The psychology behind the phenomenal rise in adorning oneself with tattoos in recent years

While approaching a young patient of mine who was sitting in the waiting area, I was struck by the extensive tattoos on his arms. One could barely see the skin for the lacework of  tattoos. The charm of the white skin was well hidden by the criss-crossing dark designs. 
Now this patient who suffers from obsessive compulsive neurosis avoids facing the world and uses his OCD rituals to accomplish that end. The compulsive senseless  movements of his arms and body not only divide his attention and detract him from noticing others in any depth,  others too are distracted from noticing him, the focus transfixed upon his motor restlessness instead of his total self.
His obsessive rituals made me wonder if the modern world en masse has now not been granted a socially sanctioned obsession that serves us the same purpose as his individualized private OCD - fiddling with Smartphones in public. Being tuned into Whats Up and Facebook enables us to avoid any deep emotional interactions with people we are in company of. Is modern world's tuning out of actual physical interaction with each other in favor of cyber interaction is a new world religion? A new mass obsessional neurosis?
Coming back to the patient.
As if these obsessive motor activities of his hands, fingers, legs and trunk are not enough, every now and then he cracks his knees, neck or finger joints. These cracking of joints, which are compulsive in nature, also give the impression of being another attempt to avoid social give and take which is what life is all about.
And the violence with which he cracks these joints, gives a distinct impression that the rituals are some kind of symbolic punishment meted out to his legs, neck and fingers - [for attempting to get out of bounds?] It appears as if since his whole self is under some form of hold (repression) the individual parts of his body want to  reach out and touch others and are being slapped on the wrist for doing so. For after all the raison d'etre for OCD lies in preventing one from sexually [and aggressively] touching others. Freud did say once that if the term obsessional neurosis had not been already coined, and so well accepted, he would have named this disorder the touch neurosis. The fear of touching others and getting [sexually] contaminated lies at the very heart of OCD.
And this compulsion to keep running away from others follows this patient in to his sleep. He also suffers from severe Restless Leg Syndrome.
He is undoubtedly a man on the run.
Now one would expect that someone who has such dread of the world will at least groom and dress himself well, put on jewelry and perfume, deck himself with other accessories to make up for his lack of self confidence. But he does nothing of the sort. He puts on sleeveless shirts, torn jeans, dilapidated sneakers and no socks. Majority of his skin remains exposed.
Or does it?
The tattoos block whatever parts of himself escape getting covered by clothes.
If his compulsions and joint cracking are ways to create a wall between him and others, do his tattoos serve the same function?
And at this point one recalls how motorbike club members adorn themselves with tattoos; uninviting, and hostile appearing monstrosities, etchings of skulls and daggers, cobras, scorpions, ghosts, ghouls and goblins, swastika and other wild creepy things.
But anybody, whose body exudes such aggression, at the core of his being must be a frightened soul. And since bikers are usually pussycats in isolation and feel sure footed only when feeding upon each others' swagger, one wonders if their tattoos serve them the same function, give them the bluff to face the world that they are so afraid of?
But this cannot be the whole explanation for why people today are so obsessed with tattoos.
For there is another class of tattoos which are distinctly inviting in nature, and it is not hard to guess which sex favors them. Roses, flowers, creepers, colorful designs, butterflies, ornate hearts, entwining patterns that remind one of lingerie, and other soft and cuddly objects, welcoming and aesthetically pleasing, also appear as tattoos.
So it appears that tattoos are another exaggerated display of our masculinity and femininity, props to enhance the active and passive aspects of our individuality.
But then why aren't we all tattooing ourselves? If it enhances our secondary sexual characteristics then why aren't we all rushing to do so? The great majority of us scoff at the idea.
Here we come across the phenomena of a great divide between those who have it and those who don't.
If the display of one's masculinity and femininity depends upon subtle cues, one's natural good looks and intelligence, one does not have to drum it up by adding on to oneself disparate extraneous objects.
Tattoos are a tacky enhancement of one's persona. No different than the plumes jutting out of the Indian Chief's head gear, the rows of ribbons and medals hanging from army brass's shirt, the shiny  jewellery and super-dyed hair of a homosexual, the endless acronyms of credentials following the name of a college professor. They are the bells and whistles of those who do not feel they are anybody unless they can display their trophies. It is a man who is not sure of his manhood and who has doubt if he can be effective with others through his natural pluck who shows swagger in the gait, gruffness in the voice, hostility in the muscle tone, and the gaudy display of sunglasses,  sport cars, and flashy jewellery. A naturally feminine woman, especially one who has natural good looks, far from using tattoos to enhance her femininity may prefer not to put any make-up on herself.
The expression of masculinity and femininity in more refined individuals is through modulated and untrammeled speech and rich personality. It is half filled vessel that spills its contents. Deep waters run still.
Has there been a decline in the masculinity of men and femininity of women in recent decades?
Is there any doubt about that? As our culture has become more androgynous there has been a surprising decline in sperm count of men and rise of polycystic ovaries in women. In behavior too more and more folks are practicing LGBT  than becoming the model representative of their anatomical sex. Thus when the need arises for us to emphasize ourselves in a heterosexual fashion we are often relying less upon our actual selves and more upon adorning ourselves with extraneous objects that emphasize our original sexual nature.
But there is another great transformation that has occurred in the last few decades. The sexual revolution of the Sixties has fundamentally changed the way people communicate.  All through history human behavior was highly ritualized. There was  a script for everything. It spelled out in magnificent detail what and how to speak with the opposite sex, the children, the elderly,  the postman, the milkman, the car mechanic, the handyman; who to be deferential with and who to boss around.  There were stock phrases, stock motor movements, stock greetings, stock goodbyes, and stock feelings and display of emotions all handed down by the previous generation ready made for for every occasion. Everything was predictable and based upon what we had observed from birth. Even the clothes we wore were predetermined - white collars for those in management, and there too higher the rank the more silky and fancy was the tie. Bow ties were reserved for the eccentric professorial type or those in corporate world who had castration issues. A blue collar worker occasionally wore tie too, but the coarseness or at least its dated design gave away his lower station in life.
All these moorings which allowed us to interact with others without feeling anxious, and often with  grace, granted modeled after somebody from one's past,  have evaporated, or at least greatly eroded, in the last few decades. In the aftermath of the two World Wars the flower children came upon the scene as if to make up for that orgy of violence and fundamentally changed the way we behave with each other. The television, computers and the Internet did the rest. Now every conceivable human behavior was available to model after at the click of a button. Differences in wealth and social privileges ceased to matter as well. No matter how poor, with cyber information available to all, the poor kid has same degree of access to cultural accessories as the rich one.
But there is a  catch when there is abundance of something. One may fail to take possession of any of it. As long as something is rare we value it. If something is available for the asking one may have no interest in permanently acquiring it. If you give a child few toys he will treasure them.  If you give him a whole roomful, he may develop no attachment to any. The idea of possessing the greater quantity of them may become more important than mastering a few. In olden days when finding somebody to marry was not that easy a task, with all financial and cultural hurdles, not to speak the elaborate wedding that one had to go through, one valued the woman one was paired with. For if you lost her, it was not that easy to replace her. But today when women are available to have sex with without any effort and as readily changeable as Kleenex, one often shows no appreciation for any one of them.
Hence we are growing up culturally denuded. While submerged in sea of information we are  growing up culturally thirsty. We know so much but we cannot translate it into words or behaviors. We can tell so little of ourselves to others with refined behavior that was taught to us in past generations with mother's milk. And hence we feel naked, inadequate and anxious in dealing with others.
Tattoos give us a protection from this nudity. It tells others who we are and how to behave with us and how to keep your distance. They have become our credentials, our substitute for cultured behavior.

Women playing with their hair on approaching stoplights

In an Internet site where I banter with my classmates from my medical school, one of them raised the following question.

why women play with their hair when they approach stoplights ?

And he answered it himself, of course as a joke, Unlike men they do not have b---- to scratch.

While he meant it as a joke the fact that he had noticed this phenomena, and had found it humorous enough to quip on it, and then had associated it with - rather had  found equivalency with - touching of genitals, points to the presence of some psychological riddle here. 

First of all we have to decide whether it is a phenomena worthy of psychoanalytic investigation by which I mean that it is a distinct behavior present not just as a quirk in one particular person, which would be a manifestation of his or her individual neurosis, but a universal neurosis, present in all of us, ready to emerge as a defense mechanism if the circumstances demand; a repetitious behavior arising from our phylogenetic past as a response to the experiences of countless generations that have left genetic imprints in all of us, and whose raison d'etre remains shrouded in mystery because the underlying motives and processes of the phenomena have become unconscious due to repression. 

There is little doubt that some women under stress do reach for their hair - usually the frontal locks - and run their fingers through it as if searching for something hidden. On being questioned they dismiss it as just a habit or as simple straightening of hair and may even get irritated as to why one would nitpick over a little extra grooming.  

Now superfluous grooming is a sign of obsessional neurosis. In a subset, the compulsion to clean and groom reaches ridiculous proportions. The patient, especially in the mornings, may literally spend hours in front of the mirror, straightening hair, looking for flaws on the face, clothes and other aspects of one's appearance, as if one has to wipe out every trace of what may be construed as offensive by others, before leaving the house. Trying to put the hair in order seems to be a specially favored aspect of this ritual, as if these individuals are having a-bad-hair-day everyday, and they may accumulate an impressive array of shampoos, gels, conditioners, sprays, and shaving paraphernalia as counter measures against these (unconscious) harmful impulses. 

And here we cannot help but reflect whether patients who suffer from trichotillomania - a malady where the person compulsively pulls out her hair in clumps sometimes to the point of going completely bald - are not taking this fear to an extreme.

Now sometime back on this blog I discussed a case of trichotillomania: "A childhood screen memory of penis envy and its connection with trichotillomania" (April 16 2011). There we saw how the patient, under the sway of penis envy, wanted to pull out anything that reminded her of the difference between the sexes and the underlying motive was to equalize the playing field between the two.

Could it be possible that such apparently purposeless playing with hair under stress is just an embryonic trichotillomania?

We do know that trichotillomania is another manifestation of obsessive-compulsive disorder. To the patient the hair feels as something alien and hostile that one must get rid of. Anything out of place, anything not fitting in with rest of the pattern; littered pieces of papers, dirty linen dropped on the bathroom floor, magazines thrown haphazardly upon the coffee table, hair in the bathtub, they all have to be put in the general scheme or yanked out altogether, so goes the reasoning of the obsessive, and hair become another object in the series.

What surprises us, and fills us with not a little fascinated horror, is that here what the obsessive is finding incongruous is not something external but part of his own self. But a little reflection tells us that  feeling and treating part of oneself as a foreign object is perhaps not all that strange but quite common. We just do not see it that way and therefore it unpleasantly surprises us when somebody brings to our attention as to how we can treat part of our own body as something vile and foreign. In fact picking upon pimples and other flaws of complexion is almost a rite of passage in adolescence; women in throes of post partum depression may consider their own child - which just so recently was part of their body - as incarnate of evil, the devil himself and kill it;  and in psychotics it is not all that rare to actually castrate themselves or enucleate their eyes [where eyes symbolize the penis]. Those suffering from psychogenic pruritis can relentlessly dig their own skin convinced that under it lie bugs or other contaminants, and psychogenic poludipsics are known to gorge themselves with gallons of water in order to wash out the impurities of the environment that has got lodged inside their bodies. Recently a patient of mine, who for years had been digging her skin and her torso and arms were puddles of sores, stopped doing it, when her Remeron (Mirtazapine) was stopped. She was perhaps feeling the side effects of Mitrazapine as something foreign inside her. A mechanism that I will not be surprised is common across the board in causing psychogenic polydipsia in patients on psychotropic medications.  

Now coming back to the analysis of these obsessive patients who are forever trying to get rid of the incongruities in their environment or in themselves. At the deepest level they are fearful of contamination of others by the bad aspects of themselves. Incongruities in the environment is just a reminder of their own unacceptable impulses, and they are forever straightening out the environment to banish from their sight everything that will provoke further activation of their own incongruent/evil/extruding impulses. And these extruding impulses show themselves to be the intimate aspects of themselves that should be hidden from the environment. While immediate examination shows them to be arising from the anal-sadistic phase of sexuality - we recall here that the fear of leaving the house is associated with not being cleaned and groomed enough - at the deepest level they arise from the fear of the destructive power of the phallic impulses. The fear that one's anal-sadistic impulses will show is but a regression from the fear that one's phallic/genital impulses are out of control and will be seen by people/society. 

Why the penis and the impulses originating from it are felt to be destructive? 

Sexual drive is often felt as evil and incongruous with the rest of the self; an anomaly, something gross, physical, material, smelly, crude and not refined or spiritual enough. 

And with good reason. People who are so dignified in every other respect when under the sway of the sexual drive can behave most incongruously. A man huffing and puffing in the act of sex looks ridiculous if not outright animal. There is nothing dignified about one human being mounting and humping another. And the phallus/penis is the most visible manifestation of this drive which turns us into such a coarse being. In women there is further fear of it being a harbinger of cooties - diseases - if not outright pregnancy, which is the beginning of the destruction of one's own body and ultimately death. No wonder people often develop neurosis in order to suppress/escape from this coarse drive. We cannot help but reflect here that in the Hindu Trinity of Brahma, Vishnu and Shiva the latter is symbolized by the penis and is attributed the function of both the procreator and its exact opposite the destroyer.

But what exactly is the connection between women playing with their hair on crossroads, trichotillomania and fear of getting touched by the penis, you want to ask me. 

This question cannot be answered directly and instead I will take up two instructive cases. The first one is actually not even a case but someone I worked with 25 years ago. He was a Jewish doctor who stammered quite badly; a malady that I could see had arisen as a mean to control his inordinate ambition which must have begun as an excessively powerful aggressive drive. Coupled with this was his habit of relentlessly twirling and untwirling a lock of hair that he still had upon his balding head. The underlying psychological mechanism behind the obsession was easy to discern. His extreme competitiveness wished nothing less than castration for anyone who even hinted of crossing his path. But living in society and hampered by its rules  and unable to do anything of the sort even with words, for stammering would arise to block the discharge of aggression through speech, he wanted to do it with his bare hands. But the danger involved in laying his hands upon others had deflected the impulse to find discharge upon his own self and in the form of twirling and untwirling his hair - castrating and uncastrating himself, symbolically of course.

The second case is that of a woman who was in early thirties, eager to settle down but unable to do so because of undischarged anger towards men, stemming from growing up in a divorced household where the mother was absent and the girl was dumped with the responsibility of taking care of the father and her brother, both of whom had lorded over her because she was the girl. Her relationships were predictable. After a brief  period or romance, she would lapse into continuous arguments with whoever she was courting.  All her lovers after a few months of honeymoon would metamorphose into her brother behind which lay the image of her father. Her life was a series of her old battles with the new incarnations of her brother and father. 

And her brother gave her fresh justifications to do so. She had a regular job while her brother, older than her, was more or less of a bum. Whenever she talked about him she showed contempt for his inability to hold down a job and this would be followed up with expressions of outrage that he still remains their father's favorite. And she knew that the only reason  this was happening was because he was the boy and she was the girl. "If only I had a penis," in her unconscious she reasoned, "I would have been my father's favorite." 

Now whenever she talked about her brother in this fashion, and additionally whenever she felt I was putting her down through my 'interpretations' of her psychological conflicts, she would get excited and start playing with her hair. And the way she played it looked like as if she was searching for something there. The movement of her fingers through her hair would remind me of how homosexual hair dressers fiddle with their clients' hair fetishistically as if they are searching there for something as well.  Now one of the most common subtype of homosexuality occurs in those who cannot forgo the idea of the lack of penis in their love object. These homosexuals love everything about women and their beauty but cannot tolerate the dread of the missing penis in them. They often turn to feminine looking youthful boys for their love needs. And it is this type of homosexuality that marks the hair dressers who cannot give up the idea of finding the penis in the tresses of the hair while grooming and straightening it out. The facial expression and behavior of this girl was so similar to those homosexual hairdressers, the unconscious motives behind such playing with hair became easy to fathom. "You jerk," she wanted to say, "You are shoving those interpretations down my throat with such surety because being a man, and possessing a penis, you consider yourself naturally superior to me. Now I know that I too have a penis. It is hidden somewhere, deep inside me, perhaps hidden behind these lock of hair of mine. And if only I get hold of it, which will place both of us on a level field, I will teach you a lesson as to who is better between the two of us."

If we take the Jewish doctor who played with the hair to symbolically self-castrate, and this girl's search for the hidden penis which would put her on equal footing with men, then we can extrapolate that perhaps many women when stopped at crossroads experience the situation as stressful and also deal with the anxiety by reaching for the penis that would put them on equal footing with men and make them not feel so vulnerable. 

But why would a woman feel vulnerable on stoplights? 

Here we run into the psychology of agoraphobia. Agoraphobia - which literally means fear of the marketplace - arises from fear of coming to harm in interacting with others especially in public places. Analysis reveals that behind the fear of interaction lies fear that one would be tempted to exchange one's goods - displacement from exchanging one's sexual goods - and would come out a loser. In the agoraphobic the give and take of life has gone sour. Iron has entered the soul especially in the matter of the most pleasurable of all exchanges - the give and take of sex.

What causes this fear and sourness?


Throughout our existence we are in search for somebody with whom we can exchange our bodily goods. The very process of life depends upon such exchange. In this love exchange, only in the beginning we are generous, and this more so the case in women. In her, if the culture and men has taken advantage of her, and given as to how exploitative cultures are towards women it is invariably the case, she may show increasing ambivalence towards this search for love. She may rather not exchange 'her treasures' with that of a man, or do it in a manner where she gives less and takes more. She may even resort to deception, ruse and tricking. It is these negative impulses behind her love that makes folks lament at the femme fatale and her enigmatic and unfathomable nature.

The woman's inner conviction that she has been shortchanged in life adds a further twist to this search for love.  Her sense of lacking something which she must make good and complete by getting it from a man makes her approach him with poor self esteem and trepidation and leads her to adorn herself with all kinds of jewelery, make-up, and other shiny trinkets that she hopes will be a match for that one jewel that he possesses. Women's endless shopping is also the search for that jewel that would deflect attention from her  great defect/wound  and would make the man believe that he is getting more than what he is giving. The term "turning tricks" for the act of prostitution perhaps arose from this attitude of exchanging and tricking the man into giving what she wants without his getting anything in return. For the prostitute convinces herself that she feels nothing and gives nothing in the sexual exchange and gets the man's money through just tricking him.  

But the attitude of tricking, deceiving, stealing, and in the more spirited one pulling it out as a tuft of hair, provokes the fear of retaliation and subjection to physical harm and other dangers as getting the cooties (venereal diseases) and pregnancy. The  revolt at the thought of playing the passive sexual role and a stranger's dirty organ penetrating one's body adds to the disgust and provokes further withdrawal from the impulse.

No wonder at the stoplights, in a situation to meet somebody - for crossroads are like a marketplace offering choices as to which direction to take and who to choose from amongst all the other stopped passengers - tempted and yet fearing the retaliation for her evil intention, she reaches for her hair and searches for the penis, which she has a conviction she does possess, and it is only a matter of searching. For if she is successful this time in that eternal search, she does not have to bother exchanging her goods with another; for what she so ardently desires she already has.

Restless Leg Syndrome, Cracking of joints, Fibromyalgia, Catatonia: different manifestations of Obsessional Neurosis

A young man, now  21, developed severe obsessional neurosis at the age of 16 when a disfiguring bone tumor emerged on his left upper arm. The tumor, though benign, could not be removed right away because the growth plate next to it had not matured and early resection would have shortened the arm. So he had to live with this growing menace for a couple of years before the surgeons finally went in and removed the unsightly growth.

 During this waiting period, the obsessions grew by leaps and bounds.

In the session the patient insisted, and the mother who came with him, agreed that the whole of his mental problems could be accounted for as a reaction to the  emergence of this misfortune. But a more careful history taking revealed that he was given to severe temper tantrums even earlier, and in fact they were already so severe by the time he was 13 that in his fits of anger he would put holes through the walls of his house, one time he had shattered a flat screen TV, and mother added that every cell phone bought for him had been smashed via getting violently hurled upon the floor.

It was easy to see that the narcissistic injury that had changed this wellspring of anger to frank obsessions was the disfigurement - the tumor was very embarrassing and scary to him - but its pathological strength appeared to have been derived from the repressed wish  for the misfortune to have struck his younger brother instead of him. This younger brother was his rival from the earliest childhood. His earliest memory is of his rage at his brother and the  first time he put a hole in the wall was when he saw his brother wearing his clothes.  

The patient then gave a whole series of obsessive symptoms which were all manifestations of saving his mother from his death wishes or getting even with his father. These obsessions the patient had to admit were present even before the tumor emerged. From a young age he would check and recheck the stove twice, and sometime three times, to make sure that some bad luck does not befall his mother or him or his entire family.  Patient added that it is crazy for he loves his mother very much so he does not understand why he is preoccupied with her death.

The patient then shifted to describing his obsession with symmetry which were to get even with his father who had left the family when he was 2. Anything that was done towards right side - all activities had to be initiated by the right hand - had to be countered by similar action towards the left. Also the number of times something was done towards the right side had to be counter-balanced with exact same number of times towards the left.  He then added that this obsession for symmetry is what lies behind his Restless leg Syndrome. He may spend hours moving his body right and then left, leaving him awake and exhausted through the night.  His mother added that yes, he has RLS. It is painful to watch him in his bed, for he  moves his leg this way and then the other way all night long, vainly trying to fall asleep and even after he falls asleep, often the movements continue.

Patient added that his Restless Leg Syndrome extends to his hands as well and coming to think of it to his whole body and that Restless Leg Syndrome is just a mini-version of Restless Body Syndrome. "I am always on the run, day and night, and my body is still running mentally as I lay there in bed. Restless Leg Syndrome is nothing but my running away from the disaster that is about to happen to me or my family." He then gave some details of his Restless Hand Syndrome. He had to  move his wrist in clockwise and then counterclockwise direction. This process started with having to make wrist motions to make sure that the stove is turned on and off : starting the fire and then undoing it.

All these movements causes constant muscle tension and pain which is only relieved when he cracks the joints. Patient said that the cracking of his joints gives him pleasure and it is part of his OCD. It is no different than checking and rechecking the stove.  He demonstrated this cracking of joints, which were, as claimed, impressively loud, in his knees and neck. He did not say so, but the way he described his body aches and pains they could easily be viewed as fibromyalgia.

When asked why he has to crack the joints, the patient claimed the tension in his muscles locks them up. In my mind this raised the thought that catatonia itself perhaps is no more than an extreme form of muscular intent in cross purposes rendering the person immobile (catatonic) - and mobility is restored to them only if the joints to which they are attached is cracked.


That the cracking of joints is a from of OCD is furthered bolstered by the following case that I saw recently.

A 15 year old girl, who is depressed for years over her parents separation and their neglect of her, and who because of her overweight gets bullied at school, and who fights with her sister all the time to discharge her aggressive impulses, reported that she has a tough time stopping herself from cracking her knuckles.

She gave the usual explanations that it is a habit, that it makes her feel good, but there was little doubt that it was continuation of her obsessional defenses. For every time she cracked her knuckles in her right hand she had to do it in her left in a symmetrical fashion. At one telling demonstration in my office she cracked her knuckles, then touched the mobile phone which she was holding between her thighs and which was sticking up from her pubic area as a symbolic penis, and then symmetrically touched her right and left knees. The touching of the upstanding phone was no different than how obsessive-compulsive must touch a particular part of the body which is symbolic of the penis every few minutes. In many obsessives the touching is quite openly of the genital area.