Annette Deigh, who survived her father’s sexual abuse, has a tattoo on her right arm of a heart rising in a ball of flame.

Kimberly Velasco has a beloved sister’s birth and death dates inked on her right arm.

And across Sylvia Metzler’s upper body, a vine blooms and a butterfly hovers where her breasts used to be.

Deigh, Velasco, and Metzler are among a diverse group of 28 women whose skin speaks volumes in Tattoo Monologues, a new book by longtime Philadelphia nurse practitioner Donna L. Torrisi.

Co-written by Torrisi’s friend and colleague John Giugliano, with striking black-and-white portraits by Center City photographer Ken Kauffman, the book is an eye-opening testament to the power of body art. Tattoo Monologues is published by She Writes Press.

“I was seeing a lot of women with tattoos, in my primary care practice. I started asking questions and hearing stories,” said Torrisi, the founder of the Family Practice and Counseling Network, which serves about 25,000 patients annually in North and Northwest Philadelphia neighborhoods.

“About six years ago I decided I wanted to do a book about women and their tattoos,” she said. “But we were doing work with trauma at our centers, and I was hearing stories of trauma from some of the women who had tattoos. So the book evolved.”

In addition to people she knew or met through her practice, Torrisi talked up the project while at the gym, in coffee shops, and elsewhere, eventually selecting 28 women for the book — all but one from the Philadelphia region. They include a lawyer, an accountant, and several medical and other professionals, as well as a homemaker, an Uber driver, and a number of social service workers.

The women are young, middle-aged, and older, and some have survived unspeakable sexual, physical, and emotional abuse, as well as bodily harm (one nearly lost her arm during a dog attack). Others have recovered from life-threatening conditions, including cancer, anorexia, and stroke, or are grieving the loss of a loved one.

“My tattoo keeps my sister alive in my heart,” Velasco, 38, who works in IT and lives in north-central Philly, said in the book. She has many other tattoos, including a sun on her chest, and told a reporter it’s there to remind her of her own son — whose birth helped raise Velasco from the depression she struggled with for years after her sister’s death.

The ink-work the women of Tattoo Monologues have chosen to live with on their bodies and display in the book include modest, literal markings and elaborate, even dramatic pieces, like Metzler’s.

“Getting the tattoo was a way of coping with the sadness of losing part of my body,” said the 84-year-old retired nurse who lost her breasts to cancer. She lives in Northeast Philadelphia. A fierce environmental advocate, Metzler said that were she to have the chest tattoo done today, she would choose either an image of a seascape marred by an oil derrick, or a design calling attention to racism’s role in higher breast cancer rates among young Black women.

Once largely associated with drunken sailors, tattoos — an ancient practice — have become fashionable, and a big business, in recent decades. In the forward to Tattoo Monologues, psychiatrist Sandra Bloom noted that 45 million Americans have one or more tattoos. Last May, the Washington Post reported the industry includes 25,000 businesses, 30,000 artists, and annual revenues of $1.1 billion in the United States alone.

“Some of these women had used their tattoos to express really important things they couldn’t express in any other way,” said Bloom, who teaches at the Dornsife School of Public Health at Drexel University. “Making a personal statement on your skin is a whole other dimension” of self-expression.

While tattoos have become familiar, or seem to be ubiquitous, their usefulness as therapy is less well-known.

But a tattoo can be a way of taking control of something in the past that was negative, said Torrisi.

That’s why the author included Jeannette Harrington in the book. Harrington had been molested as a child by a man named Wolf, and later got a tattoo of a wolf on her lower back. “I wanted to take the name, and the power, back,” she told Torrisi.

Lauren Silverstone nearly lost her arm when two dogs in a shelter where she was volunteering attacked. But in Tattoo Monologues, she proudly displays her surgically repaired limb, which now bears a tattoo of her own dog’s footprint next to the “miles to go before I sleep” stanza by the poet Robert Frost in his seminal work, “Stopping by Woods on a Snowy Evening.”

And Sylvia McField, whose five children were removed from her custody, had their names, in the order of their birth, tattooed on her left arm, as if on a scroll. “The scroll saved me from suicidal thoughts and gave me strength; it kept [them] always with me and continually reminded me that I could not give up,” she said in the book.

Noted Torrisi, “A highly visible tattoo also can be a way of not only of telling a story, but having people ask what happened to you, and an opportunity to tell them the story, and to have a conversation.”

Giugliano, a therapist who also teaches at Widener University, pointed out that getting a tattoo is a serious undertaking that requires commitment: It can be expensive, larger pieces can take many hours, and the procedure can hurt. A lot.

“When I notice that a patient has a tattoo, I always ask about it,” he said. “If someone writes something on their skin, it might have some significance.”

Giugliano contributed “clinical connective tissue” at the end of each of the interviews with the women, suggesting how the ink-work can have genuine therapeutic value. Tattoo Monologues also includes professional contributions from trauma researcher Roy Wade, MD, who is associated with the Children’s Hospital of Philadelphia and teaches at the University of Pennsylvania, and trauma experts Delmina Henry and Judith Stern, both of whom are on staff of the Family Practice and Counseling Network.

Like Bloom’s forward, these professional observations give Tattoo Monologues weight that adds to the significance of the stories, the tattoos, and the women who carry them. Kauffman’s dramatic black-and-white photographs also add to the dignity of the presentation. A video he made to accompany the book is similarly understated.

The photo and video sessions “were strong and vital,” said Kauffman. “These women were sharing the deepest parts of their lives.

“I’ve always been drawn to stories of courage,” he said. “This project truly was a high point for me in my career.”

Deigh, a mother of two who lives in Delaware County, said getting the tattoo after she escaped her father’s abuse was a celebration of her liberation. “I had to have a heart on fire to get out of that situation,” she said.

Recently, Deigh got a tattoo to help her overcome the traumatic loss of her family home in a fire. The blaze last February claimed the life of a beloved cat named Panther; Deigh asked the artist for an image of a paw print next to the punctuation mark celebrated by the mental health awareness organization Project Semicolon.

“Tattoos absolutely are powerful,” Deigh said. “And I’m privileged to be part of this project.

Torrisi is grateful to Deigh and all the other women who shared their stories in Tattoo Monologues.

Trauma survivors need to know “you’re not alone,” she said. “Ordinary people can have trauma. Joy and suffering are both part of life. There are lots of ways people can resolve their suffering. And tattoos are one of them.”