Tattoo’s and tattooing has become somewhat mainstream in western culture today and we, as therapists, will work with tattooed individuals every day. But how many of us have actually considered them through an occupational lens?

The notes collated for this episode were kindly researched by the amazing Emily Cheesman. I can’t thank her enough for the time and effort she has put into this!

During the episode, I also discuss Dr Sarah Grey, an Australian Surgical registrar who actively pushes against the negative stereotypes often associated with heavily tattooed individuals.

Check out a news story about “The World’s Most Tattooed Doctor” here:


  • We, the tattooed nation: Australian tatt stats: 2018 statistics released by McCrindle state that 1 in 5 Australians admit they have a tattoo.  Women with tattoos outnumber men with tattoos (21% to 19%); people of all ages have tattoos (and not just in their youth – 36% were 26+ when they got their first tattoo). 31% of people with tattoos say they regret ‘to some extent’ getting a tattoo  (McCrindle, 2018).
  • There’s a global resurgence of ink: Tattoos are increasingly visible with a global stage of celebrity/social/media/TV (Rees, 2016).  The current tattoo in a resurgence in Australia is sometimes dismissively referred to as a fashion or fad.
  • However, tattooing traditions have rich histories and meanings: these can be traced back to the Stone Ages, and across continents and cultures, with tattooing traditions developing independent of each other (Buss & Hodges, 2017, p.5; Dinter, 2005, pp. 9-21; Farley, Hoover, & Rademeyer, 2019, p.155). 
  • Buss & Hodges (2017, p.5) explain a trajectory of tattooing:(1) from ancient traditions in which tattoo practices were fully integrated into social settings; to (2) a period of tattoo stigmatization, even taboo, which paralleled the rise of organized religion and nation-states with ambitions to conquer and colonize the world; and then  (3) to the resurgence of tattoo [from the 1970s] that we are seeing today.’
  • Multicultural & contemporary Australia may represent many tattoo traditions and systems of meaning: Nearly half (49 per cent) of Australians have either been born overseas (first generation Australian) or one or both parents had been born overseas (second generation Australian) (Australian Bureau of Statistics, 2017). See also Rees  (2016, pp. 165-167) on cultural fluidity, appropriation & tattoos generally.

Key concepts/literature informing tattoo as an occupation:

  • There’s no tidy formula to explain the reason for, or the impact of being tattooed, either in historical or contemporary settings (Buss & Hodges, 2017).
  • But an occupational lens can be applied: Kay & Brewis consider ‘mainstream’ tattooing in UK through an occupational lens of doing, being, belonging, becoming and suggest that ‘the process of tattooing is complex and involves multiple facets of art, sensation, exploration of issues and creation of connections’ (2017, p.361).
    •  Wilcock’s framework of occupation looks at doing, being, and becoming with occupation as a dynamic interaction between each component (see, eg, Wilcock, 1998). Belonging’: Hammell discusses how occupation can encompass more than the individual (2014).
  • Literature has considered motivations, processes and implications of tattooing, but considering tattoos as occupation ‘challenges understandings of what occupation is’  (Kay & Brewis, 2017, p.361); this may be because of our understanding of ‘occupation’ should be broader (see, eg Twinley, 2012).
  • Potential explanations for why tattoos and tattooing may be outside a narrow conception of occupation:
    • Occupation is generally conceived as activities, tasks and ways of being that are health-promoting, pro-social (see, eg Twinley, 2012).  Occupational literature and models are also based primarily in Western practice and experience (see, eg Iwama generally).
    • The Western understanding of the body is often informed by the ideals of the pure, young and unmarked body, established and reinforced through colonisation (distinguishing colonisers from tattooed indigenous inhabitants), dating back to Roman and Greek expansion (Buss & Hodges, 2017, p.5; Dinter, 2005, pp. 23-53)
    • The body is increasingly seen as a site for constructing (and commodification of) identity: (Rees, 2016, p. 160). However, tattoos are seen differently to other forms of ‘cosmetic’ body modification: [teeth whitening & straightening, tummy tucks and breast implants] because they challenge dominant ideas of beauty.   
    • Tattoos are a marker of pathology in health and social research:
      •  Heywood et al. (2012): A health study on demographic & behavioural characteristics of 8656 Aussies about tattoos.  Found that ‘tattoos appear to be a marker for risk-taking behaviour in adults.’  Includes references to previous (old) Aussie studies that included a consideration of tattoos (see pp51-52, but the main survey cited was focused on sex and relationships; tattooing was incidental).
      • A German study of personality characteristics of 540 tattooed individuals found that tattoos were primarily an act of self-expression (as well as risk-taking and other factors) (Swami et al., 2012).
      • A 2008 review of medical and health literature on the meaning of tattoos and the people who were tattooed found descriptions from the 1980s onwards of the tattooed person as “simple-minded.” “immature.” “hostile.” “aggressive.” “self-destructive.” “untrustworthy” and “infantile” (Sanders & Vail, 2008, p.37)
      • Attitudes towards tattoos can impact on the quality of health care: consumers have a negative reaction to body art, viewing surgeons less favourably (less competent/trustworthy) if they have ink (Baumann, Timming, & Gollan, 2016, p.37).
      • Tattoos are considered to be related to the taboo:
        • Some literature focuses on the sexualised nature of tattooing: “The very process of tattooing is essentially sexual. There are long, sharp needles. There is the liquid poured into the pricked skin. There are two participants of the act, one active, the other passive. There is the curious marriage of pleasure and pain..” (citing Parry, 1971 in Sanders & Vail, 2008, p.38).
        • See, also Vice’s series on tattoos, pain as means and ends, ritual, passion, performance art & BDSM (Kaviani, 2019, 2016).

Tattoos within Wilcock’s framework for occupation


  • Kay and Brewis (2017) suggest that the ‘doing’ of an occupation lens involves consideration of how tattoos and the tattooing process ‘can be adapted to meet individual needs and [how they are] constrained by external factors’.
  • What is a tattoo?  Dinter (2005) names 3 elements:
  • Indelible, fixed mark on the body by inserting pigment under the skin
  • Deliberate (rather than accidental or incidental) darkening of the skin or scar
  • Creative (but see brands – below)
  • The choice/act of getting a tattoo can involve an individual’s control/adaptation of:
  • Meaning
  • Design and style (often now drawing on many traditions and styles; ‘tribal’ or ‘blackwork’  is shorthand for styles that aren’t easily traced to a contemporary Western tattoo style: Dinter, 2005, p.23).
    • Unique tattoo designed for you or flash tattoos (generally quicker, picked off the wall of a studio) or replication (thanks, internet).
  • Timing and paying the cost (artist fee or exchange; waiting & planning time; time for tattooing; acknowledging potential future cost to self and reputation; achievements required to be able to bear ink; life experience; anaesthetic vs experience of pain)
  • Choice (of an artist(s), studio location, tools, ink source, negotiating design and redesign with the artist. Could be done in professional, traditional, amateur, or cosmetic settings (Farley, Hoover, & Rademeyer, 2019, p.154).
    • Trust & power underpins the relationship between artist and wearer. But the nature of relationships between artist and wearer can vary:
      • Commercial (for a monetary fee, where the artist is a service provider and the outcome is what matters)
      • Transactional (in exchange for an offering, trade)
      • Rite of passage (role of the artist to tattoo the wearer)
      • Artistry (where the wearer is the canvas of the artist)
  • Placement and size: meaning is attributed to parts or regions of the body (‘tramp stamp’); beauty marks; potential for pain; public vs private.

Being, Becoming

  • Kay and Brewis (2017) suggest that being relates to how personal tattoos and emotions experienced are. Becoming incorporates ‘a transformation of the body and self through tattoos’. ‘It is through doing that humans become what they have the capacity to be(as cited in Wilcock, 1998, p.255).
  • Contemporary practices of tattooing generally either tap/stick & poke or electric gun (from 1861 Buss & Hodges, 2017, p.18).
  • Many contemporary tattoos (including those that draw on older traditions, such as ‘tribal’ tattoos’) have ‘meaning that may [instead] lie in personal projections’ (Buss & Hodges, 2017, p18). They are ‘an expression of personality, interests and desires’ (Thompson, 2015, p. 152); and can also be seen as a therapeutic experience (see eg, Tsang & Stevenson, 2014; Strübel & Jones, 2017).
  • Tattoos and their experience and meaning on the (female body) are an intersection of class, gender, race, culture and age (Farley, 2019, p.155).
  • Thematic experiences and meanings/reasons for being inked:
    •  A love of the aesthetic; a collection of art; tattoos (like graffiti) being increasingly accepted in the art world; tattoo artists are increasingly demonstrating highly developed & professional aesthetic styles, technical skills & academic training; these are paired with cultural & historical roots of tattooing (Rees, 2016, pp. 167-171).
    • Primarily ornamental, a means of building self-esteem, attracting attention or potential mates; marriage or a relationship
  • Enhances the body; conceals, masks or reframes the body (and psyche) to something positive (Strübel & Jones, 2017).
  • But this is disclaimed by research as a myth that “people who have tattoos get them for the viewers or for the ‘outside gaze,’ that tattoos are some sort of personal advertisement.”  Overwhelmingly, heavily tattooed women start their collection in spite of the attention they begin to receive, not in order to receive it.” (Thompson, 2015, p. 161)
  • See Makonde fertility tattoo traditions.
  • Then there’s the couple tattoos….
  • Self-empowerment; protection.  Tattoos may also provide protection against malevolent forces; against natural forces or occurrences. 
  • Pain becomes something beautiful: The body & mind (and its experiences) can be reclaimed through control over what is experienced and displayed. You know you are alive when you’re hurting.
  • Survivors of abuse reclaiming control & bodily integrity (Buss & Hodges, 2017, pp. 21-23) (se also Survivor Ink below)
  • Living scars & tributes –  ink stories from American military (Deitch, n.d.)
  • Project; (mental health awareness & suicide prevention) (“Project Semicolon—Mental Health & Suicide Prevention,” 2017).
  • A message to oneself & memorialisation; survivor
    • Back tattoo that represents the Iraq war civilian and fighter dead (Pellegrini, 2010)
      • Breast tattoos for survivors of breast cancer (Lauriello, 2018)
  • An expression of penance, redemption, remorse
  • Living scars & tributes – ink stories from American military (Deitch, n.d.)
  • Marking growth or milestones; initiation, a rite of passage; bravery; warriors, ritual; tradition
    • See eg, Filipino Taktak (Tagalog ( a dominant ethnic group post colonisation) word for a tattoo; and other traditions, which Magellan first spotted in 1521 and called the indigenous peoples ‘pintados’ (painted ones). People wore tattoos as clothing, and ink reflected the patterns of the natural environment of their provinces/lands/waters. Tattoos awarded for bravery, coming of age, and also marked the ability to withstand the pain of the tattoo  (Wilcken, 2010).
    • VS embracing cultural otherness (and appropriation).
  • Reclaiming, reaffirming, sharing, renewal of familial, cultural or religious heritage and identity; resistance
    • See eg,  part of sharing and renewing a culture in Mentawai (ABC Australia, 2017)
    • See eg, a way of sharing pride in Hindu faith (Thompson, 2015, p. 168)
  • Tribute to an interest or passion; humour; status-enhancing
  • BUT: tattoos have also been used punitively, to mark & brand people against their will; punishment (Dinter, 2005, pp. 9-20, 32), obscuring individuality and dehumanising (Buss & Hodges, 2017, pp. 11-14)
    • eg including British soldiers who committed offences such as desertion (and then shipped off to colonies such as Australia) (Dinter, 2005, p. 32); Nazi treatment of camp prisoners (Farley, 2019, p.155); women in situations of sex slavery are demeaned and diminished (Sidner, 2017).
    • BUT: reclaiming narrative bodies (Survivor Ink) erasing the inked marks of sex slavery (The Guardian, 2014) ‘you have to look at these scars… you wonder if you’ll ever be anything else’… [at 2:30ish] ‘turn that ugliness into something beautiful…. That’s what art is’.
  • Experiences post fresh tattoo: aftercare
  • It’s an open wound. About a month or so (depending on size, location of ink) to heal; healing practices vary & everyone has better advice.
  • Careful washing, covering & avoiding abrasion, protection from the sun.
  • Experiences post-tattoo: health concerns (Farley, 2019, p.163)
  • Ranging from mild irritation, infection, scarring and burns; concern about bloodborne diseases.  Increasing range of reported complications due to relatively lax regulation of ink and mixed compliance with international health standards (see eg, Hall, 2016 & Farley, 2019).
    • Shame about what’s seen as self-inflicted may mean people don’t seek help.
    • The meaning attributed to tattoo (see above) may impact on the choice to seek help.
    • The view that health professionals don’t understand tattoo care.
  • Tattoos may mask health issues (eg less visibility of melanomas, other skin issues, etc).
  • See stats above.
  • Pretty tricky to get complete removal; 10 or more sessions for some tattoos. Random google sets a minimum for a single session at $60.
  • Booming trade & entertainment about tattoo regrets.
  • Tattoo coverups (new replacing old)


  • Kay and Brewis (2017) suggest that ‘belonging’ is experienced through connections created by tattoos.
  • Ink can simultaneously support belonging as:
  • an expression of:
  • belonging (to a group (military, family, tribe) or cultural identity; or sub-cultures) 
  • individuality (including collector of art; trendsetting and ‘the mark of the idle rich’ & wealth (Farley et al,  2019, p.155); deviance, adventure and challenging norms) AND
  •  a source of exclusion (primitive, lower class, criminality and punishment, ownership/slavery).
  • Wearers transition from ‘blending in socially to standing out visually’ (Thompson, 2015, p. 153) … ‘Ultimately, tattooed people understood that their visible tattoos would receive attention, but none of them expected the extent of it’ (Thompson, 2015, p. 161).
  • Nothing lasts forever: However, the symbolic meaning of ink (from wearer and observer’s perspectives) is constantly changing (Farley, 2019, p.155). While the ink is static ‘the canvas upon which it is rendered is not, altering its appearance as the skin undergoes change, whether from weight gain or loss, pregnancy, ageing, or a skin disorder’ (Farley, 2019, p.155).
  • Being tattooed often seen as permission for others to sanction: to stare, to comment, to ask and to touch; tattoos can break down the [Western] social wall of ‘tactful inattention’ (Thompson, 2015, p. 152).  The private becomes public.
  • There are moral entrepreneurs (who see tattoos as deviant); arbiters of taste (whose aesthetics don’t include tattoos or types/styles etc of particular tattoos) and those who see tattoos as ultimate transgression (e.g. women choosing to transgress gender norms by choosing to be unfeminine and be ugly by being tattooed (and/or have a traditionally masculine tattoo, like a skull) (see, eg Buss & Hodges, 2017, p.18; Thompson generally).
    • Common experience of tattoo bingo: visibility of tattoos often initiates comments and questions from non-tattooed strangers.  It is an act of ‘othering’ (see eg, Sanders & Vail, 2008 generally):
      • Why do you wear your pain on your skin?
      • Won’t you regret that when you’re older?
      • You’re such a  pretty/innocent blah girl, why would you do that to yourself? What if your future husband doesn’t like it?
      • Didn’t that hurt? Etc
    • There are also the interactions with other inked people: there are subtleties of hierarchy and posturing between those with ink (comparisons of styles, tattoo artists, size, etc; different subcultures; tattoo war stories (have you told your mum?) (eg, Thompson, 2015).
  • However, context is ultimately what matters as to how tattoos are perceived:  ‘for instance, the same behaviour or even the same good can appear distinguished to one person, pretentious to someone else, and cheap or showy to yet another.’ (Thompson, 2015, p.156).
  • Wearers of ink have different responses for different situations/reactions to ink:
  • Polite, to combat stereotypes
  • Palatable & censored
  • Grandiose stories
  • Stare down

Episode picture provided kindly by my friend @merrynmayhem 

Reference List

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Australian Bureau of Statistics. (2017, June 27). Media Release – 2016 Census: Multicultural. Retrieved November 6, 2019, from Australian Bureau of Statistics website:

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