Original Article

The tattooed therapist: Exposure,

disclosure, transference
Abby Stein
John Jay College of Criminal Justice, 899 Tenth Avenue, Room 432E, New York, NY
10019, USA.
E-mail: astein@jjay.cuny.edu

Abstract Following an intense experience with a client who inadvertently discovered my tattoo, I became interested in the dynamics of clinicians disclosing this
particular kind of personal information to psychotherapy patients. My interviews with
tattooed colleagues explored the erotic, aggressive, and narcissistic overtones of such
revelations, as well as their more affiliative nuances, given the growing likelihood that
many clients have themselves modified their bodies in this way. I found that whatever
their disclosure decisions and however much they eschewed traditional notions
about the psychopathology of tattooing the practitioners I interviewed were equivocal
about revealing tattoos in professional settings. The idea of the tattoo, despite its
embrace by mainstream culture, is still strongly identified with a kind of deviant
identity and a defiance of patriarchal authority that makes thoughtful tattoo
wearers think twice about the message they are sending out.
Psychoanalysis, Culture & Society (2011) 16, 113131. doi:10.1057/pcs.2010.17
Keywords: tattoo; body modification; clinician self-disclosure; psychotherapy;
professional appearance

Underneath your clothes, theres 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.

r 2011 Macmillan Publishers Ltd. 1088-0763 Psychoanalysis, Culture & Society

www.palgrave-journals.com/pcs/

Vol. 16, 2, 113131

Stein

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 wearers 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 courts inclination to dismiss rape charges
brought by females with tattoos, as the mutilating act undermined their credibility. (How times change! Contrast this claim with Mattels release in 1999
of a Tattoo Barbie.) Parry, noting the regressive nature of tattooing, likened
the painting of the body with ink to a childs 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 1825, and 40% of those aged 2640,
have at least one tattoo. That is 40 million Americans and, given Raspa and
Cusacks 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 womens desire to vote. After all, tattoos are by far more minor players in the
psychiatric culture wars than other Lombrosian1 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
114

r 2011 Macmillan Publishers Ltd. 1088-0763

Psychoanalysis, Culture & Society

Vol. 16, 2, 113131

The tattooed therapist

tattoo loses it primary subjective relevance as a barrier-crossing communique 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 therapists most cherished
aesthetic (or provides embodied evidence of the therapists 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 therapists 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 Stones 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
r 2011 Macmillan Publishers Ltd. 1088-0763

Psychoanalysis, Culture & Society

Vol. 16, 2, 113131

115

Stein

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 Tattooed2

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 Kafkas 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 couldnt 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 naivete and
obliviousness, came to tragic, violent ends. As I recall now, he quickly associated
in another direction and the conversation moved elsewhere.
116

r 2011 Macmillan Publishers Ltd. 1088-0763

Psychoanalysis, Culture & Society

Vol. 16, 2, 113131

The tattooed therapist

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 clients dreams, I had been oblivious to the treacherous
intentions of others.
r 2011 Macmillan Publishers Ltd. 1088-0763

Psychoanalysis, Culture & Society

Vol. 16, 2, 113131

117

Stein

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 couldnt be quite sure what you were
seeing. She had gotten it when she was in her 60s: My cousin came from Israel
and said, Lets 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, Theres a touch
of the histrionic in me. I wanted to show that its never too late. Im 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, Its not a number from them; Im proud, its Hebrew.
And so, along with assertions about the eroticism of putting something on the
body, the liberation of transcending ones generational Zeitgeist, the nod to
118

r 2011 Macmillan Publishers Ltd. 1088-0763

Psychoanalysis, Culture & Society

Vol. 16, 2, 113131

The tattooed therapist

exhibitionism, was this other kernel of rebellion that seemed to have sprouted
through Ruths skin rather than having been drawn on it. She had branded
herself, where the Nazis 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. Ruths 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 y 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.
Thats 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 cant 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 Ruths 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 wasnt noticeable. Then the spring came and I had to make
a choice. I could have put it somewhere where disclosure isnt an issue, but
I chose an obvious place. Some patients noticed it right way and it could
lead to some kind of discussion. I didnt give the details (that it was my
name in Hebrew). I dont have to reveal what it is. Others never noticed,
or mentioned it, or cared.
r 2011 Macmillan Publishers Ltd. 1088-0763

Psychoanalysis, Culture & Society

Vol. 16, 2, 113131

119

Stein

Its a statement of disclosure. But if I had an anti-semitic patient, he or she

wouldnt even speak Hebrew, wouldnt even know to ask.
Ruths 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. Ornsteins sense of agency (and
even her vanity) is transcendent of the surreal surround, a reminder of the
quotidian registers of humanity. Ruths tattoo, woven among the bracelets at
her wrist, cuffed her to these meanings and embodied pleasures 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 didnt seem to matter.
I guess when you are helping people in such dire circumstances, they dont
ask questions. They just go with it.

The Doctors 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. y 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
tattoos power to reveal and obscure simultaneously. Dr. S always wears a suit.
120

r 2011 Macmillan Publishers Ltd. 1088-0763

Psychoanalysis, Culture & Society

Vol. 16, 2, 113131

The tattooed therapist

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 dont 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 y 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 Im 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 wasnt so
painful.
There is the image of a heart on fire on the right side of Dr. Ss 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
r 2011 Macmillan Publishers Ltd. 1088-0763

Psychoanalysis, Culture & Society

Vol. 16, 2, 113131

121

Stein

canvas of his back, Dr. S. has in mind the Holy Ghost (in bird form) flying out
of a burst of flames.
Dr. Ss 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. Ss Christ becomes an
object dart 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, Thats just the inspiration. y 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 its 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. y 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 wearers eyes because they assert ones 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 skins barrier function. She likens
122

r 2011 Macmillan Publishers Ltd. 1088-0763

Psychoanalysis, Culture & Society

Vol. 16, 2, 113131

The tattooed therapist

the painting of it to a kind of deceit, reminiscent of Winnicotts (1960) false

self made to interface with the real world. She says that body modification
is a facade implying that the tattoo is sly frontage meant to obscure the
wearers 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 Churchs 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 persons 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 Shocks 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
r 2011 Macmillan Publishers Ltd. 1088-0763

Psychoanalysis, Culture & Society

Vol. 16, 2, 113131

123

Stein

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 Psychiatrists 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. Its 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
124

r 2011 Macmillan Publishers Ltd. 1088-0763

Psychoanalysis, Culture & Society

Vol. 16, 2, 113131

The tattooed therapist

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 uncles (a forearm dagger that had to be
surgically removed). Eds 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 wasnt really necessary. The tattoo was a concession to his
fathers 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, didnt fit in, I was shy,
not happy in high school. But not unrestrained. I didnt 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,
thats 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 hadnt crossed his mind: I didnt 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 didnt 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 Eds
surgical scar and his tattoo supply external verification of internal traumas
perhaps, one with a disease and the other with his fathers perceived autocracy
in his mothers 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.
Its a secret life, says Ed knowingly, The information is most powerful when
its sequestered.
r 2011 Macmillan Publishers Ltd. 1088-0763

Psychoanalysis, Culture & Society

Vol. 16, 2, 113131

125

Stein

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
y how my skin changes once the tattoo is not fresh. That particular initial
phase of wound healing. y But you can also keep doing it, like [self-]
cutting. But people are ashamed of those. You cant 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 arent 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 thats not in your control. For the most
part, Ed says, It stays invisible; its 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 y my choice was more intellectual. I dont 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 its like my fathers
sports car. y I resist the urge to get another tattoo; Ive been stopping
myself. I dont 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 didnt 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
126

r 2011 Macmillan Publishers Ltd. 1088-0763

Psychoanalysis, Culture & Society

Vol. 16, 2, 113131

The tattooed therapist

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 patients 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 clinicians 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 childrens
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
r 2011 Macmillan Publishers Ltd. 1088-0763

Psychoanalysis, Culture & Society

Vol. 16, 2, 113131

127

Stein

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 selfaffirmation, identity creation, and agentic reverie. Moreover, tattoos affirm the
bodys 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 realityfantasy 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.

About the Author

Abby Stein, PhD is an Associate Professor at John Jay College of Criminal
Justice in New York City. She is the author of numerous articles on domestic
128

r 2011 Macmillan Publishers Ltd. 1088-0763

Psychoanalysis, Culture & Society

Vol. 16, 2, 113131

The tattooed therapist

violence, criminality, states of consciousness, and contemporary culture. Her

book, Prologue to Violence: Child Abuse, Dissociation, and Crime, was
published by The Analytic Press in 2007.

Notes
1 A highly respected physician at the turn of the twentieth century, Cesare Lombroso (1896, 1911)
diagnosed criminality by documenting the aberrant facial features of men and women interred in
Italian prisons, and linked tattoos to savagery and depravity. When used as an adjective by
sociologists, Lombrosos name connotes the embrace of bifurcated classification systems for
assessing human character, particularly those taxonomies based on peoples observable physical
characteristics.
2 An allusion to Freuds (1919) paper A Child Is Being Beaten, which explores the association of
pleasure with suffering and the nature of memory versus fantasy.

References
Anzieu, D. (1993) The autistic phenomena and the skin ego. Psychoanalytic Inquiry 13:
4248.
Anzieu, D. (2005) Skin ego. International Dictionary of Psychoanalysis, http://www.
encyclopedia.com, accessed January 2010.
Aryan, A. (2006) Body modification. International Journal of Psychoanalysis 87: 849851.
Bick, E. (1968) The experience of the skin in early object relations. International Journal of
Psycho-Analysis 49: 484486.
Biesta, G. (1994) The Identity of the Body: Philosophy of Education. Normal: Philosophy
of Education Society and Illinois State University.
Blanchard, M. (1991) Post-bourgeois tattoo. Visual Anthropology Review 7(2): 1121.
Downing, E.K. (2004) Living with s(k)in: An analysis of tattoo removal. Paper presented at
the annual meeting of the International Communication Association, New Orleans, LA.
Allacademic.com/meta/p112705_index.htm, accessed April 20, 2010.
Favazza, A.R. (1996) Bodies Under Siege: Self-Mutilation and Body Modification in
Culture and Psychiatry. Baltimore, MD: John Hopkins University Press.
Ferguson-Rayport, S.M., Griffith, R.M. and Strauss, E.W. (1955) The psychiatric
significance of tattoos. Psychiatric Quarterly 29: 112131.
Firmin, M.W., Tse, L.M., Foster, J. and Angelina, T. (2008) Christian student perceptions
of body tattoos: A qualitative analysis. Journal of Psychology and Christianity 27(3):
195204.
Forbes, G.B. (2001) College students with tattoos and piercings: Motives, family
experiences, personality factors, and perception by others. Psychological Reports 89:
774786.
Foucault, M. (1975) Discipline and Punish: The Birth of the Prison. New York: Random
House.
Freud, S. (1919) A child is being beaten: A contribution to the study of the origin of
perversions. Standard Edition, 17. London: Hogarth Press, pp. 179204.
Fromm, E. (1954) The psychology of normalcy. Dissent 1: 139143.
r 2011 Macmillan Publishers Ltd. 1088-0763

Psychoanalysis, Culture & Society

Vol. 16, 2, 113131

129

Stein
Gaddini, E. (1980) Notes on the mind-body question. International Journal of PsychoAnalysis 68: 315329.
Goren, E. (2003) Americas love affair with technology: The transformation of sexuality
and the self over the 20th Century. Psychoanalytic Psychology 20: 487508.
Greenberg, J. (2001) The analysts participation: A new look. Journal of the American
Psychoanalytic Association 49: 359383.
Grover, S.F. and Dueck, A. (2010) Self-disclosure, wild analysis, and Winnicott: Selfdisclosure and object usage. Paper presented at the conference of Division 39
(Psychoanalysis) American Psychological Association. April 2225, Chicago, IL.
Hoffman, I.Z. (1994) Dialectical thinking and therapeutic action in the psychoanalytic
process. Psychoanalytic Quarterly 63: 187218.
Kosut, M. (2006a) An ironic fad: The commodification and consumption of tattoos.
Journal of Popular Culture 39(6): 10351048.
Kosut, M. (2006b) Mad artists and tattooed perverts: Deviant discourse and the social
construction of cultural categories. Deviant Behavior 27: 7395.
Lombroso, C. (1896) The savage origin of tattooing. Popular Science Monthly 48:
793803.
Lombroso, C. (1911) Crime: Its Causes and Remedies. Boston: Little, Brown.
Manuel, L. and Retzlaff, P.D. (2002) Psychopathology and tattooing among prisoners.
International Journal of Offender Therapy and Comparative Criminology 46:
522531.
Maroda, K.J. (2004) The Power of Countertransference: Innovations in Analytic
Technique. Hillsdale, NJ: Analytic Press.
Namir, S. (2006) Embodiments and disembodiments: The relation of body modifications to
two psychoanalytic treatments. Psychoanalysis, Culture & Society 11: 217223.
Ornstein, A. (2004) My Mothers Eyes: Holocaust Memories of a Young Girl. Cincinnati,
OH: Emmis Books.
Parry, A. (1933) Tattoo: Secrets of a Strange Art as Practiced Among the Natives of the
United States. New York: Simon and Schuster.
Penley, C. (1992) Feminism, Psychoanalysis, and the study of pop culture. In: L. Grossberg,
C. Nelson and P.A. Treichler (eds.) Cultural Studies. New York: Routledge,
pp. 479494.
Pew Research Center for the People and the Press. (2006) A portrait of generation next,
http://people-press.org/reports/pdf/300.pdf, accessed 9 January, 2007.
Raspa, R.F. and Cusack, J. (1990) Psychiatric implications of tattoos. American Family
Physician 41: 14811486.
Rolling Stones. (1971) Sticky Fingers (record). London: Rolling Stones Records.
Romans, S.E., Martin, J.L., Morris, E.M. and Harrison, K. (1998) Tattoos, childhood
sexual abuse, and adult psychiatric disorder in women. Archive of Womens Mental
Health 1: 137141.
Rosenblatt, A., Villa, J. and Wiseman, D. (2008) Tattoos can harm perceptions: A study
and suggestions. Journal of American College Health 56(5): 593596.
Spitz, E.H. (2000) Tattoos and teddy bears: Fetishism on exhibit in Paris. Studies in Gender
and Sexuality 1: 207222.
Sullivan, H.S. (1937) A note on the implications of psychiatry: The study of interpersonal
relations, for investigations in the Social sciences. American Journal of Sociology 42(6):
848861.
130

r 2011 Macmillan Publishers Ltd. 1088-0763

Psychoanalysis, Culture & Society

Vol. 16, 2, 113131

The tattooed therapist

Winnicott, D.W. (1960, 1965) Ego distortion in terms of the true and false self. In: The
Maturational Process and the Facilitating Environment: Studies in the Theory of
Emotional Development. New York: International Universities Press, pp. 140152.
Winnicott, D.W. (1963, 1965) Communicating and not communicating leading to a study
of certain opposites. In: Communicating and The Maturational Process and the
Facilitating Environment: Studies in the Theory of Emotional Development. New York:
International Universities Press, pp. 179192.
Winnicott, D.W. (1965) The Maturational Process and the Facilitating Environment:
Studies in the Theory of Emotional Development. New York: International Universities
Press.
Yablonsky, L. (2008) Body of evidence. New York Times Sunday Magazine 17 August.

r 2011 Macmillan Publishers Ltd. 1088-0763

Psychoanalysis, Culture & Society

Vol. 16, 2, 113131

131