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BDSM: psychotherapy's grey area

2015; Elsevier BV; Volume: 2; Issue: 3 Linguagem: Inglês

10.1016/s2215-0366(15)00058-9

2215-0374

Tania Glyde,

LGBTQ Health, Identity, and Policy

A client goes to see a therapist about his anxiety. A few sessions in, he tentatively tells her about a significant aspect of his private sexual life. To his horror, she immediately stops the therapy and says they cannot continue until she has uprooted and cured his terrible pathology. This story could be about a gay man on an analyst's couch in the 1950s. But it's not. This is the experience—and more's the point, the anticipated experience—of a number of people who practice BDSM, or Bondage and Discipline, Dominance and Submission, Sadism and Masochism (once known as S&M). While so-called gay conversion therapy is in the process of being ethically and hopefully legally forbidden, there are no such protections for people who fall into the broad category that might be defined as “kinky”. Change, however, may be on the horizon, but it is not coming quickly enough. The publication of Fifty Shades of Grey in 2011 started an earthquake in British culture. The tremors were quiet at first, occurring mainly on features pages. Commentators had a good snigger at author E L James' prose style—and then they wrote about her sales. Fifty Shades is one of the best selling books ever; the film, directed by Sam Taylor-Johnson, is scheduled for release on Valentine's Day (Feb 14), 2015. After decades giggling about fluffy handcuffs, sex dungeons, and busty Miss Whiplashes, something appeared in British society that seemed to bridge the gap between the simple human need to deepen personal pleasure and connection, and the apparently sinister and dangerous S&M lifestyle, enjoyed by unsmiling people wearing black leather. Over the years, BDSM culture has periodically found itself in the limelight, but to many it has remained the province of a tiny minority who were almost never seen, save when they popped up on late night TV. Except, of course, that this isn't accurate at all. As a therapist I am well aware that many more people are kinky than ever reveal it, or who ever go to a BDSM club or party. The kink community is only the public face of a collection of orientations and lifestyles that stretches far further into society than the media and most researchers ever bother to explore. But there has been a huge barrier to public understanding in the form of the mental health establishment, whose long-time dogma was that nobody knew what to do with BDSM apart from try to cure it. And, until DSM-5 in 2013, kinky people could be safely written off as suffering from a “paraphilia”, given that sadism, masochism, and fetishism were listed there, and, as such, might be regarded as inherently disordered. People who enjoyed kink were the stuff of case studies, psychologically damaged and likely to damage others. Dominants were sadistic sociopaths and submissives helplessly acting out past abuse. Now, at least, behaviour and pathology have been separated, which is a step in the right direction. To be diagnosed with a “paraphilic disorder” under DSM-5, it has to cause harm or distress to yourself or others, and there is a recognition that many people are quite comfortable with their consensual practices. Unfortunately, in many countries the law does not hold the same opinion, and practitioners of BDSM remain in some danger from prosecution, as well as societal shaming. The word “outing” sounds almost passé but, unfortunately, for this group it is very much current. It is paradoxical that, ongoing prejudice notwithstanding, people who are gay, lesbian, bisexual, or trans* have more legal protection than a heterosexual person who happens to be kinky or polyamorous. Once, someone publicly outed as kinky could have their children taken away and lose their job, and that fear legitimately remains. It seems increasingly incongruous that in the UK, despite the extensive legally sanctioned injuries sustained by boxers and other sportspeople, a person practising BDSM is still not legally able to give, or consent to receiving, marks on their body that are more than what the law defines as “transient and trifling”, even in writing with witnesses. The key issue here, which so many in the mainstream seem unable to get to grips with, is consent. One therapy trainer I heard of had a problem with BDSM because they had worked with abused women. But consensual BDSM is not abuse—precisely because it is consensual. This is not taught on psychotherapy courses (at least none that I know of) because awareness of gender and sexual diversities is barely taught at all. And in some branches of psychotherapy, the further a person departs from being heterosexual, monogamous, vanilla (non-kinky), and cisgender, the more disordered and perverse they are labelled by default. The law and media still talk about people as if they are children who need protecting from themselves, and these attitudes can extend into the therapy room. But in BDSM, negotiation must happen, both in terms of personal boundaries and in asking for what you want, because there could be damage done if not. This level of interpersonal communication is taboo in our culture of unspoken acceptance of the status quo, so asserting consent is actually a radical act. I often wonder what society would look like if girls in particular were taught their true rights in terms of consent, at home and school. Consenting to, and asking for, pleasure takes things a step further and I suspect this is why there is so much disapproval and fear. But is BDSM an orientation, a lifestyle, or both? Some people are wired to be dominant or submissive from birth. Some discover a love of it when young, and some get into it later in life. This could be because they discover that it enhances their sex life, or because conventional genital sex doesn't work for them, and they are looking for other ways to deepen physical and mental connection. People tell me they have experienced a personal renaissance when exploring BDSM, through learning new skills and finding new friends. Many report profound, life changing, therapeutic, and even spiritual experiences. Others simply find it to be a lot of fun. And the prejudice is also curious because power exchange and extreme sensation are ever present in religion, throughout history. Whether resulting from self-deprivation, self-flagellation, or full-on martyrdom, religious ecstasy is transcendent and intoxicating, without any need for drugs. Allowing yourself to be controlled by a higher power and its representatives, or enacting the control yourself, is a major part of this too. In fact the quality of mental health among BDSM practitioners doesn't vary far from that of the general population. For example, a 2013 Dutch study reported good levels of mental health in the kink population they studied, compared with a control group, even finding a better sense of wellbeing in some individuals. A 2008 Australian study of nearly 20 000 people concluded that “BDSM is simply a sexual interest or subculture attractive to a minority, and for most participants not a pathological symptom of past abuse or difficulty with ‘normal’ sex.” But does abuse happen in BDSM? Of course it does. Like all communities created by human beings, it is not a utopia. But it's useful to point out that many people enact non-consensual sadomasochistic scenarios (with neither special clothing nor implements) in so-called normal relationships that are happily sanctioned by society, every day of their lives. Many people in ordinary life do not externally negotiate their relationships at all, nor understand or value their own boundaries and limits, and entire marriages are sustained on this inauthenticity. It is easy to volunteer for suffering, simply by going along with societal norms without asking yourself if they are right for you. With the growth of the internet, the BDSM lifestyle has opened up irrevocably. The older, strictly essentialist, “one true way” (being either dominant or submissive, preferably from birth, with those that switch between them seen as suspect) is giving way to a more fluid interpretation of roles as younger people enter the scene. One long time scene-goer told me about how 30 years ago you wrote to a PO Box number and drove miles to a party where you might not know anyone. Now there are global contact websites and a very large number of events. The increasingly popular cosplay lifestyle, meanwhile, helps to normalise roleplay and fantasy. And so I come back to Fifty Shades, and its portrayal of what is increasingly enjoyed as a hobby, albeit with the shadow of societal disapproval still attached to it. While the book has aroused many people, especially women, and encouraged a lot of experimentation, it is actually hugely problematic and a really terrible presentation of BDSM. The book might have pulled back the curtain on mass desire, but its portrayal of consent is appalling. Grey is a sociopathic stalker and a bully, whose preferences apparently developed out of sexual abuse, a persistent and tiresome cliche. Anyway, the true fetish in Fifty Shades is capitalism—Grey is a rescuing prince of a sort, taking Anastasia away from her workaday life and into a rarefied existence buoyed up entirely on seemingly infinite funds, and I cannot really blame any reader for fantasising about this. The trailer feels quite 1980s in its worship of the corporate world, but I suspect a lot of people will go and see it. A film like this could be a pioneering window into a much misunderstood subculture, but everything I have read about it so far indicates that I might be disappointed. In the therapy room, the kinky client might be seeking help for reasons that are nothing to do with BDSM—they just need to know that their therapist isn't going to pathologise or reject them. The therapist does not have to be totally fine with every practice their client describes, but they need to do their own research and not use their client as a learning zone. Practitioners of BDSM deserve the same respect that any client should get from their therapist, but if they feel stigmatised by their therapist—or, for that matter, their doctor—they are in a difficult position as to who to complain to. Bearing in mind the rules on risk reporting, an especially prejudiced or simply inexperienced therapist could at worst report a client for taking part in what was in fact consensual activity, in a bid to rescue them and cover themselves. After being potentially traumatised by such an experience, the client will also then need to locate a more knowledgeable therapist and start again. When society accepts the sexual self-actualisation of minorities as well as the majority, change might happen. Right now, therapists who reject or pathologise people from the BDSM lifestyle are losing an opportunity to learn, but more importantly they are potentially endangering the mental health of their clients and patients. Now there is a chance to change things.