Tattooing Among Combat Soldiers as a Coping Resource With Their Military Service Experiences

ABSTRACT

This study aims to examine how former combat soldiers use tattoos as a coping resource in response to their military service experiences. Qualitative analysis of semi‐structured interviews with eight combat soldiers identified two main themes: (a) the military events and distress as a background story of the tattoos; (b) the tattoos' meaning as a coping resource for military service experiences. The thematic analysis revealed two coping resources which the soldiers utilised through tattooing. The first is the emotional‐relief coping resource, which allows combat soldiers to express and process their emotions in response to events experienced during their military service, and helps them reduce feelings of stress. The second is the positive‐productive coping resource that enhances positive feelings, serves as an empowering, promoting and strengthening resource, and expresses a transformative process of change. The findings also revealed that both of the coping resources were adaptive coping resources. This study contributes to the limited research on tattooing among combat soldiers, expands the knowledge regarding tattoos as a coping resource with military service, and identifies two types of coping resources utilised by combat soldiers. On a practical level, our findings offer insights for interventions aimed at promoting awareness among combat soldiers about the effectiveness of tattooing.

1. Introduction

During military service, soldiers encounter stressful, possibly life‐threatening situations including prolonged battles, death of comrades, and struggles for their own survival (Farnsworth et al. 2017; Jones 2017). These experiences can instigate symptoms of distress, mental disorders (Anderson et al. 2019; Lazarov et al. 2020), and problematic behaviours (Chui et al. 2022), putting them at risk, both during and after their service (Blakey et al. 2022; Nichter et al. 2021).

Getting tattooed is one way to cope with psychological distress. Studies among the general population indicate a relationship between the two, either as a processing mechanism to regain a sense of control over one's life (Crompton et al. 2021) or as a way to acknowledge difficult experiences (Wonneberger 2020).

There are various motives for tattooing including self‐expression, being unique, feeling independent, preserving personal identity (Alter‐Muri 2020; Dickson et al. 2015), and in strengthening an individual's body image and self‐esteem (Ball and Elsner 2019). Others get tattooed to commemorate special events, people or places, or for aesthetic reasons (Csesznek and Stemate 2019; Notara et al. 2022).

Studies examining tattoo use among soldiers show that tattoos express their war experiences, allowing them to share their experiences with others (Dyvik and Welland 2018). To the best of our knowledge, the few studies (Dyvik and Welland 2018; Roggenkamp, Nicholls, and Pierre 2017) investigating the role of soldiers' tattooing did not specifically examine the term ‘coping’. The present study attempts to fill this lacuna, focussing on tattoos' role as a coping resource among combat soldiers who have participated in military operations and combat.

2. Military Service and Distress

During military service, soldiers, by defending their country, are put in stressful situations (Goldner et al. 2022; Zhao, Wang, and Shi 2020), and cope with uncertainty and threat (Clemente‐Suarez et al. 2018). Their lives and physical wellbeing are threatened (Farnsworth et al. 2017), and they are possibly exposed to the death of comrades or civilians (Jones 2017). Consequently, soldiers experience physical, emotional and psychological reactions during and after their military service (Gouws 2018).

The multiple stressors that soldiers encounter during military operations and battles could result in mental disorder symptoms (Anderson et al. 2019), psychological distress and post‐traumatic stress disorder (PTSD) (Kinney et al., 2023; Lazarov et al. 2020; Zerach, Ben‐Yehuda, and Levi‐Belz 2023), alcohol abuse (Chui et al. 2022), general anxiety disorders, suicidal ideations (Anderson et al. 2019) and a tendency towards aggressive and violent behaviour (Russel et al. 2021).

Discharged combat soldiers often experience a period of transition and adaptation to civilian life (Blackburn 2016). Many discharged soldiers face mental health problems following combat exposure (Borowski et al. 2022), and experience forms of psychological distress such as depression, anxiety (Bartone and Homish 2020; Lee et al. 2019), feelings of shame, guilt, mistrust, loss of meaning (Blau and Miller 2022), and functional difficulties in the psychosocial, social, personal (Blackburn 2017), and employment (Knežević and Krupić 2016) realms, as well as inabilities to cope with various life events (Bartholomew et al. 2017).

3. Soldiers' Coping With Their Military Service

Soldiers must cope with their unique experiences and psychological stress during their military service (Ben‐Shalom and Benbenisty 2016). Coping requires cognitive and behavioural efforts to reduce, control or alleviate stress, and is defined as realistic thoughts, actions and flexibility aimed at solving problems (Lazarus 1999; Lazarus and Folkman 1984). While various perspectives on coping exist (for a review, see Carver and Connor‐Smith 2010), early research primarily distinguished between problem‐focused and emotion‐focused coping (Lazarus and Folkman 1984). Problem‐focused coping entails strategies aimed at altering stressful situations through problem‐solving, decision‐making, or direct action. In contrast, emotion‐focused coping involves cognitive and behavioural efforts to manage the emotional impact of stress (Lazarus and Folkman 1984).

Studies on soldiers coping with military service shows that how discharged soldiers react to their psychological symptoms significantly effects their military to civilian life transitioning (Bowes, Ferreira, and Henderson 2018). Combat soldiers utilise various adaptive coping styles, such as faith, which can enhance their sense of belonging and motivation to fight (Ben‐Shalom and Benbenisty 2016; Laffey, Bjorck, and Currier 2020), and reevaluation, where they reinterpret negative events during combat more positively (Henson, Truchot, and Canevello 2021). Family and social support also play a significant role (Blackburn 2017). Specifically, support from fellow veterans who faced similar situations can help develop personal resilience (Blau and Miller 2022). The use of these coping styles are associated with better psychological wellbeing and less severe symptoms of psychological distress (Laffey, Bjorck, and Currier 2020).

Soldiers also use less effective coping strategies, such as negative beliefs about themselves (Sheerin et al. 2018), denial, and dissociation (Laffey, Bjorck, and Currier 2020). The use of addictive substances is also a coping style employed by soldiers due to extreme stressor exposure resulting from combat operations (Bartone and Homish 2020; Szabo et al. 2020). These strategies are associated with post‐trauma (Sheerin et al. 2018), lack of motivation, feelings of depression, and a decline in quality of life (Laffey, Bjorck, and Currier 2020).

The choice of coping styles appears to be significant for veterans, influencing their physical, psychological, and social wellbeing over time (Laffey, Bjorck, and Currier 2020). Adopting positive coping styles can alleviate psychological symptoms, which then reduces reliance on negative and maladaptive coping mechanisms (Knežević and Krupić 2016; Laffey, Bjorck, and Currier 2020).

4. Tattooing as a Coping Mechanism With Distress and Trauma

Psychological distress is a significant motivation for tattooing (e.g., Ward 2022). Tattooing is common among people who experienced traumatic life events such as sexual abuse, family violence, mental illness, breast cancer, and early life trauma (Arora 2018; Maxwell, Thomas, and Thomas 2020; Ward 2022).

Trauma survivors cope with their ongoing invisible wounds through tattooing (Crompton et al. 2021; D. R. Maxwell 2017). For trauma survivors, tattoos signify empowerment, hope, and self‐love (Buss and Hodges 2017). Tattoos indicate the trauma experienced (Crompton et al. 2021), and express psychological pain such as worries, discomfort, anger, and loneliness (Ward 2022). Tattoos help process and cognitively deal with the traumatic event (Crompton et al. 2021). Studies show increased trauma recovery when victims focus on constructive thinking, ways to understand the event, or on the event's positive outcomes (Cadell et al. 2022; Wonneberger 2020). Tattooing helps relieve psychological distress and alleviate stress (Alter‐Muri 2020; Mann et al. 2020), and can facilitate mental healing (Crompton et al. 2021).

Tattooing as a coping strategy turns stressful and traumatic events into power and survival narratives, allowing individuals to acknowledge past difficulties and reframe them positively through internal processes (Wonneberger 2020). Women who survived breast cancer and underwent a mastectomy may choose tattooing to cope. This helps them maintain a positive outlook and afford a sense of protection (Eschler, Bhattacharya, and Pratt 2018). Female sexual abuse survivors use tattoos to regain control by choosing the tattoo and the tattoo artist (D. Maxwell et al. 2020).

Tattooing gives people a chance to tell their story. After being tattooed, some can talk about the traumatic event more freely and may find it easier to choose what they want to share with others (Eschler, Bhattacharya, and Pratt 2018; Reid‐de Jong and Bruce 2020). The tattoo may prompt questions from others, making it easier for individuals to share their story and repeatedly convey the tattoo's symbolic significance (Woodstock 2014). Thus, tattoos help people to turn their personal story into a public narrative of coping that society can relate to (Crompton et al. 2021).

Tattoos can help overcome remnant psychological conflicts, and serve as a means for personal change, growth, and healing (D. R. Maxwell 2017; Wonneberger 2020). The tattoo and its symbolic significance are psychologically beneficial in coping with difficult and traumatic events (Black and Riley 2018), and can be a tool in the healing process (Alter‐Muri 2020). Rather than daily reliving the traumatic experience, tattoos may serve to empower and reinforce those memories (Black and Riley 2018).

5. Soldiers' Tattooing as a Coping Mechanism

As mentioned, the few studies investigating tattooing among soldiers did not investigate it as a coping mechanism for their military experiences, and did not explicitly address tattooing as a coping resource, but rather focused on tattooing as a way to express negative emotions (Dyvik and Welland 2018; Roggenkamp, Nicholls, and Pierre 2017). For example, Dyvik and Welland (2018) found that soldiers told their war experiences via body tattoos. Post‐military service tattoos ‘trap’ soldiers' war experiences. In cases of loss, the tattoo expresses the soldiers' grief (Roggenkamp, Nicholls, and Pierre 2017), anger and guilt that they survived while their fellow soldiers did not (Dyvik and Welland 2018). The tattoo allows soldiers to reveal emotions embedded in their war experiences, which continue to shape their lives even after the war had ended (Roggenkamp, Nicholls, and Pierre 2017). Tattoos document feelings of change and hope, memorialisation, and respect for their fallen comrades (Dyvik and Welland 2018).

The present study closely examined how combat soldiers, who have participated in military operations and combat, use tattoos as a coping resource with their military experiences.

6. Method

6.1. Research Approach

This study utilised the qualitative‐phenomenological approach. Phenomenological research is based on qualitative‐constructive paradigm principles, characterised by its holistic approach to phenomena (Patton 2002; Strauss 1987). Accordingly, this method provides information on personal experiences and interpretations as it is presented from a subjective point of view (Bruner 1986). This approach was chosen because of its ability to illuminate the combat soldiers' experiences with the studied phenomenon, how combat soldiers interpret and perceive their military service experiences through tattooing, and how they cope with these experiences and express their subjective feelings and thoughts via tattooing (Creswell and Poth 2016).

6.2. Participants and Sample

The study included eight discharged Israeli combat soldiers, who were tattooed during their military service or shortly after discharge, following a traumatic event experienced during their combat military service such as participating in lengthy battles, injuries, or having friends injured/killed/committed suicide during military operations. 2 of the participants were female and 6 were male between the ages 21 and 29 (average age was 25). Four were single and four were married. On religiosity, three reported being traditional and five categorised themselves as secular. Five participants had a high‐school education, two had academic degrees, and one had a vocational certificate. 2 participants had 1 tattoo each, 2 had 2 tattoos, 1 had 3 tattoos, 1 had 6 tattoos, 1 had 8 tattoos, and 1 had 15 tattoos. The majority had one tattoo related to their military service, and one participant had two. Four had tattoos done during their military service, three had it done after their military service, and one had two tattoos, one during and one after. Table 1 presents their demographic information.

TABLE 1.

Participants' demographic and combat information.

Alias	Age	Gender	Role	Events during military service
Danny	28	Male	Combat soldier	Participated in lengthy fighting; a friend committed suicide; he was injured; friends were injured
Shalom	28	Male	Combat soldier	Participated in lengthy fighting; friends were injured; friends were killed; friends committed suicide
Lior	27	Male	Combat soldier & medic	Participated in lengthy fighting; friends were injured; friends were killed
Rotem	21	Female	Combat soldier	Participated in military operations; a terrorist escaped; condemnation by comrades
Lavi	21	Male	Combat soldier	Participated in military operations; injured during company activity
Dikla	24	Female	Combat soldier & medic	Participated in military operations; injured in basic training; friend committed suicide
Zohar	29	Male	Combat soldier	Participated in military operations; injured
Leo	24	Male	Combat soldier	Participated in military operations; his direct commander was injured; participated in fighting

Purposive sampling (Patton 2002) was used to select information‐rich cases. The inclusion criteria were discharged combat soldiers who got tattoos during their military service or shortly after their discharge. Purposive sampling can involve a snowballing method, in which participants identify other participants (Cohen and Arieli 2011). The ultimate sample size was established based on the comprehensiveness and depth of the data collected from the participants, adhering to Morse's (2000) principles of theoretical saturation. Following the completion of interviews with eight participants, the recurrence of themes suggested that saturation had been achieved (Saunders et al. 2018).

6.3. Data Collection

Data were collected using semi‐structured interviews based on open‐ended questions. Semi‐structured interviews enable participants to raise subjects, and express emotions and personal views regarding the researched phenomenon (Britten 1995). The interviewer's guide consisted of several open questions regarding the way they perceive their military experience and how they coped with these experiences through the tattoos. For example, the participants were asked, ‘Were you injured during your service?’, ‘Was anyone close to you killed or injured in the army?’, ‘How did you feel when you got the tattoo?’, ‘What made you get the first/last tattoo?’, ‘Why did you get tattooed?’, ‘How did you feel after you got the tattoo?’, ‘Did the tattoos change your feelings in any way?’, ‘Did the tattoo help you cope with the situation or your feelings at the time?’.

6.4. Procedure

The researchers approached Israeli Facebook group managers whose groups focus on tattoos such as ‘Talking tattoos’, or ‘Tattoos and tattooers’ and asked to advertise the study on their page. After permission was granted, the researchers posted a request that included the study participation criteria.

The participants could choose the interview's location, or to do it online via Zoom. All eight participants chose the Zoom option. The interviews were conducted in 2022 and each interview lasted between 1 and 2 h. The interviews were conducted approximately 3 years after the participants got their tattoos. The research was approved by Ariel University's Ethics Committee (Approval number 20211103).

Before starting the interview, the interviewer explained the research aim, and the interviewees signed an informed consent form, in which they were promised full confidentiality and anonymity. The participants were given aliases to preserve their anonymity. They agreed to have the interview recorded, that their participation was voluntary, and that they were not reimbursed for it. They were told that they were free to stop the interview and leave the study at any time without explanation.

The participants filled out a demographic background questionnaire (age, gender, etc.) and questions regarding their military service (e.g., ‘Were you a combat or non‐combat soldier?’, ‘Have you been in combat situations during your service?’) and their tattoos (e.g., ‘When did you get your first tattoo?’, ‘How many tattoos do you have?’, ‘At what age did you get your tattoos?’) etc. Before beginning the interview, the interviewer made small talk to create a relaxed atmosphere, and at the end asked the participants whether they had any questions about the study. The participants received the interviewer's telephone number in case they wanted to discuss the interview or ask questions, and were also referred to hotlines that offered help for psychological distress and trauma.

6.5. Data Analysis and Trustworthiness

The methodology used in this study was inductive thematic analysis. The researchers identified, analysed and reported recurring themes, and endeavoured to understand the individual's underlying experiences (Braun and Clarke 2006). Thematic analysis analyzes in four stages: open coding, axial coding, selective coding, and core category (Strauss 1987). Open coding transforms the mass of mainly textual data into manageable categories by assigning primary labels, or preliminary concepts, according to the respondents' exact words. Axial coding captures the data's substance in more abstract terms than open codes. Repeated use of certain terms suggests their relevance as conceptual categories. Selective codes are created by uniting axial codes, and selecting evidence in the data. The selective codes are analysed to identify themes that cut across the data, and then are refined to create core categories of the emerging themes.

Considering trustworthiness, all data (i.e., quotations, categories, and subcategories) underwent peer debriefing (Lincoln and Guba 1985). The analyses were presented to two experienced qualitative researchers, who were asked to examine whether the formed quotations and categories were satisfactory. The categories and subcategories were subsequently reviewed and restructured.

7. Findings

Two themes emerged from the interviewees' discourse. One related to the effect during and after their military combat service of events they experienced. The second theme related to using tattooing as a coping means with their combat experiences.

1. Military events and distress as a background story of the tattoos

Most participants' narratives about their military experiences included narratives about stress and trauma. They stated that their experiences had a profound impact on them, leading to feelings of self‐blame, nightmares, suicidal ideation, and a need to suppress their difficulties. For instance, Dikla, whose army friend committed suicide, described her guilty feelings, repression, and the nightmares:

I had thoughts about how I didn't see it [the suicide]. The day it happened, she [her friend] came and sat with me, and then in the evening she killed herself. It felt like if she had said something to me that day, so… I blamed myself for a long time. First, I repressed it for a long time. Three months after the course ended, the nightmares began.

Rotem described the suicidal ideation she experienced at that time:

It was the worst period in my service. At the time, I had thoughts of really wanting to be in an accident so I wouldn't have to go back to the base.

In addition to what the participants felt during their army service, they described the effects of those events on their mental state after they were discharged. The participants' statements indicate that even after their military service, they experienced feelings that are related to or similar to post‐traumatic symptoms. Some of the participants described symptoms similar to intrusive symptoms expressed in memories and nightmares.

When I was discharged, nightmares and all sorts of things started at night. [Shalom, who participated in a number of military operations, lost two of his friends in a terrorist attack, and two other friends committed suicide during their military service]

When I was discharged, I thought about it a lot, about my commander, about the bullets flying over my head. I see him with blood and everything. [Leo, who had to extract his wounded commander under fire]

Others described symptoms that resemble symptoms related to negative cognitive and mood changes, expressed in feelings of anger, self‐blame, injustice, depression, and suicidal ideation.

It overwhelmed me. For a long time, I was angry that I have a friend who won't continue with us, who isn't alive today, who can't experience this period. I thought to myself, why do I deserve it [to live] and he doesn't. For a long time, I blamed myself, I felt wrong, that maybe I could have prevented it, or why do I deserve to go out and travel and see everyone, and study and blossom, and here is this kid who won't continue his life.

[Danny]

I was clinically depressed for three months. I wanted to kill myself. I suffer every day. It came to the point that I lie in bed, look up at the ceiling and pray to him up there [God], and ask him not to wake me up, pray with tears in my eyes and cry that I can't anymore,

[Shalom]

Analysis of Danny's recollections shows symptoms that resemble those of hyperarousal.

You can say that these two years were two years of distress. I had a lot of difficulty with noises, slamming doors, loud noises, people yelling… I was the most irritable and impatient person ever.

[Danny]

• 2.The meaning of tattoos as a coping resource

The second theme that emerged from the analysis pertains to the tattoo's beneficial effects as a coping resource. The soldiers' revealed that it helped them cope with the distressful events they experienced during their military service. The analysis revealed that the participants' descriptions of their tattoos' effects on them can be categorised into two types of coping resources through tattooing. The first identified coping resource is a response to an existing stressor, serving as an emotional expression and relief, thereby reducing negative feelings. We termed this coping resource ‘emotional‐relief coping' as it resembles the emotion‐focused coping described in the literature (Lazarus and Folkman 1984; Lazarus 1991). The second type is coping that increases good feelings, and helps to overcome stress and move forward. We termed this coping resource ‘positive‐productive coping'. Our analysis showed that most of the combat soldiers described the tattoo as a positive‐productive coping resource.

7.1. Tattooing as an Emotional‐Relief Coping Resource

For three of the participants, the tattoo served as a resource that helped them reduce their stress levels induced by their military service, by expressing and relieving their feelings. The tattoo also helped in providing a sense of relief and calm.

Mostly, some of the tattoos help me lower my stress level and be calmer. I could actually boil with stress in certain situations, but when I think about the tattoos being a part of what I experience, I'm calmer and less stressed by the situation.

[Shalom]

The tattoo is a form of coping. Through the tattoo I let out what I feel. [Zohar. His leg was injured when an explosive device exploded on the vehicle he was in]

Before my trip to South America, I suddenly internalized all the things I experienced in the army. I noticed that I think about it a lot. I thought a tattoo could relieve some of what I think and feel. when I got the tattoo I had a certain sense of relief. I felt I had externalised some of my mind and heart through my body.

[Leo]

7.2. Tattooing as a Positive‐Productive Coping Resource

Most participants (seven) identified tattooing as a tool or resource that facilitates positive and productive coping, bringing out positive aspects within themselves. This theme includes three parts: tattooing as an empowering, strengthening and promoting resource; tattooing that provides positive meaning; and tattooing as a tool that expresses a process of transformation or change.

7.3. The Tattoo as an Empowering, Promoting and Strengthening Resource

Participants reported that the tattoos evoke positive feelings that help them cope with their military service experiences. These positive feelings included the ability to draw on their inner strength, overcome challenges, move forward, and achieve a sense of self‐confidence.

Both Lavi who sees his tattoo as his ‘inner lightning' (his tattoo is a lightning bolt with clouds), and Rotem who tattooed her own image above water, revealed that the tattoo helps them overcome their former experiences and gives them internal strength.

I decided to go to a tattoo artist and make a sketch of a lightning bolt with a cloud, because lightening is sudden, a powerful surge of electricity, crazy energy that comes with a boom, targeted at one spot. That's exactly the internal process I feel when I need this internal power, you can call it 'inner lightning'.

[Lavi]

The sentence that grabbed me at the time was 'powerful silence, silent power'. It's something that was said about me, and I decided to get this tattoo of always keeping your head above water, and no matter what happens around me, I have to hold myself, hold my head up.

[Rotem]

Lavi who was injured in the army and Dikla whose friend killed herself, added that the tattoo helped them put stressful times behind them and achieve closure, and that it made them feel better.

I felt it [the tattoo] was a rubber stamp, both physically and verbally, that it was really over, that the period was really behind me. It was the final rubber stamp.

[Lavi]

When I finally saw the tattoo, I was excited. I felt better afterwards. It was a sort of momentary pleasure that felt a little like closure, that I did something for her [her friend]. A small closure, but it was closed.

[Dikla]

In this context, Dikla described the butterfly‐shaped tattoo she got after her friend's funeral:

I have a butterfly tattoo. I got it because, at the end of her (friend's) funeral, a butterfly landed on my hand. They say that a white butterfly represents a person's soul, so I decided to get a butterfly tattoo in her memory.

Danny and Lior described how getting a tattoo helped them move forward.

The tattoo made me let go of other things and focus more on myself. For me, the tattoo is like writing something in a diary and putting it in a drawer. You know it's there and you can move on to the next adventure or deal with other things. You sort of create a memory about your leg, or any other part of your body, put it there, and you can move on.

[Danny]

The tattoo reminds me of what happened, shows me my progress, and that I'm not sinking and remaining in the past. It motivates me to continue with life but without forgetting what I had been through.

[Lior]

Danny also described how the tattoo helps him with his sense of confidence and progress in his personal life.

After getting the tattoo, many aspects of my life began to fall into place. My self‐confidence increased. Ghosts from the past stayed in the past, and my mind was free to focus on other activities, both professionally and socially including romantically.

7.4. The Tattoo as Providing Positive Meaning

For some of the participants, the tattoo gave a positive significance to military experiences. Leo and Lavi spoke about the tattoo helping them remember the good things and turn the hard, negative things into positive ones, and giving the events a positive meaning.

When I see the tattoo, I mainly remember the good things, that after all we are still alive, which is not trivial considering the situation we were in.

[Leo]

The tattoo reminds me of that period in a good way, not bad. There is always a good ending, and you just have to make an effort and find the mental power to see it.

[Lavi]

Lior also described specifically that the tattoo helped him to remember that he is alive: I did it to remember that we are alive.

7.5. The Tattoo as a Tool Expressing Transformation/Change

For some of the participants, the tattoo is a tool that expresses a personal process or journey of maturation or change. Leo, who experienced being shot at, described how his tattoo (in the form of a hiking cane) is for him a symbol of his maturation journey in the army.

I got a tattoo of a trekking cane. I did it here [points to the inside of his upper right arm]. It sort of represents that my military service was a journey, and I went through a lot. You could say I matured there.

Shalom, described how the Peter Pan tattoo enabled him to express how he changed from the person he was in the army, metaphorically ‘buried in the army', to an eternal child‐like Peter Pan, an active person that does things.

It's a cliché, but I'm really Peter Pan. I'm nearly 30, and I do a lot of things, things that many children, adolescents and adults would like to do, like moving the way I do or doing things I want to do. So, I feel connected to him, and he means a lot to me because the person I was in the army was buried there and he won't come back.

For Dikla and Leo, the tattoo helped to turn their feelings and thoughts into something more tangible and physical.

I think the tattoo helps me cope. It makes what happened more tangible, that suddenly it's not just in your thoughts but something physical too.

[Dikla]

I decided to get the tattoo to both remember and let go a bit. It's like if it becomes more physical, maybe it will not be mental, it will be physical. It would be a memory for me.

[Leo]

8. Discussion

The purpose of this study was to examine tattoos as a coping resource for combat soldiers. Two main themes emerged from the analysis of the participants' discourse. One relates to the military events and distress as a background story of the tattoos. The second theme relates to the meaning of the tattoo as a coping resource with their military service.

The first theme revealed that during the military service, the combat soldiers experienced distress. They felt the need to repress distressing events, and experienced self‐blame, nightmares and suicidal ideation. The findings also show that the military‐related events they experienced affected their mental state after their discharge. Those interviewed reported that they suffered from symptoms similar to those of PTSD such as reexperiencing trauma memories, negative cognitive and mood changes, and hyperarousal.

This finding aligns with previous research, which found that information processing after traumatic events could present as nightmares or flashbacks, and could be a precursor to PTSD (Cohen‐Louck and Zvi 2022; Lazarov et al. 2020; Zhang et al. 2018). Other studies found that suicidal ideations stem from the effects of exposure to stress events mediated by the severity of post traumatic symptoms (Glenn et al. 2020) and negative cognitions (McLean et al. 2017). Combat soldiers' acclimation back to civilian life after their discharge is for many of them not simple, and is accompanied by mental symptoms due to the stressors they experienced (Anderson et al. 2019; Blackburn 2016). This makes their day‐to‐day conduct in their new environment difficult (Blackburn 2017).

The second theme indicated that the tattoo served as a coping resource with military service experiences. Two types of coping resources were found, the emotional‐relief coping and the positive‐productive coping. A few of the participants (three) used the tattoo as an emotional relief‐coping resource. Through the tattoo, the combat soldiers expressed and processed their feelings towards the distressed events they experienced. The tattoo helped them alleviate their sense of stress and provides a sense of relief. It seems that it functioned as a tool for relieving emotions. This finding is in line with previous research that found that tattooing among the general population who experienced psychological distress helps to alleviate distress (Eschler, Bhattacharya, and Pratt 2018; Mann et al. 2020; Ward 2022). This type of coping resembles the emotion‐coping style (Lazarus and Folkman 1984), which aims to employ cognitive and behavioural efforts to manage the emotional impact of stress.

Although this study did not directly assess the efficacy of tattooing as coping, participants' discourse suggests it indeed is a coping mechanism, as they mentioned that tattoos reduce their stress levels and relieve their feelings. This is similar to the emotion‐focused coping utilise by combat soldiers (Ben‐Shalom and Benbenisty 2016; Blackburn 2017; Laffey, Bjorck, and Currier 2020), which is associated with better psychological wellbeing and less severe psychological distress symptoms (Laffey, Bjorck, and Currier 2020).

Another coping resource expressed by almost all of the participants (seven out of eight) was termed positive‐productive coping. The participants described tattooing as enhancing positive feelings and serving as an empowering, promoting and strengthening resource, which symbolises and expresses a process of transformation or change in life.

The participants did not merely react to their distress during their military service, but used tattoos to positively cope with their experienced events. For most of them, the tattoo serves as a tool or resource through which they cope in a positive and productive way that leads to change and progress. Their statements reveal that tattoos help bring internal strengths to the surface, help perceive the stressful event in a positive light and give it a positive meaning. It allows them to overcome, achieve closure, leave the difficult period behind, and move forward. This finding is supported by previous studies conducted on the general population, in which tattoos were perceived as efficient and safe ways to help individuals undergo an internal process that transformed events from negative to positive, and helps to overcome the traumatic event (Wonneberger 2020).

In addition, the participants reported that coping by means of the tattoo helped them through their personal journey of processes of change. They described being a different person from the one they were before the army, following the stressful events they experienced during their military service. Another change process was an expression of their maturation journey. The tattoos (e.g., the hiking cane or Peter Pan) fit their perception of the process. Previous research has shown that coping through tattooing helps trauma victims to change and grow. The tattoo reinforces the symbolic meaning of the personal experiences by focussing on the tattoo's design and the positive outcomes of those experiences (Cadell et al. 2022; D. R. Maxwell 2017). This personal journey increases self‐awareness and understanding, enabling to experience the experience as empowering and hope‐inspiring (Buss and Hodges 2017), and increases the chance to embark on a personal journey of change and healing (D. R. Maxwell 2017).

Another change that the participants experienced through the tattoo was that it helped them change their feelings and thoughts into something more tangible and physical. As far as we know, this finding has not been reported in other studies on tattoos. Perhaps the transformation from emotional to physical helps with the combat soldiers rehabilitation process. They do not leave the tattoo on an emotional level, but transfer it to the physical level, which may relieve their mental pain. Further research is needed to better explore this phenomenon.

The positive‐productive coping resource fits previous study that found that the tattoo evoked positive feelings such as change and hope, memorialisation and respect to those who served with them and did not survive (Dyvik and Welland 2018). The participants' discourse revealed that this coping resource presents the tattoo as helpful and useful and can, therefore, be perceived as a productive resource.

The positive‐productive coping resource is similar to the positive coping described in the literature (Zong et al. 2010; Andrews et al. 1978). Positive coping in the literature includes actively coping with setbacks by seeking social support and advice from family and friends, learning from others' experiences, searching for meaning, changing negative thoughts and taking a positive view of stress, self‐control, hopelessness, sadness and anger, and finding alternative solutions (Su et al. 2018).

The study participants used some of these strategies through the tattoos, such as changing negative thoughts and taking positive views of stress. They reported additional strategies where tattoos serve as an empowerment tool and assist in the cognitive process of change and progress. Another similarity to the literature is that positive‐productive coping includes active coping, as the act of getting a tattoo itself represents an active coping mechanism. Studies have shown that a positive coping style is a mental‐health protective factor (Wu et al. 2020; Su et al. 2018).

Some of the emotional relief coping resources and positive‐productive coping resources utilised by the soldiers through their tattoos may align with emotion‐focused and problem‐focused coping strategies, as outlined by Lazarus (1991), such as providing a sense of relief and calm and providing positive meaning. However, the participants also described other coping strategies that could not be categorised within these traditional frameworks. Furthermore, the soldiers' narratives revealed coping approaches that diverged from the conventional focus on emotion and problem, suggesting alternative forms of coping.

9. Conclusions

This qualitative study shows that combat soldiers use tattoos as a coping resource to enable them to adjust and cope with events they were exposed to during their combat military service. The participants' discourse revealed two coping resources, which the soldiers utilised through tattooing: emotional‐relief and positive‐productive coping. According to the participants, it seems that both types of the coping resources are adaptive. The emotional‐relief coping resource may be effective in reducing distress and the positive‐productive coping resource may be effective in enhancing positive feelings.

The current study has its limitations, primarily attributed to its retrospective design. The participants were interviewed, on average, 3 years after getting their tattoos. In retrospective studies there is a risk of recall bias. Participants are asked to remember and recount past experiences and events. Soldiers may not recall or share all the details related to getting their tattoos, particularly if the memories are painful or traumatic. Additionally, their recollections may be inaccurate, with a potential for forgetting, or downplaying certain experiences (Devlen et al. 1987). Further research should examine getting a tattoo as a coping resource soon after discharge. Additionally, the study did not examine whether the participants understood the significance of their tattoos at the time they did the tattoos or if this understanding developed later.

Second, this study used a small sample size. This size is appropriate for qualitative research, especially when exploring new phenomena. However, it is too small for the findings to be generalised to the general population of combat soldiers. In addition, the small sample size does not enable exploration of causal relationships between variables. Further quantitative research is needed to understand the causal pathways between the distress that combat soldiers feel to the coping resources found in this study. We recommend conducting a longitudinal study to examine whether tattoos are used as a dynamic coping resource initially, as both emotional‐relief‐coping to reduce negative emotions and stress, followed by positive‐productive coping to enhance positive feelings, or whether the use is dichotomous, namely, each coping resource is utilised independently. Although this study has indicated that both coping styles are effective, it would be beneficial to quantitatively examine the relationship between emotional‐relief and positive‐productive coping resources and feelings of emotional relief to understand whether those resources are adaptive or maladaptive.

In addition, it is important to note that the study participants only expressed positive aspects of their use of tattoos, without mentioning any negative ones. This could be attributed to two main factors. First, cultural perceptions of tattoos as symbols of strength and resilience (Carrere and Peake 2020), particularly among combat soldiers, may have influenced their focus on positive interpretations. Second, participants with more positive experiences may have been more inclined to participate in the study, potentially explaining the absence of negative perspectives (Patton 1990). It also might be that the soldiers who participated in the study were inherently interested in tattoos and predisposed to hold positive views about them. Further exploration of these factors could provide a more nuanced understanding of the role tattoos play in coping with trauma.

Finally, while combat soldiers use tattoos as a positive coping mechanism, they may also rely on less effective strategies, such as denial and dissociation (Laffey, Bjorck, and Currier 2020). Future research should examine additional coping strategies beyond tattoos to gain a more comprehensive understanding of their coping mechanisms.

Despite these limitations, the study extends both theoretical and practical understanding. Theoretically, it contributes to filling the lacuna in the literature about tattooing among combat soldiers, and adds to the knowledge about tattooing as a coping resource with military service. Further in‐depth research is needed to investigate the phenomenon of tattooing as a tool to cope with psychological distress among discharged combat soldiers.

In addition, this study introduced two coping resources that combat soldiers use through tattoos: the emotional‐relief coping (a coping type that resemble the emotion‐focused coping), and the positive‐productive coping (a coping type reminiscent of the positive coping type found in the literature). Although these coping types are similar to those found in the literature, the specific strategies identified in the current study were not identified in previous research, neither among combat soldiers nor in the context of tattoo use. Future research should extend the knowledge about emotional‐relief and positive‐productive coping in general and among combat soldiers and explore its scope through quantitative and qualitative research.

On a practical level, our findings offer insights for interventions that aim to promote awareness of the efficacy of tattoos among combat soldiers. The current findings indicate that tattoos have therapeutic importance by helping discharged combat soldiers cope with the psychological distress they experience.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.