Jill Bajorek dissertation

Institute for Clinical Social Work

EXPLORING THE FUNCTION OF TATTOOING IN DEVELOPMENT OF THE SELF: A CONCEPT

MAPPING STUDY

A Dissertation Submitted to the Faculty of the Institute for Clinical Social Work in Partial Fulfillment for the Degree of Doctor of Philosophy

By Jill Bajorek Chicago,

Illinois

April 22, 2023

Abstract

This research explored the meanings of tattoos to various participants and provides insight into the complex emotional processes that led them to obtain tattoos. This exploration was achieved through interviews with this researcher, where she asked participants questions about their tattoos and the specific meanings they associate with them. The questions centered on the theme of identity and yielded some quantitative demographic data and narrative qualitative data discussing the meanings behind their tattoos.

Concept mapping analysis was utilized in this study to better understand and make meaning out of the narrative qualitative data. This methodology allows for finding similarities and differences between data items and is a helpful tool for making sense of the narrative data participants provided. The photovoice method adds to this process as it allows participants to better comprehend the responses people gave.

In this study, 51 participants engaged in Phase I interviewing and provided quantitative and qualitative data, and 48 provided pictures of their tattoos as requested by this researcher. Subsequently, 11 people participated in Phase II and sorted tattoo pictures based on their meanings, generated and discussed a concept map, and discussed the findings with each other to better develop the meanings of the tattoos and the study as a whole.

The final map consisted of eight clusters decided by the participants that best represent the categories of meanings of tattoos in this study. The findings revealed unique reasons for getting tattoos while having a connecting factor of helping the recipients feel connected to their identities. This connection is crucial when thinking of the development of the self from a self psychology perspective. The findings highlight the complex nature of tattoos and tattooing and how deep meaning can be under the surface.

Acknowledgements

I would like to sincerely thank my committee members, who have given me incredible guidance on this dissertation journey. Thank you to my chairperson, Dr. John Ridings, who guided and supported a unique topic that was also close to my heart. I appreciate the late-night feedback, which genuinely highlighted his dedication. Thank you also Dr. Jim Lampe, for helping me remember all the specific psychological terminology and for his consistent support and moments of comedic relief through my years at ICSW. His demeanor made learning much more enjoyable and easier to consume.

I'd like to also thank Dr. Greg Rizzolo for helping me develop a comprehensive understanding of theory that I find invaluable to who I am as a therapist, and Dr. Michael Casli who helped me work through an especially challenging case. I have worked with outstanding faculty members in the program and would not be as effective in my work without them all.

I am thrilled to extend a thank you to my parents, Tom and Louise Bajorek, who consistently remind me how proud of me they are and how genuinely excited they have been to hear every update along the way. Thank you to my partner Erik Sandberg who provided me support and comfort while listening and caring so wonderfully for my emotions through this journey. Thank you to all my wonderful friends for supporting me and allowing me to vent while providing me so many good memories. Lastly, thank you to my cats, who provided me the most comfort I could ever ask for.

1. Point Map of Tattoo Meaning

2. Eight Cluster Map of Tattoo Meaning Outcomes with Point Map

Chapter I Introduction

A. Statement of Purpose

The primary purpose of this study was to investigate if and how people use tattoos to contribute to their sense of self. In order to understand the idea of developing a cohesive self through tattoos from a psychodynamic perspective, self psychology theories were utilized to explore the information found. Participants provided testimonies through an interview survey about why they chose to receive their tattoos, resulting in quantitative and qualitative data. Photovoice was utilized to generate descriptions of narrative responses from the interviews, and concept mapping was the method used to analyze data. This data was ultimately used to develop a conceptual map of the tattooing phenomenon. Self psychology was the best theoretical lens to use in order to study what functions the act of being tattooed serves for people as it allows for the exploration of conscious and unconscious processes in a way that looks at the formation of the self.

B. Significance of the Study for Clinical Social Work

This study contributes information to the base of knowledge in social work, specifically regarding the development of the sense of self. There are many reasons people choose to get tattoos. From the outside, tattooed people are often viewed as dangerous or reckless, which stems from several historical instances where tattooed people were associated with criminals. Over time tattoos have become more mainstream and accepted by various groups, though still sometimes seen as something distasteful. (Jones, 2000; Patterson, 2018). This stigma creates the importance of studying tattoos and understanding some of the individual and collective reasons

someone may choose to get a tattoo. Some tattooing decisions are not made quickly; much thought goes into the permanent image someone puts on their body. For many people, that decision includes thinking about the image itself, where they want to put it on their body, and a conscious understanding of the significance of both those choices (Bell, 1999). There might also be some consideration about the social implications of having a tattoo. This study explores the conscious and possible unconscious reasons people get tattoos and how that affects their identity. Exploring how people unconsciously develop their sense of self is something crucial in the field of social work. People utilize the selfoject functions based on other people or objects in their lives to form a cohesive self. This utilization of selfobject functions starts when someone is young, and the selfobjects functions are often provided by parents or caregivers. The self develops as the caregivers respond to the child and either affirm or reject the child's affect. Rejection would lead to a deficit the child may look to fulfill later in life. Learning what has and has not been affirmed for people provides insight into how their selves have been developed and what might be lacking (Banai, 2005; Kohut, 1977; Scorides and Stolorow, 1984). Through therapy, the therapist and client can investigate the client's potential deficits in an attempt to resolve something conflicting. Investigating specific ways selves develop can saturate the body of knowledge in social work. Discussing the presence of tattooing provides insight into a particular area of body modification and how that can provide a selfobject function and relate to self formation.

C. Foregrounding

This topic is especially of interest to this researcher as she identifies as a member of the tattooed community. She has been tattooed 14 times, with a few pieces being large. There is companionship with others who have tattoos, and there seems to be an instant social bonding

opportunity between tattoo community members. It seems like they already have something in common and have an easier time starting a conversation. There are differences, however. People often ask why this researcher chose her tattoos. She typically responds that she wanted to look a certain way, suggesting intent related to aesthetic components compared to the singular meanings of the pieces. This aesthetic intent feels like its own meaning, however. Intentionally looking a certain way has meaning by defining how one presents to themselves or others. Other people have expressed less importance on aesthetics and more on the specific significance of their tattoos. Some explain that their tattoos hold a deep emotional meaning connected to someone they love or an experience they had or represent something they want to remember. Differences like those have interested this researcher for a while because they indicate a broad spectrum of reasons people choose to get tattoos. However, this researcher has not looked at that dynamic through a psychodynamic perspective until now. This study hoped to better understand what people hope to achieve by getting tattoos and how that helps them psychologically.

D. Theory

The theory used in this study to understand tattooing is self psychology. Heinz Kohut developed this theory, which has since been used to study the development of the self. According to Kohut (1977), the normal psychological development of the self consists of a bipolar split of two lines of narcissistic development. This development begins in childhood, and the child's caregiver provides a selfobject function that will be internalized. The split occurs for the infant when the caregiver does not adequately respond to all the child's needs. The child preserves the caregiver by splitting off the idealized parental imago. On this side, there is a need for the child to merge with the strong, competent, calming, and protective other. Ideally, the parent exhibits behaviors that provide calming reassurance functions, creating a feeling of safety. If this

successfully occurs, those needs are satisfied. The other pole is the grandiose self which requires preserving the perfect sense of self. Mirroring occurs, which affirms and validates competency. An example of mirroring is a mother smiling at her child when they accomplish something like walking. These moments start as primary need fulfillments and continue as the child grows. When the needs of these poles are not satisfied, a disorder can develop. Kohut (1977) explains that in a normal situation, the caregivers will satisfy most needs, but there will be a certain amount of frustrations when the child's needs are not perfectly met. These frustrations can be moments of anxiety that are not actually traumatic but imperfections in situations. He refers to these as "optimal frustrations." The child feels the frustrations of not having their needs immediately met and having to manage anxiety, and the caregiver's presence assists them in working through the frustrations. Ultimately, after experiencing many small moments of unresponsiveness, the child will retain self-esteem and be able to handle frustrations throughout life without the parent present because the soothing function of the parent has been internalized. The child will feel the safety alone they once felt with their caregivers in those frustration situations (Kohut, 1977).

Sometimes these needs are not optimally met, and problems can arise. When the child cannot work through these frustrations due to them being excessive, they begin to seek fulfillment of these needs elsewhere. They seek selfobject functions through people in their lives and possibly in therapy. This seeking can persist through adulthood. In therapy, the therapist can explore the needs and possibly work towards the patients being able to learn to serve those needs for themselves healthily (Kohut, 1977). As applied to this study, the theory holds that people would get tattooed to help them better manage their frustrations and needs through meaningful

expression through this method of body modification. This frustration management could happen through tattoos serving affirming functions for the recipient.

E. Statement of the Problem and Specific Objectives to be Achieved

Recent studies show that 29% of Americans in 2015 had at least one tattoo, compared to 15-16% of the population in 2003 (Bridges, 2006; Shannon-Missel, 2018). This percentage is a significant portion of the population choosing to permanently alter their bodies. While it is unknown exactly when the art of tattooing began, there is data to suggest it dates back to ancient times, and meanings have changed throughout centuries and across cultures (Lineberry 2007). Through these changes, tattooing is becoming increasingly common in mainstream American culture and holds different meanings for groups and individuals (Patterson, 2018). Often these meanings are analyzed as surface-level understandings, such as group affiliation or culturally assumed meanings. Missing from that is the range of deeper psychological meanings that may not be talked about as often or even consciously known by the recipients. There is a dearth of research available on both tattoos and self-reported formation of the self. While many articles address those topics, few examples explore the direct connection between the two. The application of how tattooing helps a person develop a sense of self is still unclear and could be due to the highly individual aspect of tattooing. Broadening that research to include additional understanding aids in better understanding the functions that tattoos serve for people.

Some have speculated that being tattooed represents ownership over one's body. One feels a sense of control when one can permanently change their appearance. Tattooing can also serve as a connection between someone and something external (Eli, 2013a). It is also speculated that a tattoo can aid in the formation of one's self or identity (Bridges, 2006). This concept could

manifest as tattoos provide a way to separate one's psychological self from others and the environment. When one gets a unique tattoo, they will look different than other people, which is a desired outcome. Also suggested is the idea that a tattoo has both pain and pleasure associated with it, which together create a self that can experience both in other areas of life, too. An example of this concept could be a person who can experience optimal frustrations and better understand that there will always be disappointments in life. A strong sense of self will aid in tolerating those frustrations (Eli, 2013b). Unconsciously, a tattoo may allow someone to reenact something from childhood and internalize the ability to heal oneself (Karacaoglan, 2012).

A study by Gadd (1992) explored the intentions of tattooed soldiers in the United Kingdom. The soldiers answered questions to explore the reasons for their tattoos and any risks they experienced. The study mostly explored appearance, questioning how attractive the soldiers felt because of their tattoos. That study's researchers also explored how attractive the soldiers found women with tattoos. While most participants found themselves and women with tattoos attractive, they also questioned people without tattoos and found significantly lower ratings of finding tattooed people attractive. These findings indicate the presence of a collective tattoo culture, specifically with this group of soldiers. People with tattoos seem more likely to find them attractive on other people (Gadd, 1992).

Sands (1989) discusses the analysis of a specific person in therapy who chose to get tattoos to express exhibitionism due to having grandiose fantasies. This person got her entire body tattooed, which was likely viewed as unusual compared to mainstream acceptance. This patient did this because she was not adequately mirrored as a child, resulting in the need to express herself for validation. This lack of mirroring created a deficit in the formation of the self, resulting in her inability to independently formulate a grandiose self. In this case, discussing her

tattoos in a therapeutic setting ultimately revealed this deficit (Sandy, 1989). This case is an example of tattoos providing a function due to a problem of a need not being met. It is possible that the act of tattooing specifically led to resolving this deficit and was a favorable decision by the patient.

These studies and articles above explore the ideas of tattooing and some reasons behind those choices. What is still unclear is how this can be utilized from a direct therapeutic application with self psychology theories. Also, it is worth exploring whether tattooing is ever a method, consciously or unconsciously, that people use to access the feelings behind finding deficits of the self and serving functions.

This study will explore those ideas and potentially suggest the connection between tattoos and self formation. The results could be used in therapeutic settings to explore why people get tattooed and how that can develop into conversations about identity formation. This exploration could lead to a better understanding of the selfobject functions people seek.

F. Research Questions

1. Do tattoos help people develop a more cohesive sense of self?

2. What are the individual theoretical concepts that should be used to understand the drive to get tattooed?

3. What are the various conscious motives people identify for getting tattoos?

4. What are some observed or understood unconscious motives people may have for getting tattoos?

5. Does position on the body, specifically if the tattoo is hidden or visible to others, signify something either consciously or unconsciously?

6. Does the meaning of the tattoo change based on how an outsider sees it and assumes meaning, compared to the original intent of the recipient? Does that matter to the development of the self?

7. What similarities or connections, if any, are there between people’s reasons for getting tattoos?

G. Theoretical and Operational Definitions of Major Concepts

Self

“The self (viewed as a process or system that organizes subjective experience) is the essence of a person's psychological being and consists of sensations, feelings, thoughts, and attitudes toward oneself and the world” (Banai et al., 2005, p.225; Kohut, 1977).

Selfobject

“Significant others...experienced as non-autonomous components of the self.” These “play a vital role in the development of healthy narcissism” (Banai et al., 2005, p.227; Kohut, 1977).

Tattoo

“An indelible mark or figure fixed upon the body by insertion of pigment under the skin or by production of scars” ("Tattoo," n.d.).

H. Statement of Assumptions

Based on this researcher's experience as a therapist and a person with tattoos herself, the following four assumptions were made for this research study.

Assumption #1

Tattooing helps a person develop a sense of self.

Assumption #2

Tattooing is not associated with the development of collective identity.

Assumption #3

Tattooing is both associated with social identity and personal identity, which both contribute to the sense of self.

Assumption #4

Tattooing serves both a conscious and unconscious function for the recipient.

I. Epistemological Foundation of the Project

To best frame this research and assess the assumptions, the most appropriate research paradigm is social constructivism/interpretivism. In this epistemology section, knowledge is gained through studying cultural meanings assigned to concepts. Context is crucial, and no one reality exists within this worldview (Bloomberg & Volpe, 2012). This idea is essential for exploring tattoos because the meanings and symbols often found in tattoos are different throughout history and various cultures, all decided by the people in those situations. Additionally, tattoos have individual meanings and can still be viewed differently by others within a cultural context.

This study partially relied on personal narratives as data since the tattooed person can best discuss what their visual artwork represents to them. It was impossible to remove the researcher's subjectivity, so it was imperative that participants' reported tattoo meanings were accepted as truth (Bloomberg & Volpe, 2012). The open-ended interview questions asked of the subjects in this study allowed for meaningful dialogue in which the researcher could inquire about a broad picture of the participants' narratives. One symbol may hold meaning for someone with that tattoo, while the same symbol can mean something entirely different for another person

who has that same tattoo. Additionally, society may assume an interpretation of a symbol that matches or differs from the individual's meaning. These perspectives were all essential to consider for fully understanding participants' tattoos.

J. Outline of Dissertation

This dissertation is composed of six chapters. Chapter I initiates an overview of the study and associated goals. Chapter II provides a review of relevant literature and a discussion of the base framework used to best understand and interpret the data. Chapter III discusses the methodology used and details the importance of the procedures. Chapter IV presents the results of this study, including quantitative and qualitative data, and introduces some significant findings. Chapter V discusses all relevant and meaningful findings in this study. Lastly, Chapter VI looks at the different implications and recommendations on what to do with the findings of this study.

Chapter II

Literature Review and Theoretical Framework

A. Introduction

This mixed methods study explores the psychological significance behind tattoos and tattooing. This researcher sought to obtain narratives from participants, from which different themes can be drawn and explored. The psychological meanings were explored in what the act of tattooing consciously and unconsciously means for the participants and the meanings of the images themselves.

This literature review collects information about tattoos and tattooing from a broad perspective. The information presented includes exploring the act of tattooing for an individual, what the tattooed image itself means to the person, what this means in society, how history has viewed tattoos over time, and what tattoo images mean in a more symbolic and global context.

The most relevant research to this study centers around psychoanalysis and psychology related explicitly to tattooed individuals since that is the lens with which the narratives of participants were studied. From a broader perspective, the meanings of tattoos in society are discussed since it is imperative to see participants as part of their own environments. In order to encompass a more comprehensive understanding of the topic, the history of tattooing is presented. Lastly, to best understand the tattooed images, this author explored the symbolism of images in art and what psychological meanings exist in that field.

Keywords that were used in searching for materials were: “tattoos," “tattooing," “tattoos identity," “tattoo AND identity," “psychology tattoos," “psychology body modification," “history tattoos," “tattoos meaning," “symbolism tattoos," “symbolism in art," “tattoo narratives," “tattoos

mainstream," and "art in psychoanalysis." These resources include peer-reviewed journals, dissertations, internet searches, articles and websites, books/ebooks, and data files. These were obtained by internet searches in Google, Google Scholar, PsychInfo, PEP (Psychoanalytic Electronic Publishing), www.amazon.com, and recommendations from faculty and peers. These were collected from the Fall of 2014 through the Winter of 2023. While this researcher did not limit the date range of materials overall, much of the information presented is from the more recent past. This era significantly impacts the main themes addressed in this study, including current societal implications. This research was limited to tattoos obtained voluntarily, and excluded tattoos received nonconsensually through imprisonment, genocide, or otherwise forced. Thus, this discussion of literature mainly reflects that material. Each section of this literature review provides a comprehensive synopsis of the information available on the topics.

B. Brief History of Tattooing in the United States

This researcher has grown up in a culture where getting tattoos and other body modifications are relatively common and often thought of as trendy. In fact, tattooing is the sixth fastest-growing retail business in the United States (Taylor, 2012). Large tattoos and tattooing certain areas of the body are still sometimes taboo, but for the most part, they are generally not seen as shocking in society. However, getting tattoos was not always as prevalent or accepted in the past. It is crucial to explore their origins and how the reasons and meanings for tattooing have changed throughout history.

Tattooing has been around for thousands of years. The name comes from the Polynesian word "ta," meaning to strike something, and "tatau" from Tahiti, which indicates marking something (Taylor, 2012). Pinpointing the exact time it began is debated, but multiple sources cite incidents from thousands of years ago. In 12,000 B.C., tribes would cut their skin and rub

ashes over the area during times of bereavement, resulting in permanent markings (Grumet 1983). This practice mirrors similar rituals of the present day since it seems significant to the grieving process. Puncture tattooing likely existed in 8,000 B.C. as archaeologists in some European countries found pigments and sharp objects to suggest they were used to penetrate the skin. Egyptian mummies from 4000-2000 B.C. display markings on their skin. African countries, China, and Japan have also noted instances of tattooing during a similar time period (Grumet 1983). Since then, tattoos have been noted at many historical points, and their significance has varied dramatically. This section will present and discuss some of those meanings over time.

One specific ancient example of a tattoo was on a frozen man found near Austria from 5,200 years ago. The way the markings were arranged on his body suggested they were performed for therapeutic reasons to assuage pain (Lineberry 2007). This example gives some insight into the meaning behind the tattoo. The image itself may not have been the main reason for its occurrence; the penetration of the skin could have served a healing purpose. Drawings on tombs representing the skin of the people inside were found from 3,000 B.C. in Japan. They seemed to have a spiritual meaning and give insight into the traits of the deceased person (Taylor, 2012). Hambly (1927) reviews multiple groups who engaged in body marking for religious reasons, suggesting the rites (tattooing) were ways to access non-human forces. People were tattooed in a ceremonious fashion that often corresponded with being a certain age. The Naga people get tattoos to be recognized in the spiritual world. These tattoos focus less on aesthetics and more on function. While wealthier people would wear jewelry that would identify them in the afterlife, poorer people would get tattoos (Hambly, 1927). Ancient Greeks would differentiate between classes with tattoos. A tattoo on someone would indicate a lack of civility, so enslaved people and criminals would be tattooed to be easily identified among others (Jones,

2000; Patterson, 2018). Romans would tattoo criminals for the same reasons, sometimes even tattooing the crime or punishment. These examples are thought to be why criminals voluntarily got tattoos later in history as an act of resistance by embracing the tattoo (Gustafson, 2000; Patterson, 2018).

Aboriginal cultures would utilize tattoos as rites of passage into adulthood and marriage. They were done by hand and connected to images in nature and would indicate to others their age or status (Bell, 1999). The Māori people in New Zealand also utilized tattoos to indicate the status of a person, getting decorative tattoos to suggest ranking among the tribes. Women would have smaller tattoos, and men would have more extensive and visible ones. Occasionally those tattoos would be used as signatures (Hambly, 1927; Sanders, 1988). In these examples, the tattoos have a meaning as a group since the people getting them are following a group custom. However, there is also an individual component as they are different enough to distinguish people from each other. The ritualistic aspect seems to suggest a connection to identity both within the community and the individual.

In Japanese history, tattoos were accepted for many centuries as the irezumi art form (Sanders, 1988). Japanese tattoos historically center around telling a story and expressing a broader theme. This concept differs from American tattoos, which tend to present more often as individual objects with less abstract themes (Bell, 1999). In the 5th century B.C., however, tattoos were used as a form of rebellion against the elite, who were allowed to wear kimonos. Tattooing was made illegal in 1870, so it became less common and less accepted (Taylor, 2012). Today they are rarely seen except on laborers and Yakuza groups as forms of expression, often with themes of inner conflict (Bell, 1999; Sanders, 1988; Taylor, 2012). These examples suggest the impact the culture and government have had regarding why people chose to get tattoos and how

they are perceived. As an art form, it was respected, but as an act of rebellion, it was seen as uncouth. Thus it spawned a vast dislike of tattooing, generally being associated with lower classes and criminals.

Tattoos began infiltrating Western cultures, and some literature suggests this effectively happened because Captain James Cook, a British explorer, began seeing tattoos in his travels to the South Pacific in the mid-18th century. The sailors would then get tattoos related to the various places they had been to commemorate their travels (Demello & Rubin, 2000; Lineberry, 2007; Patterson, 2018; Sanders, 1988; Taylor, 2012). Since some tattoos were of distasteful images, more polite societies in the U.S. and England did not favor them. This act suggests that something negative was assumed about the person based on what image they chose for their tattoo. An image on the skin resulted in dismissing someone entirely due to stereotypical assumptions. These negative assumptions continued in the mid-20th century when having a tattoo indicated some deviance about a person since many tattoos were done in unhygienic parlors or seedy areas. Even though going to high-class tattoo establishments did not exist, the recipients were still considered deviant based on going to unsavory venues. Even today, people can be viewed negatively for having a tattoo even though high-end, clean tattoo parlors exist and are more mainstream. The person is sometimes assumed to be part of a dangerous group or may seem untrustworthy and unreliable; tattooed people are even sometimes denied employment. There became a perceived social division between tattooed people and law-abiding, familyoriented people, assuming there could be little overlap (Patterson, 2018). There are some exceptions, however.

The U.S. has historically seen a connection between military service and tattoos in the name of honor. One example was from the 1960s when tattoos were viewed differently, and

during some wars, soldiers would respectfully get tattoos in solidarity with each other (Grumet, 1983; Sanders, 1988). The tattoos for the military and navy would indicate a proud life separation from mainstream society (Patterson, 2018). In the 1970s, popular bands embraced tattoos, which has continued with the music scene for decades. The 1980s saw an improvement in the quality and artistry of tattoos, allowing more incorporation into mainstream society and contribution to the economy (Patterson, 2018). In the 1990s, tattoos were seen as fashionable and became popular with athletes (Taylor, 2012). Today, contributing to the more accepting modern attitude, experienced artists often express their work through tattoos. Because tattoos are seen as art forms in these cases, they are more well-received. Sometimes museums feature them from an artistic perspective (Sanders, 1988).

It still seems that a tattooed person might be negatively perceived because of the external factors of the tattoo rather than for the person's inner qualities. This concept is intriguing, as many people today get tattoos to represent something individual and internal. Grumet (1983) even suggests that much tattoo research focuses on the more deviant and poorly executed tattoos and neglects information about well-done pieces. This information gives additional significance to this study as it focuses on the internal processes someone experiences when getting a tattoo that people often overlook when initially assessing someone.

Taylor (2012) suggests the circus industry helped with the acceptance of tattooing as fans would get tattoos to model those of the performers who made a good wage and were respected. The industry created a popularity for this body modification (Taylor, 2012). What motivated spectators to emulate what they saw in the sideshow entertainment pieces is still unclear. Perhaps the viewer wanted to identify with someone they respected or admired and hence followed similar actions.

Tattoos, even as they are more prevalent, are considered body modifications against typical beauty standards. Sanders (1988) discusses any changes to the body as interactions with culture and how some modifications are done in conjunction with the accepted beauty aesthetic. Women in China binding their feet to create the illusion of having smaller feet aided them in achieving beauty and therefore being more likely to find marriage. Plastic surgeries and exercise to conform to beauty standards are body modifications that society accepts in the U.S. and are sometimes proudly publicized. However, the corset in history was an example of a body shape change that was a resistance to the cultural norm. As the corset made women appear skinnier, it was believed they would be less able to bear children, and therefore the look was not favored (Sanders, 1988). Now, this culture tends to favor a slimmer figure. This example suggests that changing appearance as a form of protest is not exclusive to tattoos. However, the perception of the end image (i.e., appearing skinnier) can change over time from being less desirable to attractive from a general societal perspective. This concept mirrors the changes in how tattoos are perceived differently over time.

The types of body modifications are growing beyond the act of tattooing. One modification is scarification which is intentionally cutting or burning the skin to leave scar marks for aesthetic purposes. Initially, the Māori people partook in scarification on their faces to display identity and fierce attitudes. Like tattooing, this has also become more mainstream in Western culture. Scarification was first seen in the U.S. in San Francisco in the 1980s with gay and lesbian cultures (Guynup, 2004). Guynup (2004) also considers that scarification may be a more daring means of expression as tattooing may be more mainstream and accepted. This type of body modification is often popular among darker-skinned people when a tattoo would be less

visible (Sanders, 1988). Therefore, body modification is becoming more common as an attempt to stand out for people who are not just lighter-skinned.

The perception of tattoos' roles and presence can depend on the cultural and societal context. In the past, tattoos were often connected to a certain kind of cultural expression, whereas now, tattoos are becoming more commonplace. One example of this is explored by Bell (1999), who discusses gender differences. He suggests that tattoos are a liberation from societal beauty standards for women in general. When women get tattoos, they tend to be softer images like flowers. There are also differences in the quality of tattoos; well-done tattoos by artists would be more respected than prison tattoos, for example. He suggests a societal fear of permanence that can present in a non-tattooed person acting judgmental towards someone with a tattoo. Sanders (1988) discusses how often stability is inferred from a person's image. Someone risks being defined as unstable or inferior when permanently altering their body. This inference could be based on assumptions, whether or not they are correct. Alternatively, the person with tattoos can be seen as someone who has the strength to tolerate those judgmental stares and assumptions (Bell, 1999). The perception of the person likely starts with how the viewer perceives the act of intentionally looking different.

Many people understand tattooing as a way to divide oneself from society; it can be seen as antisocial. For example, certain gangs get tattoos to differentiate themselves. Additionally, since tattoos are still not a norm, frequently marginalized groups embrace their identities through tattoos. This act implies a meaning of resistance for some and pride in doing so (Bell, 1999; Grumet, 1983). Pritchard (2000) and Sanders (1988) note how tattoos can function to separate someone from cultural norms while linking someone to certain parts of society. So, while someone may be using tattoos to separate themselves from larger societal groups, they are

simultaneously permanently tying themselves to smaller subgroups or cultures. This divergence itself is a kind of identification with a group. There is a perceived strength and emotional closeness in resisting something together with others or even having a common enemy and joining in solidarity.

When people get tattoos to align with a specific group, it is often an attempt to feel included. Soldiers would get tattoos together to boost connectedness and morale in wars. Family members might get similar tattoos as each other to all feel connected. (Bell 1999; Grumet, 1983). Some people will get them to mark progress and feel connected to others who have been through similar challenging life events, such as people who have been suicidal, had related psychological issues, experienced trauma, or dealt with addiction. (Grumet, 1983). The act of doing this with others seems to solidify closeness. One could argue that family members or groups experiencing hardship together already feel close without getting the tattoo. However, because tattooing is often seen in these situations, there must be something more solidifying about it on an emotional level. For this reason, discussing this phenomenon with people who choose to get tattoos could give insight into this process.

Adolescents often feel isolated as they learn about their identity, and getting tattoos can remind them of how they begin to define themselves (Grumet, 1983). The prevalence of tattooed people has even increased dramatically since 1990, when the percentage was 3% of the population (Armstrong & Fell, 2000; Dickson, Dukes, Smith, & Strapko, 2015). In 2016, The Harris Poll showed that 53% of people ages 18-35 had tattoos, signifying increased popularity with younger age groups (Dickson, Dukes, Smith, & Strapko, 2015; Shannon-Missal, L. 2016). Could this rise be related to identity development if younger groups are getting tattooed more?

Some suggest this can be a way to define body autonomy and mark developmental milestones, similar to how some tribes would do (Karacaoglan, 2012).

Getting a tattoo shows ownership and choice over one's body, allowing one to feel a greater sense of control. The body is the external physical manifestation of the self and needs to be adequately cared for. Many agree that it is inherently connected to identity, and therefore if someone makes changes to theirs, a new or changed identity is projected outwardly. How the physical body connects to identity is debated, but many recognize it as one of the ways people perceive others and their own identities (Alcina, 2009). When people observe someone's physical presence, they can recall and hold space for the person's existence in their mind. This concept suggests uniqueness that already exists when perceiving someone; with or without tattoos, each body reflects different identities. If it is acceptable for people to have different facial structures, why is it harder to accept the presence or absence of skin markings? A combination of born physical looks combined with chosen ones such as clothing, body modifications, and other physical changes all create an image for each person that is different from others and therefore meaningful and representative of the self (Alcina, 2009; Butler, 1990).

Tattoos about permanent status changes, like adolescent development, metaphorically coincide with the idea that tattoos are permanent. Sanders (1988) compares this idea to impermanent ways to alter the appearance (like costumes) as less connected to life changes. Therefore, getting a permanent tattoo about a stage in their life could show the recipient understands the significance of passing that point and are proud of it. Getting the tattoo means the person does not want to forget about it. Armstrong et al. (2002) found that the college-age students interviewed perceived tattoos as a part of their identity, and that act aided them in feeling more identified with others their age. That act allowed them to assume support from

others when they could connect with them because of having tattoos. This emphasis on support seems to differentiate permanently marking developmental milestones with others from simply going through adolescence together. When someone intentionally gets a tattoo about a shared experience, it shows some acknowledgment of the event. It could aid in that perception of support between people, which helps them accept the journey (Sanders, 1988).

Alcina (2009) suggests a connection between tattoos forming an identity and someone having a consistent narrative of their self. Tolpin (1971) also discusses a cohesive self connecting to an inner narrative. While much of someone's identity comes from an unconscious place, someone's conscious awareness of the self also plays a role, and an internal narrative encompasses both. This researcher's intent in this study was to understand if people who have tattoos consciously and unconsciously utilize tattoos and tattooing in the formation of their identities.

Kertzman, Kagan, Hegedish, Lapidus, & Weizman (2019) performed a study with 120 women in order to better understand the connection between tattooing and self-esteem. Since tattooing is a form of body modification, they wondered if people who chose to get them lacked satisfaction with their bodies on a more general level. They also wondered if those with tattoos saw themselves as individual and creative, which could suggest a higher level of self-esteem. Overall, they found that the tattooed participants showed lower levels of self-esteem than the non-tattooed participants. However, tattooed participants showed higher levels of body satisfaction based on feeling more connected to their ideal selves. Those participants seemed to achieve higher self-esteem once their tattoo was completed and therefore felt closer to their ideal body image. Those participants saw themselves as unique and felt favorable about that. This feeling likely resulted from participants making an active decision to change their bodies based

on how they wanted to look. They also found a stronger correlation between body image and self-esteem with tattooed participants, which supports this researcher's interest in studying the importance of tattoos in developing the self (Kertzman et al., 2019).

What about tattoos for the sake of tattoos? Purely aesthetic preference and expression is itself a culture, and tattoos have created a subgroup. The presence of tattoos has fostered a sense of camaraderie among individuals who share this form of self-expression, surpassing their initial symbolic meanings while simultaneously coalescing with them. Not much research addresses this or considers people with tattoos their own culture, but Bell (1999) sees a difference between "people who have tattoos," which refers to people with a few, possibly hidden ones, and "tattooed people" who tend to have more bold and prominent images. The latter example is a group subscribing to the culture with the word "tattooed," modifying them as a person. In contrast, the former example is simply a person who added some images to their body and probably would not want to be considered a "tattooed person" due to negative perception from society. She considers the tattooed people part of a subculture that can withstand judgment and embrace marginalization. Armstrong et al.'s (2002) research of tattoos among college students concludes that tattoos are less seen as deviant behavior among people in that demographic and more seen as body art. While not everyone accepts the image of a tattooed person as "normal," it is more accepted now than in the past, even by people who do not have tattoos (Armstrong, 2002).

In summary, tattooing goes back centuries without one specific, easily recognized origin date. The act signified different meanings over time. Tribes utilized tattooing to signify milestones and rankings among each other. This act helped them quickly identify specificities in each other. In more contemporary Western culture, it became more commonplace with

subgroups as a way to both stand out from the crowd and assimilate with the other people in their respective groups. Apart from the specific groups of people with tattoos that signal their affiliation, many people get tattoos for highly individual reasons as a deeply personal choice and do not wish to express connections with others. The meaning behind this choice is internal and therefore connects with their self identification. This study explores those reasons and attempts to understand any internalized meanings for people who get tattoos.

C. Societal Meaning and Culture

Because of the increase in tattooing, societal norms are changing; tattoo-seeking individuals are not necessarily seen as marginalized, nor do they have to have a particular group affiliation. The increase in tattooing (Taylor, 2012) perpetuates the newly emerging flexibility and variance in the reasons people identify why they get tattooed. Furthermore, this progression has developed the possibility of people getting tattoos for essentially any reason (or lack thereof) they choose with greater acceptance by society.

In today's culture, tattooing typically has a specific meaning. Karacaoglan (2012) and Grumet (1983) see this as a means of expression that is more tangible than words that can help certain people who may be socially shy express their deeper feelings without engaging in conversation. It is also possible to glean how someone feels about their own tattoo when they speak about it, depending on how they describe it and what body language they use (Grumet, 1983; Kertzman et al., 2019). The images represent something about the person. Hambly (1927) sees connections in today's culture with developmental changes like puberty and adolescence, love, status, mourning, and connections to some groups. Bell (1999) suggests that the meaning of a tattoo can even change over time, and the person who got it can go through different phases of interpretation of the image.

From personal experience, this researcher has heard many people say they got a tattoo to commemorate a deceased loved one or to remember a significant life event like traveling somewhere or achieving a goal. These suggest personal meanings where permanence is of some significance. Bell (1999) discusses a type of person who might get a small tattoo or cover one with clothing, intending the tattoo to represent something important about themselves. They may keep it secret or tell a select few people about it, but the intention of getting the tattoo is less about aesthetics and more about what it means to them. Bell also notes that in her experience, not every tattoo has to mean something specific to the image portrayed, especially to people with many visible tattoos. She suggests the act of tattooing can have meaning, as she described with wanting to be part of a tattoo subculture.

Karacaoglan (2012) also discusses the secrecy behind some tattoos and connects this meaning to psychological processes. He understands tattoos can be hidden, but the fact that they are visible suggests a need to express something. Suppose someone needs to make an image permanent. In that case, they might view it frequently for "prohibited identification," described as looking at the image to assimilate to it again (Karacaoglan, 2012). In doing this act, someone might put a tattoo in a spot where they and possibly others can see it. Similarly, someone might choose a tattoo to commemorate a deceased loved one, for example, to process their feelings about that loss. The person can look at their tattoo at any time and be able to remember and feel connected to the person lost, which would imply it assists in the mourning process. It also implies that grief might be more difficult for that person without an ever-present image.

Karacaoglan (2012) relates this to identity formation, as someone looks at objects and identifies with them. This idea suggests a psychological and possibly unconscious component to forming the self through the process of tattooing.

Seemingly a paradox, tattoos indicate both the plasticity and permanence of the body. People hold the control to get tattoos and change what is on their skin. Once someone decides to get a tattoo, they accept its permanence. People can change themselves to an extent (Patterson, 2018). This concept indicates a level of risk someone is willing to endure when getting a tattoo. The recipient must be sure they will like the tattoo for the rest of their lives, or at least understand the permanence of it. Tattoo removal is an option, but it is unlikely that someone would get a tattoo with removal as a future plan. By committing to a tattoo, the person accepts the permanence; therefore, most tattooed people would not likely engage in a brief fad. Alternatively, they could get a tattoo of something trendy, understanding the risk of that trend passing (Patterson, 2018). These ideas highlight the different considerations people make when deciding to get a tattoo.

Freud (1917) suggests there is meaning in holding onto objects to assimilate to them. When people possess something that helps them remember, they can feel connected and relate to whatever the object represents. This concept can apply to those people or memories the tattooed person has lost. When people get tattoos to commemorate a lost loved one, they may be trying to hold onto that person as a means of grieving and not seeing them as truly gone. For them, this eases intense feelings of grief into something more tolerable. They integrate the lost person within themselves to move through the grieving process, hold that person, and better assuage the pain of grief (Freud, 1917). Tattoos can be used to connect someone to whom or what they have lost as it better helps them remember someone or something, which can aid in that holding function.

D. Symbolism

Since tattoos are a form of visual art, it is essential to consider the possible meanings of symbols. There could be some conscious or unconscious meaning behind the actual images people choose to have tattooed on them. Why choose one image over another? When thinking of symbols, metaphors also come to mind. People sometimes choose tattoos that are not an exact depiction of what they say it means, suggesting there could be some meaning coming from a less conscious place. Understanding symbols can aid in interpreting the choices people make.

Humans and primates use symbols, and psychoanalytic symbolism is exclusive to humans (Blum, 1978). Art and psychoanalysis have always been connected. Slochower (1965) discusses the importance of symbolism for communication between people. Symbolism provides a way to better understand each other which relates to psychoanalysis; both symbolism and psychoanalysis allow for exploring subconscious states through indirect means (for example, words or pictures). These means create a way to express the self to more effectively connect and relate to others (Bernstein, 1982; Burchard, 1958; Slochower, 1965). Many have connected the use of symbols to the development of cultures and humanity as a whole, suggesting they affect how people think and perceive things (Burchard, 1958; Slochower, 1965). Slochower (1965) notes Freud's stance that the mind functions in symbols, such as representations and language, and they can often be seen in dreams.

Symbols can be used to make someone's thoughts more understandable and relatable. This concept is essential when thinking about tattoos because while they mean something specific to the recipient, if the intent is to convey a message to someone else, there has to be a way for the other person to understand the image. Freud suggests (Slochower, 1965, p. 122) that the artist opens the meaning of an image to those who cannot create it themselves; they take it from thought and make it something comprehensible to others. Thus, the tattoo artist serves that

purpose since the recipient needs their expertise to implement the design. Abstract painting and sculpture themes are often less clear without direct or obvious meaning. Instead, those are depictions of the artist's experience creating it which is often ambiguous (Blum, 1978; Burchard, 1958). Perhaps art is more relatable if people can find their own way to connect with it, seeing something that resonates with them. This idea suggests the potential that someone will interpret it differently than the artist intended, which makes sense since the symbol is something displaced from the initial idea to something more abstract (Blum, 1978).

Symbols are representative, and the intended meaning is often more profound than the external expression. These deeper meanings can even connect to psychological concepts that might otherwise feel crude or vulgar. The symbolic image or word is conscious, such as a flower, and the underlying meaning could be unconscious, such as a vagina. In this way, the symbol is a disguise that can be processed through psychoanalysis (Blum, 1978). Slochower (1965) cites Jones (1916), who suggests that symbolism is what is repressed from consciousness. Blum (1978) suggests that what is not repressed will not manifest in a symbol. That symbol, which represents the repressed idea, can be expressed then. The symbol has its own separate meaning that is more worldly, with which others can identify. This idea reinforces the connection of symbols to the unconscious; utilizing symbols can allow someone to express something they might otherwise repress since they can be disguised as something else and are, therefore, easier to express (Slochower 1965). When someone engages in this type of repression, there is internal conflict. Using symbols would aid in alleviating and resolving that conflict as they are a means to access the repressed ideas. With this idea in mind, it seems getting tattoos can aid in conflict resolution, as one may get a tattoo in an attempt to resolve an unconscious internal conflict.

Esman (2011) explicitly discusses using imagery in art as a function of psychological drives by highlighting the use and frequency of erotic imagery in art. It is again related to psychoanalysis as the artist's feelings emerge through the expression of these symbols. This concept is seen in the works of Salvador Dali, as sexual expression is seen frequently in his works. He developed a negative association with sex after his brother died of a sexually transmitted disease, and his father instilled fear when educating him about sexuality. His expression of sex in his art suggests that his childhood remained relevant to him throughout his adulthood, which is often seen in psychoanalysis. While expressing those fears in his works, some of his images are more clearly associated with sex, while others are more abstract. In the abstract images, the viewer is allowed to draw their own, possibly different, interpretations from looking at the same image (Martínez-Herrera, 2003). The viewers' subconscious minds connect to the painting and, therefore, Dali. Viewers likely form interpretations as a combination of their and Dali's ideas (Burchard, 1958; Martínez-Herrera, 200).

When a symbol's meaning is unclear or abstract, the symbol can serve a defensive function, like displacement or repression, for the artist. This defense could mean the artist has a reason for being unclear, possibly indicating something about their relationship with the object or idea being represented (Blum, 1978). This notion highlights the connectedness between visual art and the use of words during psychoanalysis, both sometimes being an indirect path to understanding what is unconsciously trying to be expressed.

While abstract symbols allow for more extensive interpretation, some symbols have become more common and generally accepted to represent something specific, such as objects looking phallic that can relate to the penis. Sometimes words bring up the same unconscious meanings across languages, and this is often seen with genitalia. The underlying ideas and drives

are often connected to the ego, infantile instincts, and body. (Blum, 1978). This concept is imperative to explore when people get tattoos because it could indicate how much the tattooed person wants the viewer to understand about the design and them. If the design is more abstract, does that mean the viewer has more freedom to interpret what they see? If it is a commonly known image, does the tattooed person want to convey a specific message that does not involve as much of the viewer's own thoughts?

Language is a common symbol people use to express thoughts. Spoken words do not have any inherent connections to what they describe, except if the word is onomatopoeic, where the sound is associated with the object or action (Blum, 1978). Humanity created words in order to have symbols and relatable ways to communicate about objects and thoughts. Because of this, people use symbols to define and better understand themselves (Blum, 1978). Freud was interested in language since it was a secondary function of verbalization after thinking. Language can be verbal or non-verbal, but it gets someone to think outside their own thought process (Blum, 1978). Tattoos can be used to communicate something non-verbally to someone else.

Kertzman et al. (2019) highlight the extensive way that tattoos communicate one's unique feelings using the body as a platform.

Piaget (1951) highlights the importance of symbolic play in infants. The infant learns through what they perceive, and most objects have no inherent meaning yet. The child initiates cues based on their needs and ultimately learns via imitation of other cues and language through others around them. The child can eventually accept those symbolic means of communication as their own without having to mirror them. Lacan (1966) discusses the idea of a mirror image as a separate self that a child can project themselves onto to better understand their self. It seems that being able to visually perceive the self at a slight distance provides some aid to the child in

simultaneously dissociating and relating. In these examples of development through symbols, the level of dissociation that occurs since the expression or image is separate from the self aids in the development of identity.

Tattoos can be seen as transitional objects. Similar to an infant using symbols to represent the mother, for example, when differentiating themselves, tattoos can be used as a symbol to represent something else. It creates a bridge between the two (Blum, 1978; Karacaoglan, 2012). The classic transitional object example of a security blanket does not inherently relate to the mother as they share no outward characteristics. However, the infant unconsciously utilizes it to represent the mother. Eventually, the blanket becomes not the mother, which indicates a resolution of the differentiation. Tattoos may sometimes look like what they represent and sometimes not, but ultimately the unconscious meanings are not fully depicted through the visible ink. The psychodynamic implications of tattoos as transitional objects will be discussed further in the next section.

Looking at tattoos as symbols, it is clear there are similarities with the artistic world. Tattoos fit with many other art styles by connecting people through familiar images and ideas while allowing for individual interpretation by the viewer and the holder of the art. The connection between science and art allows science to observe, understand, make connections, and make predictions about art (Bernstein, 1982). This idea is the reason for this dissertation, to understand the various meanings behind tattoos from different artistic and psychological perspectives in the hopes of better understanding the mind within the environment. A psychodynamic understanding of tattoos will be discussed next.

E. Psychoanalytic Thought on Tattooing

Some research supports the idea that tattoos represent conscious and unconscious psychological meaning. Patterson (2018) suggests tattoos depict the narratives the person intends but also allow others to formulate a story about the recipient that may have nothing to do with their original intentions. Karacaoglan (2012) suggests that tattoos signify stability in the chosen image for the person who possesses it. The tattoo sometimes aids a person in achieving stability in conflictual situations. In the example of someone who got a tattoo to commemorate achieving something, say an educational degree, they may have particularly struggled with the process. The initial conflict, i.e., completing school, threatened the person's stability. Getting the tattoo on them after graduating solidifies the achievement as representing success.

Grumet (1983) believes the tattooed person is attempting to define boundaries of the body which could be related to childhood fantasies. He does not explicitly elaborate on this, but he seems to suggest that getting a tattoo mimics the development of the ego when someone is seeking a sense of belonging and adequacy. The tattoo, representing an alliance with a group or a way to commemorate a milestone, acts as proof and a declaration of that identification.

Karacaoglan (2012) further develops this idea, discussing infants knowing the skin to contain the body and personality. It plays a role in separation as the infant sees the skin as a part of them that contains them, but what separates them from external space. Karacaoglan (2012) cites Ogden (1985) when speaking of infants seeing the skin as an object, and while most objects are external, the skin is still part of the person when seen as a separate object; the skin is both part of, and separate from, the infant. This awareness would also help someone define their identity by seeing the skin acting as a boundary, strengthening the ego in the development of the self (Armstrong et al., 2002; Bell, 1999; Grumet, 1983). As the skin acts as a boundary between the internal and external world, the tattooing process would imply a function of connecting the external to the

internal. The skin becomes permeable with the meaning of what is being tattooed. This process impacts the ego as the meaning is internalized from something that began as external.

Karacaoglan (2012) discusses the ability of tattoos to be transitional objects. Ogden (1985) describes these objects in the following way: The transitional object is a symbol for this separateness in unity, unity in separateness. The transitional object is at the same time the infant (the omnipotently created extension of himself) and not the infant (an object he has discovered that is outside of his omnipotent control). (p.132).

These physical objects can be utilized symbolically for an object an infant is separating from at age-appropriate times. The child eventually realizes they do not have control over their caregiver and separates. The transitional object helps the infant in understanding and experiencing the caregiver (or other object) as separate, thus with less anxiety than without something they can hold during the transition, while they develop that sense of connectedness (Ogden, 1985; Winnicott, 1953). Karacaoglan (2012) discusses how a tattoo recipient could have difficulties maintaining the difference between the tattoo and what is represented, or what Winnicott (1953) refers to as potential space. This struggle is due to the tattoo's permanence and the recipient's need to not relinquish the symbol. A tattoo can only partly be a transitional object since it is permanently affixed to the skin, and true transitional objects are separate. The tattoo becomes an object someone never has to give up. The experience of having the tattoo is maintaining the fantasy of holding the object from which the person must separate. For example, a person struggling with grief may utilize a tattoo as a coping mechanism to try to gain stability and hold onto something or someone they have lost.

As previously mentioned, Freud (1917) discusses the psychological importance of holding on to an object through the process of grieving. In the case of melancholia, someone falls into a pathological grieving that becomes more problematic than normal mourning in a conscious state. The object lost can be someone deceased or lost in another way, such as a breakup. The impact of the loss occurs on an unconscious level and diminishes the person's self-worth. Freud concludes that the loss causes the person to unconsciously feel pain about the object. They then feel pain about their self in an effort to identify with that object. That painful feeling that would otherwise be directed toward the object is now directed within since the object is no longer present. Thus, the person internalizes the object into the ego. This internalization occurs because the loss is too difficult to tolerate. The person cannot replace the object with a new one and instead has to take it on (Freud 1917). This concept relates to tattooing to commemorate a deceased loved one if the person struggles with the grieving process and wants to get a tattoo to feel the deceased as a part of them. It could suggest that the grieving process of a lost loved one could not be accomplished with external objects, and the person had to take action to permanently affix the lost one to them. Perhaps this aids in the unconscious transfer of the object to their ego, and perhaps it is not quite as extreme as melancholia if it is believed the skin is both part of the person and a permeable boundary to external objects.

The body healing from a tattoo can also be a transitional object as the pain reinforces physical presence and solidifies existence. If someone were to struggle with identity formation, they could benefit from the pain of the tattoo as a reminder of their own presence. It reminds people of their consciousness and allows them to feel connected to themselves (Patterson, 2018). Additionally, needing care requires the presence of a caregiver in some form, which would also validate someone's existence (Karacaoglan, 2012; McDougall, 1989). In the case of a tattoo, the

healing care typically comes from the self. This idea further emphasizes that the act of tattooing, and not just the images portrayed, has a purpose (Bell, 1999). Oksanen and Turtiainen (2005) found that people report the pain helping them access previous feelings, especially when those feelings are emotionally painful. When someone gets a tattoo, it breaks the skin and the skin has to heal itself. Karacaoglan (2012) suggests that rupture provides the person an opportunity to take care of themselves. The person has to soothe their skin which could allow them to engage in necessary self-care. This need for a tattoo could also be connected to a rupture from childhood, and by getting a tattoo, the person is attempting to reenact and resolve a situation. When someone has an opportunity to take care of their body, it can be a reaffirmation of their abilities. Suppose one felt conflict when a parent neglected caregiving, requiring them to take on that task themselves. In that case, they may recreate that feeling and initiate a chance to invoke soothing self-care that applies to that past rupture.

F. Theoretical Framework

Self psychology provides a theoretical lens that lends itself to interpreting the findings of this study. Through this lens, one can understand that tattoos provide the recipient a selfobject function. When one internalizes the function of a selfobject, that function becomes part of the self. Ultimately, this process helps develop the self and, more specifically, a cohesive self (Kohut, 1977; Scorides and Stolorow, 1984). As outlined throughout this literature review, a survey of research has defined an association between tattoos and persons or ideas that indicate they assist in internalizing that function. The tattoo becomes a visual representation and reminder of the function the image represents. If someone consciously chooses a tattoo that reminds them of someone who represents strength, for example, the tattoo serves as a visual reminder of the

strength they have or hope to internalize as part of their own self. This process could also unconsciously serve as an attempt to fulfill the archaic idealized needs someone has. Someone who consciously chooses a tattoo to signify something cultural or belonging to a group could unconsciously seek to fulfill twinship needs. Seeking to fulfill this need demonstrates an association with archaic grandiosity, which has left the person craving external validations that assist in maintaining a feeling of self-cohesion. The conscious reason someone provides for choosing a tattoo could be a clue to what they are unconsciously seeking and, therefore, what vulnerabilities they have (Kohut, 1977; Scorides and Stolorow, 1984).

When discussing someone having a need, this could imply that there is some vulnerability the person is experiencing. Through self psychology, this vulnerability would be associated with some disruption earlier in the person's life. This disruption leads to someone's needs not being adequately met. The self contains the needs for mirroring and can internalize the function the selfobject has previously provided. Within the self and selfobject relationship, the person eventually internalizes what is provided to them. In healthy self development, needs are sufficiently met, so the child eventually internalizes the selfobject functions and can tolerate disruptions and self-soothe. When idealized and grandiose needs are adequately met in development, a self develops the psychological structures necessary to maintain a cohesive self. When the needs are unmet, and there is a disruption in internalizing the selfobject function, the self is left vulnerable and engages in behaviors or seeks relationships to decrease the propensity to fragment. The person may constantly seek to fulfill those needs. An example of this process could be someone seeking approval from others and seldom being able to maintain that confidence themselves (Kohut, 1977). The tattoo is an external symbol while being an actual part of one's body that is a conscious reminder and has the potential to unconsciously hold self-

cohesion and self-identification when the functions have not been fully internalized as selfstructure. In the example of someone looking for a reminder of strength from their tattoo, they may have seen an example of strength in their development. That need to internalize strength may not have entirely been consolidated, but the tattoo reminds them of that example and therefore aids in self-cohesion and reduces the risk of fragmentation.

Tattoos are attached to affect, which is crucial in defining the self (Scorides and Stolorow, 1984). Affects are reflections of someone's experiences, including those with selfobjects and how they are perceived. People develop the self within the self/selfobject relationship. This development occurs through their affects which often need to be affirmed by functions of selfobjects, typically accomplished with caregivers in development. The function of the caregiver can be internalized when the affect response of the caregiver is congruent with what the child expects. The caregiver is able to provide what the child needs by affirming their affect. Since the child is in the process of internalizing the function of the caregiver, they anticipate the same affect as they have, so they can relate to it as part of themselves. This connection supports the child's affect; over time, the child can tolerate a disruption as long as they have been sufficiently affirmed in the past. When not met with affirmation, a person is at risk of fragmenting from affect responses (Kohut, 1977; Scorides and Stolorow, 1984).

Kohut (1977) describes the importance of affect states with self formation. When affects are appropriately responded to when younger, individuals can integrate multiple emotional states and internalize the affirmation they received. Since this is something the child can utilize to build confidence, they have a better chance of being able to self-soothe later on. The soothing that once came from a selfobject function is something they can internalize and do with themselves. They will have the space to explore those emotions since their affect has been adequately

responded to, therefore internalizing it and being able to affirm on their own with their feelings (Kohut, 1977).

As Kohut (1977) discusses, psychic continuity suggests that a person's self is a product of all their experiences and environmental influences. Knowing these environmental aspects of a person allows them to better know themselves internally. The consistent pieces of the person make up their psychic continuity. This concept connects to affect and explains why people look for responsiveness from others in order to maintain that continuity. Often with tattoos, the recipient is looking for some type of affirmation from others, specifically when the image is visible to others. This affirmation could be either an indicator of self-soothing in a familiar way or seeking affirmation as the person may struggle to do it for themselves. If someone is looking to self-soothe by getting a tattoo, it could mean that they lacked the self-soothing function provided by a selfobject in development. The tattoo could then provide that unmet function and be something the person depends on to better self-soothe.

In contrast, if the person's self-soothing needs were met in development, they may want to get a tattoo as a reminder of those functions to maintain self-cohesion. They may be drawing from past experiences where selfobjects have provided the function of security or reassurance, for example. The addition of others seeing it could reaffirm the presence of the tattoo and be a reminder of the selfobject function. If someone is seeking affirmation from others, they may be basing their decision to get a tattoo on wanting certain responses from others that could affirm a specific meaning for them. This meaning could be something the recipient sees as an identifying quality for themselves and by others seeing it that would qualify their connection to the idea (Kohut, 1977).

Psychic continuity relies on memories, according to Ornstein (1994). Memories come from an individual's personal narrative, which will always be through their unique perspective their history, environment, and other elements of the self. These memories help people know themselves and allow others insight into them as well, especially in theory and practice. The continuity of memories allows people to form a better idea of the self. Continuity also risks interruption by traumatic memories. These types of memories are not simple single-episode memories but fragments that can scatter into different levels of consciousness, including repressed memories. Integrating those into personal narratives allows people to maintain their psychic continuity more comprehensively (Ornstein, 1994; Tolpin, 1971). This idea suggests that narratives are essential for maintaining identities as the tattoo holds the memory that holds the narrative.

G. Tattoos as Narratives

From a theoretical perspective, having a narrative is more about connections and coherence than it is about the "truth" of what happened. Language is a way to communicate that narrative. Symbols are a form of language, which suggests tattoos can be a type of narrative if the person is trying to convey something. A structured narrative contributes to a structured self.

If one feels disconnected from the past (e.g., through lack of memory), one will feel disconnected from the self (Ornstein, 1994). Tattoos are then connected to this self psychological concept as they aid in memory, therefore allowing people to feel connected to themselves. This connection would be an unconscious process, whereas the narrative itself could be conscious. Memory also implies lived experiences (Ornstein, 1994). A tattoo based on a narrative from memory reinforces being alive and having the experience associated with it by using a tattoo image to communicate it. Also, memories associated with intense emotions are remembered

better. Would this lead to thinking people unconsciously want to continue remembering, and a permanent tattoo is a way to ensure that remembrance? This possibility seems likely as people seem to get tattoos based on more memorable or significant ideas.

Oksanen and Turtiainen (2005) discuss the connection between identity and tattoos as personal narratives. They looked at modern-day tattoo culture and how tattoos are more mainstream than in the past. Having tattoos suggests that the body itself allows for narration and seems significant in forming some individuality. One can project their perceived identity into their tattoos, and others will see that story. Some people report their tattoo being a signifier of becoming an adult. Many get tattoos to commemorate events, both negative and positive. Some do it to embrace the cultural acceptance of it, and some to rebel against societal judgments. Some report wanting to express themselves through tattoos, and some deliberately want to hide behind them (Oksanen & Turtiainen, 2005). Through these narratives, it is crucial to note that there is a broad range of reasons people get tattoos; some even seem to conflict with others. This concept highlights the truly individual psychological process one experiences when choosing to get a tattoo.

For many, the visibility of the tattoo is part of the narrative. Brooks (1993) recalls the story of Odysseus and how his scar was able to identify him to others upon his return to Ithaca (Brooks, 1993; Oksanen & Turtiainen, 2005). The idea of someone’s identity and personhood being conjured by a marking specific to them helps explain the appeal to seek out an intentional marking like a tattoo.

Oksanen and Turtiainen (2005) discuss how Tattoo magazine provided a narrative platform to people when they asked them to pose in pictures showing their tattoos and discuss their conscious reasons for getting them. This opportunity allowed people to describe the

conscious meanings behind their tattoos and explore the idea of exposing themselves in the magazine. Many reported that the tattoos they showed in the magazine were not fully visible to others because they could negatively affect their careers. This finding seems to indicate a level of safety they felt by allowing visibility in the magazine. One would think many more people would see their tattoos when utilizing that print platform, but perhaps the participants felt the viewers would be part of the tattoo culture that would not be judgmental. The authors note that the participants were able to create their narratives which gave them a sense of control while also not being able to control how others interpreted them, which is why people perhaps choose to cover them (Oksanen & Turtiainen, 2005).

Rosenfeld et al. (2020) discuss a shift in perceived identity due to the COVID-19 pandemic that could be relevant when people think about their tattoos, especially if they are interviewed during the pandemic. The authors suggest some uncertainty that can occur when something like the pandemic happens, and it causes people to reflect on their selves. Some people have developed a higher sense of purpose in life due to the threat the virus poses. For others, their identities are shaken, and it becomes more challenging to think and feel in ways they regularly would, which can cause some unease. They also could develop different ideas on how others will view them, which could affect tattoo meanings since there is a societal component to how they will be perceived. People often turn to groups to feel inclusion and generate a more solid identity when this happens. This group inclusion aids someone in feeling more confirmed in who they are and solidifying their attributes (Rosenfeld et al., 2020), as also discussed above, referencing Bell (1999) and Grumet (1983). These ideas are necessary to consider as external

factors that affect someone's internal perception of themselves and what they define as meaningful, including tattoos.

H. Intersubjectivity Theory

Intersubjectivity theory and the need for affect responses can give some insight into the different reasons people discuss for getting tattoos. When the tattoo is overt and visible to others, it likely requires the other to respond or at least notice it to affirm the affect. This response would be relational. Stolorow (1988) describes intersubjectivity theory and suggests that much psychoanalytic work relies on two subjective perspectives. From a developmental perspective, the environment in which someone grows up shapes how they develop; more specifically, the people around them are crucial in the development of the self (Stolorow, 1988).

Subjectivity lies in the idea that people have their own individual perceptions. There arguably is not an objective reality between two people regarding interpersonal interactions. Each person represents their own subjective reality of the same relationship or conversation. People can participate in that by being introspective and reflecting on their inner selves or being empathic and perceiving the affect of the other. The combination of these empathic responses allows for intersubjective interactions (Stolorow, 1988).

Stolorow (1988) highlights the importance of dialogue in achieving this intersubjective interaction. This dialogue seems to include verbal and nonverbal language and could include communication employing symbols, like tattoos. What occurs is an empathic understanding of what the other is communicating. When looking at this concept from a therapist/patient lens, the therapist would typically assume the role of someone paying specific attention to these empathic responses and encouraging them. This concept looks different when it occurs in a nontherapeutic setting and is much less conscious. In any situation, the empathic responses will rely

on what someone is able to perceive of the other while having their own internal processes. Therefore, an encounter with someone will not be the same as with someone else. No two therapists would formulate the same analysis because of the differences in their own processes (Stolorow, 1988).

The reality of situations like these is always subjective. This subjective reality becomes more apparent as intersubjective communications occur. Stolorow (1988) discusses how some of this process is conscious and some unconscious. In a therapeutic setting, for example, a patient may come into sessions discussing ideas they are curious about or have identified as problematic. On an unconscious level, the patient organizes the themes in distinctive ways that a therapist may be able to perceive through the dialogues and understand some meanings not outwardly mentioned (Stolorow, 1988). Unconscious communication is especially apparent in therapeutic relationships where the therapist does not consciously disclose anything about themselves. The client can often infer information about how the therapist thinks or even some objective information about them based on reactions and responses (Orange & Stolorow, 1998). This inference would similarly be possible in non-therapeutic settings where people engage in dialogues. One person communicates something, and the other empathically hears it from their perspective. The dialogue becomes something unique between both people rather than a simple sum of the two separate sets of ideas. With non-verbal communication, such as seeing someone's tattoo, the separate viewer likely perceives the symbol differently than the person who has the tattoo. Even if seen similarly, the viewer perceives it through their personal, subjective reality. If verbal communication occurs, it could bring the subjective perspectives about the tattoo closer together, though never matching exactly. Unconsciously, those thoughts get attributed to the tattoo and the person who has it. An example of this concept could be someone with a common

tattoo image, perhaps one associated with mainstream culture. One that comes to mind is a tribal tattoo around someone's upper arm. When a tattoo like this becomes common, sometimes it is seen as unoriginal and disliked by others, especially those with many unique tattoos. If someone makes that judgment, they are perceiving it through their subjective lens and inferring something about the person that may or may not be accurate. The person who got the tattoo may have wanted to choose something mainstream to be more culturally acceptable, or they could have some unique connection to the symbol. If there is an opportunity to increase communication, there could be a chance to formulate an empathic understanding of the other (Stolorow, 1988).

I. Categories of Tattoos

When looking at tattoos through this lens of consciousness and unconsciousness, it is necessary to distinguish between the types of tattoos and the reasons for getting them. Based on the above literature review, this study looks at both conscious and unconscious affects, each in hidden and visible tattoos. The data is based on narratives from people with tattoos. This researcher anticipated four categories of tattoos: visible conscious, visible unconscious, hidden conscious, and hidden unconscious. A tattoo is considered visible if it is able and intended to be seen by many or any, and a hidden tattoo is described as for the recipient only. The conscious aspect of a tattoo is what someone states it means to them and what the outward symbol is the external symbol of affect. Unconscious tattoo meanings would be the functions the person does not know they serve, like when someone gets a tattoo to hold onto someone they have lost.

● Visible tattoos with a conscious motive would seem to suggest pride in the outward expression of the image with the need to receive some feedback. An example of this concept could be someone hoping to open a discussion with others about the tattoo to be able to tell a story, or allowing the tattoos to infer a story without the person having to

explain. It could mean they want comments from others that would affirm something for them, even if those are adverse comments that could separate the person from others. The person could consciously want others to see them as part of a group, like a music crowd, cultural group, gang, or something else that would connect them to others who would know the symbol and identify with that same group.

● Visible tattoos with unconscious motives would be the affirming of some character traits about themselves. This concept is primarily unconscious as the affirmation process occurs on an unconscious level. Someone may consciously express some confidence in their visible tattoo while feeling fragile internally and needing that validation. Similar to how Orange and Stolorow (1998) describe unconscious self-disclosure in therapeutic environments, a person with a tattoo may be communicating some things to others with their tattoo that they do not realize. This communication could convey qualities about them that may not have been a conscious motive when getting the tattoo.

● Hidden tattoos with conscious motives could be on people looking to remind themselves of the tattoo's meaning without needing others to validate it. Someone may be utilizing the tattoo as a partial transitional object so they know it is there and can check it when needed. The tattoo can also be so personal to them that they specifically do not want others to see it because of some protective functions, like keeping the bond between a loved one close to them and not wanting to share that. Additionally, a tattoo could be largely hidden but visible to a select person or few people if the conscious need for it is on an intimate level. For example, the image may be something personal and meaningful between a couple, and the exclusivity of only one other person being able to see it would be an attempt to strengthen a relationship. The recipient may choose to hide a tattoo

because they are worried about what others may think. They may hide the tattoo because others would not understand the meaning of the symbol itself, or the image may be offensive if it is sexual or explicit, for example. The person may also choose to hide the tattoo because of the stigma against tattoos in workplaces or for cultural or religious reasons. Hiding a tattoo would allow the person to choose with whom to share It.

● Hidden tattoos with unconscious meanings may suggest some shame about having one or having some specific image on them. By not allowing others to see it, they would not have to face the reality of having it as often. It would still provide some function for them, possibly internalizing the object just by knowing it is there. By having a hidden tattoo, the recipient sees it less, especially if it is in an area that someone would not see even if they remove their clothes, such as their back or behind their ear. Placing the tattoo in a hidden location could create some distance from it, and the person would not have to experience the shame as much. Something about getting the tattoo would serve a function, but not seeing it could signify some internalized shame. The tattoo could represent some events that may have some negative ideas associated with them. If the recipient projects their own thoughts onto it, it could allow them to split their thoughts and have the tattoo represent an unfavorable object, and not seeing it could allow them to feel separate from it. For example, someone might want to emotionally separate from a war tattoo or something representing a traumatic event.

J. Summary

This research has shown that tattoos have a long history with humans, signifying different meanings throughout history. Some of those meanings are ancient, in the way of physical healing, and some transcending time, like getting tattoos to indicate status or

achievement. The meanings vary from person to person through aesthetics to object representation. Tattoos can hold cultural significance. People may want to feel different from large groups by getting tattoos to either feel separate from a larger population or closer to subgroups. Psychologically speaking, tattoos can serve different functions, either consciously or unconsciously. The psychological ideas about tattoos have been primarily theoretical. What is missing is the attempt to glean psychological significance from self-reported conscious descriptions people provide regarding the meaning of their tattoos and how others would categorize those meanings, which is explored in this study.

Chapter III Methods

A. Introduction

This study aimed to evaluate the possible function of tattooing in the development of the self. The design was a mixed methods approach utilizing group concept mapping: quantitative and qualitative data from narratives and pictures of participants' tattoos were collected. In Phase I of this study, data was collected from 51 participants through survey interviews with them. The qualitative narrative data was utilized to create a short description of participants' tattoos via the method of photovoice based on their narrative responses. These descriptions accompanied the provided pictures. In Phase II, data was sorted and analyzed using concept mapping, which allowed for the generation of categories based on the content of participant responses. Fourteen people engaged in a sorting activity on the Group Wisdom Concept Systems software, where they viewed the tattoo images and relative photovoice descriptions and grouped tattoos together based on perceived themes. They titled these categories based on the themes they generated. The concept mapping software created a point map from the sorting done by the 14 participants. It also generated visual cluster maps with multiple options for cluster quantities. The clusters were generated, displaying how similarly participants conceptualized and sorted the 48 tattoos in the study. Finally, 11 recruited participants from Phase I participated in a focus group in Phase II. They discussed the cluster meanings, decided on an appropriate quantity, and engaged in a discussion of themes with each other.

To best explore the functions tattoos serve, this study addresses the following seven research questions

(a) Do tattoos help people develop a more cohesive sense of self? (b) What

are the individual theoretical concepts that should be used to understand the drive to get tattooed? (c) How do tattoos help people develop a sense of self? (d) What are the various conscious motives people identify for getting tattoos? (e) Does position on the body, specifically if the tattoo is hidden or visible to others, signify something either consciously or unconsciously?

(f) Does the meaning of the tattoo change based on how an outsider sees it and assumes meaning, compared to the original intent of the recipient? Does that matter to the development of the self?

(g) What similarities or connections, if any, are there between people’s reasons for getting tattoos?

This chapter discusses the methodology for this study, including (a) the rationale for using a mixed methods design, (b) the population chosen for this study with a focus on justification of inclusion and exclusion criteria, (c) an overview of the steps of the research process, (d) means of data collection with rationale for using photovoice, (e) explanation of data analysis and justification for the use of concept mapping, (f) ethical considerations, (g) an evaluation of validity and reliability, and (h) any limitations to the study.

B. Rationale for Mixed Methods Design

In order to obtain data to best answer the research questions, the participants engaged in verbal interviews with this researcher. Some questions were multiple choice and were later analyzed in a quantitative frame with SPSS (Statistical Package for the Social Sciences). Some questions were open-ended and narrative in a qualitative format, requiring photovoice and concept mapping to best analyze. A subjective report was necessary to fully understand the participants' experiences of tattooing and their individual meanings behind the act or the images. Qualitative research is exploratory and descriptive (Daley, 2004) and, in the case of this study, relies on personal interviews. Cresswell (2007) emphasizes the importance of deducing themes

through qualitative research while focusing on the participants' natural experiences. Qualitative research is advantageous when an issue exists that requires a complex understanding. The concept of tattooing fits into this as there are many possible reasons for getting tattoos, ranging from the act of getting one to the meaning behind the images, as discussed. In this study, obtaining information from personal narratives allowed the researcher to receive the best comprehensive information to answer the research questions. Engaging in narrative interviews for data collection can empower the individuals as they discuss their thoughts and explore meanings. This narrative type of interview also allows for flexibility and can give the participants more power by being so involved in the process (Cresswell, 2007).

Kane and Rosas (2017) highlight the importance of the participant's voice, specifically in group concept mapping. Encouraging the participants to speak freely about their thoughts not only yields more complex data but emphasizes the importance of the individuals' narratives. This technique has a deeper meaning in some fields, such as social work and mental health, where the goal is often to focus on the individuals' voices for better representation. By understanding the specifics of someone's perspective, value is given to them, and the results are more connected to the person (Kane & Rosas, 2017). This method also mimics a therapeutic encounter with a client where a therapist might ask questions and allow the client to answer freely, typically yielding more honest and personal responses. While this study has a clear topic and intent to gather information, the benefits of encouraging a participant to engage in free-flow dialogue are related to some of the psychological theories discussed in Chapter II, where the individual is more likely to tap into some real and meaningful thoughts.

To initiate the interviews, this researcher asked potential participants if they had at least one tattoo related to their identity. During the interviews, participants were asked to identify a

tattoo they defined as most tied to their identity. It was up to the participant to select that tattoo–this could have been one singular tattoo or something broader. These options were not directly suggested; participants were simply asked to identify one. These tattoos were discussed in narrative form. Participant narratives reflected their decision about their meaningful tattoo and what that significance meant to them.

C. Rationale for Concept Mapping Methodology

In order to best address the study questions, concept mapping was utilized. Concept mapping is an effective method for interpreting and analyzing qualitative information (Daley, 2004) and transforming the qualitative data into a visual map showing relationships between data points. This method allows for the exploration of topics in an open manner as it encourages participants to generate their own ideas. The goal is often to look at this provided information to better understand the participants' perspectives and sometimes facilitate change, such as in a company or through social policy (Kane & Rosas, 2017; Kane and Trochim, 2007). Through the concept mapping process, data is plotted on a visual, spatial map and shows how concepts are related to each other, and sometimes highlights the importance of the items. This map displays the variety of responses, how related to each other they may or may not be, and also adds additional value when participants identify which they find most important to them. All items have a space on the map, representing all voices. This representation is especially significant for social work-related studies such as this one, as amplifying voices is often a mission prioritized in the field. Any spatial connections seen between data points suggest that those responses seemed similar to the participants who completed the sorting task. Discussing connecting factors can be meaningful as comparisons can be made. When a connection is not made or items seem dissimilar, this does not make the data less meaningful; this could suggest something more

unique about the responses. Concept mapping can be effective because there are multiple ways to find meaning (Kane & Rosas, 2017; Kane and Trochim, 2007).

Group concept mapping allows the researcher to construct a framework of data obtained to show the complex relationships between them. The role of the researcher is crucial for the structure of the study. As much as the participants can provide open responses, the structure set by the researcher will guide the study in the direction of gathering data that is on topic, ultimately allowing for the most appropriate responses and analysis. The researcher designs the project, which includes setting the focus and identifying the type of participants most appropriate. They then collect the data and ensure the responses are related to what is being asked (Kane & Rosas, 2017; Kane & Trochim, 2007). Knowledge about implicit and explicit information can be gained by looking at the narratives given by participants and extracting themes that will later show on the concept map (Bloomberg & Volpe, 2012). The researcher analyzes said responses, ensuring accurate comprehension, and interprets those results. The participants are involved in the analysis to check if the responses seem consistent with the results (Kane & Rosas, 2017; Kane and Trochim, 2007). The focus is on finding the meaning(s) of the qualitative data given by participants (Daley, 2004). Ravitch and Riggan (2012) in Bloomberg and Volpe (2012) suggest that a concept map can be a way to understand data through a theoretical lens, which is a psychological framework in this study.

Multiple reviewers contributing to the concept mapping process generate categories based on themes seen in the data and sort the available data into these categories. A pictorial graphing of the data is typically created through software, and a visual representation of the data is formed (Haque & Rosas, 2010). Concept mapping is a practical tool when qualitative data, such as in this case, comes in the form of open-ended questions, often leading to long narrative

answers. A large amount of data can be represented in just one page of mapping, allowing for a holistic understanding of participants' reports by condensing data into a map. Additionally, since reliability is essential, participants can be shown the maps to check if it accurately represents what they meant in their responses (Daley, 2004).

Concept mapping provides a practical method to understand the meaning behind each participant's qualitative report and allows for linking themes between multiple participants' data to compare and differentiate. This function can assist when discussing different topics, for example, and finding similar themes throughout (Daley, 2004). As previously discussed, this also allows for finding meaning whether the data is either similar or different.

In this study, the qualitative data received from participants' narratives was made into a handout which allowed participants to sort the data into perceived categories. The software created a point map and depicted possible cluster quantity options that would ultimately be finalized with a completed concept map. Since these narratives included broad discussions of reasons people reported for getting their tattoos, the concept mapping process provided a better understanding of the frequency of and relation between categories. A discussion about possible implicit and explicit information will follow. Table 1 describes the steps in concept mapping (Kane and Trochim, 2007).

Table 1. Steps in a Concept Mapping Process

1. Preparing for Concept Mapping

1. Focus

2. Sampling and Participants

3. Scheduling and Logistics

2. Generating the Ideas

1. Brainstorming

2. Ideas Analysis

3. Structuring of Statements

1. Demographics

2. Unstructured Pile Sorting

3. Rating(s)

4. Concept Mapping Analysis

1. Multidimensional Scaling

2. Hierarchical Cluster Analysis

3. Bridging Analysis

4. Production of Maps

5. Pattern Matching

6. Bivariate Plots (“Go Zone” Plots)

5. Interpreting the Maps

1. Structured, Participatory, Stakeholder-Based Interpretation.

6. Utilization

1. Action

3. Evaluation Step 1: Preparing for Concept Mapping

During step 1, the researcher helps to manage the beginning of the process in collaboration with key participants to set the structure, expectations, and desired outcomes. Initially, the researcher, in this case, a doctoral candidate, works with the advisor to clearly articulate the desired outcomes of the study. The researcher then helps the group develop a specific focus for the study and ensures the selection of relevant participant stakeholders. The participants are identified, and logistics are discussed (Kane and Trochim, 2007; Trochim, 1989).

When developing the focus, Kane and Trochim (2007) recommend utilizing two statements to guide the participants: first, developing the focus for brainstorming sessions, and second, the focus for ratings. The brainstorming focus ensures that the prompts successfully yield results that fit the study's intention. The focus comes in specific instructions, and all participants must be in agreement. Brainstorming focus ideas may be related to goals, outcomes, or other possible topics. The rating focus could be about importance, relevance, or anything else that seems fitting to the topic of the study. Rating focus ideas may be related to how important brainstorming topics are (Kane and Trochim, 2007; Trochim, 1989).

The facilitator selects a group of people who have knowledge or experience about the topic being discussed in the study. This selection of participants aids in using a wide range of viewpoints regarding the rest of the steps and that the data collected will be applicable and related to the people whom this study seeks to understand. If the purpose is to argue that the concepts are generalizable to others, not providing a narrative in this study, a random selection of

participants is beneficial. The facilitator may also elect to specifically choose the population to account for a variety of perspectives. The number of participants can vary depending on the study, from fewer than 10 to hundreds, and not all participants need to participate in every step of the study (Kane and Trochim, 2007; Trochim, 1989).

This study aimed to discuss and learn more about tattoos and their meanings to the recipients. People with self-identified meaningful tattoos were the most knowledgeable in formulating ideas and possible outcomes. Participants with relevant knowledge would best be able to answer questions about meaningful tattoos. It was crucial that the narratives provided seemed appropriate and exhaustive of the main goal, which was also identified in this step.

Step 2: Generating the Ideas

In this step, concept mapping begins. People brainstorm many ideas freely. They generate statements based on the questions, and the facilitator writes down the participants' responses. There are no limits to the number of statements the participants generate, and there should be no judgments of statements in order to best allow for the free flow of thought. This method replicates a therapeutic setting, as limitations on a conversation can be disruptive and hinder productivity. Additionally, building off ideas is encouraged, so brainstorming in a live setting is ideal (Kane and Trochim, 2007; Trochim, 1989).

While there are no limits to the number of statements produced, many responses can pose difficulties for the following steps in the study. To correct this, the group edits what statements the study uses through thorough analysis and consideration of what best fits the topics. This process of idea analysis ensures a more focused approach to the prompts. Having fewer than 100

statements still allows for a wide range of ideas without being too vague (Kane and Trochim, 2007; Trochim, 1989).

Participants were asked to identify a meaningful tattoo and engage in an interview with the researcher via a live video platform. This step was significant when discussing tattoos because the narratives were so subjective. Because the concept mapping process measures and categorizes something subjective, it was crucial to understand and accept what someone said as their truth. Making the responses easier to compile simplified the step of comparing common responses. Therefore, simplified descriptions were generated so participants in Phase II could make connections between statements and agree on what they felt was similar.

This study's brainstorming stage was related to the number of tattoos and interview responses received. The number of items corresponded to the number of tattoo pictures received (48) and the short titles generated were based on the tattoo images for ease in identifying pictures quickly

D. Photovoice

Photovoice is a data collection method that relies on people telling stories related to pictures taken of something. It generates dialogue on a topic. A caption from the dialogue is attached as a caption to the picture taken (Haque & Rosas, 2010). Wang and Burris (1997) describe the importance of photovoice as a tool to better represent a community through pictures. It empowers the person taking the picture and allows the viewer to see the intended image as the photographer wanted, which leads to a higher chance of understanding the story the person is trying to tell. One goal is encouraging dialogue after viewing the pictures (Wang & Burris, 1997). Photovoice allows for a richer understanding of personal narratives, which is meaningful

as this study focuses on narratives for tattoos. When data collection involves narratives, the person's story is communicated more comprehensively and in their words. Readers and researchers accept the narratives as truth for the participants, and photovoice allows for a better representation of those truths (Mulder 2015).

Mulder (2015) suggests that photovoice brings depth to studies and decreases the tendency for generalizing populations. The author highlights the importance of the participants' explanations of their chosen photographs because that provides deeper insight into the images.

They also describe the importance of using photovoice for better dialogue. As discussed in Chapter II, language can be in the form of picture symbols and create a higher level of accessibility since pictures can create a better understanding than words alone. This deeper understanding is crucial for accessing communities that would benefit from more means to communicate.

Short descriptions of the data can replace entire written input in a concept map setting. Participants view the photographs with their respective captions when preparing to sort (Haque & Rosas, 2010). Having both images and words represents the data in more depth and clarity for the concept mapping process.

For this study, photovoice provides a means to view and understand the tattoos as the participant describes. The combination of image and description is crucial since the participants' narratives are only the conscious individual parts of the stories. Viewing the tattoo image with the photovoice description allows the reader to formulate their own thoughts while reading what the participant said.

Step 3: Structuring the Statements

This step involves an explanation of how the statements generated in Step 2 are related to each other. The demographic for this step is decided: the participants could be people in the organization if the goal of collecting data is for a company or other system, or individuals if the study is not part of some larger structure. This study recruited individual participants. Typically the statements are written on cards, and the researcher asks participants to sort them into piles. This method allows participants to see all statements at the same time in order to sort them most effectively. This step can also happen electronically through programs allowing someone to move statements into groups. This researcher provided virtual methods for participants to engage in this step. When using photovoice, pictures with captions serve as the statements. The statements are sorted by proximity based on how the participants think they relate or are similar. Each statement must go into only one pile, they cannot all go into the same pile, or go into their own pile. Participants are encouraged to sort as they see most fit, and each participant's sorting may differ (Kane and Trochim, 2007; Trochim, 1989).

This step provides a greater examination of the relatability of participants' narratives. Putting statements into categories demonstrates how participants perceive each statement. This step is vital as it includes an external data perspective beyond what the initial statements say. The sorting process also allows for differences in all sorters' perspectives as they may relate to or categorize a statement in various ways. This range of perspectives is helpful in understanding the global impact of an individual's tattoo meaning.

Step 4: Concept Mapping Analysis

In this step, the statements' spatial locations on the map become visible. A multidimensional scaling analysis puts each statement on the map and suggests a relation to each

other. When the statements are closer, people piled them together more often, and when farther apart, less often (Kane and Trochim, 2007; Trochim, 1989). Non-metric multidimensional scaling spans ideas over two dimensions to measure multiple relationships simultaneously (Kane & Rosas, 2017). The system creates maps overlaying the ratings either by cluster or point. A hierarchical cluster analyzes nearby groups and related statements into clusters that are part of a larger, more comprehensive concept (Kane and Trochim, 2007; Trochim, 1989). During this analysis, the relationships between concepts become more meaningful and valuable to the organization or group leading the study (Kane & Rosas, 2017).

In this study, a visual representation map was developed based on how people perceived the narratives and tattoo images relating to each other. Participants already provided narratives, but this map makes the connections more tangible. This step was helpful in understanding how similar or dissimilar the tattoo concepts were, and the meanings of those relations were essential for the next step.

Step 5: Interpreting the Maps

There are multiple elements contributing to understanding the items on the map. The original statements from the brainstorming step and the clusters from the previous step are again utilized. The researcher reviews possible cluster quantities with participants. Participants are asked if they feel the clusters best represent the data. Once decided, the researcher confirms the final cluster map with the participants. The statements are presented as they were clustered. Participants are asked to think of a word to describe that cluster of statements. The group works to decide on a name for each cluster. If an agreement cannot be achieved, the researcher can suggest combining the ideas for names into a hybrid name. After the group decides on names,

they examine the number point map. This map shows that the items placed closer together were piled together more often. The participants then look at the cluster map, which visually shows what they looked at on the cluster list. They write the names the group formulated for each cluster and look at the map with the names to see if it makes sense. The researcher may also ask the participants to identify regions of clusters that make sense. The software displays the regions, and the group comes up with names for the regions. This process is considered the conceptual framework resulting from concept mapping. The facilitator gives the participants point rating and cluster rating maps. Again, the participants decide if they make sense and generate ideas about the evaluating task's implications (Kane and Trochim, 2007; Trochim, 1989).

This step in this study ensured that tattoo meanings were represented well on the map. The goals and ideas generated before about tattoos still needed to be addressed, and meaning needed to be inferred. The names of the regions became the general meaning ideas from the participants. Again, this group agreement ensured a higher level of relatability and transferability of these ideas to others with tattoos.

Step 6: Utilization of Maps

The group considers the information and data gathered from the previous steps and discusses how the final map can affect the evaluation of the topic. The group can use the map for many different purposes depending on what they are evaluating or planning. These purposes could include restructuring something within an organization or generating some understanding of the information from the study. Evaluation can be in the form of understanding patterns and measuring certain concepts to re-evaluate later (Kane and Trochim, 2007; Trochim, 1989).

This researcher has mentioned therapeutic relationships as a destination for the information in this study because of how closely people tie their tattoo(s) to their identity.

Exploration of identity is often a goal in psychotherapy and gives additional purpose to this study. However, there might have been other ways to utilize this information. The group, already having knowledge on the subject, was encouraged to formulate ideas for other uses of this information.

E. Research Sample

Participants were selected via a multistage design. During Phase I, potential participants were asked if they had at least one tattoo they felt connected to their identity. Once confirmed, this researcher sent them a consent form (see Appendix A) to complete and scheduled an interview time. As discussed, the interview included quantitative and qualitative questions, and also included a question about willingness to take a photograph of their tattoo to share with this researcher for this study. This researcher hand documented responses herself. The initial goal for Phase I was to target a minimum of 50 survey interview responses and 51 were obtained. The goal for Phase II was 10 participants and 11 were obtained.

The population consists of a nonprobability sample as there is no general list of tattooed people. Members were recruited via a snowball method through word of mouth, participants knowing other qualifying participants, and social media posts. This snowball method was the best option since the main inclusion criterion of having tattoos can be rare among the general population. The participants for this study needed to have at least one tattoo that they found meaningful to their identity, however they personally defined that. The researcher excluded any

family members and those who might have a tattoo that could create a bias or conflict of interest. Participants did not receive financial or other compensation for this study.

F. Demographic Information

Demographic information was collected from the participants of this study in Phase I interviews. This data included basic information such as age, gender, socioeconomic status, religiousness, and race. Some quantitative questions were multiple choice, and some required participants to fill in a response (such as, "What is your gender?"). This quantitative data was ultimately analyzed using SPSS.

The perceptual information is what the participants report as their reflection of the subject of the study. This information was obtained by interviewing participants who provided a narrative discussion as a response. This narrative discussion included questions about tattoos and why participants chose to get them. The questions focused on understanding the relations to their identities. They were asked to identify a specific tattoo that was meaningful to them and discuss their responses with that tattoo in mind.

G. Research Design

The following list summarizes the steps used to carry out this research.

1. Conducted interviews with 51 participants and secured photos of their most meaningful tattoos, which were eventually paired with photovoice descriptions.

2. All descriptions were compiled into a list, written in common tense, and checked for redundancy and fit. The final list was entered into the Group Wisdom Concept Systems software.

3. Eleven core group members sorted the final items based on a principle of similarity. This sorting task occurred within the concept mapping software.

4. The rating step was not included in this study.

5. The concept mapping analysis was performed by concept mapping software. The software completes this by plotting points near each other based on the sorting stage results and creating cluster maps.

6. Using the concept mapping software, the participants helped develop the final concept map by choosing the number of clusters they felt was appropriate and naming them accordingly. They also interpreted and made sense of the map by discussing themes and concepts.

7. These participants checked the face validity of the final concept map and ultimately agreed on the final product.

8. This researcher analyzed and discussed data from the interviews and concept mapping process.

H. Data Collection

As discussed, the demographic questions were part of the Phase I interview. Participants were emailed the interview questions prior to their individual meetings so they could see the questions during their interview. This researcher interviewed participants via video platform to observe COVID-19 safety precautions. Participants were asked to discuss their responses to the questions on the survey, and this researcher recorded responses by documenting them on a password-protected computer in real-time.

The demographic questions were partially based on a survey instrument that asks details about tattoos: "Stories on the Skin: Tattoo Culture at FAU" (Leader & McCarthy, 2010). However, this instrument was modified to focus on demographic questions relevant to

understanding tattoos from a self psychological perspective to focus on the self functions tattoos provide for participants.

I. Phase I: Tattoo Survey

The complete survey (see Appendix C) for Phase I interviews was created based on multiple surveys: one used in "Inked Lives: Tattoos, Identity, and Power" (Garcia-Merritt, 2014) and the other in "Stories on the Skin: Tattoo Culture at FAU" (Leader & McCarthy, 2010). This researcher sought and used questions that allowed the participant to provide information about the tattoo through visual description, stylistic preferences, intentions, and information about themselves. This researcher modified and added questions to integrate the specificity of this study, including questions about personal narratives of the tattoo and psychological meanings they associate with it, especially pertaining to identity. Additional questions were added to offer participation in the concept mapping portion of this study

At the end of the survey, participants were asked if they would send a picture of the meaningful tattoo they had been discussing in the interview via email. While all agreed, ultimately, 48 participants executed this task. The photovoice descriptions were generated by this researcher from the qualitative interview data collected. All narrative data was considered and condensed into a few sentences that this researcher felt best captured the meaning as reported by the participant.

Before this study, this researcher ran a preliminary study where some people were interviewed in person. This researcher asked the pilot participants the survey questions to evaluate the questions' quality and understandability. Narrative data was collected to see if the answers fit what was asked. In this pilot test, the participants adequately answered the questions

as intended, and the questions asked seemed to allow for a broad and inclusive narrative. This preliminary study is discussed in more detail later in this chapter.

J. Phase II: Data Analysis

Photovoice descriptions were paired with the respective pictures of tattoos that participants singled out as most important to their identity. The pictures with captions were then sorted into categories based on how the participants felt they related to each other. Participants viewed on a map where the tattoo data fell and noted the proximity of the items. This proximity was based on how they determined the items to be related to each other. Participants were able to collectively decide what quantity of clusters best represented the data. They labeled the clusters of items as they saw fit. Lastly, they utilized the information received to infer and discuss any implications about the meanings of tattooing and identity.

K. Ethical Considerations

The COVID-19 pandemic has introduced a new set of ethical concerns for research involving participants. Rosenfeld et al. (2020) discuss the effects of this pandemic on lifestyle and research methods. They suggest the goal to be researching while being aware of these ethical concerns and continuing to strengthen the field of science.

Because of the pandemic, much research that would otherwise occur in person has ceased. This halt is due to many health and safety concerns when physically near someone else as the COVID-19 virus is contagious (Rosenfeld et al., 2020). The virus creates a vulnerability that researchers must protect, per the Belmont Report (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1979). Rosenfeld et al. (2020) suggest that these precautions should continue until herd immunity is achieved. Since participants' health needed to be prioritized, video software was the safest route to conduct

research. This study complied as it was unclear when herd immunity would be achieved. Using video software also broadened the pool of potential participants since it allowed access to a virtual interview method that did not pose physical limitations as would going to an in-person location. (Rosenfeld et al., 2020). As the data collection stages of this study took place during many high rates of COVID-19, video platforms were utilized. Video platform usage was continued to maintain consistency and allow participants in different regions of the country to still participate.

Participants were asked to sign informed consent forms prior to beginning the study. The consent form identified the researcher and the purpose of the study. Benefits and risks were defined, as well as confidentiality boundaries. The participants were informed that they could withdraw from the study at any time for any reason or choose not to answer a question. Lastly, the consent form contained information about whom to contact with questions or concerns. These items were reviewed at the beginning of the interviews, and participants were encouraged to ask questions to ensure understanding (Cresswell, 2003).

The researcher attempted to minimize any risks. This study included voluntary participation in sharing life experiences which had a psychological aspect. Since pictures were taken and shared, this researcher was prepared to honor any privacy requests of participants since a tattoo is an identifying feature. While the risk of psychological distress was expected to be low, the possibility was still discussed with participants and evaluated throughout the entire length of the study. Participants were made aware of the steps when screening them and would have been discouraged from participating should they have anticipated any issues for themselves. This researcher was prepared to intervene if any distress was detected and offer resources to participants should they have needed any.

L. Issues of Trustworthiness

To best ensure credibility, the researcher monitored any potential biases she might have had throughout the study. She has tattoos and is familiar with the tattooed community. Because of this, she likely already has a favorable opinion of people with tattoos. This opinion could have put a positive bias on participants' interview responses. In order to address this, she kept a journal of personal reflections throughout the study. Also, the fact that there were 51 participants in this study increased credibility by providing multiple responses as sources of data. Member checks were also performed to conclude if the participants agreed with the analyses (Bloomberg & Volpe, 2012).

M. Dependability

The results of the study were analyzed through concept mapping. In order to increase dependability, three reviewers who did not participate in Phase I took part in the sorting task. Additionally, the Phase II discussions enriched the study and contributed to the dependability as other participants could discuss and interpret the data collected in Phase I. While some reviewers categorized responses similarly, leading to increased credibility, the fact that the clusters were based on qualitative data suggests that reviewers naturally viewed the data through different lenses. According to Bloomberg and Volpe (2012), challenging discrepancies can increase credibility.

N. Limitations and Delimitations

A delimitation of this study is that it was predicated on recruiting non-random samples.

Random selection is often ideal as participants would have an equal chance of being selected (Cresswell, 2003). However, the inclusion and exclusion criteria created a smaller group of

people to potentially sample. Random sampling would have recruited a large number of people, many of whom would not have fit the criteria asked. Also, because there is no sampling frame of people with tattoos, the best way to find potential participants is through word of mouth. Therefore, non-random sampling was the best choice. Another delimitation of this study is that people who do not consider their tattoo(s) to have specific meaning to their self-identity did not respond to the prompt to be a participant in this study. It should be acknowledged that not everyone views their tattoos to have specific conscious meaning to their identities. Since this study examines responses from people who find meaning attached to their identities through their tattoos, some tattooed people would particularly not fit the criteria and were naturally excluded by the wording of the prompt.

A limitation of this study is that participants who were successfully recruited consciously reported why their tattoos have influenced their self-identity when the conscious thought process can differ from a person's unconscious motives. In the self psychology framework, many of the functions people seek are unconscious. In order to combat that, this researcher noted interpretations of verbal responses and non-verbal communications in the researcher's journal. Subsequent participants in Phase II were also instructed to look for any possible additional meanings in the tattoo data. These meanings are discussed in the results section of this paper.

This discussion helped increase the chances of finding the most accurate responses possible without the ability to uncover participants' unconscious motives. However, it cannot be guaranteed that all unconscious processes were exposed.

It is worth noting that video interviews can pose some economic pressures or limit participants if they do not have access to the necessary technology. Additionally, some people

may have been affected by the COVID-19 pandemic with financial hardship or unexpected psychological responses. Rosenfeld et al. (2020) discuss some people developing new fears, social behaviors, and different worldviews due to the pandemic, as well as identities being reformed. Some people feel more attached to groups to maintain identities, which could present in participant responses when it may not have as much as before (Rosenfeld et al. 2020). While video interviews broadened the possibility of sample recruitment to those located in a different region than this researcher, that could have also posed limitations to those who do not have access to the required technology or those affected by COVID-19 in new psychological ways.

O. Role and Background of the Researcher

The role of this researcher was to facilitate the data collection and execute the concept mapping method. It was essential to ensure participants engaged in each process step and allow the group to formulate and interpret the necessary items for concept mapping. This researcher has prior experience with quantitative studies related to amnesia research. She also has tattoos and works with many clients who have tattoos, which spawned her interest in performing a study such as this.

In the previously discussed preliminary study, the goal was to interview people about their tattoos to formulate ideas of information needed for this study. Three people participated in this trial study. This researcher asked people she knew who had tattoos to participate in this study. They were asked a few qualifying questions to ensure they fit the requirements for the preliminary study. Since this study focuses on people's tattoos and their relation to the self,

preliminary participants were asked if they felt they had at least one tattoo that they felt meant something to their identity. They all responded that they did.

Some questions about the participants' tattoos felt more straightforward, and others felt more complex. They included the age they received their first tattoo: two said 18, and one said 19. There were some questions about the visibility of tattoos. All the participants reported that their tattoos were not always entirely covered; however, the degree to which they were visible differed. One had to cover hers for her job, and two had to cover theirs in front of their families.

All were proud of showing their tattoos to others.

The questions that were more difficult for the participants to answer required more thought in their responses. These questions were about how they felt when perceived by other people. Two participants reported they had been made to feel bad and discriminated against for their tattoos. One said their tattoos frightened someone. One person reported regretting at least one tattoo, but none of the participants had tattoos removed or altered.

The questions that required people to think most deeply were the ones that related to their identities. All three reported that their tattoos had meaning to them. All three also discussed how they felt better about their appearances with tattoos, stating they felt more comfortable and unique. One mentioned that her tattoos helped her remember parts of her life.

The participants were asked to think of one specific tattoo that they felt related to their identity. Participants all picked one that was on some part of their arms. The reasons participants felt they related to their identities were different. One participant stated she had wanted her tattoo since she was young and it related to her heritage. One participant had a tattoo that was a commemoration of her uncle who had passed away. The last participant got his tattoo to

represent his spirituality and connectedness to Buddhism. All participants said the meanings of their choice tattoos did not change over time.

All three participants reported that their tattoos made them happy when they got them and that they were still happy with them. Also, all three reported they would agree to have their tattoos photographed. Lastly, all three participants said that they would agree to be in additional studies related to this dissertation.

After the interview, participants were asked if they felt comfortable discussing their tattoos with this researcher, and they said they did; it seemed like they liked talking about their tattoos. Since all participants were proud of their tattoos, it makes sense that they enjoyed the opportunity to talk about them to someone. Even the more complex narrative questions did not seem to be a burden on the participants. The reasons they all said they received their tattoos were personal and not always apparent to someone unless they were asked about them.

After concluding this preliminary study, this researcher was confident in pursuing the main study. Participants were happy to discuss their tattoos and responded appropriately to the prompt, suggesting the questions were worded well to best answer the research questions. Therefore, the same interview questions were used for this study.

A. Introduction to Results

This study aimed to explore the psychological functions that tattoos serve for the people who get them. The goal was to better understand if and how tattooed people utilize tattoos in the development of their sense of self. This researcher used a mixed methods approach with group concept mapping to process the collected data. These were the seven research questions posed in this study:

1. Do tattoos help people develop a more cohesive sense of self?

2. What are the individual theoretical concepts that should be used to understand the drive to get tattooed?

3. How do tattoos help people develop a sense of self?

4. What are the various conscious motives people identify for getting tattoos?

5. Does position on the body, specifically if the tattoo is hidden or visible to others, signify something either consciously or unconsciously?

6. Does the meaning of the tattoo change based on how an outsider sees it and assumes meaning, compared to the original intent of the recipient? Does that matter to the development of the self?

7. What similarities or connections, if any, are there between people’s reasons for getting tattoos?

For Phase I, 51 participants identified that they had at least one meaningful tattoo they connected to their identity and were willing to be part of an interview process for this study.

Phase I consisted of this researcher interviewing those participants. The interviews included demographic questions, multiple choice questions about their tattoo(s), and some open-ended questions where the participants could engage in a narrative discussion with a free-flow discussion mentality. All quantitative survey data was analyzed using SPSS. Qualitative data from narratives in the form of photovoice was summarized in descriptions and paired with respective pictures of the participants' discussed identity tattoos. These photovoice descriptions were summaries of the narratives provided in the interview questions and placed under the photographs (see Appendix D).

In Phase II, group concept mapping was utilized to sort and analyze collected data. A total of 14 participants sorted the data collected in the narratives from Phase I into categories they created that made sense to them. This researcher utilized concept mapping software, Group Wisdom Concept Systems, to create a visual map representing the sorting results, showing how similarly participants conceptualized and organized the 48 tattoos in the study. Then, 11 of those 14 participants participated in a final focus group to discuss the findings, decide the number of clusters, name the clusters, and engage with this researcher in a process of meaning making.

B. Phase I: Survey Results

1. Sample Description

The sample for Phase I consisted of participants of any adult age who had at least one tattoo that they considered tied to their identity. The resulting sample was 51 participants obtained through word of mouth and social media posts asking for participants who fit the criteria. The participants were instructed to email this researcher confirming they had a tattoo

tied to their identity and were interested in the study. Once received, this researcher sent them an Adobe link to read and complete/sign the Phase I consent form (see Appendix A). Following the signature submission, a link was sent to schedule a meeting time for the virtual interview. This researcher used the website www.calendly.com to schedule the interview times. This site allows one to enter their availability based on their electronic calendar. Since the site is connected to that calendar, it would automatically conceal any times that were not available as the schedule changed. This system allowed participants to see open availability and did not require this researcher to confirm it immediately. Many noted and appreciated the simplicity of this method, as scheduling can often feel burdensome. Lastly, leading up to the interview, participants were given a link to a private virtual meeting platform on www.doxy.me, which is HIPAA compliant. They were also told they would be on camera as conversing with someone they could see felt more natural. When it was their scheduled time, the participant and the researcher logged on and began the call. For ease, participants were given a copy of the questions so they could follow along since some questions had many answer choices, and it would be easier for them to read along with this researcher.

In the interviews, the interviewees were asked to speak their answers out loud for each question posed, and this researcher hand-recorded the responses. The same questions were asked of each participant in the same way, and they were encouraged to answer questions openly and honestly. When participants had questions, this researcher would provide clarity but still encourage them to answer the questions based on what it meant to them when hearing the wording. This encouragement of openness was critical since many questions about identity and personal details could have had different meanings to different people. All the interviews took

under 30 minutes, and most took between 20-30 minutes. Time was not limited and participants were encouraged to speak as much as they wanted for the narrative responses.

As previously noted, the survey questions were based on two surveys: one in "Inked Lives: Tattoos, Identity, and Power" (Garcia-Merritt, 2014) and the other in "Stories on the Skin: Tattoo Culture at FAU" (Leader & McCarthy, 2010). The questions were modified to better focus on participants' perceptions of tattoos as part of their identity. This modification allowed the questions to better fit within the self psychology theoretical framework. The complete survey can be found in Appendix C.

2. Participant Survey Interview Data

The participant demographics for Phase I are summarized in Table 2. The average age of participants was 37.45 years old. The youngest was 22 and the oldest was 71. The participants were asked to identify themselves in their own words regarding their genders. There were 36 (70.6%) women, 12 (23.5%) men, two (3.9%) gender queer/non-binary participants, and one (2.0%) gender fluid participant. There were 39 (76.5%) Caucasian participants, eight (15.7%) Hispanic, two (3.9%) Asian, and two (3.9%) Native American.

Most respondents, 33 (64.7%), reported themselves as middle class when asked about their perceived socioeconomic status. Then nine (17.6%) said upper middle class, seven (13.7%) said lower middle class, one (2.0%) said poor, and one (2.0%) said wealthy. Religiousness and spirituality were combined in one question, and 23 (45.1%) reported being religious or spiritual but not observant, 15 (29.4%) said they were not religious or spiritual, 10 (19.6%) said they were moderately observant, and three (5.9%) said they were very observant.

Table 2. Phase I: Participant Demographics (N=51)

The demographics specific to tattoos and tattooing are summarized in Table 3. This researcher reconfirmed that each participant had one or more tattoos, with all 51 (100%) reporting yes. The responses for the number of times tattooed ranged from one to 34, with an average of 8.20. The number of tattoos ranged from one to 32, averaging 7.59. The number of times tattooed was defined as the number of times someone sat with an artist for any period of time in one day. The number of tattoos someone has was defined as the number of artwork pieces someone has, and this was left to them to define. For example, someone might see a sleeve, which typically encompasses most or all of someone's arm, as one tattoo or many tattoos. There were questions to differentiate between the number of times sitting for a tattoo and the number of tattoos a person has because one tattoo could take multiple sessions to complete, and alternately, multiple tattoos could be completed in one sitting. Although the number of times they were tattooed was differentiated from the number of tattoos participants had, the average numbers were quite similar.

Participants reported on how long ago they got their most recent tattoo completed, with 26 (51.0%) reporting more than a year ago, 12 (23.5%) saying 2-6 months ago, eight (15.7%) saying within the last month, and five (9.8%) 7-12 months ago. Most participants, 33 (68.6%), reported it was very likely they would continue to add tattoos to their body, 14 (27.5%) said it was somewhat likely, and two (3.9%) reported it was not likely for them. The age at which participants got their first tattoo ranged widely from 12 to 65, with 24.18 years old being the average. The age of 18 was the most commonly reported age for a first tattoo, with 17 (33.3%) participants reporting that age, whereas other ages were reported with a maximum of four participants. This finding is noteworthy as 18 years old is typically the legal age to get a tattoo without parental permission.

Demographics specific to the experience of being tattooed are summarized in Table 4. When asked if their tattoo(s) are visible to the general public, 22 (43.1%) participants reported usually, 16 (31.4%) said sometimes, 10 (19.6%) said always, and three (5.9%) said almost never.

This question was generally interpreted as asking how often tattoos were visible when wearing everyday clothing and people going about their usual schedules. Additionally, 41 (80.4%) reported they enjoy showing their tattoos, 10 (19.6%) said that varied for them depending on different situations, but zero participants reported they did not enjoy showing their tattoos in some capacity. When asked if people intentionally covered their tattoos for any reason, 36 (70.6%) reported no, while 15 (29.4%) said yes. Of those who said yes, their reasons varied and encompassed multiple different personal scenarios they would choose to cover, ranging from

Table 3. Phase I: Participant Tattoo Table (N=51)

personal choices, such as their tattoos having meaning to them and wanting to keep private, and some environmental demands, such as jobs that did not allow tattoos.

Most participants (32 [62.7%]) reported they had been made to feel bad by others for having tattoos, and eight (15.7%) reported being discriminated against, which was defined as being denied opportunities based on their tattoos. Additionally, six (11.8%) reported that their tattoos had frightened someone at some point. For these last three measures, the rest of the respective participants reported no, and all of these responses were based on participants' selfreported perceived experiences.

Most participants reported being happy with their tattoos in some way, with 39 (76.5%) reporting they never regretted getting tattooed, 50 (98.0%) never having one removed, and 37 (72.5%) never having a tattoo altered or covered. The rest of the respective participants reported yes to each of those without more detail.

Of the 32 participants who reported they had been made to feel bad about their tattoos by others, 11 (34.4%) also reported they choose to cover their tattoos for various reasons. Additionally, of the 32 participants who reported they had been made to feel bad about their tattoos by others, 11 (34.4%) reported regretting getting tattooed at some point.

Of the eight participants who reported being discriminated against, three (37.5%) reported choosing to cover their tattoos for various reasons. Of those eight who reported being discriminated against, five (62.5%) reported regretting getting tattooed at some point.

Of the 12 participants who reported regretting tattoos at some point in their lives, the following are the ages they got their first tattoos: 12 (1), 16 (1), 17 (1), 18 (8), 19 (1). This finding does not necessarily suggest they regret their first tattoos at those ages. Of the 39

participants who had not regretted getting tattooed, the lowest age when they first got a tattoo was 18 (9), and the rest were higher ages.

Discriminated Against Because of Tattoos

If Their Tattoos Have Frightened Someone

Table 4. Phase I: Participant Experience of Tattoo(s) (N=51)

Table 5 includes summary data related to the "identity tattoo." Toward the end of the interview, participants were asked to choose one tattoo they felt was most part of their identity. This researcher did not steer participants into any understanding of the word "identity" and instead left that up to the participants' interpretation. This open interpretation enriches the study as identity can mean different things to different people, and all meanings are relevant to this study. The age ranges for getting the tattoo most part of their identities was vast, ranging from 14 to 65 years, with an average of 29.65 years. It should be noted that three (5.9%) participants' data was missing from here, likely from researcher error as this question was asked in between narrative questions and easier to miss when someone was in the middle of telling their story.

Most participants (46 [90.0%]) reported having a regular story they tell or would tell strangers who ask about the tattoo that is most tied to their identity. The stories varied in depth as some would tell just as much detail as shared with the researcher, and some would share a condensed version. Those responses were given narratively. Participants were then asked if the meaning of that one tattoo has changed over time, and 31 (60.8%) reported not at all, 17 (33.3%) reported somewhat, three (5.9%) reported quite a bit, and zero reported completely. Their explanations were given in narrative form and spanned many different reasons. These responses were utilized with other narrative data for photovoice description formation.

When asked about motivation for getting the tattoo most tied to their identity, 44 (86.3) participants reported that it was their own decision, and seven (13.7%) said they were encouraged by someone else. Most participants (49 [96.1]) were happy with the immediate results of that one tattoo, and all 51 (100%) were happy with it at the time of the interview. The improved number sometimes came from people getting the tattoo altered or appreciating it more than when they got it. However, this question was not measurable; some participants offered that information. When asked if there was any element of secrecy in the one tattoo tied most to their identity, most (39 [76.5%]) reported no, and 12 (23.5%) reported yes, with reasons varying. These responses were utilized with other narrative data for photovoice description formation.

Lastly, the vast majority (50 [98.0%]) were both 1. willing to share a picture of the tattoo most tied to their identity with this researcher and 2. willing to let other participants see the picture. Though 50 reported they would share a picture, 48 participants provided a picture, and those 48 photos were utilized in Phase II of this study. The data from the remaining three was only utilized in Phase I results. All 51 (100%) participants reported they were willing to participate in Phase II of this study. Many noted how much they enjoyed talking about their

tattoos in the interview and wanted to continue participating so they could hear about others' tattoos. Table

If They Are Still/Currently Happy With

Any Element of Secrecy in Tattoo’s Meaning

5. Participant Discussion of Identity Tattoo(s) (N=51)

This researcher generated a handout representative of the narrative results and collected pictures of Phase I. On this handout were color images of the 48 provided tattoo pictures and relative photovoice descriptions based on the narrative responses. This handout represents the findings of Phase I, minus the three participants who did not provide a picture. This document was given to participants for Phase II sorting stage. This handout can be found in Appendix D.

C. Phase II: Concept Mapping Results/Focus Group

1. Photovoice and Qualitative Data

Phase II of this study required participants to sort the photovoice into categories and engage in the concept mapping process. The participants would do this by organizing the photos provided by participants in Phase I into meaningful groups with each other, noting similarities and differences. In order to prepare for Phase II, this researcher utilized photovoice to generate descriptions. As discussed in Chapter III, photovoice is a data collection method that allows a

description to accompany an image to create a more comprehensive and cohesive understanding of the participants' responses. This method was significant for this study as some tattoos have surface meanings, and some are only known through the participants' explanations. Thus, the participants were given the pictures in a handout and a photovoice description under the pictures based on the participants' qualitative survey data. This researcher read through the collected narrative data, pulled out the most prominent points, and summarized those in photovoice descriptions under the photos. This method allowed the participants in Phase II to see the pictures and generate their own ideas of meaning while also seeing what the tattoo holders said themselves about their respective meanings. A handout was made with the tattoo photos and respective descriptions (see Appendix D) to ensure the participant could adequately see the full image of the tattoo (2 photos per page). Some photos were resized to achieve this, and some were cropped to remove unnecessary background imagery and only show the tattoo. This researcher listed the tattoos in concept mapping software with numbers corresponding to the tattoos on the handout and a brief name or phrase describing the tattoo image for ease in referring back to the handout. For example: "Photo 5: Cattleya Flower '' or "Photo 40: Lightning Could Strike." These were generated based on easily identifiable words within the tattoos or descriptions of the images. These brief descriptions were the brainstorming result of this researcher and her chair; they generated short titles based on the tattoo images, and the quantity corresponded to the 48 photos. These appeared on the concept mapping software as rectangle boxes with "Photo (number) Photovoice: (Brief description of image)" inside.

2. Sample Description

The participants for Phase II were recruited from the participants in Phase I. Since all participants reported being interested in Phase II in Phase I interviews, this researcher sent an

email asking participants if they still wanted to participate in Phase II and instructions on how to do so. They were told they would engage in individual sorting. Then in the focus group, participants would further discuss sorting and the results. They received a link to electronically complete the Phase II consent form (see Appendix B) and another link to select possible times they would be available for a virtual focus group meeting. The consent form was uploaded to PDF Filler, where participants could electronically read and sign the form on the website. The scheduling link was through www.whenavailable.com. On this site, this researcher entered 13 possible time frames to choose from over the next two weeks and asked participants to choose all available times. The time with the most participants available would be picked. Once completed, this researcher chose the most popular time, resulting in 11 available participants who could commit to the meeting. Three additional people were able to complete the sorting task, one was unable to join the focus group meeting, and the other two were this researcher and her dissertation chair who would refrain from providing input during the group discussion.

3. Demographics

Demographics for Phase II participants are summarized in Table 6. The participants' ages in this Phase II ranged from 27-49, with an average age of 34. The ages are relatively evenly distributed in this range, with three people in their 20s, six in their 30s, and two in their 40s. There were seven (63.6%) women and four (36.4%) men in this focus group. Most (nine) of the Phase II participants were white (81.8%), and there was one (9.1%) Asian participant and one (9.1%) Hispanic participant. Eight (72.7%) participants reported being in the middle class, and the remaining three (27.3%) reported being in the upper middle class. Six (54.5%) participants were not religious or spiritual, three (27.3%) were religious or spiritual but not observant, one (9.1%) was moderately observant, and one (9.1%) very observant.

Table 6. Phase II: Participant Demographics (N=11)

Demographic summaries of tattoos and tattooing are summarized in Table 7. The number of tattoos these participants had ranged from 1-11, with 3.18 being the average. The ages of their first tattoos ranged from 18-49 with a fairly even distribution. Six (54.4%) participants' tattoos are sometimes visible to the general public, three (27.3%) usually, and two (18.2%) always. Most (nine [81.1%]) participants reported enjoying showing their tattoos to others, while two (18.2%) reported it varies. Four (36.4%) participants cover their tattoos at times, while seven (63.6%) do not. Four (36.4%) participants had been made to feel bad about a tattoo by someone else, and seven (63.6%) reported not having that experience. None of these participants experienced someone else being frightened by their tattoos or discriminated against. Nine (18.2%) participants regretted getting tattooed, and two (81.8%) did not. All 11 participants in Phase II reported having a regular story they tell strangers about their identity tattoo. Six (54.5%) reported needing to be encouraged to get their identity tattoo, while five (45.4%) reported it was their own decision.

Table 7. Phase II: Participant Experience of Tattoo(s) (N=11)

4. Photo Sorting

The participants were asked to participate in a sorting exercise to prepare for the focus group. Participants were asked to review the handout with all 48 provided photos and photovoice descriptions for this exercise. They were also asked to think of category titles the tattoos would fall into based on their perceived meanings of the tattoos, which again included what they saw when looking at the image and reading the photovoice descriptions. While one tattoo could have multiple meanings, the participants were instructed to focus on a central meaning or the meaning that seemed to be the most prominent when thinking about what types of category piles they would generate. They were instructed on how to use the concept mapping software so they could create these categories and drag and drop the tattoo description boxes into the appropriate categories. Participants each received login information for this software website and created categories based on tattoos' meanings. They could then add other tattoos to the same category or create a new one. They were encouraged to think of meaningful connections when doing this. They were told to not make only one category, not make 48, and not make a "junk" pile." All tattoos had to be categorized in some way based on meaning. They were given ample time (two weeks before the focus group meeting) to complete this task and were encouraged to take breaks as needed as the software would save their work. They were instructed to review the categories, and once they felt they had sufficiently completed the task, to hit the "Finish" button on the site and wait to discuss more in the upcoming focus group. They were also encouraged to ask this researcher any questions along the way to ensure they fully understood the task. When reviewing the sorts from the 14 participants, it was clear they were successful in categorizing based on their perceived meanings of the tattoo images and descriptions in the

handout–all sorting achieved the goal of the prompt. The point map resulting from the sorting analysis can be found in Figure 1.

5. Cluster Analysis

In the point map (see Figure 1), each point has a number next to it, which indicates which item it was in the sorting task. This number is not the same as the listed tattoo numbers in the handout; it is an arbitrary number generated by the concept mapping software (see Appendix E) A point's location indicates whether that outcome (tattoo) was sorted nearer or farther away from other points. The bridging value is an index of how closely related a point is to its region on the map. That value ranges from 0-1: if a point is closer to zero, it suggests that point is closer to that central cluster meaning and less often sorted with points in different regions; if a point is closer to one, it was more often sorted with and therefore connected to other regions (Brennan et al., 2012). The item with the lowest bridging value was point 31 (Photo 19: "Birthstone Flowers"; 0.00), and the item with the highest bridging value was point 48 (Photo 2: "Beloved"; 1.00). These values add to the multidimensional analysis that concept mapping provides, demonstrating a more complex understanding of proximity. All the items' bridging values can be found in Appendix G.

During the group meeting, 11 participants, plus this researcher and her dissertation chair, gathered via Zoom video platform to discuss and interpret the findings on the map. Most of the clusters (all but Cluster 2) were represented by participants who attended this meeting, suggesting a robust representation of tattoo clusters. This researcher previously prepared maps showing different quantities of clusters to show participants. During the focus group discussion, she asked the participants for input on what quantity of clusters best represents the data. They decided that eight clusters felt the most appropriate, with the main reasoning being that increasing to nine would separate pet tattoos from tattoos about family members, and participants strongly felt that the tattoos about pets should be included with the other kinds of memories that were represented with family tattoos. This cluster was ultimately titled "Homage." They also

Figure 1. Point Map of Tattoo Meaning Outcomes

decided seven clusters felt too few, noting differences in what became clusters "Journey" and "Pride" and seeing significant reasoning for those to be separate clusters or separate constructs. An eight-cluster solution was determined by participants in the discussion and interpretation meeting, noting that they felt the clusters to be different enough from each other and indicate a meaningful representation of the tattoos inside each. This group discussed emphatically and cohesively, ultimately without disagreements with the final solutions. The final eight cluster solutions (in no particular order) are 1: Self-Discovery, 2: Pride, 3: Journey, 4: SelfAcceptance, 5: Heritage, 6: Connection, 7: Familial Bonds, and 8: Homage. These numbers do not indicate any specific meaning or ranking; they are simply identifying numbers (see Figure 2). An itemized list of tattoos in each cluster can be found in Appendix F.

Figure 2. Eight Cluster Map of Tattoo Meaning Outcomes with Point Map

Cluster 1 seemed simple for participants to label as "Self Discovery." They suggested this title was fitting because the tattoos in this cluster related to how people viewed themselves or came to view themselves. Cluster 2 provided some difficulties in finding an overarching meaning, with people noting key differences in the tattoos' meanings; however, "Pride" was ultimately seen as a commonality and, again, differed from Cluster 3. Initially, Cluster 2 was given the temporary name of "Prideful" by the concept mapping software based on some sample titles participants generated in the sorting task. Participants agreed that "Prideful" had a negative connotation, and the tattoos in this cluster were more positive in design. Cluster 3 led to difficulty deciding a name, and participants noted many possible appropriate meanings. Two participants in the discussion had tattoos in that cluster and were able to provide additional insight. This cluster included specifics about health, hobbies, and travel, making it more difficult to find a common theme. However, ultimately the group decided that they each shared a commonality of a meaningful journey, thus naming that cluster "Journey." Cluster 4 was noted to be similar in some ways to Cluster 1, but participants discussed a vital difference of accepting identity through those tattoos, thus naming it "Self-Acceptance." Cluster 5 seemed simple for others once ruling out the idea of "cultural" as not all tattoos included that element. In order to highlight the importance of culture in some tattoos and acknowledge some meaning that fell outside of that description, they felt "Heritage" best represented the cluster. For Cluster 6, participants struggled most with a description that included all four tattoos that were in there. It is worth noting that this cluster is closest to the middle of the map compared to other clusters, suggesting the points in this cluster were paired with points throughout the point map. In order to find a more central meaning, participants thoroughly reviewed the tattoos on the handouts. One participant had a tattoo that was in this cluster and was able to provide insight to aid in the

decision of the cluster as a whole. The participants ultimately decided on the name "Connection" since that could mean a connection to others in their lives or even the tattoo artists. Cluster 7 seemed simple to name, but participants wanted to add more specificity as this cluster represented some meaningful connections. The concept mapping system populated a possible title of "Family." Participants felt that was too vague, so they decided "Familial Bonds" would better represent this cluster since the tattoos represented a way to feel closer to others and did not simply represent family members. Finally, Cluster 8 contained multiple tattoos relating to experiential memories, memories of people, and, as mentioned, memories of pets. Notably, some of these tattoos were related to death, and some were not. Participants stated that "In Memoriam" felt "too dark" and did not fully include all tattoos. In order to best represent this cluster to honor the range of memories, participants felt "Homage" would be best. These clusters are discussed in more detail in Chapter V Discussion and their bridging values can be found in Appendix H

6. Group Interpretation

Participants were encouraged to make general comments after deciding on clusters and cluster labels. One participant noted there were many tattoos about queerness, though none of the clusters seemed to represent that exclusively, and other participants agreed. He wondered about tattoos in the queer community and how people often take pride in them; since queerness is part of people's identities that they often feel they need to hide, getting tattooed is a visualization of taking a stand against hiding or the pressures to be heterosexual/cisgender. Additionally, he felt the tattoos' permanence helps with acceptance of that queerness. Another participant saw value in that and added that they did not want to use queerness as a category because they saw other meanings beyond queerness in the tattoos.

Others noted that all these tattoos were essential parts of who the recipients are. This point could be due to the nature of this study asking for participants whose tattoos have meanings tied to their identity but overall wondered about tattoos as a whole and their meanings. They noted that someone might be able to quickly and randomly pick a tattoo without much initial meaning, which is a meaning itself, such as spontaneity. Additionally, some people spend much time and consideration when getting theirs, showing surface-level meaning but also possibly deeper with themselves with the amount of thought they put into it. One participant reported disliking the image of her first tattoo but feeling it still has much meaning to her. Others noted that sometimes the images themselves have meanings, and sometimes the people one goes with or the artist one gets tattooed by are what hold the meanings.

Someone noted that all the tattoos in this study seemed to be about something that has already happened to the receiver, compared to something more ongoing, like a mantra or motto. Even when some tattoos represented something people wanted to carry with them into the present/future, they seemed to have been sparked by something in the past. There was a heavy presence of remembrance, spanning multiple topics, with the tattoos they all viewed, and many agreed.

One participant suggested they did not realize the specific meaning of her tattoo until doing this study. She felt she had some loose ideas based on jumping from one point in her life to another, but this study allowed her to see a bigger picture of meaning rather than randomness. Another participant continued this thought process noting he felt similarly about his. That participant discussed when he got his tattoo and how it was on a whim, but after some time, he realized the story behind getting it was tied to his identity, and it encompasses him more than he previously thought.

One participant discussed the symbolism of having a tattoo permanently and how that allows something to become part of someone, quite literally, and how this can translate to being emotionally permanently part of them. They referenced tattoos about pets and how they live shorter lives than humans, so getting a tattoo of them when they have passed or even while they are alive is a way to hold onto them.

Someone discussed how the image of a tattooed person has changed over time, noting that at some points in time, someone with tattoos might have been seen as scary or dangerous. He noted that now, many people of all socioeconomic statuses have tattoos, and they are not seen as much as something dangerous but more as art. That participant also noted that even face tattoos, which historically were a boundary for many people, are even more prevalent, which he did not expect.

Another participant noted that getting tattoos changed some of the judgmental stances of people in her family. She noted that others even wanted to get tattoos after seeing hers, which is part of the meaning. This story revealed more than just the literal tattooed image but highlighted the connection to others around her. Multiple people noted that once they personally knew someone with tattoos, they viewed them as “not so bad” anymore.

Lastly, some talked about "tattoo culture" and how they feel that exists. They noted that they encountered many people who enjoy talking about their tattoos, which can be a talking point. Sometimes that talking point is not even about the tattoos, but when talking to a tattooed person, they anticipate they might be more kind or approachable. Many of the participants agreed and discussed a general feeling of community.

These stories echoed what many said in Phase I interviews; however, talking to other participants seemed to aid them in thinking more deeply about these topics. As some people built

off others' stories, they shared connections and differences interestedly. They seemed to enjoy the camaraderie and appreciate the variety of perspectives in this discussion.

D. Summary

This section restates the research questions and includes a presentation of data collection and results. This study had two phases for data collection. In Phase I, 51 participants engaged in individual interviews where they answered questions from a tattoo survey. Quantitative and qualitative data was collected. Photovoice was utilized in summarizing qualitative data. In Phase II, 14 participants sorted the tattoo data collected in Phase I, and 11 of those participants engaged in a final focus group. Phase II participants discussed clusters, made final decisions about the findings, and engaged in additional discussion about tattoo meanings. A total of eight clusters represent the findings and core meanings of tattoos this study found. A discussion of this data will be provided in Chapter V.

Chapter V

Interpretation of Findings

A. Phase I: Quantitative Data Discussion

The participants' ages ranged from 22 to 71 years old. This finding suggests that tattoos are essential to many ages for many reasons. This finding is consistent with people seeking identity confirmation at various ages. Identity formation begins at an early age but can be contributed to across the lifespan, which supports the concept of tattoos serving multiple functions and not just those associated with a certain age or point of development.

It is worth noting that most of the participants were women. While many people of other genders have tattoos, not as many responded to this prompt. This researcher sought participants of all genders, and curiously, mostly women responded. Of the gender fluid and gender queer/non-binary participants, their tattoo meanings seemed to reference their gender identities. In contrast, participants who are cisgender men or cisgender women did not always have that association. This finding connects to the idea that a tattoo can assist in forming someone's identity and raises questions about cisgender individuals possibly not needing to go through gender acceptance in the same way as trans, genderqueer, gender fluid, or non-binary individuals. Some tattoos of cisgender participants discussed topics of gender, but they did not tend to be the primary focus. This topic would require further research to better understand.

People of all races get tattoos, but this study attracted mostly Caucasian participants. It is unclear if there is any reason for this on a larger scale or if this is a result of the method by which this researcher obtained participants. More research would be needed to explore if race is a factor regarding getting tattoos related to a person’s identity.

Most participants identified as middle class. Interestingly, participants did not discuss their socioeconomic status much when discussing their tattoos in Phase I, outside of answering the quantitative question asking where they are in the socioeconomic spectrum. This piece of data could reflect that many people fall in the middle class overall, and it is unclear if that indicates the likelihood of getting a tattoo. Tattoos may be more associated with a privileged class due to cost, but additional research is needed to explore this further. More participants tended to have 10 or fewer tattoos, with 38 (74.5%) falling into those quantities, and 20 (39.2%) of those had only one or two tattoos. In the range of 11 to 32 tattoos, there were 13 (25.5%) participants. These findings suggests that people ranging from having few tattoos to many covering their bodies still benefit from having a tattoo connected to their identity.

It is unclear if people having more tattoos would report less meaning to their choices to get tattooed or if this represents the population where people tend to have fewer tattoos. Age could also be a factor where someone younger might have had less time to get many tattoos, not necessarily representing that they would not want many tattoos.

As noted, the age that saw the highest frequency of acquiring first tattoos was 18 years old. This finding is likely because the legal age for getting a tattoo is 18. More research would be needed to determine when someone first wanted to get a tattoo. However, this finding does suggest much interest in getting tattooed in adolescence/young adulthood, which relates to other research that notes the importance of tattooing and discovering identity at those stages of life (Grumet, 1983).

Notably, the 12 participants who regret getting tattooed at some point in their lives all got their first tattoos at 19 or under. It is unclear if their first tattoos are the ones they regret, but there seems to be some indication of being younger when getting a tattoo and having regrets at some

point. Additional research would be required to further understand any conclusions related to this.

The findings also suggest a higher level of tattoo regret for the participants who have been discriminated against. With five out of eight participants (62.5%) regretting tattoos, it would be worth exploring if their discrimination contributed to the regret. Additionally, of the participants who reported being made to feel bad about their tattoos at some point, there also seems to be a higher prevalence of them wanting to cover their tattoos or regretting their tattoos at some point as well.

Participants seemed to take pride in their tattoos being visible to the general public as only three fell into the "almost never" category, and zero fell into "never." People can choose to get tattoos that would never be visible, but interestingly no one in this study reported that their tattoos are never seen. Since participants reported that their tattoos somehow connect to their identities, this could suggest a correlation between having meaningful tattoos and wanting some degree of visibility. This finding is supported by the fact that 41 (81.4%) participants reported enjoying showing their tattoos. As many people take pride in their identity or learn to over time in the development of the self, the tattoos that represent them could also connect to that pride.

The ages at which participants got the tattoos most connected to their identity ranged from 14 to 65. Within this, a few ages included more participants than others but nothing remarkable. Additionally, the higher ages saw slightly fewer participants in each. Finally, the ages when people first got a tattoo compared to when they got their meaningful tattoos did not differ much. The average age for getting their first tattoos was 24.18, and the average for getting their identity tattoos was 29.65. That finding shows a slight increase in age but does not indicate

that the tattoo a person associates most with their identity would consistently occur later than their first or later in life.

B. Phase II: Quantitative Data Discussion

While all participants in Phase I noted they would be willing to participate in Phase II, some could not join due to scheduling conflicts. No participants reported changing their minds about that decision; they either did not respond to the Phase II query or could not accommodate the date picked. As these statistics are reviewed, this should not be considered a reflection of people's lack of willingness to participate in this Phase II.

The age range of participants in Phase II was still wide, spanning 27-49. With only 11 participants in Phase II, this was a decent representation of the study as a whole traversing three decades of age. The average age was 34, which is also close to the average age of participants in Phase I, which was 37.45. This fact was important as different ages and generations might differ in views and discussion of tattoos, so this enriched Phase II.

Gender representation in Phase II was a similar percentage to Phase I. However, it is worth noting that no genderqueer/non-binary or gender-fluid participants could participate in Phase II. Race was similarly represented in Phase II as well. However, no Native American participants participated in Phase II. It is unclear if the lack of representation on these data points was due to any specific reason or simply happenstance. Not all socioeconomic statuses were represented, but the ones that were resulted in similar percentages to Phase I.

The percentage of people who reported they were "religious or spiritual but not observant" was lower than in Phase I. There was a higher representation of participants who were not religious or spiritual in this Phase II focus group. It is unclear if there is any specific reason for this shift in representation or if this impacted the findings of Phase II.

The number of tattoos these participants in Phase II had ranged from 1-11, and 3.12 was average. The average for Phase I was 7.59, so Phase II represented a group with fewer tattoos overall. It is unclear if this was due to any specific reason or if this impacted the findings of Phase II.

Tattoo visibility in Phase II also reflected a percentage change from Phase I, with more representation from those who reported their tattoos sometimes being visible and less from those who reported they are usually visible. The percentage of enjoyment of showing tattoos was similar to the percentage of Phase I, as well as choosing to cover tattoos. There was a higher representation of those who have not been made to feel bad about their tattoos compared to those who have had that experience, compared to Phase I. Perhaps these findings indicate more willingness to discuss tattoos in a group setting, though it is unclear as this was not explicitly discussed.

Even though Phase I had higher percentages of people reporting both not being discriminated against and their tattoos not frightening others, it is noteworthy that in Phase II there was no representation of any participant who reported "yes" to either of those. These categories seem to represent upsetting topics to people who have tattoos, as reported in the narrative data of Phase I. Those participants may not have wanted to discuss tattoos in a group setting, though again, they made up a small percentage of Phase I, so that conclusion is unclear.

With all 11 participants in Phase II reporting having a regular story for their identity tattoo, this could indicate enjoyment of talking to others about their tattoos in a forum setting such as a focus group. Additionally, 90.2% of participants in Phase I reported a regular story associated with their tattoos. This finding could also suggest a willingness to participate in this study since many participants already had regular tattoo stories they tell others.

Interestingly, even though most participants reported it was their decision to get their identity tattoo, in the Phase II focus group, there was a higher representation of participants who had been encouraged; of the seven people in the study who reported needing to be encouraged to get the tattoo, six of them were in the focus group. Perhaps those who need encouragement to get tattoos have a broader perspective of the process and more willingness to talk about tattoos.

C. Revisiting Research Questions

As previously discussed, there is much information on the history of tattoos and how they have evolved. Some researchers and historians have theorized what tattoos mean to people, but there is a gap in research on how tattoos or being tattooed specifically affect someone's sense of self. Discussing participants' experiences with tattoos allows more exploration to better answer the study research questions.

1. Do tattoos help people develop a more cohesive sense of self?

This study called for participants who already had at least one tattoo that was meaningful to their identity. When thinking about this question, it is clear that many participants referenced ideas that could connect a tattoo to developing their sense of self. In addition, even though tattooed people worldwide might not consider their tattoos meaningful compared to their identity, 51 people responded affirmatively to this study prompt, suggesting that some people consider their tattoos part of their identity.

Participants discussed how tattoos seem to have meaning for people in some form or another. Even the idea of a tattoo having "no meaning" to some people was still discussed as a meaning in and of itself. The choice to permanently alter one's body signifies something special for people, as discussed by the participants in Phases I and II. Therefore, it was difficult for participants to imagine an absence of meaning.

As previously discussed, people utilize selfobject functions to form their sense of self. A strong or cohesive sense of self would indicate that someone can cope with situations and tolerate the ruptures in life in a way that feels balanced and self-aware. As people build their selves through childhood development and ultimately adulthood, they internalize selfobject functions and learn to provide those functions for themselves (Kohut, 1977; Scorides & Stolorow, 1984). While some have theorized that there is a connection between tattoos and the psyche, this study aimed to discuss specifics. While this was a small sample compared to the total number of tattooed people worldwide, tattoo meanings within this sample (as depicted in the concept map) shows that a psychological connection exists furthermore, the focus group discussion allowed for access into why and how.

Some participants discussed how their tattoos have specifically helped them heal or remember. This concept demonstrates a relationship with the tattoo that provides the function of finding or maintaining a sense of strength and emotional resilience. As the tattoo provides this psychological function, the self can reorganize structure to provide greater cohesiveness. When someone reports getting a tattoo to help them through a life struggle, they consciously note that they did so to help themselves. Sometimes the tattoo is a result of a coping mechanism someone engaged in, for example when some participants did something difficult, they got a tattoo to commemorate it. This act felt like a symbol of resolution to them. An example of this act was the participant who got the dates of her breast cancer diagnosis and dates of remission. Another participant completed the Ironman competition and got a tattoo after. Each of these examples highlights the person's capability to hold a feeling of strength, the tattoo functioning and allowing the self to hold strong from complete disintegration.

Some other participants noted that getting the tattoo was part of their life or coping process, not just the end of it. Some participants chose tattoos related to their genders and felt it was a helpful piece to carry with them. One person noted that she chose a tattoo to remind her of her children and specifically be a focal point in a stressful work environment. A participant got angel wings on her back to signify who she became after enduring trauma (an angel to be a light for others), indicating her current identity. Another got a tattoo of her grandmother's and mother's letter salutations, another of her dogs' ears, another of her dog's paw print–all to feel like they could carry those relationships with them. Those meanings did not need a completion; they were ongoing and acted more like a permanent transitional object (Blum, 1978; Karacaoglan, 2012).

Some participants discussed their tattoos and implied coping functions without directly saying those words. This implication suggests some unconscious or less conscious understanding of the functions tattoos can serve for people. For example, one participant reported wanting to go to the same artist as her boyfriend and not thinking of any more meaning than that. After some discussion, she mentioned being married to him now and finding that tattoo to be a fond memory with more emerging meaning. This example was likely an act of connecting with someone else meaningfully, even though she did not realize that then. Another participant reported getting a tattoo on a whim after winning it in a contest. He later processed how his tattoo had more meaning than expected, signifying his ability to be spontaneous, now representing transitions in his life as he changes. That meaning was unknown to him at the time, but it is possible he unconsciously appreciated himself as a spontaneous person who also knew that a tattoo would not be something he would regret; otherwise, he could have declined the tattoo prize. Of course, the deeper unconscious meanings are not entirely known by this researcher since this was not an

attempt at psychoanalytic therapy, but the statements the participants provided undoubtedly hint at some deeper meanings they were not, and might still not be, fully aware of that suggest a connection to the formation of the sense of self in an unconscious way.

All these examples connect to the selfobject functions of tattoos, which provide an opportunity for the self to reorganize fragmented components into a more cohesive structure with greater capability to endure stressors. Knowing psychologically how humans develop a cohesive sense of self and some ways to utilize selfobject functions to cope, these tattoo descriptions fit those functions. While all the selfobject functions will not be known to this researcher, this study indicated the presence of at least some.

2. What are the individual theoretical concepts that should be used to understand the drive to get tattooed?

As previously discussed, self psychology provides a theoretical lens to best understand the connection between tattoos and people's identities. Through this theoretical framework, some central concepts become relevant. The concepts of "sense of self," "selfobject," "internalizing selfobject functions," and "cohesive self" have been discussed much in this study and are essential terms to better understand the drive to get tattooed (Kohut, 1977; Scorides & Stolorow, 1984). Through some discussions, participants noted how tattoos helped them process difficult times, remember and feel connected to others, and even celebrate something. These participants could have chosen a different method to represent their tattoo intent, such as writing something down or holding something in their memory. However, making something tangible, visible, and permanent became appealing to participants at some point. Some participants even noted overcoming potential judgment from others if they got a tattoo and chose to despite that possibility. This act suggests some level of importance in getting tattooed and that tattooing

assisted them with their intentions. The choice to get the tattoo highlights importance because that action is so intentional. This concept connects to some conscious and unconscious elements of self-psychology. Infants are capable of having their physical and psychological needs met early on. The simple act of a smile brings the parent closer, providing comfort. The experience of picking a tattoo with meaning and making it a permanent part of their body represents a sense of agency, working to meet one's psychological needs. This agency provides a relationship with that tattoo and represents the person's ability to have psychological functions provided for by the relationship with the tattoo (Kohut, 1977; Scorides and Stolorow, 1984). Tattoos and tattooing aid in that internalization process based on the data and discussions in this study.

3. How do tattoos help people develop a sense of self?

Internalizing selfobject functions can occur when an environment is supportive, reliable, and needs are being sufficiently met. A gap can form when there is a disruption to any of those elements, and the person is then driven to fulfillment for those needs. When younger, caregivers would ideally serve those functions. As adults, people seek fulfillment from others in different ways (Kohut, 1977; Scorides & Stolorow, 1984).

As discussed, tattoos and the process of being tattooed can aid in that internalization. While that process happens on an unconscious level, there are some conscious clues that it might be occurring, and sometimes the actions to aid in that process are intentional. As participants discussed their reasons for getting tattoos, they processed connections to their lives and how the tattoos helped them in some ways. One of the central themes was acceptance, not only of themselves as a person but sometimes of events in their lives. Acceptance can allow for normalizing and tolerating those concepts, possibly because the tattoo allowed those instances to feel or become more real. For example, one participant noted how her tattoo helped her accept

the reality of death. Her tattoo was a memorial and had a cultural element that was also meaningful, but the central significance was acceptance. Another participant had a tattoo that helped her accept her imperfect past. The tattoos following death provide a relationship with something tangible that promotes acceptance. Similarly, accepting imperfection was found in the relationship to the tattoo, providing comfort and reassurance. These tattoos were sought as the fragile structure of self required additional selfobject relationships to hold this stronger self, i.e., a more cohesive self.

As previously discussed, tattoos can also aid with maintaining self-cohesion. Even when someone's needs are adequately met in early development, the person must maintain that for themselves throughout the remainder of their life. Tattoos help with the ability to maintain that stability, allowing people to connect to past experiences where selfobjects have provided soothing and secure functions.

4. What are the various conscious motives people identify for getting tattoos??

Participants noted a variety of reasons for getting tattoos. Some reasons were more literal and about the image, such as getting a picture of an object that had meaning tattooed on them. A few participants chose tattoos of flowers that are specifically related to their cultures and some people in their lives. This conscious motive was to feel connected to the culture and those people by tattooing those images on them permanently. Other participants discussed getting tattooed as a part of a motive. Some participants noted getting tattoos to be like someone else in their lives who had that same tattoo, and some reported having a connection with their artist where the image of the tattoo meant less than that connection. The tattoo itself and the act of getting tattooed were both discussed often in this study, suggesting that the tattoo and tattoo process are both critical and part of the meanings of people's identities.

5. Does position on the body, specifically if the tattoo is hidden or visible to others, signify something consciously or unconsciously?

As discussed, tattoos seem to fall into four general categories: visible conscious, visible unconscious, hidden conscious, and hidden unconscious. Some participants discussed placement as an essential element of their tattoos. These choices were conscious recognitions. Some participants associated special meaning to the placement, such as getting a tattoo in the same place as someone else to feel connected, putting it somewhere they felt was attractive or wanting their tattoos to be specifically visible or not visible to others. One participant discussed getting a tattoo of their (gender-neutral) pronouns on their legs specifically for people to see when looking at their legs since others often judged their leg hair. Another participant noted getting an image of a stump on her ankle partly to represent her nickname, but the placement on her body represented sturdiness "like a stump," which she also associated with her personality. A participant described wanting to "be an angel" and have others see her that way, so the wings were on her back as they would be on an angel. These tattoos would fall into a visible conscious category where the participants chose locations that could be seen and could indicate clear reasons for their importance.

One participant got a heartbeat line on his chest near his heart, noting the significance of placement. He mentioned that not many people would see that area of his body and it felt more intimate, indicating the tattoo was meant for him. The participant who chose a tattoo of a chair with tufts of cut hair noted that many others do not understand the meaning of the tattoo, which indicates some level of hiding the meaning from others and her being intentional about that. These tattoos would fall into the hidden conscious category.

Regarding unconscious motives, it is unclear if some participants had any regarding tattoo location. Placement seemed mostly intentional whether for others to see or not, or if the placement related to something symbolic. Some participants with large or especially conspicuous tattoos, who did not mention placement as significant to them, could fall into the visible unconscious category. They chose to have their tattoo show but did not outwardly express meaning for that. Some people reported having many tattoos, so some placements were based on available space on their bodies, but perhaps there could be some additional meaning to the placement.

One participant got a tattoo of her cancer diagnosis and remission dates on her back. One could wonder if that placement that is not always visible to her suggests some unconscious meaning. This example could indicate a tattoo in the hidden unconscious category as it has meaning to her, but she might not want to look at it every day, perhaps due to the grave nature of the theme. She outwardly expressed relief at remission, but the journey itself could still feel painful to remember. More research would have to occur to better understand any unconscious motives regarding placement.

6. Does the meaning of the tattoo change based on how an outsider sees it and assumes meaning, compared to the original intent of the recipient? Does that matter to the development of the self?

As participants spoke in the survey interviews and more in the focus group, it became more apparent that this group of tattooed people heavily focused on the importance of their tattoos to themselves, respectively. Some participants noted that others occasionally misinterpret their tattoos, such as the participant getting a tattoo with chairs, scissors, and tufts of fallen hair. She discussed that many people think this relates to a cosmetology career but has a deeper

meaning of reclaiming her body and declaring independence. She reported being unbothered that others misinterpret it, stating that the meaning is for herself and not others.

Some other participants mentioned that others had misinterpreted their tattoos, which caused them to wish the images were slightly different. Some participants chose to alter or cover their tattoos because of that misinterpretation. These examples indicate that others' perceptions of these participants’ tattoos mattered to some degree, even if the participants still felt connected to the tattoo's meaning. However, these different interpretations of their tattoo did not seem to change the meaning. Instead, those participants wanted the tattoo to better communicate the correct meaning. Therefore, this misinterpretation does not seem to negatively impact the person's sense of self. The primary importance was the relationship the person had to their tattoo with less concern for a negative external response.

Some participants noted that their tattoos were well-received by others, sometimes by people they did not expect to like tattoos. Some participants discussed feeling part of the tattooed community, which felt inclusive and welcoming. With these examples in mind, the positive responses from others add to the tattoo's effectiveness in developing the sense of self. Those positive external interactions might be fulfilling some validation, reassurance, and twinship needs, which could help someone internalize those functions themselves (Kohut, 1977; Scorides & Stolorow, 1984).

7. What similarities or connections, if any, are there between people’s reasons for getting tattoos?

The clusters in the concept map suggest similar themes among participants' tattoos. Within this group of 48 tattoo images, the resulting clusters depicted at least eight connecting themes. More concepts were verbally indicated in the individual sorting stage and focus group

discussion, some of which did not have their own separate cluster. Beyond the eight cluster themes (self-discovery, pride, journey, self-acceptance, heritage, connection, familial bonds, and homage), participants noted some additional connecting themes such as queerness, death/mourning, artistry, owning or regaining control of one's own body, culture and ethnicity, and hobbies/interests.

In the focus group, participants discussed their own preconceived ideas of tattoo meanings and some new themes they derived as they looked through the handout of tattoos. Some participants discussed how vital remembering is for people overall and how tattoos are helpful because they are permanent. Many noted how connected they felt to others with tattoos and how that was something they appreciated. Similarly, some noted tattoos being a form of communication with strangers, those close to them, those who have passed, and with themselves. Finally, participants discussed how some tattoos felt emotionally heavier than others, yet there was a way to appreciate the range of meanings.

D. Clusters

A further discussion of how the eight clusters in the concept map may be explored psychoanalytically is provided here. The clusters are listed in no particularly meaningful order.

1. Self-Discovery

In this cluster, there are six tattoos, and participants felt an appropriate heading was "Self-Discovery." This cluster has a moderate bridging value (0.32) which suggests some connection with other clusters on the map. There was a common theme of learning something about oneself with these tattoos, which led to Phase II participants deciding on this title in the focus group discussion. Some elements of the self-discovery theme were identity, sexuality, strength, mental health, and individuation. For two tattoos in this cluster, the participants felt

they had rediscovered themselves which was a crucial part of their lives. Other participants discussed different elements of discovery, but all noted how important that was to their lives enough to get a tattoo to represent their experiences.

When looking through the self-psychological lens, part of the self-development journey includes knowing oneself as separate from others. While people utilize selfobject functions in the formation of the self, the process is internal and ultimately a unique journey. Selfobject functions present as how someone internalizes someone or something else, and it is less about the other person as being separate (Kohut, 1977; Scorides & Stolorow, 1984). This concept connects to the idea of self-discovery as someone begins to learn more about themselves, and more specifically, their self. Someone learns about their drives, wishes, preferences, anxieties, coping mechanisms, etc., and the gaps they seek to fulfill.

This also connects to some of the research that addresses self-discovery through identity development with tattoos. With the increased prevalence of tattoos among younger adults, there has been much discussion of tattoos connecting to identity and body ownership (Alcina, 2009; Dickson, Dukes, Karacaoglan, 2012; Shannon-Missal, L. 2016; Smith & Strapko, 2015).

Armstrong et al. (2002) discuss people getting tattoos to remember essential points in their lives and not wanting to forget. When thinking about self-discovery, someone would want to hold onto something they realized about themselves or their identity to better internalize that. The tattoos people received relating to this theme aid in that remembering, which could allow someone to understand better themselves (Armstrong et al., 2002).

As participants with tattoos in this cluster discussed their tattoos in Phase I interviews, and when others discussed those tattoos in the focus group, it became clear how these participants utilized tattoos or experienced a moment that allowed them to better understand

themselves. This cluster stands out from others as it represents the moment one knows their self more consciously. Other clusters focus on later stages after knowing the self, such as acceptance after discovery. One can know their self and still struggle with acceptance. However, this cluster included participants on their way to that acceptance, and this self-discovery was a positive experience. This theme was agreed upon as a fitting title for the cluster and a significant one others could recognize.

Better knowing the self also relates to understanding a cohesive internal narrative. Ornstein (1994) and Tolpin (1971) discuss how a person's collection of scattered memories combine to form an internal narrative that contributes to their psychic continuity. The impact of trauma affects the psyche, and that cohesion is interrupted. This example would not be an optimal frustration but something that requires more stabilization, often in the form of a transitional object. In this cluster, the tattoos assist in memory and maintaining one's story, which indicates a more cohesive narrative, integrating the meaning and emotions connected to the participants' experiences in life (Kohut, 1971; Ornstein, 1994; Tolpin, 1971).

2. Pride

This cluster that the group decided to name "Pride" contains four tattoos. This cluster has a high bridging value (0.67) which indicates that this cluster is highly correlated with other clusters on the map. The focus group saw significant differences between the tattoo images and even some meanings but felt they could all relate to a theme of pride. Furthermore, they felt this theme represented participants' positive feelings about their tattoos in this cluster.

One of the tattoos in this cluster was related to commemorating travel, resembling the feeling of having a souvenir. Sometimes when traveling, people challenge themselves to face new or different experiences resulting in a feeling of pride. People often collect souvenirs from

places they have traveled, and while that can be an enjoyable activity, there may also be a deeper meaning. When people are holding onto something that reminds them of a time or place, it can act as a transitional object (Blum, 1978; Karacaoglan, 2012). As previously discussed, tattoos can essentially act as transitional objects, though slightly different because they are separate (something someone was not born with) but always attached to the person and, therefore, part of them (permanently on the skin). Understanding the function of tattoos as transitional objects better explains their significance as souvenirs and the associated feelings of pride.

Another tattoo was about the specific event of completing the Ironman triathlon. While the tattoo partially acts as a transitional object of a kind of trophy to signify completion, it also connects the participant to other people who have completed the triathlon. She noted that this was part of the journey, and most people choose to get the tattoo after finishing the competition. The focus group noted pride in her accomplishment and feeling part of that community. The other two tattoos focused heavily on their connection to a group. For example, one participant was proud to be an American citizen, and another was proud to be a fan of a specific baseball team. These tattoos indicate how important connectedness to others can be and how tattooing can aid those feelings of closeness (Bell, 1999; Grumet, 1983). This concept connects to identity as some can reflect on themselves with these tattoos and see others around them as external validation when they feel belonging.

3. Journey

The tattoos in this cluster centered around a journey for the participant. This cluster has the highest bridging value (0.79), which indicates that this cluster is highly correlated with other clusters on the map. Five tattoos fell into this cluster and as previously stated, the participants felt

it was essential to have these five in a separate cluster from those in "Pride," which the concept mapping system would have joined if there were only seven clusters.

Upon initial viewing of the tattoos in this cluster, they outwardly seemed quite different from each other. The high bridging value reinforces this idea as participants saw many connecting meanings with the tattoos in this cluster. Some participants reported meanings include liking a band, love for travel, a cancer diagnosis and remission date, sobriety, and love for sports. The themes here did not have a clear central connection, so the focus group constructively engaged with each other and heard from participants who had tattoos in this cluster to better decide what the title should be. When participants decided on the thematic similarity of "Journey," they felt confident that this included all five tattoos. There was an element to each tattoo that included celebrating something specifically transitional. This cluster differed from the cluster "Self-Discovery" as “Journey” did not seem to include the new realization that comes with discovering something, and it differed from "Pride" because these tattoos all contain a progressional element that is associated with the transitional aspect of a journey, which was crucial to the tattoos' meanings.

Connecting these ideas back to the literature, Sanders (1988) discusses how important life transitions are to people and how getting a tattoo can provide a way to accept that journey. The tattoo's permanence acknowledges the path the person has gone down, whether chosen or not. Mostly, the commitment to a tattoo highlights the significance of that journey. One can feel connected to a life experience without getting a tattoo. However, getting the tattoo indicates a conscious understanding of that time being meaningful to them and wanting to signify it somehow to themselves and/or others. The conscious intention behind a tattoo suggests importance. Armstrong et al. (2002) discuss how having similar tattoos to others can be a

connecting experience, aiding people in identifying with each other. The authors also discuss how support can sometimes be inferred when people have a similar tattoo. The importance of support in forming the self has been discussed, so in this cluster, the tattoos serve as a function of support and conscious acceptance of a journey someone has gone through.

4. Self-Acceptance

Six tattoos are in the Self-Acceptance cluster. The cluster has a low bridging value (0.21), indicating it is well differentiated from other clusters on the map. The concept of self-acceptance differs from other cluster topics as it conveys some internal understanding and tolerance of the self. As discussed, this cluster differs from "Self-Discovery," as acceptance would likely come after discovery. Acceptance comes from an increased tolerance of multiple aspects of the self, including optimal frustrations. A stronger sense of self would allow someone to handle those situations better as there is more stability and security. The self would be more cohesive (Eli, 2013b).

Tattooing for self-acceptance seems to serve either or both functions: to aid someone in accepting themselves and to signify when the recipient feels some acceptance has happened, which includes celebrating that and reminding the recipient. The themes of these six tattoos suggest that the participants accept and embrace: gender, femininity, religiousness, body ownership, and appearance. There also seems to be an undertone in these tattoos of accepting something that others could negatively judge in some way. The choice to get a tattoo is an attempt to accept an aspect of the self and stand firmly with it in confidence. Someone discussed feeling like she embodied an alternative way of thinking which is directly related to feeling different from others. Accepting being different was a victory; she now feels ownership over her identity. This example relates to separating from a norm while simultaneously joining a subgroup

to feel connection and belonging (Bell, 1999; Grumet, 1983; Pritchard, 2000; Sanders, 1988).

The group separation and connection themes found within this cluster indicate doing so not simply for fun as one would for an interest or hobby. Instead, the topics result from straying from societal expectations. In this acceptance, this straying was not a choice but an idea of acknowledging someone as they are, despite possible rejection from others. This concept revisits the idea Grumet (1983) discusses that people will often get tattoos with others who have been through similar complex life events to feel closer. Someone's gender is what it is; they know that about themselves. If the societal expectation is to be binary gender-conforming, that does not change that the person is non-binary. If the expectation is to have perfect skin, it does not stop the person from having a skin condition. Acceptance is vital for forming the self by acknowledging and possibly embracing who they are rather than feeling disheartened about something one cannot change. Reflecting on the pressures of society, it is evident that selfacceptance is challenging to achieve at times, and the need for doing so is often born out of external judgment. For the participants in this cluster, the tattoo may aid in repairing developmental trauma stemming from developmental twinship failures. Feeling apart, not feeling similar, impacts one's self-esteem and self-worth by leaving the self vulnerable. The tattoo functions to provide reassurance to the vulnerable self.

5. Heritage

Four tattoos are in this cluster, and the focus group felt that "Heritage" was an appropriate title. This cluster has a moderate bridging value (0.48) which suggests some connection with other clusters on the map. There was a strong theme of cultural representation in three of these tattoos, and the other represents the participant's hobbies and family. The group struggled with naming this group based on the tattoo that did not have a cultural element. Otherwise, they might

have picked "culture" as a title. However, they saw that the seemingly different tattoo still held importance to the participant as it connected back to multiple aspects of her identity and family, which the group felt could fit with the rest into the category of "Heritage." The similarity is a connection to others through something that occurred with birth: birth into a culture or birth into a family dynamic.

Tattoos have historically been closely tied to heritage and cultural connections. In some instances, tattoos have specifically been part of cultural practices. No one in this category reported getting a tattoo through a cultural practice; instead, the tattoos represented their relationships with their cultures or heritages. This meaning is still historically significant since many cultures incorporated tattoos into their practices for similar reasons to those of the participants in this cluster. Some cultural reasons for getting tattoos ranging from ancient times through the 18th century were assuaging pain, connecting to others in a group, signifying accomplishments, commemorating travel, rites of passage, acts of rebellion, etc. (Bell, 1999; Gustafson, 2000; Patterson, 2018; Sanders, 1988). These themes emerged through the collection of tattoos in this study, especially in this cluster.

Since the cultures and groups of the past could see value in getting tattoos to signify those events, and since many of those reasons continue today, it can be concluded that a benefit to tattooing is connecting with others. This concept has additional value when people get those tattoos based on connectedness to others based on inherent qualities. Since many environmental changes and technological advances have occurred over centuries, the fact that tattooing remains a meaningful act for similar reasons over time supports the idea that tattoos can and do serve the functions discussed in this study. This idea is coupled with the fact that participants, especially in

this cluster, consciously report feeling closer to others they are similar to or related to because of their tattoos.

6. Connection

The Connection cluster also contains four tattoos and is the one closest to the middle of the map. The cluster has a moderate bridging value (0.44), which suggests some connection with other clusters on the map. Initially, the focus group thought they would need help labeling this cluster, but the task proved easier than expected to name. When looking at the tattoos in this cluster, the group felt these were the most different from each other compared to other clusters based on the tattoo images and reported meanings. The tattoos include a beautiful image of someone who got to feel connected to her partner, flowers that reminded someone of her lessthan-ideal relationship with some family members and her childhood, one in the style of Japanese irezumi because that participant liked her artist, and one representing some fond memories someone had with inspirational words from a movie. The group revisited the meanings in the photovoice descriptions to find a common theme and this aided in naming this cluster. Upon discussing these tattoos and with the aid of one participant who had a tattoo in this cluster, the group realized there was a central theme of connection. They discussed how even a negative connection, such as the participant with a troubled childhood, was significant, hence her choice to get a tattoo. Acceptance of a troubled childhood, closeness with a partner, having a relationship with an artist, and feeling impacted by a movie all felt like they could easily fit into a category about connectedness.

This differs from the cluster "Heritage" as that category had the component of feeling close to others based on a trait the participants were born into. The tattoos in this cluster

"Connection" rely more on choice connection. While one participant had a connection with

family in this one, she specified that her feelings reflected in the tattoo were about connection with childhood in a way that she is choosing to live her life differently now. The other tattoos are about people or a message the participant found later in life. These meanings all felt different from the "Heritage" connections, which were more innate. Connection has been discussed as an essential function of tattoos for many people. While the tattoo itself is an individual possession, there is often an element of connection with others. This connection could be accomplished by getting a tattoo that reminds someone of others, getting a tattoo with another person, or getting a matching tattoo as someone else. Historically getting tattoos to feel connected to others boosts morale in some groups, increases feelings of inclusion, and helps people process shared hardship (Bell, 1999; Grumet, 1983). Additionally, thwarted twinship needs earlier in development could underlie what is sought out in connection to culture and heritage. In the case of this cluster, the feelings of connection from the tattoos provide a sense of belonging to the people who got them, which suggests a relationship between the tattoos and vulnerability of feelings of exclusion (Kohut, 1971).

These elements of connection are all helpful when forming a more cohesive sense of self. As one feels more confident, they become more accepting of their sense of self. The process is still an individual and internal one, but the presence of others assists with this. Feeling included allows people to feel validated by others, which helps reaffirm the self. Processing hardship with others allows someone to better tolerate ruptures in life, which is crucial to self-regulating (Kohut, 1977; Scorides & Stolorow, 1984).

7. Familial Bonds

This cluster was the easiest for the focus group to name and in fact had the lowest bridging value (0.14), suggesting the items were more differentiated and less often sorted with

items in other clusters. This value is noteworthy as this cluster also has the most tattoos, with 10. This finding highlights many tattoos that seemed thematically similar and easier to identify and connect. The group reviewed the tattoos in this cluster and noted themes of closeness to kids, siblings, and parents. A specific meaning all these tattoos share is the bond of these relationships. The title "Familial Bonds" was therefore chosen as it heavily emphasizes connection with family members based on their positions in their respective families. This cluster differs from "Heritage" as the bonds with specific people are prominent in “Familial Bonds.” There were some specific connections in the category "Heritage," but those tattoos represented a broader connection to inherent qualities. The "Connection" cluster also differs from this one as those connections are not all about family and do not contain what group participants labeled as a representation of interpersonal bond, which does exist in "Familial Bonds."

As previously noted, family members will get similar tattoos to each other to feel connected (Bell, 1999; Grumet, 1983). This connectedness feels similar to some ancient tribal reasons for getting tattoos in the way that they signify to themselves and others that their family members are part of the same group (Bell, 1999; Hambly, 1927; Sanders, 1988). Some tattoos in this cluster show position or status in the recipients' families, such as parents and children. For example, one tattoo is of a moon and stars, with the participant noting that the moon represents her as the mother and the stars as her children. Some tattoos show a connection to siblings, such as a tattoo with three hearts, with each sibling getting their respective hearts filled in with black ink based on their age order placement with each other. Another has her children's names on her, with the symbol of arrows connecting to a meaningful poem.

Other tattoo images in this cluster were less directly connected to families but had specific meanings that helped remind participants of those people in their lives. Some tattoos

reflected fond memories the person had with family members. Another tattoo was of handwriting her mother and grandmother would use as a salutation is greeting cards or letters to each other.

One participant has a tattoo of a tree that she feels represents a family tree but feels an additional significance of getting the same tattoo with her daughter. One person with an entire sleeve tattoo reported that this tattoo represented an entire journey of having kids, and there is much personal symbolism within the landscape of the image. All tattoos in this cluster reportedly helped people feel closer to the person or people they got these tattoos for and with. While these people are consciously aware of their connection to their familial bonds, they each saw value in getting a tattoo to represent those connections and indicate being part of something bigger with others.

Sometimes people report family as one of the primary sources of judgment against tattoos. Also, historically people with tattoos were sometimes considered deviant and specifically not family-oriented (Patterson, 2018). Therefore, this cluster having a theme of family connection becomes extra meaningful since the family could be a dissuading factor, yet for these participants, it was not. For some people, it might be the case that they would not want to get a tattoo about their family because they do not feel connected or would fear their family would negatively perceive them. However, the participants in this study whose tattoos fell into this cluster saw something powerful about signifying their connections and bonds to their family members. They reported feeling a sense of identity from that.

8. Homage

This cluster has the second-highest quantity of tattoos in it, with nine total. This cluster has a low bridging value (0.26), which indicates it is well differentiated from other clusters on the map. Many of the tattoos in this cluster reflect topics of grief or important specific memories.

Four participants chose tattoos relating to a person or people who have died, two participants got

tattoos for their pet or loved one before they died and reported they have special meaning now that they have passed, and one person reported getting tattoos for their dogs who have not yet passed but in recognition that they will not be alive forever. The other two tattoos in this category did not have a connection to death but did have a connection to an event or events in the past. One connected the participant to childhood memories with her family and neighborhood kids, and the other was fond memories of visiting a friend's cabin. The focus group noted a theme of leaving a memory behind in all these tattoos, thus labeling the cluster "Homage."

The focus group initially considered naming this cluster something in the theme of memorial or memoriam. Participants decided against that because they felt that the word "memoriam" felt "too dark" when the tattoos in this category did not seem to fit that tone; they felt these tattoos were uplifting, even when they were related to a somber topic such as death. The participants reported feeling empowered or connected with these tattoos, so "memoriam" did not feel like a fit. They also discussed words like “memorial" or "memory" but felt that did not fully capture the complex meanings of the tattoos. These tattoos contain memories but also a feeling of honoring for the participants. This discussion helped the focus group differentiate the title "Homage" from something related to memory.

Many participants whose tattoos in this cluster are about death reported that the tattoo helped them process grief. It was said multiple times that the tattoos help people feel connected to their loved ones and that getting a tattoo about them can "carry" the loved ones with them after they have passed. This concept connects to the idea of a transitional object again, but possibly with a different level of importance, as the tattoo recipient does not want to transition out of holding onto the deceased one as one would with a traditional, transitional object; they want to keep them (Blum, 1978; Karacaoglan, 2012). This concept also applies to the two tattoos about

memories. There may be some grief involved when reflecting on times they will no longer get to experience. Even if they still connect with the people in the memories, it will not be the same as being in those initial experiences. Remembering is a large part of mourning, as discussed by Freud (1917): when someone is mourning, they hold onto a memory and internalize it in a way that relieves the intense pain of loss over time. By getting tattoos to signify something in the past that they want to hold onto, these participants are helping themselves cope and solidifying some crucial developmental influences for themselves. These tattoos also connect to identity formation and how people, pets, and experiences help form who someone is. It is common to look to others to try new things and make new bonds, which leads to better knowing the self. Those external sources provide comfort and validation, which assists with developing and maintaining a sense of self.

It is worth noting again that the focus group was adamant about not separating tattoos about pets from tattoos about human bonds. Participants decided that pets are just as crucial in feeling connection and love and that they have experienced similar grief for pets as humans. Because of this similar experience, they felt the connections to pets and their loss of them fit in with that of humans and should be kept together in this cluster.

History shows the connection between tattoos and bereavement, even from ancient times. There is significance in representing pain, grief, the ability to cope, and the need to hold onto what is lost, which extends beyond tattooing and are shared functions of being human (Freud, 1917; Lineberry, 2007; Ogden, 1985; Winnicott, 1953 ). Some theorists suggest that the physical pain of being tattooed helps people access emotional pain and better process grief (Patterson, 2018; Turtiainen, 2005). This process might be conscious or unconscious. Since many tattoos

represent death or memorial, there seems to be a connecting factor that could include some unconscious function of aiding in processing grief.

This cluster of "Homage" differs from other clusters in multiple ways. Even though not all the tattoos in this category relate to death specifically, there is a heavy theme of loss. The "Familial Bonds" cluster suggests a connection to family not necessarily related to lose. This "Homage" cluster contains some family connections, but the loss of the person or distant memory differs from representing the bonds solely. The "Heritage" cluster is also different as that one suggests a role within a group and does not necessarily have a specific remembrance component.

E. Revisiting Assumptions

The intent of this section is revisit the researchers original assumptions to see it they were upheld or not.

1. Assumption #1: Tattooing helps a person develop a sense of self.

The findings show a strong connection between tattooing and strengthening the self in particular psychological experiences. When including the factors of developing the self, the tattoos in this study served multiple functions contributing to those. Learning about one's identity and discovering pieces of the self were some topics in this study. In doing such, participants felt more connected with themselves, and the fact that they got tattoos to either commemorate that or aid them in discovering the self suggests tattooing helps with this development. Others utilized tattoos and tattooing to help with accepting and sometimes maintaining their selves. This act connects to the idea of a cohesive self and how acceptance is a goal of the development of the self in self psychology. Others discussed connectedness to others, which relates to some ideas of mirroring and twinship while seeking validation and reassurance functions. The connectedness to

others seen in these tattoos spanned a broad range of meanings but ultimately connected back to fulfilling those needs, which is crucial for self-development. Thus, tattooing can be a method to help a person develop a sense of self. Tattooing is not the only method and might not serve that function for all, but for many, it can, and for all participants in this study, it did. Everyone grows up in an environment of selfobjects, initially relying on selfobject functions for psychological survival. As people develop through adulthood, failures in adequate selfobject functions or minor and major traumas within selfobject relationships leave the self in various levels of vulnerability, impacting the ability of the self to hold or establish cohesiveness. Participants clearly describe here that the relationship to tattoos is a selfobject relationship that aids in maintaining selfcohesion. Various psychological functions are found in this data.

2. Assumption #2: Tattooing is not associated with the development of collective identity.

This assumption addresses the idea of a collective identity compared to an individual sense of self. As discussed, there are many reasons people choose to get tattoos related to others, whether that be a specific connection, a remembrance, and fun story to tell later, etc. Regarding this topic, the theoretical framework of self psychology suggests identity is an individual and personal experience, even though the presence of others exists and assists in this formation. When thinking about tattoos and the prompt of this study, the idea was to better understand how tattoos help the individual as the tattoo itself exists on the individual. The conscious and unconscious processes discussed in this research are internal, even when the person chooses to share that with others. Formation of the self is inherently an individual process. Even when someone chooses to get a tattoo to represent their role in a bigger collective group, it does not aid

the others in the group in terms of developing themselves. The purpose of the tattoo stems from the individual.

3. Assumption #3: Tattooing is both associated with social identity and personal identity, which both contribute to the sense of self.

As participants discussed their tattoos concerning themselves and how others perceived them, it became more apparent that tattoos can have meanings spanning both social identity and personal identity. Some participants reported wanting to feel more attractive by getting tattooed. Some participants reported wanting others to see their tattoos, so their identity is better communicated in their respective environments. Some participants wanted their tattoos to be conversation starters. All these meanings contribute to someone's social identity, again connecting to needs for validation and reassurance, and conscious feelings of belonging.

Other participants discussed deep personal meanings for their tattoos that did not require the images to be seen by others to have those meanings. Some participants utilized tattooing to help them process emotions about an event or people. Other participants reported feeling like they knew themselves better because of what their tattoo represented. Some participants enjoy looking at their tattoos to help them remember something important.

Many tattoos in this study serve functions of aiding someone with both their personal identity and social connectedness. For example, when participants got tattoos representing a topic they struggled to process, some reported wanting to receive support from others, which helped them accept their identities. Thus, tattooing can be associated with social and personal identities in meaningful ways that contribute to someone's development of the self.

4. Assumption #4: Tattooing serves both a conscious and unconscious function for the recipient.

This study resulted in the discussion of many conscious meanings for participants, partly because that was the prompt but also because it is common to have some reason for choosing to get a tattoo. The findings in the surveys and narrative responses all contained the presence of conscious meaning. Additionally, the cluster map and discussion of such in the focus group inspired an understanding of others' conscious and possibly unconscious meanings, suggesting tattoos can be a form of language to others the photovoice descriptions assisted in this as well by providing direct words from participants.

The focus group also allowed participants to ponder some possible meanings of tattoos that the participants did not verbally report. These additional meanings indicate some unconscious process; perhaps a participant got a tattoo and, on some deeper level, hoped to elicit a response from others of which they were not consciously aware. Some participants who engaged in the sorting task and focus group noted the beauty of tattoos even if the recipient did not mention a conscious aesthetic meaning. This idea allows for some unconscious aesthetic meaning, as the participant could have chosen a different tattoo that was not as visually pleasing. Some tattoos elicited a shocked response due to boldness; some brought laughter because they felt silly, and the recipient might have known those responses could be possible. This possibility would have to be explored in deeper psychological treatment for those participants, but it is worth discussing that possibility.

Though unconscious meanings were not always able to be gleaned from participants, some concepts emerged. Some participants reported additional meaning they realized they were unaware of when getting their tattoos. Others reported that this study helped them realize their tattoos had more profound meanings. Some participants exhibited emotional responses when discussing their tattoos that could indicate a deeper meaning that was not outwardly discussed in

this study. It seems unlikely that a tattoo could have absolutely no conscious or unconscious meaning, as getting a tattoo is an intentional choice. However, that cannot be completely ruled out. These findings indicate a strong presence of conscious and/or unconscious meanings for people who get tattoos.

F. Summary of Interpretation of Findings

In summary, the findings of this study suggest that tattooing can be a helpful tool to aid someone in better developing their identity. The data from the survey, including narrative responses and the focus group discussion, contribute to this knowledge. In addition, multiple meanings were discussed, which suggests there can be many ways for a tattoo to represent something important to the recipient and better aid in the development of the self.

1. Major Finding 1

There is a range of meanings people can attribute to tattoos. The idea of a "tattoo meaning" does not have to be one specific thing. People noted remembering, celebrating, feeling attractive, communicating with others, and more. The idea of something being meaningful is in the eye of the beholder, and participants discussed their reasons in this study. This concept exemplifies the meaning of being an individual process compared to something collective. While tattoos might share some similarities, ultimately, the meaning comes from the person choosing to get the tattoo, and it is whatever they decide it to be.

2. Major Finding 2

Tattooing aids in the formation of the self. What was less known prior to this study was how people reported that occurring for them and how conscious and unconscious that was. In these findings, it became more evident that participants sought tattooing for the image or the act to better help process something. Tattoos aided in serving validating and reassuring functions of

the self. Tattoos have also been shown to help heal through emotional processing and acceptance. Connecting with others through tattoos provides reassurance and assists the individual in better knowing themselves. Tattoos also aid in maintaining stability for a more cohesive self when they are utilized to recall stabilizing functions in someone's life. The range of what was processed was vast, but the commonality was tattooing. These findings represent these specific participants but suggest that tattooing can be utilized for these functions in general.

3. Major Finding 3

There is meaning behind tattoos being either similar to or different from other ones. This finding was primarily seen in the concept map in this study. Some overlapping themes between clusters suggest some shared common elements in tattooing. Participants in Phase I noted their fundamental reasons for getting tattoos, yet participants in Phase II sorted them in various ways, often gleaning other meanings. The reasons for getting tattoos ranged across multiple topics, some seemingly unrelated to others, and participants themselves saw different similarities when looking at the tattoos and photovoice descriptions. This experience enriches the idea that tattoos can serve a self-regulating function specifically because the tattoos are different in theme and reason; while one person can feel connected to a hobby with a lighthearted tattoo, someone else can have a somber reminder of a loved one who passed, and both can report the successful function of better knowing themselves. This concept suggests the existence of tattoo importance not specific to the literal tattoo image itself.

Many similarities in the clusters also existed. When people discuss their tattoos with others they tend to use short narrative descriptions. A more profound exploration of those in this study made it more apparent that people have more meaningful connections to their tattoos that surpass what is seen on the outside. Since many of these meanings overlap, tattooing is helpful

for many psychological needs people collectively share. Additionally, even when tattoos were grouped into clusters based on the similarity of meaning, participants could still think of connections to other tattoos outside the cluster. This finding suggests that something is connecting about the act of tattooing overall and that connection is that people can utilize them to create a more cohesive individual sense of self. In summary, the similarities and differences of the tattoos in this study contribute to the idea that tattoos can aid people in self-identity formation.

Chapter VI

Implications and Recommendations

A. Implications for Practice

This study explored the function of tattooing in the development of the self. In doing so, it was noted that some people are naturally drawn to the idea of tattooing and did not need to be previously told that it would aid them in developing their selves. Thus, a conclusion can be made that people can utilize tattooing to better understand and accept their selves. Though the act of being tattooed or having an appearance that includes a tattoo might not appeal to everyone, but for some, this could be utilized as a helpful recommendation.

As previously discussed, tattoos have spanned millennia holding different meanings for individuals and societies throughout history. While tattoos are generally more accepted in mainstream culture today, an unfavorable stigma is still seen. This study highlights tattoos' depth and meanings, suggesting something less stereotypical and less irreverent about tattoos. These findings could help destigmatize tattoos overall as one can better understand the individual meanings behind tattoos and tattooing.

An analysis of tattoos can be utilized in psychotherapy practice or the field of social work as a whole. In this study, various aspects of tattoos were discussed. If someone chooses to show their tattoo, that can be an indication of some conscious or unconscious meaning, for example. When working with tattooed clients, this could be considered, and if one is known to have a tattoo, it could be an enriching talking point to better understand how the person utilized the

tattoo and if it aided in their formation of the self. Knowledge of the various meanings mentioned in this study can be a starting point for understanding others' personal meanings. There could be some similarities or differences, and this study noted how those could present. There is meaning behind similarities in tattoos and also in differences. This concept could lead to a better understanding and discussion of the self in treatment.

Tolpin (2002) discusses forward edge transference and how a person’s past experiences can be transferred onto newer relationships. For use in therapeutic practice, a client can demonstrate forward edge transference as they express the personal meanings of their tattoos to a therapist. The tattoo suggests an attempt at self-cohesion, and in therapy, the client consciously conveys those meanings to the therapist. This concept can be empowering to the client as they are representing themselves to someone else rather than allowing the perception of an outsider, i.e., a therapist, to tell them what their tattoo means. It is crucial for the therapist to be aware of this forward edge transference as a client might be bringing their experiences with others into a therapy setting. The client might feel the need to over-justify a tattoo or experience if they have received judgment in the past. If the therapist is unaware of this forward edge transference, they can thwart the forward movement of the client’s self-cohesion. Additionally, if the therapist is unaware of countertransference issues, any judgment toward the client will disrupt the positive transference necessary for the therapeutic process.

B. Recommendations for Future Research

This study created an opportunity for open-ended discussion of people's reported meanings of their tattoos. An in-depth exploration of specific meanings could provide additional insight into those tattoo functions. To enable other comparisons, there could also be a greater exploration of specific cultures, genders, races, socioeconomic statuses, careers, and more.

Utilizing non-virtual methods in the future could also enable additional findings or comparisons as it would reach a different range of people.

This study recruited participants with at least one meaningful tattoo connected to their identity. Studying the number of tattoos someone has, and more specifically the number of tattoos people feel are part of their identity, could provide additional insight into how people utilize tattoos in forming the self. One could wonder if having more tattoos related to their identity means they struggled more, or in different ways, than others in their formation of the self. An exploration of this concept could be useful.

Utilizing methods to understand unconscious motives would enrich the research on the meanings of tattoos. While this study included some aspects of understanding unconscious motives, being in a psychological treatment setting better equipped to explore those motives would be necessary for understanding the full range of unconscious motives.

Lastly, performing similar research over time, spanning future generations and periods, could add to the findings of this study as cultural understandings of tattoos are likely to morph in the future as they have in the past. In researching this, comparisons or similarities in the meanings of tattoos and the functions they serve can be explored and better understood.

C. Strengths and Limitations of the Study

Several strengths of this study should be addressed. First, the use of concept mapping allowed for a broad exploration and analysis to address the research questions. The data was fully represented in one place, which allowed for communal meaning making. As previously noted, using imagery in the analysis of findings is especially relevant in a study researching the meaning behind imagery (tattoos) on people. Visual aids can assist in conveying more meaning beyond simply verbal language. This methodology also accommodated a large group of

participants and provided a way for qualitative data to be easier to sort and understand for participants in Phase II and the overall findings.

The use of photovoice also added to the strength of this study, as participants could better derive important meanings from the initial narrative responses. With open-ended discussions occurring in Phase I data collection, photovoice allowed this researcher to present the findings in a meaningful and representative way to others in Phase II to best capture the intentions behind the tattoos. This method allowed participants to see both the image and reported conscious meanings of tattoos and absorb the information together.

Utilization of a psychodynamic and, more specifically, a self psychology lens added to this study's strengths as that lens provided a way to best interpret the findings. By understanding the importance of self and self development, the findings related to tattooing become more meaningful. As this study needed a basis for defining the meaning of tattoos and tattooing about the self, this lens anchored findings to the same theoretical framework to best compare and connect responses.

This study was not outwardly limited to any specific population except adults over 18 who felt they had at least one tattoo related to their identity. Additionally, the study was not limited to any socioeconomic status, age, race, gender, nationality, career, etc. These factors were important when discussing tattoos, as this study explored how tattoos can have meanings to people across a range of diversity. While the outcome sample did not necessarily reflect the diversity of the population at large, there was no limitation in place for such. The study did see a slight range in age, socioeconomic status, reported careers, and stages of life.

Limitations of this study include some aspects of the participant samples. First, this researcher utilized a nonprobability sample as there is no general list of tattooed people, and

tattoos are still relatively less common in the general population. Participants were recruited using snowball sampling through word of mouth, from participants knowing other qualifying participants, and through social media posted by this researcher and shared by others. The posts were made public so that anyone could see them. However, the chances of seeing them were higher if someone knew this researcher or others who did. Finally, although the snowball method was the best to recruit participants for this study, participants were likely closer to this researcher's social circle. Because of these factors, it cannot be concluded that the sample accurately represented the general population.

Participants in this study were predominantly Caucasian (76.5%). Data collection with more representation from other races might have provided additional findings which could have enriched this study. Participants in this study were also predominantly women (70.6%). Data collection with more representation from other genders might have provided additional findings, which could also have enriched this study.

The participants in this study all live in the U.S., which created a level of cultural homogeneity. Therefore, the findings might not be generalized or applied to the world; different types of responses could come from people living in different countries. This researcher tried to broaden the participant group, not limited to one specific region, attempting to collect a diverse sample. However, the sample is only as diverse as word of mouth and social media spreading information would allow. The exact type of living situations (urban, suburban, rural) of participants is unknown and therefore there cannot be any conclusions on location affecting responses.

The research sample was limited to those with access to some form of internet and technology that allowed meetings via virtual video platforms. While access to these pieces of

technology is not always an indicator of status, it suggests a certain level of privilege these participants had which could impact findings. All participants were also able bodied in terms of viewing pictures, listening, and conversing with this researcher in Phases I and II and other participants in Phase II. It is unclear if those who could not engage in the methods used for this study would reveal different findings.

This study had a specific prompt asking for people who reported the conscious meaning of their tattoos tied to their identities. Some people may report that their tattoos have "no meaning" and would have excluded themselves from this study prompt. However, it would be difficult to exclude the possibility of unconscious meaning of tattoos. Potentially, some tattooed people not in this study who report no conscious meaning might have unconscious functions associated with their tattoos. This possibility is a limitation as they would not have chosen to participate in this study, and therefore any unconscious meaning could not be obtained. Therefore, even though this study contained discussions of tattoos having meanings beyond reported meanings, it cannot be concluded that every tattoo has both conscious and unconscious meaning, especially related to someone's identity.

This study occurred when tattoos were more accepted than at other times in the past, yet also not entirely accepted by society as discussed in the literature review and through the personal experiences reported in the narrative data. The level of acceptance in the environment influences people's choices to get tattoos. The categories of tattoo meanings in this study range broadly, but perhaps other meanings associated with tattoos will emerge or change in the future, as seen with some other meanings and time periods.

The concept mapping method generally includes a more robust sampling of phrases or images, generally around 100. This study only included 48 photovoice images, which may have

limited the development of the concept map. In addition, ratings of phrases or images are generally included (such as a 5-point rating scale of importance or feasibility), which can then be used to observe box-plots and ladder graphs. It was decided for this study that such ratings were not appropriate, however, excluding ratings does slightly deviate from the bulk of concept mapping projects. Concept mapping experts who read this dissertation can make that determination for themselves.

D. Research Reflections

This research aimed to explore the functions of tattoos and how they relate to the formation and development of the self through a self psychological lens. The goal was to better understand various reasons for the specific participants in this study and obtain information that could be useful to those outside the study. This researcher always suspected there would be value in tattoo meanings being similar to or different from each other. This study highlighted those aspects, and the findings provided more detail to enhance those comparison ideas.

This study revealed a more comprehensive range of tattoo meanings than this researcher predicted. When thinking of meanings tattoos could have, initially it felt like they would all be thematically heavy. This study contained some findings to support that, but others that were more lighthearted still felt just as much part of someone's identity as the other types.

E. Conclusion

In conclusion, this study provided an exploration of the functions tattoos serve in the formation of the self. History shows how tattoos have changed over time, and exploring them in this study gives additional insight to that historical perspective. A robust range of responses was obtained through participant interviews that gave insight into how tattoos connect to people’s identities. Self psychology best provides a lens through which to examine these meanings, as

there is a heavy focus on the self in this theoretical framework. Concept mapping and photovoice aided in highlighting the findings in a significant way. These methods allowed participants to better make meaning of the data. Participants sorted this data and saw results on a visual concept map, better allowing them and this researcher to make meaning of the information provided. Tattoo images and the act of tattooing itself were both found to aid the recipient in identity formation. These findings contribute to knowledge about tattoos and can enrich the social work field. These intentions behind tattoos and tattooing span a broader and deeper range than this researcher initially thought, supporting the idea that tattoos are beneficial in the formation of the self.

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provide insight into individual stories, suggest common relatable themes, and contribute to normalizing the process, therefre possibly reducing the sometimes-negative stigma that still exists of tattoos.

Costs

Paticipation in this study will not explicitly require any costs, just access to a phone/computer/tablet that allows fr video confrencing sofware as well as interet capabilities.

Possible Risks and/or Side Effcts

Possible risks may include exposure to sensitive topics, which could elicit a range of emotions. Discussing tattoos has the potential fr introducing sensitive topics, depending on the nature of the tattoos. The exact risks cannot be predicted, since everone reacts diferently when discussing sensitive topics.

The interviewer is a trained profssional able to discuss emotional exploration, should you feel you need additional support. Additionally, the interviewer is equipped with supplementary resources should you need. You are fee to withdraw fom this study at any time.

Privacy and Confdentiality

Privacy is maintained by limiting access to this study to the research team. No identifiable information will be collected in this phase of the study, and your input will be labeled by an alias. No personal information will be shared with anyone else unless in cases of emergencies. Infrmation will be stored on a password protected computer and destroyed afer this study is completed.

Any information you provide in this study will only be disclosed with your permission. This researcher will have access to your infrmation as well as any transcription services used to transcribe narratives. The transcription company will maintain confdentiality as well, and will destroy any infrmation afer transcription.

Subject Assurances

By signing this consent frm, you agree to take part in this study. You have not given up any of your rights or released this institution from responsibility fr caelessness.

You may cancel your consent and refse to continue in this study at any time without penalty or loss of benefts. Your relationship with the staf ofICSW will not be affected in any way, now or in the fture, if you refse to take part, or if you begin the study and then withdraw.

If you have any questions about the research methods, you can contact Jill Bajorek at jill.bajorek@gmail.com or Dr. John Ridings at 773-263-625 or jridings@icsw.edu.

If you have any questions about your rights as a research subject, you may contact Dr. John Ridings, Chair ofInstitutional Review Board; theInstitute fr Clinical Social Work; At St. Augustine College, 1345 W. Argyle St., Chicago,IL 60640; (773)935-6500.; irbchair@icsw.edu.

Signatures

For the Participant

I have read ths consent frm and I agree to take part in this study as it is explained in this consent form:

Participant Nae (please print): _

Participat Signature: Date:

1. Would you like a summary of the results of this study?

Yes:

No: For the Primar Researcher

I certif that I have explained the research to _ and believe that they understad and that they have agreed to participate feely. I agree to answer any additional questions when they arise during the research or aferward.

Researcher Name (please print): ___

Researcher Signature: Date:

Version 6.0: 7/18/2020

Appendix B

If you have any questions about the research methods, you ca contact Jill Bajorek at jill.bajorek@gmail.com or Dr. John Ridings at 773-263-625 or jridings@icsw.edu. If you have ay questions about your rights as a research subject, you may contact Dr. John Ridings, Chair of Institutional Review Board; the Institte for Clinical Social Work; At St. Augustine College, 1345 W. Argyle St., Chicago, IL 60640; (773)935-6500.; irbchair@icsw.edu.

Signatures

For the Participant

I have read this consent fr and I agree to take part in this study as it is explained in this consent frm:

Participant Name (please print):

Paricipant Signature:

1. Would you like a summary of the results of this study?

Yes:

No: For the Prima Researcher

Date:

I certif that I have explained the reseach to __ and believe that they understand and that they have agreed to participate feely. I agree to answer any additional questions when they arise during the research or aferwad.

Researcher Name (please print): ___

Researcher Signature: Date: _____

Version 6.0: 7/18/2020

Understanding Why People Get Tattoos

Investigators: Jill Bajorek, Principal Investigator

Thank you for your interest in participating in my study. The purpose of this survey interview is to gather statistical and opinion data about tattoos and tattooing, as part of my larger dissertation study. It should take you no more than 1 hour to complete this survey. You may skip any questions that make you feel uncomfortable, and you are free to withdraw from the study at any time without penalty. The ri sks involved with participating in this study are no more than one would experience in regular daily activities. Potential benefits that you may receive from participation include a deeper understanding of the meanings and motivations behind tattooing.

If you experience problems or have questions regarding your rights as a research subject, contact the Institute for Clinical Social Work at (773) 263 -6225. For other questions about the study, you should call the principal investigator: Jill Bajorek, 708927-8881. By completing the attached questionnaire/survey, you give consent to participate in this study.

You must be 18 years old to participate.

1. How old are you? _____

2. What is your gender? ________________

3. Which category or categories best describe you?

Asian

Black or African American

____ Hispanic, Latino, or Spanish Origin ____ Native American

____ Native Hawaiian or Other Pacific Islander

____ White or Caucasian

____ Other (Please specify)

4. Where would you place yourself on the socio -economic spectrum?

Poor

Lower middle-class

Middle-class

Upper middle-class

Wealthy

5. Where would you place yourself on the religious/spiritual spectrum

Not religious/spiritual

Religious/spiritual but not observant

Moderately observant

6. Do you have one or more tattoos? Yes No

7. How many times have you been tattooed? ______ times

8. How many tattoos do you have? _________ tattoos

9. How long ago did you get your most recent tattoo? Within the last month

2-6 months ago

7-12 months ago More than a year ago

10. How likely is it that you will continue to add tattoos to your body?

11. How old were you when you got your first tattoo? ______ years old

12. Is (are) your tattoo(s) visible to the general public?

13. When visible, do you enjoy showing your tattoo(s)? Yes No

14. Do you ever cover it (them) up? Yes No

15. Do you cover them up for any of the following reasons?

16. Has anyone ever made you feel bad because you were tattooed? Yes No

17. Do you believe you have ever been discriminated against because you are tattooed? Yes No

18. Do you think your tattoo(s) have ever frightened someone? Yes No

19. Have you ever regretted getting tattooed? Yes No

20. Have you ever had a tattoo removed? Yes No

21. Have you ever had a tattoo altered or covered? Yes No

22. You confirmed prior to the interview that your tattoos are part of your identity. How are they part of your identity?

23. Can you identify a tattoo that you feel is most a part of your identity? ________________________________ (description/name of tattoo)

24. Where is the tattoo located? _____________________________

25. How old were you when you got this tattoo? _____ years old

26. Can you remember what prompted you to get this tattoo, or what was going on in your life at the time?_____________________________________________

27. Do you have a regular story or narrative that you tell when strangers ask you about this tattoo?

28. If Yes, what is the story or narrative?___________________________________

29. Has the “meaning” of this tattoo changed over time?

Not at all Somewhat

Quite a bit Completely

30. If Somewhat, Quite a bit, or Completely, how has the “meaning” of the tattoo changed?

31. There are many reasons to get a tattoo. Do any of these apply to this tattoo? Please choose up to three, and rank them in order of importance, where 1 is most important.

To express myself

To be unique

To fit in

To be rebellious

To feel mature

To feel more attractive

To commemorate a life event

To be like a friend, lover or other Empowerment

Fashion

Sexual attractiveness

Just wanted it

Other:

32. Does this tattoo relate to any particular community or tradition? Check all that apply.

Ethnic Cultural Religious Military Athletic/Sports Club Gang Music Prison

Other: __________________________________________

None of the above

33. Was it your decision to get this tattoo or did you have to be encouraged?

My own decision I was encouraged

34. Were you happy with the result? Yes No

35. Are you still happy with it? Yes No

36. Is there an element of secrecy in this tattoos’ meaning? Yes No

37. If Yes, would you be willing to share the secrecy in your tattoos’ meaning?

38. Would you be willing to share with me a photograph of the tattoo we have been discussing? Yes No

39. Would you be willing to allow me to show your photograph to other study participants (your name and other identifying information will not be shared). The photograph will be altered to ensure only the photograph you are willing to share is visible and your name and identity will not be associated with the photo. Yes No

40. Would you be interested in participating in the next phase of this study , which would include an online exercise that will help to further organize sample data which includes subjects’ photographs? Yes No

Thank you for your time and thoughts. You must be 18 years of age or older to participate in this survey.

Point # Description

Appendix E

Point Numbers and Tattoo Descriptions

09. Photo 43: Owl Sleeve

10. Photo 42: Koi Fish

11. Photo 40: Lightning Could Strike

12. Photo 39: Dog Ears

13. Photo 38: Momma Moon

14. Photo 37: Two Birds

15. Photo 36: Angel Wings

16. Photo 35: XOXO

17. Photo 34: Foster Cat

18. Photo 32: Día de los Muertos

19. Photo 31: I Will Follow Where You Lead

20. Photo 30: Grandparents’ Garden

21. Photo 29: Street Sign

22. Photo 28: Family Tree

23. Photo 27: Three Hearts

24. Photo 26: Love Always

25. Photo 25: Dreamcatcher with Birds

26. Photo 24: Maya Angelou/Coordinates

27. Photo 23: Three Arrows

28. Photo 22: Four Images

29. Photo 21: White Sox

30. Photo 20: Girl Scout Stump

31. Photo 19: Birthstone Flowers

32. Photo 18: Greek for Fish

33. Photo 17: Live Free Eagles

34. Photo 16: They/Them

35. Photo 15: Chinese Dragon Head

36. Photo 14: Chair Scissors

37. Photo 13: Japanese Character

38. Photo 12: Player 2

39. Photo 11: Cabin

40. Photo 10: Three Cancer Ribbons

41. Photo 9: Pawprint

42. Photo 8: Black Bands

43. Photo 7: Sports

44. Photo 6: Rainbow Pulse

45. Photo 5: Cattleya Flower

46. Photo 4: Icelandic Compass

47. Photo 3: Feather J 48. Photo 2: Beloved

Appendix F

Final Clusters

1. Self-Discovery

01. Photo 51: Kawaii Head

07. Photo 45: Elegantly Disheveled 15 Photo 36: Angel Wings 17 Photo 34: Foster Cat 30. Photo 20: Girl Scout Stump 36. Photo 14: Chair Scissors

2. Pride 03. Photo 49: Ironman Symbol 06. Photo 46: American Shield

29. Photo 21: White Sox

35. Photo 15: Chinese Dragon Head

3. Journey 04. Photo 48: Postcard 40. Photo 10: Three Cancer Ribbons 43. Photo 7: Sports 46. Photo 4: Icelandic Compass 48. Photo 2: Beloved

4. Self-Acceptance 05. Photo 47: Lady Fingers 14. Photo 37: Two Birds

25. Photo 25: Dreamcatcher with Birds

32. Photo 18: Greek for Fish

34. Photo 16: They/Them 44. Photo 6: Rainbow Pulse

5. Heritage 08. Photo 44: Italian Stallion 28. Photo 22: Four Images

42. Photo 8: Black Bands

45. Photo 5: Cattleya Flower

6. Connection 02. Photo 50: Red Shoulder Flower

10. Photo 42: Koi Fish

11. Photo 40: Lightning Could Strike

20. Photo 30: Grandparents’ Garden

7. Familial Bonds

09. Photo 43: Owl Sleeve

13. Photo 38: Momma Moon

19. Photo 31: I Will Follow Where You Lead

22. Photo 28: Family Tree

23. Photo 27: Three Hearts

24. Photo 26: Love Always

26. Photo 24: Maya Angelou/Coordinates

27. Photo 23: Three Arrows

31. Photo 19: Birthstone Flowers

33. Photo 17: Live Free Eagles

8. Homage 12. Photo 39: Dog Ears

16. Photo 35: XOXO

18. Photo 32: Día de los Muertos

21. Photo 29: Street Sign

37. Photo 13: Japanese Character

38. Photo 12: Player 2 39. Photo 11: Cabin

41. Photo 9: Pawprint

47. Photo 3: Feather J

Appendix H