Viewpoints on Asphyxiophilia

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This file contains four separate documents on the controversial subject of erotic asphyxiation. The first document, "The Medical Realities of Breath Control Play" by Jay Wiseman, argues that this type of play is inherently dangerous and always potentially deadly. The second document, "Please Be Tender When You Cut Me Down" by Knud Romer, discusses the phenomenon of erotic asphyxiation from a historical/academic perspective. The third document, "When All is Said and Done, Life Kills Your Ass" by Michael Decker, sheds insight into what erotic asphxiation offers to the people who are drawn to it. The fourth document is a summary of some safety advice on erotic asphyxiation, drawn from various internet articles on the subject. A brief bibliography concludes this file.


by Jay Wiseman
Author of "SM 101: A Realistic Introduction"

For some time now, I have felt that the practices of suffocation and/or strangulation done in an erotic context (generically known as breath control play; more properly known as asphyxiophilia) were in fact far more dangerous than they are generally perceived to be. As a person with years of medical education and experience, I know of no way whatsoever that either suffocation or strangulation can be done in a way that does not intrinsically put the recipient at risk of cardiac arrest. (There are also numerous additional risks; more on them later.) Furthermore, and my biggest concern, I know of no reliable way to determine when such a cardiac arrest has become imminent.

Often the first detectable sign that an arrest is approaching is the arrest itself. Furthermore, if the recipient does arrest, the probability of resuscitating them, even with optimal CPR, is distinctly small. Thus the recipient is dead and their partner, if any, is in a very perilous legal situation. (The authorities could consider such deaths first-degree murders until proven otherwise, with the burden of such proof being on the defendant). There are also the real and major concerns of the surviving partner's own life-long remorse to having caused such a death, and the trauma to the friends and family members of both parties.

Some breath control fans say that what they do is acceptably safe because they do not take what they do up to the point of unconsciousness. I find this statement worrisome for two reasons: (1) You can't really know when a person is about to go unconscious until they actually do so, thus it's extremely difficult to know where the actual point of unconsciousness is until you actually reach it. (2) More importantly, unconsciousness is a symptom, not a condition in and of itself. It has numerous underlying causes ranging from simple fainting to cardiac arrest, and which of these will cause the unconsciousness cannot be known in advance.

I have discussed my concerns regarding breath control with well over a dozen SM-positive physicians, and with numerous other SM-positive health professionals, and all share my concerns. We have discussed how breath control might be done in a way that is not life-threatening, and come up blank. We have discussed how the risk might be significantly reduced, and come up blank. We have discussed how it might be determined that an arrest is imminent, and come up blank.

Indeed, so far not one (repeat, not one) single physician, nurse, paramedic, chiropractor, physiologist, or other person with substantial training in how a human body works has been willing to step forth and teach a form of breath control play that they are willing to assert is acceptably safe -- i.e., does not put the recipient at imminent, unpredictable risk of dying. I believe this fact makes a major statement.

Other "edge play" topics such as suspension bondage, electricity play, cutting, piercing, branding, enemas, water sports, and scat play can and have been taught with reasonable safety, but not breath control play. Indeed, it seems that the more somebody knows about how a human body works, the more likely they are to caution people about how dangerous breath control is, and about how little can be done to reduce the degree of risk.

In many ways, oxygen is to the human body, and particularly to the heart and brain, what oil is to a car's engine. Indeed, there's a medical adage that goes "hypoxia (becoming dangerously low on oxygen) not only stops the motor, but also wrecks the engine." Therefore, asking how one can play safely with breath control is very similar to asking how one can drive a car safely while draining it of oil.

Some people tell the "mechanics" something like, "Well, I'm going to drain my car of oil anyway, and I'm not going to keep track of how low the oil level is getting while I'm driving my car, so tell me how to do this with as much safety as possible." (They may even add someting like "Hey, I always shut the engine off before it catches fire.") They then get frustrated when the mechanics scratch their heads and say that they don't know. They may even label such mechanics as "anti-education."

A bit about my background may help explain my concerns. I was an ambulance crewman for over eight years. I attended medical school for three years, and passed my four-year boards, (then ran out of money). I am a former member of the American Academy of Family Physicians and a former American Heart Association instructor in Advanced Cardiac Life Support. I have an extensive martial arts background that includes a first-degree black belt in Tae Kwon Do. My martial arts training included several months of judo that involved both my choking and being choked.

I have been an instructor in first aid, CPR, and various advanced emergency care techniques for over sixteen years. My students have included physicians, nurses, paramedics, police officers, fire fighters, wilderness emergency personnel, martial artists, and large numbers of ordinary citizens. I currently offer both basic and advanced first aid and CPR training to the SM community.

During my ambulance days, I responded to at least one call involving the death of a young teenage boy who died from autoerotic strangulation, and to several other calls where this was suspected but could not be confirmed. (Family members often "sanitize" such scenes before calling 911.) Additionally, I personally know two members of my local SM community who went to prison after their partners died during breath control play.

The primary danger of suffocation play is that it is not a condition that gets worse over time (regarding the heart, anyway, it does get worse over time regarding the brain). Rather, what happens is that the more the play is prolonged, the greater the odds that a cardiac arrest will occur. Sometimes even one minute of suffocation can cause this; sometimes even less.

Quick pathophysiology lesson # 1: When the heart gets low on oxygen, it starts to fire off "extra" pacemaker sites. These usually appear in the ventricles and are thus called premature ventricular contractions -- PVC's for short. If a PVC happens to fire off during the electrical repolarization phase of cardiac contraction (the dreaded "PVC on T" phenomenon, also sometimes called "R on T") it can kick the heart over into ventricular fibrillation -- a form of cardiac arrest. The lower the heart gets on oxygen, the more PVC's it generates, and the more vulnerable to their effect it becomes, thus hypoxia increases both the probability of a PVC-on-T occurring and of its causing a cardiac arrest.

When this will happen to a particular person in a particular session is simply not predictable. This is exactly where most of the medical people I have discussed this topic with "hit the wall." Virtually all medical folks know that PVC's are both life-threating and hard to detect unless the patient is hooked to a cardiac monitor. When medical folks discuss breath control play, the question quickly becomes: How can know when they start throwing PVC's? The answer is: You basically can't.

Quick pathophysiology lesson # 2: When breathing is restricted, the body cannot eliminate carbon dioxide as it should, and the amount of carbon dioxide in the blood increases. Carbon dioxide (CO2) and water (H2O) exist in equilibrium with what's called carbonic acid (H2CO3) in a reaction catalyzed by an enzyme called carbonic anhydrase. (Sorry, but I can't do subscripts in this program.)

Thus: CO2 + H20 <carbonic anhydrase> H2CO3

A molecule of carbonic acid dissociates on its own into a molecule of what's called bicarbonate (HCO3-) and an (acidic) hydrogen ion. (H+)

Thus: H2CO3 <> HCO3- and H+

Thus the overall pattern is:

H2O + CO2 <> H2CO3 <> HCO3- + H+

Therefore, if breathing is restricted, CO2 builds up and the reaction shifts to the right in an attempt to balance things out, ultimately making the blood more acidic and thus decreasing its pH. This is called respiratory acidosis. (If the patient hyperventilates, they "blow off CO2" and the reaction shifts to the left, thus increasing the pH. This is called respiratory alkalosis, and has its own dangers.)

Quick pathophysiology lesson # 3:

Again, if breathing is restricted, not only does carbon dioxide have a hard time getting out, but oxygen also has a hard time getting in. A molecule of glucose (C6H12O6) breaks down within the cell by a process called glycolysis into two molecules of pyruvate, thus creating a small amount of ATP for the body to use as energy. Under normal circumstances, pyruvate quickly combines with oxygen to produce a much larger amount of ATP. However, if there's not enough oxygen to properly metabolize the pyruvate, it is converted to lactic acid and produces one form of what's called a metabolic acidosis.

As you can see, either a build-up in the blood of carbon dioxide or a decrease in the blood of oxygen will cause the pH of the blood to fall. If both occur at the same time, as they do in cases of suffocation, the pH of the blood will plummet to life-threatening levels within a very few minutes. The pH of normal human blood is in the 7.35 to 7.45 range (slightly alkaline). A pH falling to 6.9 (or raising to 7.8) is "incompatible with life."

Past experience, either with others or with that same person, is not particularly useful. Carefully watching their level of consciousness, skin color, and pulse rate is of only limited value. Even hooking the bottom up to both a pulse oximeter and a cardiac monitor (assuming you had either piece of equipment, and they're not cheap) would be of only limited additional value.

While an experienced clinician can sometimes detect PVC's by feeling the patient's pulse, in reality the only reliable way to detect them is to hook the patient up to a cardiac monitor. The problem is that each PVC is potentially lethal, particularly if the heart is low on oxygen. Even if you "ease up" on the bottom immediately, there's no telling when the PVC's will stop. They could stop almost at once, or they could continue for hours.

In addition to the primary danger of cardiac arrest, there is good evidence to document that there is a very real risk of cumulative brain damage if the practice is repeated often enough. In particular, laboratory studies of repeated brief interruption of blood flow to the brains of animals and studies of people with what's called "sleep apnea syndrome" (in which they stop breathing for up to two minutes while sleeping) document that cumulative brain damage does occur in such cases.

There are many documented additional dangers. These include, but are not limited to: rupture of the windpipe, fracture of the larynx, damage to the blood vessels in the neck, dislodging a fatty plaque in a neck artery which then travels to the brain and causes a stroke, damage to the cervical spine, seizures, airway obstruction by the tongue, and aspiration of vomitus. Additionally, there are documented cases in which the recipient appeared to fully recover but was found dead several hours later.

The American Psychiatric Association estimates a death rate of one person per year per million of population -- thus about 250 deaths last year in the U.S. Law enforcement estimates go as much as four times higher. Most such deaths occur during solo play, however there are many documented cases of deaths that occurred during play with a partner. It should be noted that the presence of a partner does nothing to limit the primary danger, and does little or nothing to limit most of the secondary dangers.

Some people teach that choking can be safely done if pressure on the windpipe is avoided. Their belief is that pressing on the arteries leading to the brain while avoiding pressure on the windpipe can safely cause unconsciousness. The reality, unfortunately, is that pressing on the carotid arteries, exactly as they recommend, presses on baroreceptors known as the carotid sinus bodies. These bodies then cause vasodilation in the brain, thus there is not enough blood to perfuse the brain and the recipient loses consciousness. However, that's not the whole story.

Unfortunately, a message is also sent to the main pacemaker of the heart, via the vagus nerve, to decrease the rate and force of the heartbeat. Most of the time, under strong vagal influence, the rate and force of the heartbeat decreases by one third. However, every now and then, the rate and force decreases to zero and the bottom "flatlines" into asystole -- another, and more difficult to treat, form of cardiac arrest. There is no way to tell whether or not this will happen in any particular instance, or how quickly. There are many documented cases of as little as five seconds of choking causing a vagal-outlfow-induced cardiac arrest.

For the reason cited above, many police departments have now either entirely banned the use of choke holds or have reclassified them as a form of deadly force. Indeed, a local CHP officer recently had a $250,000 judgment brought against him after a nonviolent suspect died while being choked by him.

Finally, as a CPR instructor myself, I want to caution that knowing CPR does little to make the risk of death from breath control play significantly smaller. While CPR can and should be done, understand that the probability of success is likely to be less than 10%.

I'm not going to state that breath control is something that nobody should ever do under any circumstances. I have no problem with informed, freely consenting people taking any degree of risk they wish. I am going to state that there is a great deal of ignorance regarding what actually happens to a body when it's suffocated or strangled, and that the actual degree of risk associated with these practices is far greater than most people believe.

I have noticed that, when people are educated regarding the severity and unpredictability of the risks, fewer and fewer choose to play in this area, and those who do continue tend to play less often. I also notice that, because of its severe and unpredictable risks, more and more SM party-givers are banning any form of breath control play at their events.

If you'd like to look into this matter further, here are some references to get you started:

"Emergency Care in the Streets" by Caroline (I'd recommend starting here.) "Medical Physiology" by Guyton
"The Pathologic Basis of Disease" by Robbins "Textbook of Advanced Cardiac Life Support" by American Heart Association "The Physiology Coloring Book" by Kapit, Macey, and Meisami "Forensic Pathology" by DeMaio and Demaio "Autoerotic Fatalities" by Hazelwood
"Melloni's Illustrated Medical Dictionary" by Dox, Melloni, and Eisner

People with questions or comments can contact me at or write to me at P.O. Box 1261, Berkeley, CA 94701.


Jay Wiseman


by Knud Romer Joergensen, Copyright 1995

An elderly, naked man, hands and genitals tied up, hanged. Autoerotic fatalities entered medical literature, when the german doctor Bernt took a special interest in this case in his paper on suicides (1821). But he reached the wrong conclusion and mistook it for a suicide with an insane twist. It took another century before attention was paid to the sexual aspects of such death scenarios. Again, it was a german forensic, Ziemke, who in 1926 finally identified and consistently described these cases as accidental deaths caused by strangulation as a means to sexual arousal. 1. The upright hangman

In the times of public executions it was common knowledge that hangings occasionally provoked erection and ejaculation. This reflex is probably caused by the snapping of the spine, but it could easily be misinterpreted as a sign of sexual pleasure. An engraving by Duumlrer shows a torture chamber filled with skeletons in chains, a hanged man ejaculating, and another being whipped. There are a number of references in 18th century literature. The most prominent is found in Marquis de Sade's "Justine" (1791), where Thirhse helps Roland achieve an orgasm by hanging him briefly. Afterwards, he exclaims: "Oh, Thirhse! Oh, these feelings are undescribable! They exceed everything!"

A few months after "Justine" was published, the first documented death by sexual strangulation occurred in London. It happend to Franz Kotzwara, composer and one of the greatest double-bass players in Europe, but an even greater libertine of the sado-masochistic variety. September 2, 1791, he payed a visit to the prostitute Susannah Hill on Vine Street no. 5. He gave her 2 shillings to buy some ham, beef, porter and brandy, and after their dinner he asked her to cut off his genitals. She declined, but complied with his wishes to be satisfied by strangulation. Kneeling, he hung himself with a rope tied to the doorknob. Five minutes later he was dead. Susannah Hill was arrested and charged with murder, but was acquitted after testimony proved her innocence. The court records were destroyed to prevent the scandalous case from going public. A secret copy was made, though, to be sold and published at a later time. It never was, but the manuscript is preserved and kept in the Francis Countway Library of Medicine in Boston.

The story did get out, however, and was hinted at in the newspapers. The year after, it was discussed at length in an anonymous pamphlet "Modern propensities; or, An Essay on the Art of Strangeling, & c. Illustrated with Several Anecdotes. With Memoirs of Susannah Hill, and a Summary of her Trial at the Old Bailey on Friday, September 16, 1791, on the Charge of Hanging Francis Kotzwara, at her Lodgings in Vine Street, on September 2" (J. Dowson, London 1791). It runs some 46 pages, the first 29 being devoted to a preamble discussing the putative effects of hanging on the body's physiology, while only the last seven pages deal with Kotzwara and Susannah Hill.

It further accounts an earlier incident concerning a certain Reverend Manacle, who was working in the Newgate prison. He wasn't known to limit himself to administering spiritual support, and had contracted a veneral desease that rendered him impotent. Observering the effects of hanging, though, renewed his hope. He approached a female prisoner, Mrs. Birdlime, who was sentenced to death for shoplifting. He pretended that he wanted to demonstrate with his own body how painless it was to be hanged. She was persuaded, and assisted him in the act. When he was cut down and regained consciousness with the expected erection, she agreed to have sex with him as a reward for his sacrifice. Manacle repeated this act with other women prisoners, and ended up killing himself in the process.

Having introduced the problem of impotency, the pamphlet proceeds with remedies like Dr. Graham's celestial electric bed and on to the assertion that "If ... the most robust and youthful require certain aids to ascend the upper sphere of conjunctive transports, what must be the situation of those ELDERLY and ANITIQUATED PEERS and COMMONERS?" It cites the example of General S. who suffered from "a certain corporeal debility which prevented him from REGULAR enjoyments." This is followed by a brief digression on the pleasure of pain and flagellation as a sexual stimulant. Then the ultimate fix of strangulation and death is introduced, disclosing that it was the notorious Jonathan Wild who first discovered, while examining the pockets of hanged felons, that "They evinced certain emotions and commotions, which ... proved that all flesh must die to live again."

From this masochistic angle the pamphlet describes in detail "the sublime science of strangulation" and the "lively sensations" it provokes. It suggests ways to lessen the visible physical marks and permit greater security and control, referring to "the celebrated Patent Inventor of Spring Bands, on Mount Street, who, from his wonderful improvements in surgery and mechanics, could very probably invent not only a safe but an agreeable and graceful mode of suspension." Turning itself into an odd advertisement, the pamphlet concludes with a promotion for "elastic garters" for selfhanging and a product from the same inventor called "Vanbutchell's Balsam of Life".

It might be a satirical text, but it is probable the excentric quack Martin Vanbutchell himself wrote the pamphlet. At that time he placed advertisements in the papers that praised hanging and strangulation as a means to sexual satisfaction (supposedly in hope of creating a demand for his products). It might also be Vanbutchell, who is the author of some articles on strangeling in "The Bon Ton Magazine"(1793). The first one explores "The Origin of Amorous Strangulation", while the other discusses "The Effects of Temporary Strangulation on the Human Body". The tragic end of Kotzwara is told once more, illustrated in a print that depicts a smiling Susannah Hill in the process of placing a noose around Kotzwara's neck. He sits in front of the fatal doorknob with a glas and a suggestive bottle in his hand that leaves no doubt about the sexual aspects of the act. Thanks mainly to Vanbutchell and his twisted interests in propagating the case, sexual strangulation has since then also been referred to as "kotzwarism" in the proud tradition that christens sexual specialities after their prime exponent.

Scientific sex research did not share Sade's and Vanbutchell's positive attitudes towards the euphoric pleasures of strangulation. On the contrary, it viewed bodily pleasures and sexuality from the perspective of the "civil" bourgeois norms, which society as a whole was subjected to throughout the 19th century. The morals condemned sexual activity as irrational and "deviating" except for the quick, procreational back and forth in the matrimonial bed. The whole spectrum of sexuality was thereby turned into a medical issue, being dealt with in terms of disease, diagnostics and classifications, with matching etiologies and normalising treatments in psychiatry (sex as insanity) and legal medicine (sex as crime). This was the case for masturbation, which was associated with sickness, insanity and death, and even more so for autoerotic satisfaction by strangulation. It was studied in connection with mental disorders in textbooks on sexual pathologies that proliferated toward the end of the century.

The pioneering work was done in Vienna, the breeding ground for psychoanalysis, as well as sexology in the Institute for Sex Research. Their dissertations on sexual practices and preferences reflected the uneasy sexuality of the times as much as the "perverse" nature of the subjects. There are discussions of sexual strangulation in works by Eulenburg (1895), Stekel (1929), Ellis (1936), and the first recent mentioning of Kotzwara's story occurred in Hirschfeld's "Sexual Anomalies: The Origins, Nature and Treatment of Sexual Disorders" (1948). It was partly due to these and other sexological descriptions that forensics, by and by, was able to identify and explain certain deaths as accidents in the process of sexual self-strangulation. It was isolated at last and defined as a clinical entity by the german Schwarz in 1952, and later given the scientific name "sexual asphyxia" by Brittain in 1968.

2. Bodyart in the clinic

The central element of the "syndrome" is the pursuit of the physiological effects of insufficient oxygen supply to the brain. This can be achieved in a number of ways: hanging and strangulation, suffocation (with plastic bags and the like), blocking the respiratory organs, compressing the chest, and chemically through the use of narcotics. The stimulation of the "high" might be enjoyed for it's own sake, but is often accompanied by masturbation when it is induced as a means to sexual gratification. In addition, sexually motivated smothering frequently goes hand in hand with other "perversions", or "paraphilia", as they are now referred to in medical literature. There is a high frequency of cordophilia (the pleasure of being bound and sometimes hung in ropes and chains); sexual bondage in the form of tight dresses and hoods (latex, leather), rain boots, blindfolds and gags; masochism with clips in the nipples, bodypiercings, branding of the genitals and other selftortures; fetishism (stimulation by the sight and touch of certain materials and objects like pieces of clothing); more or less complete transvestism; voyeristic usage of pornography (often of sado-masochistic orientation); and narcissistic mirroring or self-portrayal with cameras or video which has resulted in recordings of fatal accidents. Typically, one or more of these autoerotic practices are part of the clinical picture presented by sexual asphyxia.

Generally the cause of death is asphyxiation due to strangulation, narcotics, and similar accidents involving deficient oxygen supply. Further, it can occur indirectly in connection with other forms of autoerotic stimulation, i.e. heart-failure due to high blood pressure, perforation of the bowel wall, broken necks as a result of falling from selfbindings, or hypothermia occuring when the person is unable to free himself from intricate knots in natural settings. Schackwitz describes a case in 1931, where a 37 year old shop assistant was found dead in his bed. He was lying under the covers, gaged with hankerchiefs, the head tightly wrapped in a towel. His legs were tied with towels, the hands tied up behind his back. He was clutching a nail-scissors in his left hand to free himself, but the arteries were cut up by the tight laces around the wrists, and he bled to death. Many deaths occur during sexual stimulations with electricity, putting the genitals into a bowl of water together with both ends of a live wire, or touching the penis wrapped in tin-foil with one end of a wire, while the other end is held in the hand. Putzmann describes the death of a 15 year old electrician apprentice utilizing a complicated installation that connected the mains with a tea-spoon in his anus and an aluminum cord around the penis via a glim lamp in his mouth. Perhaps the most unique of all autoerotic fatalities, "The Love Bug", was published by Rupp in 1973, actually involving an "auto". In this case, a 40 year old pilot from the U.S. Airforce had put on a self-manufactured harness, and let himself be drawn naked in chains behind his Volkswagen sedan, set to circle in the first gear in a deserted parking lot. On one occasion, though, the chains got tangled with the backwheel, and he ended up being squeezed to death against the car. This behavior could very well be seen as an answer to Jean Rosenbaums book, published the same year,"Is Your Volkswagen A Sex Symbol?"

Sexual asphyxia is the most fascinating, when it appears together with the secondary "paraphilia" in intricate autoerotic rituals displaying the excessive inventiveness of desire. They sometimes suggest torture machines from the Middle Ages, constructed for the production of intense polymorphic pleasures through self-bindings, hangings, torments, oral, anal, and genital stimulations of every concievable kind. For the same reason, autoerotic practices were referred to as "bachelor machines" by Michel Carrouge in his influential book on sexual politics and esthetics "Les machines celibataires" (1954). This term is a very appropriate one, in so far as the actual practitioners might be anything between 8 and 80 years old, but on average they are in their mid twenties, and almost exclusively men.

In continuation with the sexual liberation and the critique of bourgeois morals and gender roles in the sixties and seventies, Carrouge's book formed the basis for an exhibition under the same name in Venice in 1975. It showed sculptures like the bicycle inspired "bachelor machines" by Marcel Duchamp ("Mariee ...") and Robert M|ller ("La Veuve du coureur"), side by side with documentary photographs of autoerotic practices, for instance a naked man strapped on an oversize bicycle wheel ("Masturbation with complicated machinery"), taken from the forensic textbook by Weiman and Prokop,"Atlas der gerichtlichen Medizin" (1963).

The same textbook furnished the materials for a series of paintings by Heike Ruschmeyer, "Artists" and "Acrobats", exhibited in Berlin in 1983. She uses photos of autoerotic fatalities, presenting the human body as dead, physical matter, deprived of emotional and symbolic content. She counteracts the public's rejection, and brings the dead bodies as well as the spectators "back to life" by stimulating emotional investments and identification through iconographical enlargements of the pictures, painted over in the brilliant colours appropriate for the polymorphous sexuality. She states in the catalogue: "I have long since left the cult of the death drive behind me, and revived Prokop's corpses in flying cadmium-red angles and lemon-coloured androids" By doing so, she takes the practitioners of sexual asphyxia away from the realm of medicine, criminology, pathology and social taboo, and recontextualizes them as artists belonging in galleries and circuses to be viewed, acknowledged, even admired by the public.

This use of forensic photos might provoke and shock by confronting the spectators with realistical representations of the body, sexual practices and death transgressing esthetic and behavioral norms. Beyond the shock value lies the intention to transform these conventions themselves, bringing about a social recognition of hitherto unacceptable and excluded subjects. For the last two hundred years, art was supposed to transcend carnality and low sensual desires that tie human beings to the physical world. On the contrary, modern art and especially the avantgarde movement has focused on the body and the mental moldings of its desires as the source of art and symbolic systems. First and foremost, this has been the domain of performance and bodyart, involving the artists themselves in sensual explorations that sometimes come indistinguishable close to autoerotic rituals.

Again, Vienna was in the forefront in the early sixties, when Hermann Nitsch presented a series of outrageous performances that would later be turned into the OM (Orgies Mysteries) Theatre. They expressed the desire to constitute something like an animistic or Dionysian oneness with nature within a "desensitized" and "alienated" civilization, as the slogans of the times went. In 1965 he formed the "Wiener Aktionismus" group together with Otto Mohl, Rudolf Schwarzkogler, and G|nter Brus. Much in the same vein, their work was devoted to catharsis and liberation through the performance of taboo acts that were extremely violent and abject. For instance, Brus would appear dressed in a woman's black stockings, brassiere, and garter belt, slash himself with scissors till he ran with blood, vomit, defecate, eat his own excrement, and so on. Within the licensed context of art, they tested the limits of their own and the public's tolerance in "Aktionen" that more often than not were received with shock and disgust, occasionally even shut down by the police.

In the following decade, the acts of self-mutilation and taboo breaking in bodyart were met with the same reaction, whether it was Linda Montano inserting needles around her eyes ("Mitchel's Death", 1978), Kim Jones cutting himself with a razor blade twenty-seven times in a pattern suggesting the body's circulatory system, or Paul McCarthy, who showed up in a wino hotel wearing a blond wig, black lace panties smeared with blood, and proceeded to fornicate with piles of red meat and ground hamburger with his penis painted red, a hot dog shoved up his rectum ("Sailo's Meat", 1975). The performances were committed to a social and esthetical emancipation and redefinition of sensuality within frames of reference that spanned ancient bacchanalia and sacramental rites, shamanic magic, Hindu ascetics and on to the notion of the artist as the artwork himself in Romantic or Abstract Expressionst art. From an alternate viewpoint, though, many of these acts only differ from autoerotic, masochistic and other polymorphously perverse sexual practices in context and intent. This even goes for a case as special as "The Love Bug", which got its artistic counterpart, when Chris Burden had himself shot in the arm and crucified to the roof of a Volkswagen in 1971 and 1974.

The resemblance is perhaps most striking in the works of bodyartist Fakir Musafar. He is a part of the sado-masochistical subculture, an early advocate of body piercings with Gauntlet Enterprizes, and a practitioner of torturous trials and body modifications as an artform. In the act "Suspension" (1964), for instance, he was placed naked in front of a mirror, hanging from a rack, suspended in his own skin, the wires hooked through the breasts, clips in the nibbles, the penis tied up with a string, and tight belts around the legs, the waist, the arms. Down to the domestic setting, and the little, improvised step-ladder of books, the act presents a picture so close to the scenery of some autoerotic fatalities that it is distinguished only through secondary information.

The literary history of sexual asphyxia followed much the same development as the visual arts. In the 19th century, the subject is absent save for a few instances. A hanging scene, similar to the one in "Justine", takes place in "Gamiani, ou Deux Nuits d'Exces" (1833), a novel filled with sadism and bestiality, often attributed to Alfred de Musset. Further, death by sexual hanging occurs in a mainstream novel by Karl Ferdinand Gutzkow, "Der Zauberer von Rom" (1859-61). With the advent of moderism, realistic representations of sexuality found their way into high literature, including erotic hanging, and it is fittingly present in "Ulysses" (1922), where James Joyce decribes the aftermath of the hanging of the Croppy Boy: "He gives up the ghost. A violent erection of the hanged sends gouts of sperm spouting through his dead clothes on to the cobblestones. Mrs. Bellingham, Mrs. Yelverton Barry, and the Honorable Mrs. Mervyn Talboys rush forward with their handkerchiefs to sop it up."

The most consistent and enthusiastic poet of sexual asphyxia must be William Burroughs."Cities of the Red Night" (1981) is practically dedicated to Ix Tab, goddess of the hanged in Mayan culture, so much so the review in New York Times was entitled "Pleasures of Hanging". Nevertheless, he is only serving leftovers from "Naked Lunch" (1951), where hanging is a regular on the menu. With a great deal of empathy he describes the sensations of a boy who is stimulated sexually while being hanged: "Green sparks explode behind his eyes and sweet toothache pain shoots through his neck down the spine to the groin, contracting the body in spasms of delight."

Burroughs envisioned the human being as a "softmachine": an uncentered sensitivity with completely unbound and liquid cathectic energies that could take on all shapes and forms and always be ready for new pleasures. This fantasy was seized by Gilles Deleuze and Felix Guattari in "Anti-Oedipus" (1972), an academic outgrowth of the french students revolt in the sixties. They celebrate the triumph of the pleasure principle and partial drives over the determination of gender, gentials and social reality through "bachelor machines". The concept of the human subject as a "machine" for the production of unrestricted satisfaction implicated a psychotic suspension of repressions and the objective world. Highly inspired by anti-psychiatry and especially Laing, this hymn to psychosis and eternal flux might be attractive on paper. In real life, though, it is a questionable thing, as was experienced by Kurt Vonnegut's oldest son, Mark. Having spend considerate time in mental institutions, being diagnosed as a schizophrenic after "three major breakdowns and a few minor ones", he wrote with some irritation about Laing's and his disciples' exalted view on the condition in "Why I want to bite R. D. Laing" (Harper's, April 1974):

"He said so many nice things about us: we're the only sane members of an insane society, our insights are profound and right on, we're prophetic, courageous explorers of inner space and so forth .... But what I felt when I found myself staring out of the little hole in the padded cell was betrayal: I did everything just like you said, and look where I am now, you bastard."

If not to the point of psychosis, the emotional and cognitive models that were tried out as transgressions within the context of art have none the less been accepted to some degree by society. The stance towards the body, its functions and desires has become less rigid, and the repertoire of social and gender roles is much broader than it used to be. The arbitrarity of the signifiers of sexual difference (haircut, clothes, gestures, etc) is not restricted to the realm of the "deviant" or avantgarde, and there is a considerable cross-over to mainstream culture even from sexual undergrounds like sado-masochism.

By and by, even the extremes of bodyart have become less offensive and out of bounds through sheer repetition, conditioning of the audience, critical acclaim, institutional acceptance, and because of the widespread change in attitudes and modes of reception that the artists themselves participated in bringing about. A few years ago, a crane suspended Stelarc from fishhooks in his skin and lifted him above (of all things) The Royal Theatre in Copenhagen. Likewise, sexual asphyxia is a regular in crime novels, since P. D. James described the alteration of a death scene to make it appear like an autoerotic fatality in "An Unsuitable Job for a Woman" (1972), and it is the subject of an entire sexological thriller by J. Money, G. Wainwright and D. Hinsberger, "The Breathless Orgasm".

3. The mechanics of polymorpheous sex

Sexual asphyxia is now being discussed in popular Sexual Advice Literature, and the normative attitude in scientific sex research has been replaced by a more neutral and descriptive approach to sexual states and mechanisms. None the less, it is still expelled to the realm of the pathological as a "paraphilia", and largely dealt with in medical terms oriented towards the diagnosis and the treatment of a "deviance" from norms of behavior considered to be natural and universal.

These standarts of behavior imply a high degree of repression and sublimation. The individual's experience of his own body and sensual pleasure is displaced and transformed into the experience of the surroundings and the desire for other persons and objects, or even channeled totally into symbolic, mental activities. The opposite takes places in autoerotics, where the active and out-turned projections and emotional investments temporarily are withdrawn from the enviroment and reinvested in the body. That is why these practices are so taboo, they go against the demand to repress the affective body and express the emotions via something else in an objectified and socially mediated way, whether it is an interest in clothes, the partner, the internet, whatever is approved by the surroundings.

The autoerotic gadgets and techniques attract a lot of attention. Spectacular as they may be, from an economical viewpoint they are only means to a goal, the emotional charging and resensitizing of the body to increase arousal. In that respect, they don't differ from roller coasters and other devices in amusement parks. Many of them are instruments to break down the individual's control of himself and his surroundings in a paralysed and helpless position. Reducing voluntary control and the ability to act produces an intense feeling of being an other-directed, passive body, where the consciousness of the body and it's sensations reaches a climax. Furthermore, selfbindings and bondage causes a blocking and a withdrawal of all projections to the body, because the blocking of the motor and perceptory systems (blindfolds, etc.) implicates the disappearence of an outer world to invest with emotions and act upon as an object. Finally, the possibility to regulate sensations and levels of arousal by motor outlets, modification of the sensed objects or flight is suspended. Therefore, the arousal can escalate uncontrollable to the point of panic (like having a nightmare, being buried alive), culminating with the orgasmic release and brief blackout of the objective world, even unconsciousness.

While often being stimulated by masturbation, orgasm also occurs all by itself. There are many indications that voluntary control disappears at very high levels of arousal connected with lacking possibilities (or enactive models) to reduce the level, triggering instead arousal-reducing autonomic impulses and response-patterns of relaxation. This orgasm-like somatic reaction might be one of the desired effects in sexual hanging besides the "high" of asphyxiation. In addition, the strong arousal by fear and high sexual arousal have the arousal itself and the increased bodily experience in common: dizziness, shivering, gooseskin, palpitation, breathlessness, and so forth. It is only the subjective evaluation of the arousal as a negative state (pain and fear) or a positive state (pleasure and sex) that determines it's quality. The same ambiguity of pain and pleasure goes for the passive masochistic passion. Again, the connection is that both passion and pain are results of a strong arousal superseding the voluntary control, while their difference is determined only by the cognitive-hedonic evaluation. Fear and pain seem to be a degree better at producing the unprojected, objectless state of arousal that is being cultivated by autoerotics.

The active desires directed at objects are established much later in life than the passive pleasures, erasing the distinctions between object and perceiving subject in a boundless sensuality. This polymorpheous sensuality goes back to a time, when the individual was helpless and dependent on the care of the nursing person, that is, the mother. Therefore, it is not unlikely to see the reactivation of early, passive-incestuous fascinations between pleasure and fear in autoerotic practices, as might well be the case in transvestism also. The rituals could be understood in terms of problems with a positive evaluation of high levels of (incestuous, or otherwise prohibited) sexual arousal, being relabeled and dealt with as fear, pain, punishment. There is a high incidence of boys in puberty who practice sexual hanging in connection with transvestism in their mother's clothes and narcissistic identification with themselves as other in a mirror. In the end, though, the subjective motives and biographical causes for the "misinterpretation" of sexuality and gender identity by masochist and transvestite asphyxiophiliacs remain unknown, because it is always to late: they are dead.

In 1972, Litman and Swearingen reported a fatal case of autoerotic asphyxia encompassing bondage, cross-dressing, masochism and extreme risktaking. The clinical picture cannot be reduced to pathology, it shows burning desire and wild aestetics, transgression, bodyart, even literature in the same blinding flash. The young man was dressed in womans underwear, brassieres, panties and garter belts, wearing a blond wig, full makeup, jewelry, and a taffeta dress. There was a pair of panties in his mouth, and he had two false rubber breast pads placed wet over the nose and the mouth. A stocking was pulled down over his head, secured around the neck with a choker. Bound in chains with padlocks at the knees, the wrists, the neck, he hung himself. His body was charred, because he had set himself on fire in the act. He left a suicide note, adressed "To whom it may concern - please be tender when you cut me down". Anticipating his last minutes in a thrilling piece of terminal prose, he describes the terror and sexual excitement of the autoerotic ritual, culminating with orgasm and death:

"I know what I'm going to do next. I'm really terrified by sadistic thrill. It is 9:35 Sunday night and in three minutes I will be dead. I strike the match, reach down and set fire to the gossamer edge of the black nylon slip. Quickly I wrap the chain around my wrists and snap the padlock firmly. In a frenzy of passion, I kick the chair over and my body is spasming at the end of the chain noose. I come wildly, madly. The pain is intense as my clothes start burning my legs. My eyes bulge and I try and reach the keys, knowing I have finally found the courage to end a horrible nightmare life dangerously."


by Michael Decker

Reprinted by permission of Michael Decker
Originally published in Drummer magazine

When I masturbate, I become one with my crotch, I am its slave, there is nothing else. Sensations converge, my soul quiets, I'm drawn inward, my eyes taped shut. Pulse quickening and breaths shortening. Vivid fantasies in sharp focus play out against the blackness of my sightless eyes. Visions of elbows pulled sharply back and taped together. Of wrists and hands squeezed tight, useless, cocooned in silver tape. Of a fine wire noose sinking, biting into a defenseless throat, the hog tie pulled taut from ankles bowed painfully. These beloved and time tested images exhilarate my fight and strengthen my resistance. I smell my own pungent fear. The sweat seeping from armpits and crotch forms cold pools on wrinkled latex. Fantasies of death, fear, and vulnerability electrify me, my crotch involuntarily rocks, metronome like.

I am alone, hog tied, ankles cinched back, clipped to the leather harness constricting my waist. Lying naked on my side the latex sheeting mutates from fire to ice as I squirm, repositioning myself, searching for the freedom I do not want. Rope tightly wrapped just under both knees and around both ankles binds my legs as one. My engorged, dark veined cock is separated from my balls and thrust out by 3 rings of welded surgical steel. The waist harness connects to the rings, and there's a carabineer welded to an aluminum plate, riveted to the harness just behind the butt plug. When I wriggle my double shock cord looped wrists, secured in the carabineer, the plug moves and twists, refocusing my attention to my very sore and sensitive portal. My elbows are also bound together by twin loops of heavy shock cord.

A long rubber belt wrapped around my thighs captures an industrial size vibrator. It's set on a low frequency, and I experience heavy pounding vibration through my balls, pulsing all the way up my shaft. Flexing my crotch increases my need to come, but it's still just out of reach. In earnest I renew my struggle, needing to reaffirm the illusion of my helplessness, "that my bondage is inescapable".

A rigid, searing cock betrays my feigned terror. My mouth is dry, tongue curled under and forced back from struggling with the red lacquered ball. The taut multi-strap muzzle digging into my temples tightly grips my head, leaving me exposed and vulnerable. A thick layer of tape covers the gag, sealing screams in and air out.

I want the delicious nipple pain to stop, the feelings are too intense. Small, wide plastic spring clips mash the sensitive tips. The nipples spasm and twitch, their metal rings wired to an automated shock box set uncomfortably high. Pain competing with pain.

Breathing is tenuous. The two inch rubber belt, snug around my neck allows little room for error, flexing the neck muscles constricts blood flow, relaxing almost restores it. The danger sharpens my consciousness, the vibration quickens my pace. There's one last device: a small rectangle of latex rubber cut from an old medium weight garment and taped in place just below my nostrils. The flap partially covers my only source of air, breathing must be slow and controlled. As fear overtakes me and panic begins, I fight for air and the flap seals my nostrils, breathing stops, and forces me to focus on control.

My goal is to get off and escape without passing out and dying, all the while cutting the edge closer, chasing the fear and aiding the "suspension of disbelief". Sometimes my imagination beats my body there, and it's a quick, intense orgasm, but sometimes it's more laborious, requiring great effort, to achieve the drenched, exhausted, depleted, soul satisfying satiation I'm after.

Doing yourself is about selfishness. It's about control over timing, sensation, fantasy, intensity, all without apology or guilt. It's about needs and fears. The need to take our physical body where we found pleasure as youths (with or without the unhealthy psychological baggage). The fear of inability to articulate our desires to a partner. The fear of their physical (in)ability to comply (God, if tops could only read minds!). The fear of being judged and then rejected. It's about chasing emotions, sensations, fantasies, intensities, taboo's, and creating a context that allows suspension of disbelief long enough to orgasm.

Getting close to panic and death excites me. At ages 5, 7, & 12, I experienced near drownings and became fascinated with pre-panic breath deprivation. My mother was a religious zealot, and when she caught me masturbating at an early age, told me "God kills masturbators". Self gratification equals death. Well, during my early teens I negotiated with God nightly, "I promise this will be the last time I beat off if you'll just will let me, really". It's easy to see why death stole my imagination. If you fear something enough, and tease it often without penalty, you may become an expert at chasing it. I'm talented with mechanical devices and possess self-control, which allows me to cut the edge close while lowering my actual risk factor. As Dirty Harry said "a man's got to know his limitations". Do I want to die? No. I want to live so I can keep pursuing the pleasures I get from stalking death's intensity. I'm as insane as any other danger seeker, from an Evil Kinevil wanna-be, to a cop, fireman, or soldier, but my motives are easier to understand, self-gratification.

When death seems inevitable, quickly approaching, when we know escape has been taken away, no stopping the inevitable machinations of our demise, we reject resignation. We fight with commitment and unsuspected strength, for in that fight we find our reward. We are never more awake, more alert, more alive than in the battle with death. Panic awakens us to all that is life. In panic, we bloom, there is no monotony or routine. "Embrace fear" is our mantra. Each time we win the combat, emptiness invades our soul, we wait, anxiously anticipating the next battle. If we're defeated, and die, we have no regrets, we've reaped the rewards of our bravery, and we've savored the extreme passions and intensities of our being. Recriminations, justifications and speculations will be left to those who have chosen a safer, more sedate existence. They are not "wrong" for their choice, nor are we for ours.

Life is not safe! Life is not benevolent! life is not consensual! There is only living what stretches out before us, honoring our chosen moral integrity, for in the end, when all is said and done, "life kills your ass".

Copyright MAY, 7, 1991 - All rights reserved - Michael Decker


Michael Decker is 46 and has been practicing autoerotic asphyxiophilia for 36 years, so far successfully. I started "Seattle Kink Information Network" a year ago to hold twice monthly educational seminars for consensual adult SM practitioners. I have the largest body of research on asphyxiophilia in this country, next to the FBI, and I'll bet I'm more obsessive about collecting it than they are. I have instructed hundreds of people in the possible ramifications of this behavior, I am fully aware of all the risks direct and indirect, and support their right to decide what's appropriate for themselves. If you wish to add to my research or contact me to further the conversation, please use the SKIN phone line @ 206-368-0384.


MICHAEL DECKER - Internationally recognized SM educator & seminar leader, workshop presenter at six National Leather Association "May Day" events and seven "Living In Leather" conferences, including the infamous "LIL" V Consensual / Non-consensual ("Death Workshop") panel. Presents workshops at C-Space in Seattle and QSM (Quality SM) in San Francisco. Started "Seattle Kink Information Network" in May of 1995 to present educational workshops for consensual SM practitioners.

SM is a life long part of his sexuality and at age 46 he's equally comfortable with top or bottom roll. Though he's hopelessly heterosexual, Pat Califia acknowledged Michael with the title "Honorary Leather Dyke" in 1987.

Michael has been interviewed in the following magazines, "Wire" (Timothy Muck) and "Taste of Latex" (Carol Queen). His educational articles and fantasies appear in "Taste of Latex". Co-Produced, with Cherie Matisse, the 1988 LIL III fashion show "SM by Design". Featured inside and on the cover of "The Spectator" a San Francisco tabloid. Appears inside Charles Gatewood's new books "Primitives" and "Forbidden Tattoos". Co-star with Lily Burana (editrix of "Taste of Latex") in Flash Video's (a Charles Gatewood company) film "Fangs of Steel" 1993. Has advised about SM practices on talk radio in Seattle.

He was president of the American Civil Liberties Union, Sno-King Chapter 1973 & 1974. Vice President and President of National Leather Association, Seattle 1992.

Michael owns & operates "The Metal Shop", a machine, fabrication, & design facility with a 14 year history. Michael treats life as an experiment and learning opportunity in progress. He strives to have: high integrity, honesty, accessibility, pragmatism, candidness, commitment, and no hidden agendas. He has been bound, pierced, tattooed, scarred, sutured, burned, asphyxiated, electrocuted, whipped and has gleefully done the same to others. Michael is a native of Seattle.


1. All of the documents we found on this subject agreed on one thing: strangulation (interfering with the supply of blood to the head and brain) is probably more dangerous than suffocation (cutting off the flow of air to the lungs by covering the nose and mouth). Both still have the potential to be deadly, however, and in the past both have been used as methods of execution. One problem with strangulation is that death can result almost instantly, due to damage to structures in the neck, and that brain damage or death can occur extraordinarily quickly during strangulation (i.e. potentially in 15 seconds or less). However, authors such as Jay Wiseman have argued that there are no good guidelines with which one may avoid causing death by suffocation either; their main argument is that changing the blood chemistry (through O2 deprivation) can trigger heart irregularities and ultimately a heart attack, all well before unconsciousness is reached through the suffocation.

2. All of the documents we found on this subject also agreed that it is EXTREMELY dangerous to play alone. Most said that at least one other trustworthy person should be present who is also certified in CPR. A few specifically recommended that a phone with which to call 911 should be in easy reach. All recommended that the person whose breath is being controlled should have some way of signalling that he or she has had enough and that asphyxiation should stop, and that there be some way to continuously monitor this person's level of consciousness.

3. All of the internet documents we found on this subject mentioned or implied that risk might be reduced during suffocation by restricting air flow for only short periods of time (one document recommended not restricting air flow any longer than someone could comfortably hold their breath for on their own, and never more than 15 seconds). Continuing suffocation until unconsciousness is reached significantly increases the probability of death or permanent brain damage. However, many documents and authors argued that none of this advice provides absolute protection against causing injury or death, and that this risk is an unavoidable aspect of asphyxiation play.

Author:        Hazelwood, Robert R.
Title:         Autoerotic fatalities / Robert R. Hazelwood, Park Elliott
Co-Author:     Dietz, Ann Wolbert Burgess.
Publisher:     Lexington, Mass. : LexingtonBooks, c1983.
Description:   xiv, 208 p. : ill. ; 24 cm.
Notes:         Includes index.
Bibliography:  p. 189-200.
Subjects:      Autoerotic asphyxia.
               Autoerotic death.  Asphyxia -- Complications.  Erotica.
               Death, Sudden -- etiology.  Paraphilias.

Author:        Money, John, 1921-
Title:         The breathless orgasm: a lovemap biography of asphyxiophilia /
Authors:       John Money, Gordon Wainwright, David Hingsburger.
Publisher:     Buffalo, N.Y. : Prometheus Books, c1991.
Description:   178 p. ; 24 cm.
Subjects:      Cooper, Nelson -- Mental health.
               Autoerotic asphyxia -- Patients -- United States --
               Biography.  Autoerotic asphyxia -- Patients --
               Rehabilitation.  Psychotherapy.

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