Tattooing as a Visual Form of Psychotherapy for Trauma Treatment: By Ali Chadderdon
It was early June when I found myself leaving the funeral reception. My father’s colleague had died of some serious illness, though I do not remember what it was because I was fourteen years old and self-absorbed and was only attending out of polite family duty. After a glass and a half of relatively decent, though slightly tart white wine, my father and I walked outside and were forced to make our way through the branches of freshly bloomed wild roses and Japanese irises that were cascading across the sidewalk from the deceased man’s plentiful garden. All the while my father was smiling with what seemed to me like a fascinating combination of a sense of contentment mixed with gratitude and a hint of submission. As we approach the car and are about the open the doors, he looks at me and smiles like a blissful Tibetan monk. He aims his pointer fingers to the sky as he places both fists just above his head like antennas. He then begins to twirl around making buzzing “beeeeee” sounds like a bumble bee while hopping up and down on both feet. He exclaims, “If you remember just one thing about me, remember this – “beeeeeeeee” in the moment! “beeeeeee” in the moment! beeeeee in the moment! For a long time I wondered just how much of that tart white wine my dad had drunk to have lead to the commencement of that hysterical, yet touching, sentimental and forever memorable moment.

As we get into the car, I realize that he is telling me to be in the moment because each moment is fleeting. By seeing death, my father had become delighted by life. He found joy in his own personal continued survival. For he says to me just as we are pulling up to our house, “If I didn’t have my skin, I don’t think I would believe I am still alive.” If my father’s plain skin could hold so much meaning for him, I wonder what an actual, vivid image of a meaningful and symbolic tattoo on a person’s skin could accomplish. Perhaps a whole new realm of possibilities?

The experience I had with my father made me realize that the body holds a tremendous amount of reminders, memories, self-assurances and emotions. The body can be viewed as a testament and reminder of life and death. It certainly did for my father. The body, fragile and impermanent, is an incalculable symbol of power. It is, in many ways, the canvas of our lives. The tremendous symbolic value it holds is incomparable to any other because the body is carried with us everywhere we go. We cannot leave it at home when we go to the grocery store, we cannot let someone else borrow it, and we cannot put it away if we want to hide it from someone. We are forever bound to our bodies. The body is ours, so we must embrace it as our own. By doing so, we imbue immeasurable meaning into our bodies. In order to do this, people often choose to adorn it in various ways in order to increase its symbolic value. Tattoos are a good and common way people choose to adorn their bodies. Individuals tattoo their bodies with symbolic and expressive material for many reasons.

Tattooing serves many purposes for human beings. In ancient times, it was often used in warfare to scare the opponent by looking fierce and unnatural. The Celts were famous for this kind of warfare. It has been used in pastoralist communities of Kenya to mark members of a familial group so they could be distinguished from outsiders, thereby fostering community. Or, tattooing can be a way to express one’s individuality to the world, as is common in 21st century western world. A person may receive a tattoo for religious reasons, or to distinguish gang membership. Tattooing can even be done to promote healing. By utilizing the symbolic nature of the body, tattoo artists are able to create overwhelmingly meaningful images for their clients which often results in them becoming a vehicle for trauma recovery.

Healing from a traumatic experience takes many forms and can be achieved through many different avenues. This healing can come from a support group or a loved one. It can come from moving to a new place. It can even come from travel and adventure. But the method that has turned out to be the most helpful, time and time again, is psychotherapy. Also called “talk therapy,” psychotherapy is the practice of regularly meeting with a trained practitioner (can be a therapist, counselor, psychologist or psychiatrist) and talking about one’s inner thoughts, feelings and emotions. It is a safe place where a professional will objectively listen to a patient’s problems and give advice as to how to solve them. Sometimes, just having someone to listen is enough in itself. Psychotherapy is exceptionally helpful in treating victims of trauma by helping them to accept, come to terms with, and move on from the traumatic event.

Psychotherapy is a verbal and auditory based kind of therapy. So, it is extraordinarily helpful for people who are verbally and auditorily inclined. However, not all people who suffer a traumatic experience are verbally inclined by nature. Some people find it extremely difficult to express their thoughts and feelings in words and often fail to do so. In their case, talk therapy will fail to be equally as effective. Thus, a different kind of healing mechanism is necessary for this group of people. People who are not verbally inclined are usually visually inclined. So, this subset of people in the population needs some kind of visual way to reconcile the traumatic event in order to foster healing.

Tattooing can serve the purpose of trauma healing for visually inclined people. Tattooing allows an individual to memorialize and revisit the traumatic event through a meaningful and symbolic image. In particular, it allows for the telling of one’s story. Tattoos are a visual way to tell one’s story both to the outside world, and to one’s self. The act of memorializing the trauma, revisiting the trauma, and telling the story of the trauma is what takes place in psychotherapy for trauma healing. Tattooing can accomplish the same goals as psychotherapy, but by approaching the issue in an entirely different and new way which serves to aid the visually inclined population.

In this comprehensive case study, I will impart some new and innovative ideas about the ability and potential function of the body. More specifically, through the use of Judith Holland Sarnecki’s theorized article about the potential use of tattoos to facilitate trauma recovery, I will use a psychological framework to take her ideas one step further and propose that tattoos can function as an avenue to trauma recovery by means of viewing tattooing as a visual form of “talk” therapy. Tattooing can serve as a way to memorialize traumatic life events, to tell one’s story, and to revisit the traumatic event. Those three concepts are identified as necessary psychological steps to trauma recovery. By using the visual mechanism of tattooing, those three important steps can be fulfilled in a way that is equivalent to accomplishing them through psychotherapy. In addition, I contend that for a certain subset of the population, a visual form of therapy may actually be more effective than verbal psychotherapy.

Judith Holland Sarnecki, associate professor of French at Lawrence University in Appleton, Wisconsin, recently journeyed into the deep and meaningful world of the art of tattooing. Through an accidental series of events, she stumbled upon a remarkable meaning-making function into which many tattoos have evolved. By using personal anecdotes, she is able to describe three main findings from her exploration. These are as follows: (1) personal trauma cannot be completely perceived until an individual experiences a return to the traumatic event, (2) it is possible that the return to the event could potentially include the process of tattooing, and (3) trauma can, in some circumstances, be expressed through tattooing. Professor Sarnecki uses five anecdotes to demonstrate these initial findings.

The first story she discloses is her experience of listening to a talk by theorist Cathy Caruth, author of the book, Unclaimed Experience: Trauma, Narrative, and History. Caruth proposes that “true trauma is characterized by what we are unable to take in due to its suddenness and enormity. When we are victims of a traumatic event…we are unable to synthesize it, to incorporate it into our psyche” (Sarnecki, 2001, p. 36). In other words, mental and emotional turmoil result when an individual who has experienced a traumatic event fails to reconcile the trauma within him/herself. In order to fully understand and comprehend the trauma, a return to the event must take place in order for recovery to ensue. Furthermore, she suggests that the failure of language to be able to stand for a traumatic event leads to a breach in the cognitive psyche which, in turn, creates the need for a different form of representation.

Sarnecki then begins to theorize about the possibility that tattoos could be the alternate kind of representation that Caruth was describing. According to Caruth, a “different kind of signification” (Sarnecki, 2001, p. 37) for a traumatic event promotes healing and survival. Sarnecki reveals the high rate of women getting tattoos to cover mastectomy scars. Receiving a double mastectomy due to breast cancer is a widespread cause of trauma. According to psychologists, this kind of operation causes women to lose their feminine identities, which in turn, leads to emotional trauma. Sarnecki declares that tattooing helps women reclaim their bodies because “receiving a tattoo becomes a way to understand and incorporate a physical and psychological loss while regaining some sense of control and a new sense of empowerment” (Sarnecki, 2001, p. 37). Therefore, the acquiring of tattoos to cover mastectomy scars aided in the healing process by helping women find control, inner empowerment and the ability to synthesize the trauma within the psyche.

Sarnecki’s second account in the article is Madame Chinchilla, a beloved tattoo artist from Fort Bragg, California who describes her experience with tattooing her clients. She explains that a large portion of the tattoos that are done in her studio “are a ritual part of grieving and healing” (Sarnecki, 2001, p. 37) for her clients. This is achieved by her creation of a multitude of tattoos that her clients describe as a literal “living memorial” (Sarnecki, 2001, p. 37) for important events that have taken place in their lives.

Thirdly, Sarnecki introduces Peter Trachtenberg; he is a man who has been through a tremendous lifetime of obstacles and strife. He endured burial rites in Borneo, crippling drug addiction in Manhattan, and deathwatches of his parents. He has a multitude of tattoos all over his body, each one symbolizing something important in his life. These tattoos are his personal narrative written in images. For example, he chose to tattoo a depiction of Christ’s bleeding side across his own ribcage. He did this for two reasons. The tattoo symbolically represents the self-inflicted pain he put himself through with his terrible heroin addiction. Presently clean of drugs, he does not want to forget that suffering so will not slip back into his addiction. So, he tattoos an illustration on his body of bleeding from the inside out because he does not want to forget the pain he put himself through. Secondly, he chooses to place the tattoo on his ribcage, a very sensitive spot on the body, in order to relive the act of self-inflicted pain. By revisiting the trauma and by giving himself a daily visual reminder of it, he is able to move past the traumatic event. The tattoos are serving as a meaning-making tool for Trachtenberg. Thus, through a visual approach to self-declamation, “Trachtenberg’s tattoos become the narrative tool he uses to penetrate the surface of his life, plumb its depths, and transform it into meaningful text” (Sarnecki, 2001, p. 38).

As a writer, it is surprising that Trachtenberg would use visual images, as opposed to the written word, to explain his thoughts and feelings. However, he states that his tattoos allow him a pathway in which to “grapple with unwieldy memory” (Sarnecki, 2001, p.37). For him, words are simply inadequate for organizing his feelings. There is no possible way to describe what he was going through, mentally and emotionally, solely through the use of words. He needs another pathway; and he found that pathway in tattoos. Tattooing allows him to create “meaningful text” without the use of words.

Sky is a twenty-two year old, fifth generation cowboy, who was recently released from prison for a gang-related murder. During a long interview, Sarnecki discovered much about the plethora of tattoos displayed across Sky’s body. A traumatic childhood forced Sky into gang life at a very young age which resulted in his time spent in prison. In prison, tattoos became a way for him to maintain his individuality while also instilling fear and reverence in the other inmates. Without speaking a word to one another, prisoners learn an inmate’s narrative and relationships purely by seeing their tattoos. In particular, one can learn much about Sky just by looking at his tattoos. For example, each spider web tattoo represents one year spent in prison and a tear drop represents each person he has killed. Sarnecki states that during the interview, “Sky removed his shirt and showed me his own tattoo collection. It was his way of telling me his life story” (Sarnecki, 2001, p. 40). By externalizing his challenging life events through the visual message of tattooing, he was able to facilitate his own trauma recovery.

Finally, the author uses a last anecdote to demonstrate her innovative ideas of tattooing and trauma. She recounts the basic plot of the movie American History X, in which a young man, Derek, gets caught up in a downward spiral of hate and racial violence as a neo-Nazi gang member. While in prison for murder, he begins to realize the destruction that his violent ways have caused and begins to move away from the gang membership. However, regardless of his transformation, the huge swastika tattoo across his chest remains permanent and will always remind him of the violence he committed. Thus, Derek’s swastika tattoo serves as a witness to his crimes that cannot be undone. When Derek’s younger brother, Danny, dies due to an act of racial aggression at the end of the movie, Sarnecki reasons that “we are reminded of how the tattooed X marks not only Derek’s own violent act, personal trauma and survival, it also memorializes Danny’s death” (2001, p. 41).

Sarnecki concludes her article by testifying that tattoos allow individuals to find meaning in life through the memorialization of traumatic events. Remarkably, this is not dissimilar to how psychology frames psychotherapy. Tattooing and psychotherapy are all about meaning. Meaning-making is the foundation of the human experience. Tattooing creates meaning for an individual by having a symbolic and important personal visual reminder permanently inked into the skin. Psychotherapy creates meaning through a more verbal approach. By talking about important and personal events or feelings, the individual is able to find meaning in his/her life through this particular mechanism.

Psychotherapy, often called “talk therapy,” is a form of psychological treatment that involves talking with a qualified therapist, counselor, psychologist or psychiatrist about problems in one’s life. It involves simply discussing with a professional inside a confidential and safe setting about issues that are severe enough to negatively inhibit an individual’s life. The goal of psychotherapy is to learn positive coping skills that will help an individual respond to stressful life events in a healthy way. Participating in psychotherapy can help individuals resolve conflicts, relieve anxiety and stress, cope with major life changes, manage healthy reactions to various situations, learn acceptance for chronic or serious mental health problems, recover from abuse, and improve sleep. Many people, both with diagnosed mental illnesses and people with no mental illnesses seek out therapy for its wide set of mental, emotional and physical benefits (Mayo Clinic Staff, 2010).

There are three main approaches to psychotherapy: cognitive therapy, behavioral therapy, and interpersonal therapy. Cognitive therapy focuses on changing harmful and negative ways of thinking. Many people get into a pattern of viewing the outside world negatively and harshly; cognitive therapy focuses on changing and manipulating those thought patterns until the individual develops more positive reflection patterns. Behavioral therapy focuses on changing one’s behavior from a maladaptive and harmful form of behavior into a more well-adapted and controlled behavior pattern. The goal is for an individual is to gain newfound control over his/her behavior. Third, interpersonal therapy teaches individuals how to relate and positively interact with other people. Good communication skills are a main focus of interpersonal therapy (An overview of talk therapy, 2006). While each of these three therapies looks at issues through a slightly different lens, the goal of all of them is to improve quality of life and quality of relationships with others. The idea is that this, in turn, will lead to a richer and more meaningful life.

A common motivation for seeking therapy is when, “thoughts, behaviors, or emotions are causing significant problems in [your] life or have the immediate potential to cause significant problems” (“Psychotherapy facts,” 2003). Anyone can benefit from therapy, whether an individual is diagnosed with a serious mental health illness such as bipolar or schizophrenia, or if an individual is simply coping with the loss of a family member or going through a bad break-up with an intimate partner (“Psychotherapy facts,” 2003). Another widespread stimulus for seeking psychotherapy is when an individual endures a traumatic life event. Psychological symptoms of trauma can be exceptionally severe. Symptoms include anger, intense mood swings, guilt, shame, depression, hopelessness, anxiety, fear, and/or social withdrawal (Segal, J. Ph.D. and Smith, M. M.A., 2011). These are very severe symptoms that greatly disturb and disrupt an individual’s life. Psychotherapy is a great way to address these issues in a safe and confidential environment. Additionally, talk therapy has been shown to be more effective in treating these kinds of symptoms than drug treatment.

There is often much debate and controversy about why use talk therapy instead of drug therapy? Drug therapy can be defined as the act of using pharmaceutical drugs to treat mental illness, such as using antidepressant medication to treat people with diagnosed major depressive disorder. There are three main benefits to using of therapy instead of drugs. The first is that there are little to no side effects of psychotherapy. While temporary discomfort is common due to the act of divulging emotionally charged content, this effect typically wears off in a matter of hours (Mayo Clinic Staff, 2010). On the contrary, pharmaceutical drugs carry a whole multitude of potential side effects, sometimes ones that are quite severe. These side effects can include issues such as stomach pain, ulcers, headaches, internal bleeding, diarrhea, and even death. Is is worth it to put one’s self at risk for these side effects when there are none present in psychotherapy?

Secondly, it has been shown through research that the effects of drugs are temporary, while the effects of therapy are more long-lasting. A study published in the 2005 April Archives of General Psychology, looked at the efficacy of cognitive therapy compared with the use of medication as treatment for major depression. In the study, the researchers found that the response rates were the same for both treatment groups (i.e. cognitive therapy and medication) during the experiment. However, in the patient follow-up after the study was completed, it was discovered that the subjects who were withdrawn from the medication therapy were significantly more likely (76%) to relapse than the cognitive therapy group (31%). This shows that the effects of the cognitive therapy are much longer lasting than the medication treatment (Boyles, 2005).

The third reason that talk therapy can be considered a better course of action than medication is because medication simply treats surface symptoms. For example, medication can alleviate anxiety or induce sleep. But it does not attend to why the individual is anxious or cannot sleep. So, it does not truly solve the problem. Therapy, on the other hand, teaches an individual how to solve the problems at the hand and thus, addresses the root of the problem. It teaches coping mechanisms and tools for dealing with challenging situations.

However, does talk therapy actually work? The answer is yes. An article in the Scientific American Journal describes new evidence that has just emerged about the efficacy of psychotherapy. Through the growing research into this field which includes measuring various treatment variables in the patient/therapist relationship and by measuring a patient’s physiological markers before, during and after therapy, researchers have found that psychotherapy is absolutely effective in a quantifiable manner. An initial quantifiable finding the article points out is that “as patients learn to regulate their emotions, that change is reflected in the prefrontal cortex, the seat of executive function” (Levy, R.A., and Ablon, S.J., 2010).

To expand on the previously addressed research finding, another study has shown that talk therapy alters the brain. The study, recently conducted in Canada on patients with severe social anxiety disorder, is scheduled for publication in the next issue of the journal Psychological Science. The study measured the amount of delta-beta coupling which is known to increase as an individual’s stress level increases. These were measured by a series of EEGs (electroencephalograms) which are designed to measure electrical impulses in the brain. At the beginning of the study, the experimental group measured similar to those of the high-anxiety control group, and significantly lower than the low-anxiety control group. After 12 weekly sessions of cognitive therapy, the patients in the experimental group scored delta-beta coupling levels comparable to the low-anxiety group ('Talk therapy' can alter brain activity, research shows, 2011). The shift from being equivalent to the high-anxiety group in the beginning to the low-anxiety group at the end, demonstrates a significant modification of brain activity. Thus, psychotherapy works by actually changing electrical brain impulses.

This sort of psychotherapy is very effective and contains a multitude of positive benefits. But there is a major drawback that needs to be noted. As it was previously mentioned, psychotherapy is the act of discussing one’s problems with another person. The patient is expected to alternate between speaking and listening with practitioner. However, this can be a problem for people who are not auditorily inclined. It is acknowledged in the psychological arena that the type of psychotherapy that is most effective differs for each individual person (Mayo Clinic Staff, 2010). However, what if there is an entire group of people that have fallen between the cracks because none of the therapy styles work for them?

The presence of multiple intelligences is a widely acknowledged and accepted phenomenon. While other fields have made adjustments for this, psychology is far behind in the particular arena. The Universal Design for Learning (UDL) is a curriculum that is focused on giving every individual an equal opportunity to learn. Because each person is unequivocally different, the curriculum allows flexibility so that individual needs can be met (2011, About UDL). Another way that multiple intelligences are addressed is through pedagogy. Pedagogy is the process of learning to teach instructive strategies. This means that a teacher’s own beliefs are ignored as they teach students according to the need of the individual in terms of their background, environment or situation, such as differing learning styles (2011, Pedagogy). Psychology has made a step in the right direction by incorporating the option of art therapy into some sessions of talk therapy. This is a visual way to express one’s feelings, but these sessions of art therapy are usually short-lived, few and far between and are also sometimes undermined by the psychologist. A more profound form of art therapy is necessary, and that is the art of tattooing.

There are three main learning styles for individuals. Auditory learners think primarily in words and are step by step learners. They can usually write quickly and neatly, follow oral directions well and have good auditory memory. Visual learners, on the other hand, think primarily in pictures, learn concepts all at once, have good visual memory and construct unusual solutions to problems (“Auditory-sequential learner vs. visual-spatial learner,” 2007). Third, kinesthetic learners have exceptionally good muscle memory and learn best by physically going through the motions with their hands or their body. Statistics show that 50% of the population learns kinesthetically, 15% learn auditorily and 35% learn visually (“Psychotherapy-reaching beyond the conscious mind,” 2010). I would like to contend that there is a whole group of visual learners (35% of the population) who are in mental and emotional need because they do not respond adequately to traditional, talk/auditory based therapy. Furthermore, I propose that these visual learners would greatly benefit from what may be theorized as a visual form of psychotherapy – the art of tattooing.

As we have learned, talk therapy means telling one’s story to a trained professional. For Sky, the fifth generation cowboy recently released from prison due to a gang-related murder, the only way he is able to tell his story is through the tattoos on his body. Sarnecki plainly states that “Sky’s tattoos are his visual aids, helping him to articulate his life story” (2001, p.40). For example, he has a tattoo on his pectoral muscles that serves as a memorial for his best friend who was killed. He has a tattoo of flames on his left arm that stand for “the hell [I] went through” (2001, p. 40). Clearly, Sky is doing the exact same thing that patients are doing in psychotherapy – he is explaining his life events. The only difference is that Sky is doing so by way of pictures and visualization (like visual learners) instead of by words and discussion (like auditory learners). Through tattoos, he has found his own way to facilitate the healing process of his harsh and seemingly unforgiving life.

Cathy Caruth contends in Sarnecki’s article that a necessary step to trauma recovery is the act of revisiting the traumatic event. In psychotherapy, this is done through discussion with the psychologist. The psychologist will carefully and gently lead the patient through the event so as to find “closure” and to facilitate the ability to move past the trauma. However, when we look closely, we begin to see that the same process can be carried out and fulfilled by the act of tattooing. When Peter Trachtenberg decided to get the painful tattoo of Christ’s bleeding side across his ribcage, he did so in order to endure the pain of it. The pain of receiving the tattoo was his way of going to back and revisiting the self-inflicted pain he caused himself when he was addicted to heroin. Thus, he revisited the traumatic event through the painful, yet visual process of tattooing in order to gain closure and move on. This is essentially no different than revisiting the event with a psychologist.

An important stage to trauma recovery identified in psychology is remembrance and mourning. The “failure to complete the normal process of grieving perpetuates the traumatic event” (Herman, J.L. 1992, p.5). Thus, the mourning and memorialization of the trauma is key to recovery. While this stage is typically successfully achieved through discussion with a psychologist in talk therapy, Madame Chinchilla shows us that there are people achieving this same outcome through a different process: tattooing. She tells us that she has tattooed images on clients’ bodies that they describe as a “living memorial” and that they serve as a “ritual part of grieving and healing” (Sarnecki, 2001, p. 37). It is a profound concept that receiving a living memorial on one’s body acts as a mourning and healing process. Madame Chinchilla’s clients are using the visual platform of tattoos to memorialize past events, instead of using the path of verbal discussion as memorialization. Thus, tattoos are being used as a visual form of talk therapy. Furthermore, tattooing may actually be more useful for trauma recovery than talk therapy due to the nature of how the mind processes trauma. Everyone, regardless of visual, auditory or kinesthetic inclination, may benefit the most from tattooing when recovering from a trauma because the brain has a specific and seemingly universal reaction to traumatic experiences.

Psychiatrist, researcher, author and teacher at Harvard Medical School, Judith Lewis Herman, M.D., states that, “traumatic memories lack verbal narrative and context; rather they are encoded in the form of vivid sensations and images” (Herman, J.L. 1992, p. 3). Thus, the visual spectacle of tattooing provides victims of trauma with a way to understand, memorialize and, as theorist Caruth informed us, synthesize the event into the psyche. Importantly, they provide a visual narrative instead of a verbal one. In addition, Herman states that trauma memories are encoded as vivid sensations; receiving a tattoo is a very vivid and painful sensation which makes it the perfect platform unto which to revisit the painful traumatic experience. Furthermore, traumas are encoded as images; that is why receiving a tattoo, which is a salient image, is a sensible and astute way to perceive of a trauma and thus facilitate healing and closure. Once closure is established, an individual can finally heal in entirety.

Through Sarnecki’s anecdotes of Cathy Caruth, Madame Chinchilla, Sky and Peter Trachtenberg, we are able to begin viewing tattoos in a new way. While human beings have been practicing the art of tattooing for thousands of years, there has been little investigation as to the profound psychological impact a tattoo can have on an individual. By applying the field of psychology to the process of tattooing, the potential for trauma recovery emerged. In psychotherapy that is aimed at trauma recovery, the most important processes to experience following a traumatic event are the memorialization of the event, telling one’s personal story, and revisiting the trauma. While these processes can be achieved through psychotherapy, they can also be achieved through the process of tattooing. The pain of receiving a tattoo allows for a return to the painful and traumatic event, the visual aspect of tattooing allows for individuals to tell their story in a visual, rather than verbal way and finally, by finding a meaningful and symbolic image to tattoo onto the skin, traumatized individuals are able to memorialize the event. By satisfying this necessary progression, individuals are able to find closure and heal from a traumatic event.

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