The companion piece to the case study we published earlier this year has seen the light of day in the same Pacific Journal of Health. Feast your eyes!

What does it mean to hurt? Is hurting the tearing of your skin, the literal tearing of your skin in your brain, an alarm bell in your brain telling you to fight, flee, or freeze, or a stimulus-response to what you think would happen?

Pain is an emotional and sensory experience with deep evolutionary roots. The three basic functions of animals are to find food, reproduce, and avoid harm. Thus, pain is an interaction of an animal and their environment. From a sensory perspective, pain involves various nociceptive sensory systems, such as for pressure, temperature, and noxious substances. But pain also involves dampening of nociceptive sensors, such as opioids.

“Pain” is defined by the International Association for the Study of Pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage.” Nociception describes the physiological activation of pain receptors and modulation of pain signals in the central and peripheral nervous systems, absent an emotional dimension. Because it’s not clear what is experienced in nonmammals, the term nociception is used to distinguish the physiological analogs of pain, since an emotional component is more difficult to detect in nonmammals, if it is in fact present.

The amount tattooing hurts depends on a person’s sensitization to tattooing pain, through both a dampening of nociception and of the emotional component—fear of pain. I have spent my career studying both dissociation and tattooing, though not necessarily in the same context.

Dissociation is the partitioning of awareness involved in everything from daydreaming to dissociative identity disorder to Pentecostal speaking in tongues, which I’ve studied. For tattooing, people often describe going into the zone, putting on headphones, talking to someone, or some other practice to distract themselves from and thus not feel pain. The pain of tattooing works through a combination of anticipation (sort of like the “white coat syndrome” of becoming nervous when a doctor tests one’s stress levels) and the physical injury to the body.

​When I receive machine tattooing nowadays, after receiving many tattoos over the past nearly 40 years, I barely notice the sensation. However, in 2019 I received a hand-tap tattoo on my lower leg and just about jumped out of my skin from the pain. I was so startled by the sensation of how a hand-tapped tattoo is literally pounded into one’s skin that I tensed up. At one point, watching a gecko on the light overhead to try to get into a zone, the gecko started twitching its tail, and my leg started to jerk sympathetically but involuntarily as well. Su’a Paul Sulu’ape paused in his tapping to ask if I was OK, and all I could do was point at the geckos. I was in so much pain, I considered tapping out in the first minute as the sensation of fire shot up my leg.

The insights into how tattoo pigments stays under the skin and only dissipates and gets blurry over many years is surprisingly recent. In 2018, a team of immunologists from the Centre d'Immunologie de Marseille-Luminy in France led by Anna Baraska tested a new genetically modified mouse model that enables exploration of the human CD64 gene for immunoglobulin G receptors via exposure to diphtheria. Gene targeted mice are mice that have specific mutations to inactivate or modify a specific gene, which enables scientists to explore changes in the gene activity compared to control mice without the change. Diphtheria is a bacterial disease that affects mucous membranes of the nose and throat with a mortality rate of 5-10% of cases, particularly among young children.

Mice were tattooed on ears and tails and compared for levels of cell types. Ears had four times more melanocytes, the precursors to macrophages, than tails. They scraped the mice with diphtheria to cause tissue damage and determine how the cells appeared after healing. They found the green pigment of tattoos remained at the highest density where macrophages were concentrated and concluded that macrophages eat pigment to remove it from circulation. However, during normal cell death and replacement, cells cast off pigment that is re-engulfed by incoming cells of similar type. They witnessed this capture-release-recapture over a 90 day period and hypothesized this process is responsible for holding pigment in place, rather than removing it from the skin, as we might expect the immune system to do.

To ensure this wasn’t simply a by-product of exposure to diphtheria, they grafted the tattooed  tail skin of a gene-targeted mouse onto an albino mouse and watched the progression of healing. The tattoo remained over 6 weeks, and the cells were host cells, indicating that the host mouse’s macrophage cells were engulfing the pigment as the preceding cells died, exactly as in the original tattooed mouse.

A follow-up study led by Helen Strandt of the University of Salzburg in Austria with members of the Marseilles group and using the same methods examined a type of structural cell called fibroblasts because they form the connective tissue of skin.  They found that fibroblasts hold pigment but occur at a lower rate than macrophage cells containing pigment. They speculate that fibroblasts are active taking up pigments during the initial administration of the tattoo when the collagen is damaged and continue to maintain pigment but at a lower rate than macrophages.

A 2022 study published in Frontiers in Immunology by a group in France specializing in the chemistry and biology of metals examined the influence of specific pigments on macrophages. Metals are at the base of several pigments, so this study involved investigation of three cobalt (purple) or cobalt alloy (blue and green) pigments and one zinc (white) pigment. The test was conducted directly on mouse macrophage cell lines and exposed to various concentrations of pigment. Pigments came from Kama Pigments and Tokyo Pigment. They compared acute exposure within the first 24 hours to a 3-day exposure recovery period. All pigments triggered macrophages to eat them, but the activity varied by pigment, and all pigments induced a slight, transitory tumor necrosis factor secretion. By contrast, blue produced a short and sustained increase in interleukin 6 secretion.

The most recent study of the role of macrophages in holding tattoo pigment in place also examined the inflammatory and toxic roles of the inks in place. The authors, a group from Aachen, Germany led by Cheng Lin, used full-thickness 3D skin models designed to study wound healing. They found that macrophages are very efficient at taking up pigment (Sailor Jerry black), that basic black has no inflammatory or toxic effects, and that monocytes (macrophage precursors), which are particularly sensitive to absorbing pigment, and lymphocytes and granulocytes may be responsible for carrying small amounts of pigment away to the lymph nodes and internal organs.

We have a new article out in Pacific Journal of Health that explores a case study of tatau. We collected cortisol throughout multiple days for a man getting a Samoan pe'a tattoo. This is the first documentation of the physiological response to traditional tattooing that we know of. Read the full open access text here.

Michelle Myles is a tattoo artist originally from St. Louis but who has been tattooing on New York's Lower East Side since before it became legal again in NYC in 1997. She was the owner of Fun City (I remember Fun City II as the only visible tattoo shop in the Village when it was illegal, run by Jonathan Shaw). Later, she started Daredevil Tattoo with her partner Brad Fink on Ludlow Street, which at the time had a few hole in the wall bars that featured occasional bands, the all-ages punk club ABC NoRio, and heroin dealers. Then they moved down to an even shadier part of LES at Division St. and Canal near the East Broadway stop on the F train, Seward Park, and the old Jewish Daily Forward newspaper building. Today that neighborhood is bougie and much safer, without any obvious heroin dealing going on.

I took a tour of the tattoo history of the Bowery with Michelle, and she told me that she tattooed a bunch of the dealers, who then protected her in the neighborhood. Michelle is a registered NYC tour guide, and her husband is a tattoo collector. They have a Tattoo Museum featuring an Edison electric pen, which was modified to become the first electric tattoo machine by Samuel O'Reilly. O'Reilly is originally from England but set up shop in NYC in the early 20th century, and they have one of his machines, as well as hundreds of sheets of flash from celebrated early and mid-twentieth century artists from New York. I arrived late because of time zone issues when booking, but we hit it off, so she squeezed in the full tour. It helps that I used to be a tour guide for the Lower Eastside Tenement Museum, so I already knew the history of the social and architectural histories of the neighborhood and  could skip to the tattooing.

​Michelle and I are the same age, both came from the Midwest to New York around the same time (she came a few years before me), and did our times in the music scene before settling down into history and intellectual pursuits, so we had a grand time talking shop as she took me to the Bowery and showed me where Charlie Wagner had his shop, where Lew the Jew had his shop, where Apache Harry had his shop (also Jewish fyi), and the list goes on. These shops were in the backs of saloons, barber shops, and dentists and only occasionally were stand-alone businesses. She talked a lot about the role of the elevated train over the Bowery making it a dingy place, which I recall from Michael McCabe's book from the 1980s, New York City Tattoo.

Tattooing existed in New York and other cities before it became electrified, but it certainly took off as an industry with Edison's and O'Reilly's inventions. As I learned from a recent webinar by Chuck Eldridge of Tattoo Archive, O'Reilly was one of several people tinkering with Edison's patent and simply the first to patent a device of his own. Tattooing has been practiced without electricity for thousands of years, but in the 19th century, numerous inventors were toying with ways to electrify tattooing. The now well-established lore is that after Thomas Edison invented the electric pen to automate filling out forms in triplicate, a number of tinkerers rushed to refine it into a tattoo machine. The first successful patent was given to Samuel O’Reilly.

​What is different about the electric tattoo machine? Electric machine tattooing is different simply in the mechanization that speeds up certain aspects of tattooing. The principle of the electric tattoo machine is that something is moving the needle back and forth at a rapid pace. Tattoo machines can be made from anything with a moving part, which is why so many prison tattoo machines are made from such devices as CD players or electric razors. In the electric tradition, the whole machine is held in the artist’s drawing handing and operated with a foot or finger switch. Non-electric styles achieve the same movement by hand. In the Pacific, one hand holds the tattooing comb (an ‘au in Samoan), and the other hand taps the pattern in with a rod (a sausau in Samoan). In Japan tebori tattooing, the pigment is poked in from the end of a wooden or metal stick of various sizes (called sashibo or nomi). With stick and poke, one administers tattoos by hand with a simple needle or tattoo needle bundle (tattoo needles come pre-made and easily obtainable via mail-order) hafted to a pencil or chopstick.

Paul “Junior” Sulu’ape pounds on his thighs to work the feeling back into them. He and his brothers Peter and Ata are sixth generation tufuga tå tatau, and Paul spends anywhere from 6-12 hours a day, six days a week sitting cross-legged on the floor of a fale giving traditional Samoan tatau in the outdoor Cultural Arts Center in downtown Apia on the island of ‘Upolu, Samoa. As a titled master craftsman, Paul’s proper name is Su’a Sulu’ape Paulo III. They are of the Su’a guild of Samoan tattooists, and the Sulu’ape family have inherited the Su’a title through family ties. Paul’s father is pule in charge of titles and land for the family. Those his father has trained in traditional tatau can earn the Sulu’ape title. Those especially trusted can earn the Su’a title. Paul and his brothers earn them automatically through training as tattooists and being sons of Su’a Sulu’ape Petelo Alaiva’a.

As most experienced tufuga working today at the Cultural Arts Center, Paul serves a head matai or chief for the samaga ceremony that takes place when tatau are completed. His legs are stretched out under a leaf mat as he massages the stiffness out of his legs, as it is inappropriate to point the soles of bare feet at others. Paul grew up in a tattoo family. His grandfather Paulo I passed before he was born, but his uncle Paulo II, father Alaiva’a, uncle Petelo, uncle Lafaele, and brother Peter were all hand tap tattooists in the Samoan tradition. However, culture is not static. Much as tatau has been uniquely maintained in Samoa through the missionary and colonial periods, accommodations have also been made to modernity. To ensure compliance with global sanitary standards. The ‘au or hammer has been redesigned with material that can be sterilized in an autoclave. Paul’s father Alaiva’a introduced these changes in the 1990s. Paul began tattooing with electric machines and picked up hand tapping from watching his father and brother. He has never used the prior tools made with boar’s tusk, which purportedly felt slightly different to use and were more painful to feel. Paul grew up in the 1980s and 1990s and spent as much time in chairs as his father and grandfather spent sitting cross-legged. While the ~25 hours required to complete a pe’a seems almost intolerably painful, the hours spent leaning over body after body tapping in Samoan designs seems even harder. Paul has dedicated himself to preserving his family and cultural heritage but needs acupuncture even as a young man in his twenties for the pain and discomfort of its hardships.

I began working with the Sulu’apes to study the biology and culture of Samoan tatau but was surprised by such additional aspects of cultural embodiment. Tattooing is the perfect topic for anthropological study, given the discipline’s varied foci on culture, biology, linguistics, and archaeology. 

We also have a brand new chapter on the medical anthropology of tattooing in the Oxford Handbook of the Archaeology and Anthropology of Body Modification. This was co-authored with former graduate student Michael Smetana. Mike wrote the first draft for a course, and I slogged away on the rest of it over the course of a year or two. Marco Samadelli wrote a short summary and didn't have time to write a full chapter, so they asked me to combine his chapter with ours. I'm quite pleased with it, though I've already found a few things that will need to be fixed if they retain it for future editions. Check it out here.

Our lab has new publications! The first is an article about podcasting, written by me with Courtney Manthey and Cara Ocobock. We compared listens to episodes of the Sausage of Science podcast that were highlighted on the pod to those that weren't from the same issues and, save for COVID outliers that were accessed at extraordinarily high rates, podcasted articles were significantly more likely to be accessed. This is good news for academic podcasters! Check it out while it's open access: ​https://onlinelibrary.wiley.com/doi/full/10.1002/ajhb.24105

The scheduled time to go to the ferry for the overnight ferry to American Samoa was something like 6pm. I was originally going to drive there and leave our rental in the parking lot. Leota didn't feel comfortable leaving us to our own devices nor with us leaving our car in the lot, so he volunteered to drive us there and keep watch over our car at his house. He didn't think we needed to be there at 5, as I suggested, to ensure we weren't late. He said we could be there at 8pm and be fine. He didn't think the ferry would leave before 10 or 11pm. I was naïve, and Leota would turn out to have been optimistic.

When we told people we were taking the ferry to American Samoa, we got a variety of reactions. Some were impressed by our mettle; ours warned us of the weather and conditions. Many Samoans have never taken the ferry to American Samoa. I think it is a bit of a status thing to take the flight over the ferry, but it is also a time and comfort thing. The financial savings are not worth the trouble, and we would've paid more to avoid it if we could have.

he wait for the ferry while they loaded took several hours in a crush of humanity. No one seemed to know how the loading worked, so everyone kind of crowded in, us included. We crowded near the front until someone finally told us how to read our ticket, and we realized we would be loading among the last groups, so we got out of the way and sat down.

Families were stocking up on food for the trip, buying meals from vendors at the station. We should have done the same. At any rate, we finally boarded around 8:30 or 9. We initially thought we'd have to sit on the floor of the cafeteria, but we ultimately found seats. Josh had been worried about getting seasick and purchased Dramamine from a pharmacy in Apia.

We took the meds and slumped in our seats. Grant went wandering. I think I woke up before we even left and eventually got down on the floor with everyone else to try to sleep. The storm kicked up before we left and buffeted us all the way there. The boat continually went up and slammed down, up and slam down. It was jarring and relentless, but I never felt unsafe inside the cabin. The boat never tipped side-to-side. Just the steady up and SLAM.

I thought the only entrance to our cabin was the one on the far side of the room, as people kept climbing over sleepers throughout the night to reach it. But it turned out there was another door right behind us that just wasn't being used, except by Grant, who found it eventually during his wanderings. Josh and I didn't leave the cabin we were in, trying to stay settled, not vomit, and get some sleep.

I did in fact sleep on the floor most of night, nodding in and out of consciousness. Most of what I know that went on comes from Grant and Josh. People were laying over every available floor space, so I had no compunction about sticking out into the aisle. My main memory is of being stepped over repeatedly throughout the night. I heard the coughing, but I didn't realize it was seasick vomiting. Apparently, a guy behind us was just throwing up on the floor in front of him as he lay trying to sleep.

Grant spent the night wandering the ship and surfing the storm up top with a bunch of Samoan guys he befriended. He was sopping wet when he finally came down.

Because Samoa is now at the beginning of the day and American Samoa at the end, the trip lasted about 6 hours, and we landed the morning of the day we'd left. Very confusing. I am time-zone challenged under the best of circumstances--this was breaking my brain a bit.

I had made reservations for us at Sadie's By the Seashore, one of two decent hotels in American Samoa. I tried to book the Tradewinds, the other decent hotel, which is near the Olaga offices in American Samoa, but they were booked up. Sadie's had vacancies, and was right next to the ferry terminal, so we were set.

​When we walked out, I looked around and thought I knew where we were. We'd go to the right, and Sadie's should be right there. We walked for about 15 minutes, and I said, "wouldn't it be funny if we walked the wrong direction?" We had a running joke of some sort, so we kept walking, but after another 15 minutes, I questioned my own impeccable sense of direction and asked a guy coming out of a store. He pointed the direction we were walking, so we thanked him and kept walking. After nearly an hour, we reached the tuna canneries, which I knew were well beyond our destination. I flagged down a cab, who gave us a ride to Sadie's for $10. It was all the way back around Pago Pago Harbor from where we'd come, just a few steps to the left of the ferry. He was a retired Filipino-Samoan schoolteacher, born and raised in Samoa. I didn't have the bandwidth to chat, but Josh and Grant kept up the banter for us. Grant was fading however.

We got ourselves checked into Sadie's early and crashed out in our room. We'd tried to reach our families back home to let them know we were safe, after ominously texting "taking the ferry in a storm" before an extended radio silence. However, we were too fried to move immediately and crashed out in our room for a few hours. Then we got up, had some food, drank some Cokes over ice that would later give us serious traveler diarrhea, and sent out emails to try to make arrangements for Friday.

I reached out to Joe Ioane from Off Da Rock Tattoos, who was our main collaborator and data collection site back in 2017. I'd had to leave a week early that summer due to a family emergency and did not say goodbye properly.  I also got in touch with Joshua Naseri, who runs the Olaga programs in American Samoa and made arrangements to meet for a happy hour beer or three tomorrow.

We were at lunch in the restaurant at Sadie's when I see someone familiar. I keep looking and keep looking. I finally decide that it's Leuila Ioane, Joe's wife, and the person with his back to us therefore is probably Joe. I'd told him in my message that we were staying at Sadie's, and he'd responded, so if he was here, wouldn't he look us up? Apparently not. I finally went up to them, and indeed it was.

Joe and Uila are a powerhouse couple. They're both Army Reserve, fitness buffs, and driven entrepreneurs. When we were there in 2017, Joe was building a workshop attached to the tattoo studio for Off Da Rock Fashions, Uila's business. She designed cloths, and they had a team of seamstresses making them. I have two great handpainted ties. Joe and Uila and their kids (four now, two more since last time) all look like rock stars modeling her designs.

Anyway, I ask Joe if he can recommend a rental agency, as I'd decided we really did need a car and was about to go try to rent one. Instead, Joe offered to rent me one of his extra cars for a flat rate if I could drive manual. I definitely prefer island cars from friends when I can get them. Cuts right through the bullshit, and I trust Joe. Unfortunately, neither Josh nor Grant had any experience with stick shifts, so I would end up doing all the driving.

After lunch, we jumped into the back of Joe's truck and accompanied him on errands until he got back to his neighborhood in Ottoville. He hooked us up with the car, and I gave Josh and Grant a brief tour of Leone until we realized Grant was flagging. So we went back to Sadie's. Grant took a nap, and Josh and I went to meet Joshua Naseri in the restaurant.

We had a few beers with Josh and told him about our project in person. I'd been emailing back and forth, but this was the first time we got to meet in person, and the project is much easier to explain in person. Furthermore, he was really intrigued by the methods. His team would be able to try out data collection over the weekend, then we'd debrief on Monday and go from there.

We were thrilled. The Olaga team were locals, so they'd be able to collect data much more easily than we could.

One of the adjustments that we'd all agree should be made it that we'd pay more in American Samoa. I don't think I've mentioned the payment, but it was made very clear at the beginning of our data collection that anything but cash would be seen as colonial and paternalistic. In Samoa, we were paying $25 tala per participant for pile sorts, which seemed like a reasonable amount to our collaborators and participants. Given the exchange rate, that would be around $9.33 USD, which is both a ridiculous amount and too low for participant reimbursement. We ended up paying $25 USD in American Samoa because it felt equivalent to people, even though it wasn't and everyone acknowledged it. Weird.

Time to convalesce and watch Women's World Cup Soccer, which was being played in New Zealand and Australia, so near our current time zone. Josh and I are sports fans and looked forward to having something to watch when we weren't out and about.

Grant was still sleeping and would be down and out for most of the next two days with a fever. I was paying for that ice non-stop all day. Good times.