs of pathology, but as opportunities to explore core aspects of self-identity. Pajor and the team (2015) emphasize that tattoos and piercings should not be considered indicators of psychopathology.

References 

Islam PS, Chang C, Selmi C, Generali E, Huntley A, Teuber SS, Gershwin ME. Medical Complications of Tattoos: A Comprehensive Review. Clin Rev Allergy Immunol. 2016 Apr;50(2):273-86. doi: 10.1007/s12016-016-8532-0. PMID: 26940693.

Mortensen K, French MT, Timming AR. Are tattoos associated with negative health-related outcomes and risky behaviors? Int J Dermatol. 2019 Jul;58(7):816-824. doi: 10.1111/ijd.14372. Epub 2019 Jan 24. PMID: 30677140.

Pajor AJ, Broniarczyk-Dyła G, Świtalska J. Satisfaction with life, self-esteem and evaluation of mental health in people with tattoos or piercings. Psychiatr Pol. 2015 May-Jun;49(3):559-73. English, Polish. doi: 10.12740/PP/27266. PMID: 26276922.

Pozgain I, Barkic J, Filakovic P et al. Tattoo and personality traits in Croatian veterans. Yonsei Med J 2004; 45: 300 – 5.

Raspa RF, Cusack J. Psychiatric implications of tattoos. Am Fam Physician. 1990 May;41(5):1481-6. PMID: 2333825.

Roggenkamp H, Nicholls A, Pierre JM. Tattoos as a window to the psyche: How talking about skin art can inform psychiatric practice. World J Psychiatry. 2017 Sep 22;7(3):148-158. doi: 10.5498/wjp.v7.i3.148. PMID: 29043152; PMCID: PMC5632599.