|the deviants' dictionary Briefing Updated 17 May 1997|
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Obviously one of the most potentially dangerous SM activities, requiring responsibility, trust and scrupulous safety practise. Please read the general notes on risks and safety before you even consider proceeding. The greatest danger is from playing alone: oxygen restriction can rapidly lead to loss of consciousness and if you pass out with your breathing still restricted brain damage and death will rapidly follow with you unable to do anything about it. Unless you have a 100% reliable failsafe system that will remove the restriction should you pass out, always play only with a totally trustworthy partner.
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Breath control is the one activity most BDSMers would unhesitatingly place in the otherwise controversial category of 'edge play'. And with good reason: a constant supply of fresh oxygen and the ability to dispose of carbon dioxide are both vital to the functioning of the body. Deprive the brain of oxygen for as little as twelve minutes and you have a human vegetable on your hands, not to mention the irreparable damage to brain and heart that will already have been done. So those who play with breath are literally only minutes away from playing with death.
And that, of course, is part of the thrill for many people. You don't have to know consciously that what you're doing is dangerous, because all your body's reflexes are screaming it at you. Put the back of a crooked forefinger over your windpipe, in the middle of the angle where your neck joins your chin, and push up and back very gently. It takes hardly any pressure to feel very uncomfortable indeed. Do it to someone else and they will certainly try to move your hand away without even thinking about it.
There are all kinds of things people might get out of breath control. You may find there is a sensual pleasure in just the fact of having their breathing restricted, or enjoy the way it underlines the sense of enclosure when using a mask or hood. And it is the ultimate trust game, with the bottom literally putting their life in their top's hands.
Breath control may be used in moderation to introduce an element of vulnerability or danger into the scene. However some people pursue it to the point of near or actual unconsciousness, and enjoy the resulting psychological 'altered state'.
Some people assume, having heard that male victims of hanging ejaculate spontaneously in their final moments, that there is a direct connection between breath restriction and sexual response. The assumption is mistaken, however: modern judicial hanging causes death not by strangulation but by snapping the spinal cord, and it is the resulting trauma to the nerves that produces the ejaculation. Nonetheless, the command to a bottom that they will not get their oxygen supply back until they come is often remarkably efficacious in producing a rapid orgasm.
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On a restrained subject this can easily be achieved using hands to pinch shut the nostrils and block off the mouth, the latter either by placing a palm all the way across the mouth. If the hand doesn't cover the mouth completely when the bottom gapes, you will have to try holding the jaw shut by pushing upwards, but don't put too much pressure on. Alternatively you can use other means to block off either mouth or nostrils: pegs (clothespins), gags, tape and so on. The advantage of using hands directly is that they are responsive and the obstruction can be moved immediatly.
Other parts of the body can be used. One activity that combines more direct physical eroticism with breath control is queening, where a female top kneels over the bottom's head, gripping the head with her legs and blocking off the nose and mouth with her cunt. It is slightly more difficult, though achievable, to do this with the area of the arsehole.
Airtight masks and hoods with some form of air inlet that can be controlled can be a thrill just to wear. Using hands over the inlet will allow subtle gradations of restriction and also give easy and safe release. Gas masks are ideal since they are usually reliably made with a large, easy-to-locate inlet; anaesthetists' masks can also be employed. Leather/fetish suppliers make a wide range of purpose-built hoods, usually from rubber, but be very careful to check their integrity before playing, especially ones with a very restrictive inlet, and think carefully about how easy they are to get off. Keep a pair of big blunt-ended scissors handy as an emergency measure.
Tanith Tyrr (1996) advises that all such restrictions should be able to be removed in a second or less, and that the full blockages should not be of no more than ten seconds duration.
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Rebreathing or suffocation involves breathing into an airtight reservoir so that the amount of oxygen in the air gradually decreases. Simplest form is a polythene bag held over the head - easily removed and giving the odd sensation of being able to see the surroundings almost as normal while the oxygen runs out. Purpose made fetish devices include breathing tubes linked to valved rebreathe bladders as used in anasthaesia. Or simply hold your noses and breathe in and out of each others' mouths for a while.
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Obstructing the trachea (windpipe) by pressing on it from the outside is highly dangerous and could result in all kinds of inadvertant damage; it really is something to be attempted only by those fully aware of the anatomy and of what they are doing. Most techniques involving pressure on the neck do not block the breathing but instead work on the carotid arteries, the main conduits of oxygenated blood to the brain. This is the secret of the unconsciousness-producing choke holds in judo and other forms of self-defence.
The procedure for finding the carotid artery is explained in every first aid manual, because it is one of the easiest sites for taking a pulse. 'With the head tilted back, feel for the Adam's apple with two fingers. Slide your fingers back towards you into the gap between the Adam's apple and the strap muscle [the easily identifiable muscle running up the side of the neck from the shoulder blade to the hinge of the jaw] and feel for the carotid pulse' (St John Ambulance et al 1992:29). A surprisingly gentle amount of pressure on here can rapidly produce unconsciousness and permanent damage will result if it is maintained. As well as using the hands, some people use blood-pressure tourniquets around the neck, but very gently.
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Hanging is an object of fascination for some people but is very dangerous to achieve 'safely' in an SM context. Though in modern 'humane' hanging, death is supposedly instantaneous, resulting from the spinal cord snapping when the bodyweight suddenly jerks at the end of the rope, strangulation played a part in the past: for example, those sentenced to be hung, drawn and quartered would be taken down while still alive. The difficulty of controlling the amount of compression and the strain on other delicate structures was not so much of a problem for mediaeval executioners whose victims were intended to die as painfully as possible anyway, but in a non-fatal SM context makes this a very dangerous game indeed, especially in solo play -- the authorities regularly record cases of death by auto-erotic asphyxiation involving hanging, and it's likely quite a few supposed suicides are attributable to this cause too.
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The drug curare, an extract from a plant native to the Amazon region and traditionally used there as a coating on blowpipe darts, is a powerful paralysing agent that prevents the lungs from working. Synthetic versions of the drug are used in surgery to keep the patient still on the operating table, and while the drug is active the function of the lungs is taken over by an external ventilation pump. The patient is usually unconscious while the drug is active but there is no reason in principle why this should be the case. Obviously medical staff train for years in order to accomplish this sort of thing safely and no-one in their right mind would suggest incorporating it into an SM scene, but it could provide food for thought for those into fantasing about such things.
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Some writers have argued that it's impossible to do any sort of BC safely. Jay Wiseman, author of the SM101 reference book, has stoked controversy with his claims that all forms of BC put the bottom 'at imminent, unpredictable risk of dying'. And when Checkmate published a piece on the subject by an enthusiast (Williamson 1994), they felt obliged to include an accompanying piece from their medical consultant warning not to do it (Tattoodoc 1994).
So what is the truth? Physiologically speaking, the body needs oxygen for the chemical reactions that power our cells, and it also needs a way of getting rid of carbon dioxide, a product of those reactions. Normally both needs are satisfied by breathing: oxygen from the air is drawn into the lungs where it dissolves into the blood, while carbon dioxide is released to be exhaled. Obstructing either of these processes results in the rapid build-up of acid in the blood, with damaging consequences. It will also trigger a number of the body's 'emergency procedures', and these can cause problems of their own.
When the heart gets short on oxygen, it starts to fire off cells that cause extra contractions. According to Wiseman, as long as the oxygen is restricted there is a chance that one of these will occur at the wrong phase of the cycle, potentially causing a heart attack. The lower the oxygen gets, the greater the risk. Unfortunately there is no reliable way of telling when the extra contractions start even with a cardiac monitor.
Wiseman's critics claim his argument is based on untested hypotheses, though anyone with an elementery knowledge of physiology would have to admit that depriving the heart of oxygen, or hypoxia, places this vital organ under unusual stress. However it seems reasonable to assume that the heart can cope with at least some hypoxia without taking panic measures. Exercise puts pressure on the oxygen supply, and undersea swimmers can develop the ability to hold their breath for minutes with no apparent ill effects. Like everything else, general health will have an impact too. Those with heart and respiratory conditions are almost certainly best advised to avoid breath play.
Another result of hypoxia is fainting, which rapidly follows from a drop in oxygen to the brain. Such a drop can happen naturally when inactive for a long time so that blood pools in the lower body: by shutting down consciousness, the body is likely to fall into a horizontal position, making it easier to pump blood to the brain. Most people into BC probably don't go as far as loss of consciousness, but for some it's the ultimate thrill.
The risk of unconsciousness in all BC play is the main reason for the best known safety rule: if you do play, don't play alone. The vast majority of BC-related deaths -- estimated at least 1 per year per million of population or 250 in the US, 60 in the UK -- are due to solo play. The warnings that a faint is about to occur, such as ringing in the ears and tunnel vision, come only seconds beforehand, which may not be enough time to escape. If you must play alone, do it with blocking an air source with your hand in such a way that if you faint the hand will fall away and leave the airway unrestricted. Bondage and BC in a solo scene are a lethal combination.
You can cause a faint without restricting the airway at all, by placing pressure on the carotid artery. Some BC fans claim carotid pressure is the safest way to produce unconsciousness since it avoids any pressure on the vulnerable throat and windpipe.
Details of how to deal with a faint can be found under First Aid.
Though victims of a faint are confused and distressed when they first come round (a fact those planning such a scene should bear in mind), recovery is usually rapid and complete, and an occasional faint in everyday life is regarded as medically insignificant. The biggest danger is striking the head while falling, easily avoided in a planned scene. Provided a normal air supply is immediately restored (which of course it should be), the loss of consciousness is temporary. According to medical sources, the brain can withstand three minutes of oxygen deprivation before serious damage occurs, but opponents of BC argue that cumulative brain damage can result from repeated forced unconsciousness.
It's well known that low level or repeated oxygen deprivation (from, say, high altitudes or in certain medical syndromes where patients' breathing ceases intermittently during sleep) can cause brain damage. Hypoxia destroys neurones (brain cells), which in adults are the only cells in the body that can't be replaced. Wiseman has cited the case of a judo instructor who may have been brain-damaged by frequent sessions as a demonstration model for the carotid strangulation techniques traditional in his sport. Checkmate's consultant Tattoodoc points out that the cerebral cortex is the most demanding of oxygen, so hypoxia 'affects the highest centres of the brain first'.
To get this in perspective, we have many billions of neurones and the brain can work with much fewer than its natural endowment. They are destroyed all the time by ageing, alcohol and other drugs, blows to the head and so on. It might be rational to decide to 'spend' some of our generous but finite supply on activities we enjoy, but spend carefully.
Like anything else in SM, sensible play requires a calculation of risks against pleasures, and the minimising of whatever risks you can. For example, some BC enthusiasts report that a second attempt at causing unconsciousness during a session requires a much longer period of oxygen deprivation, which increases the danger time for neurones, and is also not so satisfying. Rationing the amount of this sort of play to special occasions with substantial gaps in between might be advisable both in terms of brain conservation and pleasure!
And given the dangers, it's worth asking yourself how far you actually need to go, and if you would be satisfied with Tanith Tyrr's advice (1996) to 'play it out as a fantasy or fetish, talk up the verbal aspects a lot, and go light on the actual doing of the deed.' The idea of breath control is scary enough and a little may go a long way in the context of a well-played mindgame. If you play heavier, treat the practical safety aspects with extra-deadly seriousness, and seriously consider a course in first aid and CPR, which if anything does go wrong may increase your chances at least slightly.
Even Wiseman doesn't demand people stop playing with BC, just that they be aware of what he sees as the neglected dangers. The fact remains that for some people asphyxiation is a compelling fascination and they are going to experiment anyway. Squicked hysteria and blanket bans stifle the discussion, and increase the chances of some poor lonely pervert enjoying a rather-too-ultimate orgasm.
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