Biohacking Pain: On Leigh Cowart’s “Hurts So Good: The Science and Culture of Pain on Purpose”

I’VE NEVER TRAINED as a ballerina or for an ultramarathon, but I’ve lost plenty of purple toenails. A few years ago, I developed a compulsive cycling obsession and decided, one summer, to participate in an indoor cycling competition. Billed the “Tour de Fly,” the competition was designed in the spirit of the grueling Tour de France. Flywheel Sports, which hosted the competition, has since gone out of business, a casualty of the pandemic, but in 2018 it was still tenable enough to hold classes packed with as many as 60 riders.

With the competition set to officially begin the second week of July, I treated the first week as practice — a soft on-ramp to a test of character, commitment, and consistency. I became a rising slope of tension and anxiety, going nowhere fast and expelling carbon dioxide at a vertiginous rate. As I pedaled, my mind occupied itself with its own hamster wheel: in order to reach 350 total “power points” in 45 minutes, I would need to average around 80 power points every 10 minutes, assuming I took no breaks. After the first week, it was gratifying to see my name in first place on the women’s side of the scoreboard. I had no way of knowing how many points separated me from the second-ranked spinner, so I pledged to keep taking at least five classes a day so as not fall behind. The effort paid off: I maintained the lead for three weeks straight.

The best way to conquer my nerves about doing something terrifying, I believed, was to push myself to the precipice of mental or physical annihilation. I therefore settled into a routine — hit the alarm at 6:30 a.m.; drink half a glass of water; foam roll for 10 minutes; pop a stick of gum to quell appetite; don cycling kit; sprint-walk the 13 minutes to the studio; clip into bike — though routine might be too prosaic a word. There was a predictable pattern to my life before July, but the hundreds of hours spent in the cycling studio threw into sharper relief how relatively amorphous my days were before competition, how heedless a lifestyle that licensed snacking at random times and eating more than two times a day. I left each session feeling at once parched and as if I’d resurfaced from being underwater.

In Hurts So Good: The Science and Culture of Pain on Purpose, journalist Leigh Cowart asks what drives some of us to pursue such punishing activities. Pursue is the operative word: Cowart’s book is not about suffering tout court, but about subjecting oneself to pain in order to “enjoy the deliberately engineered biochemical relief that follows.” (Absent choice, suffering is not a manifestation of masochism but of abuse or torture.) A self-described “emotional, high-sensation-seeking masochist,” Cowart (who uses the pronouns they/them) describes their own years training in a prestigious ballet academy, bloodying their feet until they looked like raw “hamburger meat,” and suffering through years of disordered eating and cutting. There is a distinction, Cowart points out, between pain and harm, though they may form part of a “continuum.” They interview one doctor, the author of a paper on self-harm, who argues that one sign of a pathological behavior is its compulsive quality. Unlike a benign masochistic hobby, a “harmful pathology” is an industrial-strength magnet that draws all of one’s attention and energies. Self-harm, with its “strong link to suicide,” is treated as a taboo while body modification and polar plunges are more socially acceptable. “[P]ain on purpose can be done in healthy ways and unhealthy ways, and it can be tricky to spot the difference,” is Cowart’s own assessment.

Part of their impetus for writing the book was to interrogate why they “like to choose pain” — more specifically, “did ballet make me a masochist? Or was I simply well suited to the grueling discipline of the art form because of something intrinsic to my core personality, the nebulous you-ness that becomes solid and nameable by kindergarten?” Years of ballet have left their mark: Cowart suffered torn tendons in their legs and ankles and a fractured vertebra, and was at one point an inpatient at a hospital in Chicago and forced to undergo “procedures I didn’t consent to.” They eventually give up ballet and, after years in therapy, feel they have made progress in peeling their “desire for pain away from my desire for harm.” Their yearning nowadays is not for the absolute “dissolution of my entire existence,” but for something less harmful and on a smaller scale, such as baptizing themselves in freezing cold water, a sensation that “fills [them] to bursting like a poorly seamed scarecrow.”

Cowart’s relish for painful activities dovetails with that of other thrill seekers, including ultramarathoners, Muay Thai fighters, competitive hot pepper eaters, and BDSM safety instructors, all seeking, through straightforward or devious means, an “endorphin rush, that hit of homebrew morphine.” Cowart refuses to offer anything like a unicausal explanation for the ubiquity of masochism, yet they theorize that one reason people are drawn to it is as “a kind of biohacking: a way to use the electrochemistry of my body in a deliberate way for the purpose of curating a specific experience.” Yet, at other times, the experience of pain and pleasure runs together to such an extent that “over the years, I’ve stopped trying to delineate cleanly between the two.” (The conversational tone and first-person mode, while put to excellent use in recounting their personal experiences, tends to grate in chapters that offer potted summaries of masochism and the science of seeking pain for pleasure. Also peppered throughout the book are such phrases as “Let me explain,” “What I am saying is…,” “As we will see,” and “I’m going to show you,” all of which impart a whiff of the science textbook.)

Once Cowart “started looking for [masochism], I saw it everywhere” — one of many refrains that get repeated throughout the book; others include reminders that the word “endorphin” is a portmanteau of “endogenous morphine” and references to their own body as a “meat bag.” Cowart’s persistent reliance on these descriptors and turns of phrase gives the impression that many of these pieces were originally written as articles for different outlets, yet for the most part they hang together. Even as the language used to describe masochistic activities becomes familiar, sometimes calcifying into cliché, the activities themselves surprise by their variety. Cowart tells us of their own experience of “biohacking” pain, asking their partner, in one chapter, to prime them for fear by piercing their back with hypodermic needles. In another chapter, we accompany Cowart to a tattoo convention, where practitioners nonchalantly inject needles into their skin. The real draw that day, however, comes from people who choose to be suspended in the air by hooks pierced into the skin of their backs or knees, in so-called “suicide suspensions.” These aerial artists are drawn to suspension for a host of reasons; one practitioner Cowart interviews says that the flush of adrenaline he gets from being suspended in the air helped him overcome a drug addiction. Many of the masochists in the book are described as assuming, for an instant, the aspect of statues: a former ballerina turned Muay Thai fighter becomes a “placid sculpture of concentration” when she fends off kicks to her body; a woman preparing to have her tongue sliced in half is a stoic “marble statue in repose”; and Cowart rushing into a freezing ocean feels “the flesh of me becoming marble in the water.” It’s impossible to tell, from the outside, what a masochist is thinking or feeling as pain transmutes into pleasure.

Of all the masochists Cowart chronicles, “one of the most intense” is the ultramarathoner. Their chapter on spectating the Big Dog Backyard Ultra, an infernal race of attrition that takes place in a rural town in Tennessee, that offers no prizes, and that ends only when there is one runner standing, is full of vivid detail that put me off the idea of running even a full marathon, but it still wasn’t clear to me, by the end of the book, why exactly ultramarathons qualify as an ur-example of masochism. If a “crucial tenet of masochism is that it must always be consensual,” then ultrarunners pose a limit case. Cowart describes one runner who is so dazed after hours of running that he hallucinates being in Hong Kong until another participant comes to his rescue. Other runners with perhaps a firmer tether to reality nonetheless tell Cowart that, after a certain number of hours, they shift into a kind of autopilot, relying on crew members to goad them on. “After like forty-eight hours […] you’re not really in control anymore,” says one runner. Another runner admits to being “so out of it” that time becomes “endless but also instantaneous.” Can runners who dissociate be said to exercise bodily autonomy or have they effectively ceded the “ability to control the scene and stop the suffering”? Cowart also reproduces a note from the organizer of the race that qualifies the whole premise of their book: “[L]ike many sport there is discomfort involved, but it is a cost of competition, not an objective.” The cycling aficionado in me is inclined to agree, and Cowart’s shoehorning of the ultramarathoners into their book struck me as an odd choice, given the objection of the race’s originator. What gets called masochistic may not be the same thing for the participant as for a disinterested observer. Who’s to say what truly qualifies as a masochistic undertaking? Does it hinge on the number of nociceptors stimulated — the more masochistic an activity corresponding to a greater number of neurons flaring into activity?

I recognized myself in certain of Cowart’s athletic subjects, who “use the symphonic pain mechanisms of the body to find new ways to be conscious, new things to feel.” This notwithstanding the fact that each spin session I took was overseen by a disciplinarian instructor exhorting riders to “trust the process” and learn to optimize their VO₂ max. What may look like masochism to an observer, however, was for me simply a predisposition or an inclination to repeat a certain strenuous activity. In her 2016 book Inclinations, the philosopher Adriana Cavarero writes, “One can […] understand why philosophers see inclination as a perpetual source of apprehension, which is renewed in each epoch, and which takes on even more weight during modernity. […] [T]he thrust of inclination knocks the I from its internal center of gravity and, by making it lean to the outside, […] undermines its stability.” In this way, inclinations can be said to share something with pain without being identical to it. Pain, as Elaine Scarry has written, can destabilize one’s identity, muddying the waters of self-reflection. Perhaps inclinations are like our shadows, which never finally leave our side but manifest or recede depending on the light of our environment: every movement brings fresh possibilities.

Pain is both subjective — that is, “crafted by the mind itself” — and intersubjective. (Wittgenstein has argued that “words for feeling states like pain” have to be learned, so that pain “can never be wholly private.”) The International Association for the Study of Pain officially defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” and further notes that it is influenced by personal, psychological, and social factors. It’s a definition that Cowart endorses because it doesn’t reduce pain to a negative sensation that should simply be eliminated or avoided altogether — the opposite of pleasure. It instead “capture[s] the murkiness inherent in understanding and demarcating pain while still encompassing all of the wildly diverse experiences of it.”

Yet while we have all experienced some form of pain, it is a topic that unlanguages many of us. In The Body in Pain (1985), Scarry suggests that pain creates zones of silence, balking at description and shattering communication. Cowart elaborates: “Pain is an intimate, wordless thing. Not soundless, not silent, but prelingual […] only really understandable to an outsider if you put it in terms of what might happen to their own body.” As bodily trauma, pain often makes itself felt as an external force impressing itself upon us. Even in the absence of an outside object, we hypostasize them into being: Cowart recounts how, at 10, they discover that “not eating makes my stomach feel like knives.” This, then, is one paradox of pain: it makes the boundary between inside and outside — a boundary we often take for granted and don’t think about — throbbingly clear. As Sara Ahmed has written, “Pain seizes me back to my body.”

“As of yet, there is no method for quantifying how much pain a person has without asking them, no numeric score that an outsider can assign,” writes Cowart. This may be true on a literal, empirical level, but it hasn’t stopped some medical “experts” from treating some people differently than others based on their supposed tolerance for pain. Cowart herself is white and it seems that most of the people they write about are also white; I say “seems” because the book scrupulously avoids talking about people’s racial identities so it’s hard to tell for certain how many racial minorities are discussed. This is the book’s biggest weakness: for race to go entirely unmentioned is to give the impression that racial differences are incidental to the experience of pain. This is far from the case. Joanna Bourke’s The Story of Pain (2014), for instance, has shown how medical authorities in the 19th century came to assign their patients to one of two categories, based on their “sentience” and “sensitivity” to pain. Which bucket you were assigned to depended on your race, class, and gender. If you were Black, you were thought to be less sentient than your white counterparts and were slotted into a lower rung on the physiological “Chain of Feeling.” This thinking also provided cover for the insidious logic of colonization and racial capitalism. “Allegations that natives of New Zealand, Australia, and Canada, as well as Africans, were insensitive to pain were one of the factors that enabled them and their lands to be colonized without guilt,” writes Bourke.

“There is deep intimacy in shared pain, in knowing someone else’s pain in a very real and certain way,” Cowart writes. This seems true enough, and it’s all well and good to remember that a host of cultural, environmental, and genetic factors play into why some people willingly participate in painful activities. Yet the past two years of the pandemic have also made abundantly clear that the experience of pain is thoroughly inflected by race and further entrenches extant hierarchies. There is a long history of subjugated individuals whose pain has never even been validated as such. Needless to say, the separation of people according to their pain sensitivities also has vast implications for who is thought of as needing pain relief. If African Americans have historically been seen as “insensitive” to pain and “undeserving” of relief for all kinds of specious reasons, we might ask whether they have a different relationship to narratives of injury than whites do. Does race recursively shape one’s orientation to pain? Does it make one more or less likely to seek out masochistic experiences? To seriously ask such questions, one first perhaps needs to let go of the idea that “we are all piloting similar versions of the same haunted meat suit.”

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Rhoda Feng is a freelance writer who splits her time between Washington, DC, and New York. Her work has appeared in The Baffler, 4Columns, BOMB, The White Review, The Atlantic, The Guardian, The Hedgehog Review, Salon, Paris Review Daily, and more.