Icons of Flesh

James F. Hooper, MD, FAPA
Alabama Department of Mental Health & Mental Retardation, Tuscaloosa, Alabama

Tattooed Man In psychiatry, the border between Art and Science often hides in clinical experience, which itself often reflects only a dimly grasped set of personal experiences. In this setting, any true objective data becomes a treasure.

As a resident, I learned that tattoos and sociopaths often occurred together. The more tattoos, the more likely a diagnosis of psychopathic personality became. The words love and hate, I understood, applied to the fingers, H-A-T-E on the left hand, L-O-V-E on the right, were essentially pathognomonic of sociopathy. I have believed this for more than 20 years, but after a trip to Greece began to wonder what those patients used in languages where the words did not use four letters. So I decided to write a review, and try to find out.

I was surprised to learn that there existed no literature on the subject; Medline drew a blank on the disorder cross-referenced with tattoo. Neither subject alone yielded less than a thousand references. I finally plowed through all the titles under tattoos, and found hundreds of articles on dermatology, and a few scattered words about risk taking in adolescents, but nothing else.

I spent some time sending E-mail to psychiatrists in other countries. Dr. K, in Tokyo, kindly sent me an English language book on the art of Japanese tattoos, and I began to re-learn my old errors. I have posted mail to a number of tattoo artists, and done telephone interviews with several, including Kris Sperry, M.D., the physician who serves as Medical Consultant to the Alliance of Professional Tattooists, and who helped set the standards for licensure by that organization. I even rented and watched a movie. I will summarize my experiences below:

The process of injecting colored pigments under the skin has existed for most of human history. Egyptian tombs with drawings of tattooed people and archeological statuary with clear artificial lines on the skin exist, as do long standing customs among ancient peoples, and date back at least 12,000 years before Christ. By 2,000 BC, the art had spread to China. Many of the older reasons have been lost forever. We can only assume that some of the more modern reasons indicate their previous use. Throughout most of the world, skin markings identified social class, marital availability, beauty, skill as a warrior or crafts man (or woman), or status as a slave or criminal. The Danes, Norse, and Saxons used tattoos to identify family symbols and crests. In the Far East, with Pictographic Writing, many people chose phrases of dedication to Buddha or a lover, rather than an actual drawing. All of these have varied with time and culture.

However, the Christian Bible, in Leviticus 19:28, specifically says You shall not... tattoo any marks upon you. Bowing to this, Pope Hadrian, in AD 787, banned the art. It survived in Britain until the Norman conquests in 1066. King Harold died at the hands of William, and his body was identified by the word Edith tattooed over his heart. Thus exited skin art from Western culture for many centuries, Though Marco Polo described Tattoos on some Chinese he met.

In Japan, things took a different path. Early on, forehead marks there signified criminals. Some sources say these were uniform, while others describe variations from city to city. This punishment was severe in that ostracism remains even now a more powerful punishment than in the West, due to different values on family ties. Whatever the history, in more recent times, reaction to strict sumptuary laws imposed by the harsh Tokugawa government that allowed only royalty to wear embroidered clothing caused a change. The wealthy middle classes began to wear kimonos with brocade on the inside, but the poor began to flaunt the laws and wear full tattooed body suits.

In 1691 an English explorer named Dampier brought the first tattooed South Sea Islander to London, and a city that had not seen such art forms for 600 years looked with fascination. Captain Cook brought more, and introduced the sideshow to the Royalty. Soon this expensive and painful process became a mark of wealth for the crowned heads of European society. Japanese artists cost the most, and so were most desired. Among those known to have had tattoos are King George V, Winston Churchill s mother, King Oscar of Sweden, and Grand Duke Alexis of Russia.

Technology forces change in any time, and in 1891 the first electric tattoo needle made the process much cheaper and faster. That lead to popularity among lower classes, and subsequent abandonment by the rich. The public fascination with heavily marked skin created a market for circus freaks to collect fees for displaying their works, leading to further definition of this as a pseudo-art only for freaks and sailors.

In 1955 Robert Mitchum starred in a movie named the Night of the Hunter. In this, he plays a sociopathic traveling preacher (and serial killer) who has LOVE on his left hand and HATE on his right. He even uses them in a brief sermon about the struggle between the two forces. As best I can determine, this originated with that movie, and all the copy-cats I have seen since simply mimicked his image. Sideshow Bob in the TV cartoon series The Simpsons, has only 3 fingers per hand, and has LUV and HAT tattoos (with an umlat over the 'a' as homage to Mitchum. Sailors in the days of tall ships often got tattoos on their hands that said HOLD and FAST on their fingers, either as a totem or a reminder. (I've heard rumors of college athletes with TGIF on their feet, to remind them toes go in first. )

In order to look for this stain of sociopathy, I conducted a poll of local jail staff (in a city of 100,000). I specifically asked 2 RN s, with three and six years of experience working in the jail, respectively, if they had noted the love-hate tattoos. Neither remembered seeing this at any time. Two guards with less than three years work history each had also not seen this specific tattoo. I also polled my peers at the Forensic Hospital where I work. We serve a state of 3.5 million people. Among 3 PhD Forensic psychologists, who had worked 9, 5, and two years, respectively, the specific mark had been seen, but in only a few vaguely remembered instances. Two forensic psychiatrists, including myself, with careers that spanned more than 20 years each, could only identify perhaps a dozen such patients. Obviously, then, these specific marks betray neither historic nor frequent behaviors.

By 1961, hepatitis outbreaks led New York City and the State of Massachusetts to ban this work. These regulations continue in force as well as in Indiana, Oklahoma, South Carolina, and Ocean City, MD. Ft Lauderdale and Jacksonville Beach, FL have laws requiring a physician on site when tattooing occurs. The Alliance of Professional Tattooists arose in an effort to self-regulate, and promote standards of hygiene and professionalism. As an aside, the CDC has never reported a case of AIDS related to tattoo needles, even those done in non-sterile conditions.

Also in the 1960s, the counter-culture blossomed, and products of that led such stars as Joan Baez, Janis Joplin, and Cher to have their own personal skin art. Many stars of music and screen and professional athletes today display tattoos (including Sean Connery, Melanie Griffith,Michael Jordon, and Drew Barrymore.) In Japan, however, the tattoo has remained highly stylized, with only a small number of elaborate forms existing. almost all based on a few specific legends. There, rather than to identify oneself as unique as in the West, one gets a tattoo to become a member of a select group and to conform. The Japanese Mafia also have a set of tattoos for their members.

In the West, two primary forms of tattoos exist; professional and jail-house. The latter are done crudely, often out of boredom, and also as marks to signify membership in a gang, certain crimes, etc. The New York State Police appear to have one of the most complete books of these variations, though I have not personally inspected a copy.

A quote from William De Michele, who published The Illustrated Woman in 1992, sticks with me as appropriate: Tattoos signify commitment. As permanent marks, they generally indicate some personal transition of significance. Often this relates to efforts to gain or regain control of one's life. [for example a woman who went through a divorce and wanted to make her body different from anything her husband had ever seen.] Even avid artists tend to place them in areas that can be covered or shown at will, much like a woman lawyer wearing black lace garters under her clothes in Court, something about which only she or someone she chooses to tell, knows. Tattoos on the hands or face much more frequently mean major events, such as a rejection of society totally, or membership in some tight group such as a prison or street gang.


So for the psychiatrist who sees a tattoo: Note if it is amateur or professional. Ask about it. It may, like the interpretation of a dream, lead to highly symbolic information. Don t assume any particular psychopathology without more data, and remember the use of these has had many meanings to many people for thousands of years. Any particular view you hold is probably culturally bound and time-limited.

The Total Tattoo Book: Amy Krakow, 1994, Warner Books, New York
The Japanese Tattoo: Donald Richie & Ian Buruma, 1980, Weatherhill, Tokyo
The Night of the Hunter: MGM, 1955

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Psychiatry On-Line 1995
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