Much a tattoo about nothing – a doctor’s perspective

ben's tatto

Someone I know and love has recently had another tattoo etched (or is it drawn?) over their left shoulder, the most recent of at least 16 tattoos that I know about, about their person. Perhaps, it is a symptom of growing older but there seems to be more and more people in more walks of life with tattoos. I have a number of unanswered questions about tattoos:

  • Why exactly do people get tattoos?
  • Just how many people get tattoos these days?
  • Do just young people get tattoos?
  • Are there associations with tattoos that we make as doctors?
  • Are these associations in fact a form of prejudice against those who choose to decorate their body permanently with ink figures, symbols and pictures?

Although the cultural significance to young people in the UK today of tattoos may be a subject for sociologists to ponder I find it interesting to consider the relationship of the tattoo with medicine. The prevalence of tattoos is perhaps something for our public health colleagues to consider but I do wonder if my perception of it is accurate?

In order to try to answer my questions I carried out a brief search of the NCBI database [1] for articles including the words “prevalence” and “tattoo”, or “perception” and “tattoo” or with the MESH term “Tattooing/psychology”  as applied to humans and in the English language. This non-exhaustive, but handy search revealed approximately 50 publications since I graduated as a doctor 7 years ago and began taking notice of tattoos.

Of these only 3 were carried out in the UK. One was a touching anecdote about a patient who tattooed the name of his rare medical condition onto his body [2], another was about the effect of tattoos on body image and self-perception of the recipient [3]. The same author had carried out research which closest answers one of my questions 4 years earlier when a study of 160 undergraduates resulted in the provocatively titled article “Unattractive, promiscuous and heavy drinkers: perceptions of women with tattoos” [4].

Since I have graduated it seems that tattoos are no longer confined to rock stars, sailors, soldiers and drug addicts. Even watching football highlights over the last few years has made me realise that more and more people younger than me are getting tattoos, and more elaborate and extensive tattoos at that.

It seems a shame that the only recent piece of research in the UK draws on the opinion of university students and comes up with such a negative connotation of tattoos [3]. I wonder if this feeling pervades amongst the medical profession? Do we use phrases such as “tramp stamp” – a derogatory term for a tattoo in the lumbar region that seems popular, especially amongst women? Do we associate tattoos, perhaps wrongly with increased risks of blood borne viruses, where the majority of the research seems to focus?

If one is to rely on the evidence base about tattoos, you could be led to believe that doctors perception of those with tattoos are those with risky behaviour, certain occupations, with hepatitis B/C or some other weird and rare disease contracted from Chinese ink [5]. Our older patients fall into the categories of criminal or regretful.

My search didn’t really answer my questions, but made me examine myself. It made me examine what I thought of people with tattoos, questioning whether my observations of ink-stained flesh slip into judgements and whether there is anything I could do to change this, if that were the case. I also realised that there is a massive gap in knowledge about tattoos. If tattoos are a risk factor for both physical and psychological illness, then perhaps we should at least have a handle on who is getting tattoos, where they’re getting them, why they are getting them and how it affects us as doctors when we see and treat them.

bens tattoo2

References

  1. Pubmed. http://www.ncbi.nlm.nih.gov/pubmed/ [accessed 8 June 2012]
  2. Whittaker RG, Turnbull DM, 2009. A diagnostic tattoo. Clin Genet. 75(1):37-8.
  3. Swami V, 2011. Marked for life? A prospective study of tattoos on appearance anxiety and dissatisfaction, perceptions of uniqueness, and self-esteem. Body Image. 8(3):237-44.
  4. Swami V and Fyrnham A, 2007. Unattractive, promiscuous and heavy drinkers: perceptions of women with tattoos. Body Image 4(4):343-52.
  5. Hamsch C, Hartschuh W, Enk A, Flux K, 2011. A Chinese tattoo paint as a vector of atypical mycobacteria outbreak in 7 patients in Germany. Acta Derm Vernereol. 91(1):63-64.
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Encouragement

I was thinking about encouragement this week. I was struck by two things, firstly I wondered whether I was encouraging enough to my children and family. Secondly I wondered if I sought after encouragement too much from those around me for things that I do?

As a community, I know that we should be encouraging one another, that is one of the reasons to belong to any community, religious or otherwise, but when British reserve, lack of time and my brave face combine, I am left feeling that practically no-one really cares enough about the things that I think, say, write and do to encourage me, beyond clicking a “Like” button.
If there is a God, and all that I try to believe about Him/Her is true then I shouldn’t be worrying about what others think, because surely their opinions don’t matter. I should be secure in the knowledge of an eternal, unending love. But I’m not…
I don’t hear God as an audible voice, he doesn’t send me encouraging texts or give me hugs. He doesn’t respond to my blogs, tweets and Facebook updates and certainly doesn’t need to buy my book. That responsibility lies with the people who are known as His hands and feet, His son’s body. But they’re only human.
So perhaps, I need more faith and belief in a God who calls me beloved, and less expectation of people and myself. Perhaps I need to ask myself:
Would I still write, sing, blog, tweet, if no person cared about what I thought? Or is everything I do an expression of reflected, eternal love, that’s between me and God and everyone in between?

Our first go at house church

Believers
Four adults
Five children
The former more broken
Than the latter
Silent worship
And wonder
With music
And images
Of God’s earth
Placed
On its foundation
Bible passage
A demonstration
Not a sermon
Of what a firm foundation is
And thoughts
Response
Of what our foundations are
Prayer for the sick
Shared food
Shared time
With each other
And with God

Caring and the community

Two of my heroes are Shane Claiborne and Anthony Watt. The first is famous in a Christian celebrity kind of way, the second probably only known by a few thousand Christians outside of his native New Zealand. The thing they have in common is the formation of intentional communities. That is, clusters of open households that share a daily and weekly rhythm of prayer and worship, as well as involvement is social projects.

They have both extended their families by allowing both needy strangers and friends to come live with them, share their houses, their space, their meals and their lives. They speak and write of the love that is fostered between people as they struggle to love God, each other, the world and themselves. They move me with accounts of the suffering that they can’t help but hold close to their heart as they give up more of their lives to express their love as God tangibly as love for those around them.

But where does that leave me as a father and husband who has re-discovered God in the last 3 years? Once my family and household had already been established.

Much as I would love to be able to be part of such a community, perhaps start a community like the ones that Shane and Ants are part of, I have a strong suspicion that this will not happen for a variety of reasons. Some of these are under my control, others are not. Simple inertia, comfortable living, possessiveness, children issues and the perhaps less need in a country where there is still social welfare to sustain the most needy at least at a financial level.

So I am slowly and reluctantly accepting that I won’t be a part of an intentional community in the next 20 years at least. I’ve almost gone through the frustration stage; every now and then it flares. And I’m working through the childish strops of “well if I can’t do this, then I just won’t bother at all and live my life like everyone else I know…” But that doesn’t quite sit right with me either.

I want so much more and so much less than how everyone at my workplace, on my street at my church lives with. I want so much more of God, his love and his suffering and I want so much less attachment to my worldly possessions and ambitions. I want to take seriously the commandment to love my neighbour and in that learn to love myself, through the experience of loving God and knowing I’m loved.

So, I’ve reached the point of resigning myself to “normal” family living, but carefully seeking and searching the principles of intentional living to see what aspects of it are helpful applications of the expression of God’s love that can be put in to practice in my family. After all, my family is an intentional community of sorts. I have chosen to share my life with a woman and two small people who daily expose my capacity to love, my inability to have patience, my weaknesses and strengths. And I grow closer to God as  I share their joys, wonders and sufferings. It’s just intentional living in a slightly smaller package.

I’m left asking myself if my family community is simply a place where I unwind after a day’s work or a place that I seek to love others, love the world and love God and through that learn to appreciate that I am needed and loved. Although we don’t have the space (at the moment) to invite anyone to share in that, I have the hope that wherever we are a small bit of what we grow here rubs off onto those we meet and those who enter our house.

Perhaps I need to accept that this is not a “watered down” intentional community, just one that looks and feels slightly different to the ones that my heroes so eloquently communicate. Not lesser, simply different. Not lesser, simply different. Repeat as required until my mind understands this and my heart believes.

Letter to Anya and Elliot on their Thanksgiving (2 May 2010)

Dear Anya and Elliot

In days to come you may wonder why we put you in front of a church full of people, so I thought I would write you a letter to explain. Hopefully one day you’ll read this and it will make sense to you both.

Today is the chance for Mummy and me to say “Thank You” to God, in front of all these people, for the privilege of being your parents. To say thank you to God for lending you two wonderful children to us.

We want to say to God and to all the people here that we promise to try to bring you up to know that God knows you and loves you, that Jesus is your best friend and that God’s Holy Spirit can and will help you all through your lives. We want to promise to teach you to love God, to love each other, to love the people in this room and though this may seem like something impossible, to love all the people you meet, like Jesus would.

It may be that God’s big plan for Mummy and me is to try to make sure that we do those things so that you two can change the world you live in and help more people find out about Jesus. If that’s the case then we would be happy to do just that. That would be a wonderful plan for us.

Thank you for what you both already teach us about God’s love.

We know that we’re not perfect, so hope you don’t mind us asking our friends and family here to help us with the important job of being examples of God’s love to you – to teach you how to have compassion, kindness, humility, gentleness and patience.