ASK THE THERAPIST
by William A. Henkin, Ph.D.
Copyright © 1993 by William A. Henkin
<Q> I've heard someone described as having a bad case of "top's disease." What is top's disease, what does it affect, and is there such a thing as "bottom's disease?"
<A> You won't find Top's Disease in Dorland's Medical Dictionary but you can find it almost anyplace large groups of SM players congregate. Top's disease starts with the belief that one is better than everyone else or at least better than all bottoms because one is a Top; in its extreme form it leads to acting as if one is in charge of everyone and everything 24 hours a day, whether or not they have agreed with your assessment. It really amounts to non-consensual domineering or not to put too fine a point on it bullying, and my guess is that usually it comes from the same place playground bullying among kids or any other sort of bullying comes from: insecurity, uncertainty about who one is in the world, and a kind of damaged self-esteem that demands ego defenses other people will find difficult or simply unpleasant to try to penetrate.
As you've guessed, there is a corresponding concern for some people known as "bottom's disease." Bottom's disease starts with the belief that one is inferior to everyone else and especially to all Tops simply because one is a bottom, and it may include the belief that all bottoms are inferior to all Tops. In its extreme form bottom's disease leads to acting as if one has no responsibility for one's own behavior or well-being, or even for one's own life, simply because one is a bottom. Again, my suspicion is that bottom's disease is another way to cope with insecurity, uncertainty, and a wounded sense of self.
Since bottom's disease often amounts to non-consensual servility bottoms falling at the feet of Tops they've never properly met in bars and at parties perhaps it's worth pointing out that there can be a connection between bottom's disease and "Topping from the bottom," which is a way some people covertly run a scene from the bottom's space. Sybil Holiday has described how, before she discovered SM and her real Top space, she used to top from the bottom in vanilla sex: wriggling and ooh-ing and ahh-ing when her partner did something she liked to encourage the person to do it some more, or remaining quiet and motionless when she did not like what was happening so her partner would not be encouraged. Topping from the bottom is one way people who have or believe they have no real power can gain a measure of control over a scene, a relationship, or their lives.
If Top's disease can be thought of as unbridled aggression, and bottom's disease as unbridled passivity, Topping from the bottom might be thought of as the triumph of passive-aggression. All these behaviors can be legitimate attempts to solve difficult intra- or inter-personal riddles. Unfortunately, they are rarely satisfactory for long because, as we all hope to learn somewhere in SM 101, they are non-negotiated and non-consensual.
There is a solution that can be applied to many such riddles, which is truly assertive behavior, and is appropriate for Tops, bottoms, middles, and switches alike. In SM terms assertive behavior amounts to knowing your wants and needs and making them part of a clear negotiation.
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