Category Archives: Pain

Serial delights: Killing as an addiction

A couple of days ago I watched the 2007 US psychological thriller Mr. Brooks. The film is about a celebrated businessman (Mr. Earl Brooks played by Kevin Costner) who also happens to be serial killer (known as the ‘thumbprint killer’). The reason I mention all this is that the explanation given in the film by Earl for the serial killing is that it was an addiction. A number of times in the film he is seem attending Alcoholics Anonymous and quoting from the 12-step recovery program to help him ‘beat his addiction’. With the help of the AA Fellowship, he had managed not to kill anyone for two years but at the start of the film, Earl’s psychological alter-ego (‘Marshall’ played by William Hurt) manages to coerce Earl into killing once again. I won’t spoil the plot for people who have not seen the film but the underlying theme that serial killing is an addiction that Earl is constantly fighting against, is embedded in an implicit narrative that addiction somehow ‘explains’ his behaviour and that he is not really responsible for it. This is not a view I hold myself as all addicts have to take some responsibility for their behaviour.

serial-killers-serial-killers-5806919-532-459

The idea of serial killing being conceptualized as an addiction in popular culture is not new. For instance, Brian Masters book about British serial killer Dennis Nilsen (who killed at least 12 young men and was also a necrophile) was entitled Killing for Company: The Story of a Man Addicted to Murder, and Mikaela Sitford’s book about Harold Shipman, the British GP (aka ‘Dr. Death’) who killed over 200 people, was entitled Addicted to Murder: The True Story of Dr. Harold Shipman.

One of the things that I have always argued throughout my career, is that someone cannot become addicted to an activity or a substance unless they are constantly being rewarded (either by continual positive and/or negative reinforcement). Given that serial killing is a discontinuous activity (i.e., it happens relatively infrequently rather than every hour or day) how could killing be an addiction? One answer is that the act of killing is part of the wider behaviour in that the preoccupation with killing can also include the re-enacting of past kills and the keeping of ‘trophies’ from the victims (which I overviewed in a previous blog). As the author of the book Freud, Profiled: Serial Killer noted:

“The serial killer is most often described as a kind of addict. Murder is his addiction, the thrill achieved in murder his ‘kick.’ This addiction requires a maintenance ‘fix.’ At first, the experience is wonderfully exhilarating, later the fix is needed to just feel normal again. It is a hard habit to break, the hungering sensation to consume another life returns. Between murders, they often play back video or sound recordings or look at photos made of their previous murders. This voyeurism provides a surrogate death-meal until their next feeding”.

In Eric Hickey’s 2010 book Serial Murderers and Their Victims, Dr. Hickey makes reference to an unpublished 1990 monograph by Dr. Victor Cline who outlined a four-factor addiction syndrome in relation to sexual serial killers who (so-called ‘lust murderers’ that I also examined in a previous blog). More specifically:

“The offender first experiences ‘addiction’ similar to the physiological/psychological addiction to drugs, which then generates stress in his or her everyday activities. The person then enters a stage of ‘escalation’, in which the appetite for more deviant, bizarre, and explicit sexual material is fostered. Third, the person gradually becomes ‘desensitized’ to that which was once revolting and taboo-breaking. Finally, the person begins to ‘act out’ the things that he or she has seen”.

This four-stage model is arguably applicable to serial killing more generally. It also appears to be backed up by one of the most notorious serial killers, Ted Bundy. In an interview with psychologist Dr. James Dobson (found in Harold Schecter’s 2003 book The Serial Killer Files: The Who, What, Where, How, and Why of the World’s Most Terrifying Murderers), Bundy claimed:

“Once you become addicted to [pornography], and I look at this as a kind of addiction, you look for more potent, more explicit, more graphic kinds of material. Like an addiction, you keep craving something which is harder and gives you a greater sense of excitement, until you reach the point where the pornography only goes so far – that jumping-off point where you begin to think maybe actually doing it will give you that which is just beyond reading about it and looking at it”.

Dr. Hickey claims that such urges to kill are fuelled by fantasies that have become well-developed and killers to vicariously gain control of other individual. He also believes that fantasies for lust killers are far greater than an escape, and becomes the focal point of all behaviour. He concludes by saying that “even though the killer is able to maintain contact with reality, the world of fantasy becomes as addictive as an escape into drugs”. In the book The Serial Killer Files, Harold Schechter notes that:

“For homicidal psychopaths, lust-killing often becomes an addiction. Like heroin users, they not only become dependent on the thrilling sensation – the rush – of torture, rape, and murder; they come to require ever greater and more frequent fixes. After a while, merely stabbing a co-ed to death every few months isn’t enough. They have to kill every few weeks, then every few days. And to achieve the highest pitch of arousal, they have to torture the victim before putting her to death. This kind of escalation can easily lead to the killer’s own destruction. Like a junkie who ODs in his urgent quest to satisfy his cravings, serial killers are often undone by their increasingly unbridled sadism, which drives them to such reckless extremes that they are finally caught. Monsters tend to be sadists, deriving sexual gratification from imposing pain on others. Their secret perversions, at first sporadic, often trap them in a pattern as the intervals between indulgences become briefer: it is a pattern whose repetitions develop into a hysterical crescendo, as if from one outrage to another the monster were seeking as a climax his own annihilation”.

Schecter uses the ‘addiction’ explanation for serial killing throughout his writings even for serial killers from the past including American nurse Jane Toppan (the ‘Angel of Death’) who confessed to 33 murders in 1901 and died in 1938 (“she became addicted to murder”), cannibalistic child serial killers Gilles Garnier (died in 1573) and Peter Stubbe (died 1589) (“both became addicted to murder and cannibalism, both preferred to prey upon children”), and Lydia Sherman (died 1878) who killed 8 children including six of her own (“confirmed predator, addicted to cruelty and death”).

In a recent 2012 paper on mental disorders in serial killers in the Iranian Journal of Medical Law, Dr. N. Mehra and A.S. Pirouz quoted the literary academic Akira Lippit who argued that in films, the “completion of each serial murder lays the foundation for the next act which in turn precipitates future acts, leaving the serial subject always wanting more, always hungry, addicted”. They then go on to conclude that:

“Once a killer has tasted the success of a kill, and is not apprehended, it will ultimately mean he will strike again. He put it simply, that once something good has happened, something that made the killer feel good, and powerful, and then they will not hesitate to try it again. The first attempt may leave them with a feeling of fear but at the same time, it is like an addictive drug. Some killers revisit the crime scene or take trophies, such as jewelry or body parts, or video tape the scenario so as to be able to re-live the actual feeling of power at a later date”.

Although I haven’t done an extensive review of the literature, I do think it’s possible – even on the slimmest of empirical bases presented here – to conceptualize serial killing as a potential behavioural addiction for some individuals. However, it will always depend upon how addiction is defined in the first place.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Aggrawal A. (2009). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices. Boca Raton: CRC Press.

Brophy, J. (1967). The Meaning of Murder. London: Crowell.

Hickey, E.W. (2010). Serial Murderers and Their Victims (Fifth Edition). Pacific Grove, CA: Brooks/Cole.

Lippit, A.M. (1996). The infinite series: Fathers, cannibals, chemists. Criticism, Summer, 1-18.

Masters, B. (1986). Killing for Company: The Story of a Man Addicted to Murder. New York: Stein and Day.

Mehra, N., & Pirouz, A. S. (2012). A study on mental disorder in serial killers. Iranian Journal of Medical Law, 1(1), 38-51.

Miller, E. (2014). Freud, Profiled: Serial Killer. San Diego: New Directions Publishing.

Schecter, H. (2003). The Serial Killer Files: The Who, What, Where, How, and Why of the World’s Most Terrifying Murderers. New York: Ballantine Books

Sitford, M. (2000). Addicted to Murder: The True Story of Dr. Harold Shipman. London: Virgin Publishing.

Taylor, T. (2014). Is serial killing an addiction? IOL, April 9. Located at: http://www.iol.co.za/news/crime-courts/is-serial-killing-an-addiction-1673542

Art in the right place: Cosey Fanni Tutti’s ‘Art Sex Music’

Five years ago I wrote a blog about one of my favourite bands, Throbbing Gristle (TG; Yorkshire slang for a penile erection). In that article, I noted that TG were arguably one of “the most extreme bands of all time” and “highly confrontational”. They were also the pioneers of ‘industrial music’ and in terms of their ‘songs’, no topic was seen as taboo or off-limits. In short, they explored the dark and obsessive side of the human condition. Their ‘music’ featured highly provocative and disturbing imagery including hard-core pornography, sexual manipulation, school bullying, ultra-violence, sado-masochism, masturbation, ejaculation, castration, cannibalism, Nazism, burns victims, suicide, and serial killers (Myra Hindley and Ian Brady).

I mention all this because I have just spent the last few days reading the autobiography (‘Art Sex Music‘) of Cosey Fanni Tutti (born Christine Newbie), one of the four founding members of TG. It was a fascinating (and in places a harrowing) read. As someone who is a record-collecting completist and having amassed almost everything that TG ever recorded, I found Cosey’s book gripping and read the last 350 pages (out of 500) in a single eight-hour sitting into the small hours of Sunday morning earlier today.

cosey_fanni_tutti_paperback_signed

TG grew out of the ‘performance art’ group COUM Transmissions in the mid-1970s comprising Genesis P-Orridge (‘Gen’, born Neil Megson in 1950) and Cosey. At the time, Cosey and Gen were a ‘couple’ (although after reading Cosey’s book, it was an unconventional relationship to say the least). TG officially formed in 1975 when Chris Carter (born 1953) and Peter ‘Sleazy’ Christopherson (1955-2010). Conservative MP Sir Nicholas Fairburn famously called the group “wreckers of civilisation” (which eventually became the title of their 1999 biography by Simon Ford).

As I noted in my previous article, TG are – psychologically – one of the most interesting groups I have ever come across and Cosey’s book pulled no punches. To some extent, Cosey’s book attempted to put the record straight in response to Simon Ford’s book which was arguably a more Gen-oriented account of TG. Anyone reading Cosey’s book will know within a few pages who she sees as the villain of the TG story. Gen is portrayed as an egomaniacal tyrant who manipulated her. Furthermore, she was psychologically and physically abused by Gen throughout their long relationship in the 1970s. Thankfully, Cosey fell in love with fellow band member Chris Carter and he is still the “heartbeat” of the relationship and to who her book is dedicated.

Like many of my favourite groups (The Beatles, The Smiths, The Velvet Underground, Depeche Mode), TG were (in Gestaltian terms) more than the sum of their parts and all four members were critical in them becoming a cult phenomenon. The story of their break up in the early 1980s and their reformation years later had many parallels with that of the Velvet Underground’s split and reformation – particularly the similarities between Gen and Lou Reed who both believed they were leaders of “their” band and who both walked out during their second incarnations.

Cosey is clearly a woman of many talents and after reading her book I would describe her as an artist (and not just a ‘performance artist’), musician (or maybe ‘anti-musician in the Brian Eno sense of the word), writer, and lecturer, as well as former pornographic actress, model, and stripper. It is perhaps her vivid descriptions of her life in the porn industry and as a stripper that (in addition to her accounts of physical and psychological abuse by Gen) were the most difficult to read. For someone as intelligent as Cosey (after leaving school with few academic qualifications but eventually gaining a first-class degree via the Open University), I wasn’t overly convinced by her arguments that her time working in the porn industry both as a model and actress was little more than an art project that she engaged in on her own terms. But that was Cosey’s justification and I have no right to challenge her on it.

What I found even more interesting was how she little connection between her ‘pornographic’ acting and modelling work and her time as a stripper (the latter she did purely for money and to help make ends meet during the 1980s). Her work as a porn model and actress was covert, private, seemingly enjoyable, and done behind closed doors without knowing who the paying end-users were seeing her naked. Her work as a stripper was overt, public, not so enjoyable, and played out on stage directly in front of those paying to see her naked. Two very different types of work and two very different psychologies (at least in the way that Cosey described it).

Obviously both jobs involved getting naked but for Cosey, that appeared to be the only similarity. She never ever had sex for money with any of the clientele that paid to see her strip yet she willingly made money for sex within the porn industry. For Cosey, there was a moral sexual code that she worked within, and that sex as a stripper was a complete no-no. The relationship with Gen was (as I said above) ‘unconventional’ and Gen often urged her and wanted her to have sex with other men (and although she never mentioned it in her book, I could speculate that Gen had some kind of ‘cuckold fetish’ that I examined in a previous blog as well as some kind of voyeur). There were a number of times in the book when Cosey appeared to see herself as some kind of magnet for unwanted attention (particularly exhibitionists – so-called ‘flashers’ – who would non-consensually expose their genitalia in front of Cosey from a young age through to adulthood). Other parts of the book describe emotionally painful experiences (and not just those caused by Gen) including both her parents disowning her and a heartfelt account of a miscarriage (and the hospital that kept her foetus without her knowledge or consent). There are other sections in the book that some readers may find troubling including her menstruation art projects (something that I perhaps should have mentioned in my blog  on artists who use their bodily fluids for artistic purposes).

Cosey’s book is a real ‘warts and all’ account of her life including her many health problems, many of which surprisingly matched my own (arrhythmic heart condition, herniated spinal discs, repeated breaking of feet across the lifespan). Another unexpected connection was that her son with Chris Carter (Nick) studied (and almost died of peritonitis) as an undergraduate studying at art at Nottingham University or Nottingham Trent University. I say ‘or’ because at one stage in the book it says that Nick studied at Nottingham University and in another extract it says they were proud parents attending his final degree art show at Nottingham Trent University. I hope it was the latter.

Anyone reading the book would be interested in many of the psychological topics that make an appearance in the book including alcoholism, depression, claustrophobia, egomania, and suicide to name just a few. In previous blogs I’ve looked at whether celebrities are more prone to some psychological conditions including addictions and egomania and the book provides some interesting case study evidence. As a psychologist and a TG fan I loved reading the book.

 Dr Mark Griffiths, Professor of Behavioural Addictions, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Cooper, D. (2012). Sypha presents … Music from the Death Factory: A Throbbing Gristle primer. Located at: http://denniscooper-theweaklings.blogspot.co.uk/2012/02/sypha-presents-music-from-death-factory.html?zx=c19a3a826c3170a7

Fanni Tutti, C. (2017). Art Sex Music. Faber & Faber: London.

Ford, S. (1999). Wreckers of Civilization: The Story of Coum Transmissions and Throbbing Gristle. London: Black Dog Publishing.

Kirby, D. (2011). Transgressive representations: Satanic ritual abuse, Thee Temple ov Psychick Youth, and First Transmission. Literature and Aesthetics, 21, 134-149.

Kromhout, M. (2007). ‘The Impossible Real Transpires’ – The Concept of Noise in the Twentieth Century: a Kittlerian Analysis. Located at: http://www.mellekromhout.nl/wp-content/uploads/The-Impossible-Real-Transpires.pdf

Reynolds, S. (2006). Rip It Up and Start Again: Postpunk, 1978–1984. New York: Penguin.

Sarig, R. (1998). The Secret History of Rock: The Most Influential Bands You’ve Never Heard Of. New York: Watson-Guptill Publications.

Walker, J.A. (2009). Cosey Fanni Tutti & Genesis P-Orridge in 1976: Media frenzy, Prostitution-style, Art Design Café, August 10. Located at: http://www.artdesigncafe.com/cosey-fanni-tutti-genesis-p-orridge-1-2009

Wells, S. (2007). A Throbbing Gristle primer. The Guardian, May 27. Located at: http://www.guardian.co.uk/music/musicblog/2007/may/29/athrobbinggristleprimer

Tub zero: A brief look at bath-related illnesses and fatalities

Regular readers of my blog will know that I have an interest in all things bizarre and out of the ordinary. In previous blogs I have examined coital cephalagia (people that get headaches from having sex) and masturbatory cephalagia (people that get headaches from masturbation). It was while researching those articles that I came across a 2005 paper on ‘bath-related headaches’ (BRHs) by Dr. Mak and colleagues in the journal Cephalagia.

BRH is rare headache syndrome. They reported 13 case studies (six from their own case files collected over a seven-year period and seven from other reports in the medical literature). They reported that all the cases involved “Oriental women” aged 32 to 67 years (with an average age of 51 years). The cases were reported in females from Hong Kong (n=6), Taiwan (n=4) and Japan (n=3). All of the women reported severe headaches (lasting from 30 minutes to 30 hours) that were triggered by bathing or other activities involving contact with water. Typically, the onset of the headaches were “hyperacute” and were like ‘thunderclap’ headaches (a severe headache that takes seconds to minutes to reach maximum intensity). The paper reported that no underlying secondary causes were identified and that drug treatment was generally unsatisfactory (although use of the drug Nimodipine was reported to shorten the length of the headache in some cases). Unfortunately, the only way that such headaches could be prevented was to avoid bathing.

After reading this paper I looked for other papers relating to bath-related illnesses. A 2000 paper by Dr. S. Cerovac and Dr. A. Roberts reported on 57 cases of burns sustained by hot bath and shower water (in the journal Burns) over an eight-year period. None of the 57 cases died as a result of the burns. The authors worked at Stoke Mandeville Hospital (in the UK) and they divided the cases into child (below the age of 16 years) and adult groups. Most of the children (n=39) were under the age of three years (83%), with two-fifths having superficial burns (41%). Most of these cases occurred due to what the authors described as “inadequate supervision” by the child’s parents (85%). Among the adult group, 83% of the adults were over 60 years of age with around 65% of them having “some form of psycho-motor disorder that predisposed to an accident which should have been anticipated”. The adult group had more extensive burns which resulted in eight deaths (out of 18 cases; 44%). They reported that the number of cases had been declining over the eight-year period but the study highlighted that fatal incidents could be caused by something as simple as bathing.

Unknown

A 1995 study by Dr. J. Lavelle in the Annals of Emergency Medicine evaluated the risk factors associated with bathtub submersion injury and their relationship to child abuse and neglect over a 10-year period (1982-1992). They reported that there had been 21 patients treated for bathtub near-drownings (nine of which had subsequently died). Of these, two-thirds of the children (67%) had “historic and/or physical findings suspicious for abuse or neglect, including incompatible history for the injury, other physical injuries, previous child abuse reports, psychiatric history of the caretaker, and/or psychosocial concerns noted in the chart”. The mortality rate of 42% was significant. However, findings showed that no demographic characteristics identified at-risk children.

Perhaps the most common form of bathtub deaths are infant drownings. A paper by Dr. John Pearn and Dr. James Nixon examined the socio-demographic factors surrounding drowning accidents among children aged 0-15 years in a 1978 issue of Social Science & Medicine. Obviously this paper examined all drownings but did note that those that involved bathtub drownings occur “almost exclusively in lower social class homes” In a follow-up study specifically on bathtub drownings, Dr. Pearn and his colleagues reported the cases of seven bathtub drownings in the journal Pediatrics. All of the seven cases were infants in the US state of Hawaii. As with the previous paper, the authors reported that the families of the infant were typically of lower socioeconomic status but also added that the deaths had occurred when the father “had immediate care of the infant at the time of the accident”. In five of the cases, the drowned infant was being looked after by older sibling.

In 1985, Dr. Lawrence Budnick and Dr. D. Ross published a study on bathtub-related drownings in the USA in the American Journal of Public Health. They analysed information (1979-1981) on such deaths using data from the (i) National Center for Health Statistics and (ii) Consumer Product Safety Commission data. They reported 710 individuals had drowned in the bath during this period with an estimated mortality rate of 1.6 per million individuals per year. They reported an excess of deaths in the spring but this was not statistically significant. However, they did note that individuals “at the extremes of age were at greatest risk of death, with mortality rates of 5-6 per million per year”. Unsurprisingly, there was a frequent history of children below the age of five years being left unattended by parents. Amongst young to middle-aged adults, there was a frequent history of seizures or history of alcohol or drug use. Among more elderly individuals there was frequent evidence of having fallen in the bath.

Similarly, in 2006, Dr. G. Somers and colleagues carried out a 20-year review of bathtub drownings published in the American Journal of Forensic Medicine and Pathology. The authors retrospectively retrospective reviewed US autopsy records over a 20-year period (1984–2003). They identified 18 cases of bathtub drownings (8 boys and 10 girls) aged 6 months to 70 months (average of 17 months) almost three-quarters aged under one year (72%). The factors leading to the death were reported as inadequate adult supervision (89%), cobathing (39%), the use of infant bath seats (17%), and coexistent medical disorders predisposing the child to the drowning episode (17%).

A paper by Dr. R. Rauchschwalbe and colleagues in a 1997 issue of Pediatrics examined the role of bathtub seats and rings as a primary cause of death in US infant drowning deaths (1983-1995). The paper reported 32 deaths by drowning involving bath seats/rings with the victims’ ages at the time of the death ranging from 5 to 15 months (average 8 months old). Nine in ten deaths was due to a “reported lapse in adult supervision”. The authors concluded that infant drownings associated with bath seats/rings are increasing in the US and that very young children “should never be left in the bathtub unsupervised, even for brief moments”.

A more recent 2004 study by Dr. R. Byard and Dr. T. Donald in the Journal of Paediatrics and Child Health examined the possible role of infant bathtub seats in drowning and near-drowning (1998-2003). The authors used files from the Forensic Science Centre and Child Protection Unit, Women’s and Children’s Hospital in Adelaide (Australia). In the six-year period, there were six cases of drowning in children aged under two years. They noted:

“One of these cases, a 7-month-old boy, had been left unattended for some time in an adult bath in a bathtub seat. He was found drowned, having submerged after slipping down and becoming trapped in the seat. Three near-drowning episodes occurred in children under the age of 2 years, including two boys aged 7 and 8 months, both of whom had been left for some time in adult baths in bath seats. Both were successfully resuscitated and treated in hospital…These cases demonstrate the vulnerability of infants to immersion incidents when left unattended in bathtubs”.

In a 1984 paper in the Journal of the American Medical Association, Dr. Lawrence Budnick examined bathtub-related electrocutions in the USA (1979 to 1982). He reported that at least 95 Americans had been electrocuted in the bath and that the use of hair dryers in the bathroom had caused 60% of the deaths. It was also noted that two-thirds of the deaths had occurred during spring and winter, and that those under five years of age had the highest mortality rate.

A 2003 paper by Dr. N. Yoshioka and his colleagues in the journal Legal Medicine examined bathtub deaths in Japan. The authors claimed that approximately 100–120 cases of “sudden death in bathroom” are reported there every year and accounts for around “8–10% of the total number of what is considered unnatural deaths”. Most of the deaths occur in winter and 80% of cases involve the elderly and the authors described the deaths as “baffling” as the autopsies rarely locate the exact cause of death. By testing physiological changes 54 volunteers in both winter and summer, the authors reported that many heart conditions occurred during the winter months in their volunteers (e.g., cardiac arrhythmia including ventricular tachycardia, ventricular extrasystole, supraventricular extrasystole, and bradycardia) and that these conditions might lead to an increased risk for cardiac arrest while bathing.

Another possible reason for bathtub-related drownings is epileptic seizures while bathing. A paper by Dr. C. Ryan and Dr. G. examined drowning deaths among epileptics in a 1993 issue of the Canadian Medical Association Journal. The authors retrospectively reviewed deaths from drowning in Alberta (Canada) from 1981 to 1990. Of these drownings in Alberta (n=482), 5% (n=25) were directly related to epileptic seizures of which 60% (n=15) occurred while the individual was taking an unsupervised bath. The authors advised that all people with epilepsy should take showers (while sitting) instead of baths.

While most of these bath-related health issues and fatalities are rare, they do highlight the issue that accidents can happen anywhere and that in the bath can be a vulnerable location for infants left unattended or those with medical conditions that cause immobility.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Budnick, L.D. (1984). Bathtub-related electrocutions in the United States, 1979 to 1982. JAMA, 252(7), 918-920.

Budnick, L.D., & Ross, D.A. (1985). Bathtub-related drownings in the United States, 1979-81. American Journal of Public Health, 75(6), 630-633.

Byard, R. W., & Donald, T. (2004). Infant bath seats, drowning and near‐drowning. Journal of Paediatrics and Child Health, 40(5‐6), 305-307.

Cerovac, S., & Roberts, A.H. (2000). Burns sustained by hot bath and shower water. Burns, 26(3), 251-259.

Lavelle, J. M., Shaw, K. N., Seidl, T., & Ludwig, S. (1995). Ten-year review of pediatric bathtub near-drownings: evaluation for child abuse and neglect. Annals of Emergency Medicine, 25(3), 344-348.

Mak, W., Tsang, K.L., Tsoi, T.H., Au Yeung, K.M., Chan, K.H., Cheng, T. S., … & Ho, S.L. (2005). Bath‐related headache. Cephalalgia, 25(3), 191-198.

Pearn, J. H., Brown, J., Wong, R., & Bart, R. (1979). Bathtub drownings: Report of seven cases. Pediatrics, 64(1), 68-70.

Nixon, J., & Pearn, J. (1978). An investigation of socio-demographic factors surrounding childhood drowning accidents. Social Science & Medicine. Part A: Medical Psychology & Medical Sociology, 12, 387-390.

Rauchschwalbe, R., Brenner, R.A., & Smith, G.S. (1997). The role of bathtub seats and rings in infant drowning deaths. Pediatrics, 100(4), e1.

Ryan, C. A., & Dowling, G. (1993). Drowning deaths in people with epilepsy. CMAJ: Canadian Medical Association Journal, 148(5), 781-784.

Somers, G. R., Chiasson, D. A., & Smith, C. R. (2006). Pediatric drowning: A 20-year review of autopsied cases: III. Bathtub drownings. American Journal of Forensic Medicine and Pathology, 27(2), 113-116.

Yoshioka, N., Chiba, T., Yamauchi, M., Monma, T., & Yoshizaki, K. (2003). Forensic consideration of death in the bathtub. Legal Medicine, 5, S375-S381.

Drowning gory: A brief look at quicksand fetishes

“[There] is a natural or unexpected form of bondage where girls step into cement, wander into spider webs or sink into quicksand. Often girls find themselves in perilous or humiliating situations like being in danger of sinking under quicksand or unable to stop the advances of a horny teenager after having stepped into superglue” (Weird and Sexy website).

I used the opening quote in a previous blog on ‘stuck fetishism’ but is just as appropriate in the context of this article on quicksand fetishes. Such fetishes appear to be a sub-type of taphephilia (that I also examined in a previous blog on claustrophilia [sexual arousal from being in confined spaces]). Dr. Anil Aggrawal in his book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices defines taphephilia as deriving sexual pleasure and arousal from being buried alive. I noted in my previous blog that when I first read about this paraphilia I had major doubts about it’s existence until I came across groups such as the Six Feet Under Club and the Buried Stories website. As the Buried Stories homepage asserts:

“Buried or burial whilst still alive is a nightmare to some but a joy or fetish to others. The desire to be boxed, bagged and buried is a great turn on for many. The feeling of utter helplessness as the sounds of the first shovel of dirt hits the top of their coffin. The fantasy may also involve being placed in a casket, bodybag, or other enclosure before being buried either on the beach, in dirt or even in quicksand. Encased or entombed, enclosed or just bagged. ‘Buried Stories’ contains stories of people being buried, sunk in quicksand or encased within an enclosure. Some may have acted out their desires whilst others have written about their fantasy to share with you”

07-1457352185-quicksand

An article about ‘stuck fetishism’ (on the now defunct Nation Master website) provided a typology of all the different types of stuck fetishes. There was no empirical evidence supporting the typology but has good face validity based on what I have read about the topic. The different type of stuck fetishism includes (i) sticky substance immobilization fetishes, (ii) non-sticky substance immobilization fetishes, (iii) situational immobilization fetishes, (iv) perceived situational immobilization fetish, (v) stuck clothing fetish, (vi) stuck transport fetish, (vii) stuck transformation fetish, (viii) stuck multi-person fetish, and (ix) stuck conjoinment fetish (for a detailed description of each of these fetishes, see my previous blog on stuck fetishism). These fetishes – while specific – may not be mutually exclusive, and some stuck fetishists may gain sexual arousal from more than one of these scenario. Quicksand fetishes are an example of ‘non-sticky substance immobilization fetishes’ (i.e., the individual is rendered immobile and derives sexual arousal from a substance that is not sticky but stops the individual from being able to move such as quicksand, mud or cement).

In an article on the Cracked.com website, ‘Girls stuck in quicksand’ was one of the six most bizarre safe for work fetishes they listed. The article noted:

“There’s no official name for this weird fetish – yet – but that doesn’t mean the Internet isn’t full of videos and photos depicting it. For some people, the idea of a person, especially a woman, nearly drowning in quicksand is quite the turn on. Perhaps these viewers imagine themselves as a hero who can swoop in and save the day. Or maybe these people are aroused by the woman’s fear. Either way, this is a fetish we hope you won’t experience any time soon. This is a perfect example of a nearly ‘safe for work’ fetish – it requires no nudity or sex, and it in fact involves a situation in which sex would be utterly impossible. It’s people who get aroused at the sight of fully clothed women sinking in quicksand”.

The article then went on to say things that I have confirmed for myself when visiting such sites as Quicksand Visuals and Quicksand Fans:

 

“A cursory search online would reveal tons of sites dedicated to compiling clips from various sources of girls drowning in quicksand, and then there are the niche video sites dedicated to providing original content (there probably is a booming industry in quicksand pit installation these days). On those sites, elaborate storylines are created to justify how these lovely ladies came to be trapped in the unforgiving, bottomless pit of certain-yet-sexy death. So … maybe the quicksand thing triggers some ‘damsel in distress’ response in the [brain’s cortex]? If there’s anything lonely Internet tough guys love, it’s sitting behind their keyboards visualizing all the many ways they would totally jump in and save the unfortunate lady fake drowning in a boggy marsh”.

Reference was made in the paragraph above to a “damsel in distress response”. In a previous blog I examined ‘damsel in distress’ (DiD) fetishes. I noted in thatblog that (like quicksand fetishes) it is mostly males who have DiD fetishes and that they can be very specific including (but not restricted to) such things as (i) ‘kidnap and rescue’ fetishes (sexual pleasure from watching or engaging in women being kidnapped and/or rescued from potentially life-threatening scenarios where they are cuffed, bound and/or controlled by another person or persons), (ii) tickle bondage fetishes (sexual pleasure from watching or tickling women while they are tied up), (iii) quicksand fetishes (sexual pleasure from watching women sink in quicksand), and (iv) ‘pedal pumping’ and ‘cranking’ fetishes (sexual pleasure from watching women stranded in their cars with repeated pressing of the gas pedal and revving up – which also has elements of foot fetishism – while turning the key in an attempt to get the engine to start).

Unsurprisingly, there are no academic papers on quicksand fetishes and very few articles of any description on the topic. One article by Jagger Gravning on the Motherboard news site wrote an interesting article on ‘The fetish for video game characters trapped in quicksand’ (and could arguably be classed as a sub-type of quicksand fetishism). This could also be classed as a type of toonophilia (sexual arousal from cartoon characters) that I also examined in a previous blog.

Gravning’s article concentrated on the ‘quicksand artists’ (and other types of fetish illustrations on the Deviant Art website) rather than the quicksand fetishists (such as A-020, an artist who draws women trapped in quicksand for the titillation of those with a predilection for such imagery”) as well as interviewing various academics about the fetishistic side of the practice. However, A-020 admitted he was also a quicksand fetishist. When asked about the origins of his fetish, which he claimed were integrated with other types of fetish behaviour: “I think it could be a distant cousin of fetishes like vore and bondage with a combination of muddy and stuck elements. Those similarities may be why I find it interesting mixed with an attractive female”.

Gravning wanted to know whether witnessing human beings stuck in quicksand in cartoons over and over as a child possibly lead to this unusual fetish. She asked Dr. Catherine Salmon, an evolutionary psychologist, who wrote the book Warrior Lovers: Erotic Fiction, Evolution and Female Sexuality:

“It could be something like that. Whether it’s quicksand or tar pits, there are things like that in children’s cartoons. It could be something as simple as that. Part of it is the damsel in distress kind of image. Watching ‘Wonder Woman’ caught in that kind of circumstance when people are younger—[it’s] an image that’s eroticized, a very sexually drawn, very feminine image. And they might enjoy watching that sort of thing or the struggle, as she’s trying to get out of whatever that circumstance is. There are a lot of unusual circumstances in cartoons and fantasy and you may get aroused while you’re watching it and then carry some of that too”.

Gravning also interviewed Dr. Elizabeth Larson, the Director of the Seattle Institute for Sex Therapy, Education and Research. Like me, Dr. Larson sees the development of such fetishes as most likely the consequence of associative pairing early in childhood or adolescence. More specifically she noted:

“These associations that come to be associated with an aroused state and are ‘accidents of learning’. These accidents of learning are most potent in the early sexual learning history, although it’s not impossible later. They don’t have to be exactly like the fantasy that comes. It just has to resemble it…[Quicksand fetishists] probably fantasized and got into the feeling that goes with that, not just watching. It could [also] be identifying with it. The kid imagining himself stuck in quicksand in the victim’s place, for example, could be part of its erotic appeal. You could either be observing it or experiencing it. You could be doing both at the same time in a fantasy. Some evidence certainly suggests that sexual patterns are already there, for sure in males, by the age of eight [years of age]. They may or may not have begun masturbating to fantasies until adolescence but something is going on internally at a very young age”.

 Gravning also spoke to the US computational neuroscientist Dr. Ogi Ogas who was quoted as saying: 

“While uncommon, the notion of being smothered or trapped is universal in the sense that it exists to greater and lesser degrees ‘all over’ [the world]. It’s not just one or two people that have it. It is found in a lot of places. Clearly our normal brain design is not that far removed from [wanting to be] enveloped. It’s probably something to do with our tactile system, our touch system of the brain, that’s quite naturally wired to our sexual arousal system. The tactile system is also interconnected with sensations like being smothered and being interred, being doused with water. Probably, somehow – and I’m speculating here – that’s what got crossed up for whatever reasons…A quirk in the brain, essentially…As we’re learning more about the genetics of brain construction, we’re coming to understand the genetic expression that leads to different neural wiring is highly variable and dependent on so many things [that] could happen in the womb, things that happen in early life, different environmental things. There’s just myriad, myriad factors that can cause unusual neural wiring to arise. Following this logic, some boy who just happens to have the notion of being smothered or trapped somehow interconnected to his arousal system becomes aroused when he sees an attractive woman struggling in quicksand, and that image burns into his mind”.

I have no idea how common quicksand fetishes are (but I would suspect it’s a very niche fetish), and I doubt whether the fetish is the only type of fetishistic behaviour among such people as there is so much crossover with many other different niche fetishes (stuck fetishism, buried fetishism, etc.). As with many other extreme sexual behaviours I have examined, I can’t see this becoming an area of serious academic study any time soon, but that doesn’t mean it’s not an interesting topic.

Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Aggrawal A. (2009). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices. Boca Raton: CRC Press.

Encyclopedia Dramatica (2016). Quicksand fetish. May 4. Located at:https://encyclopediadramatica.se/Quicksand_Fetish

Gravning, J. (2015). The fetish for video game characters trapped in quicksand. Motherboard, March 19. Located at: http://motherboard.vice.com/read/quicksand

Ntumy, E.K. (2013). The 6 most bizarre safe for work fetishes. Cracked.com. November 7. Located at: http://www.cracked.com/article_20691_the-6-most-bizarre-safe-work-fetishes.html

Pop Crunch (2010). Quicksand, pedal pumping, tickle bondage, women in distress in general. May 11. Located at: http://www.popcrunch.com/the-17-most-wtf-fetishes-imaginable/

Surprise, surprise: A brief overview of our recent papers on strange addictions and behaviours

Following my recent blogs where I outlined some of the papers that my colleagues and I have published on mindfulness, Internet addiction, gaming addiction, youth gambling, workaholism, exercise addiction, and sex addiction, here is a round-up of recent papers that my colleagues and I have published on strange and/or surprising addictions and behaviours.

Foster, A.C., Shorter, G.W. & Griffiths, M.D. (2015). Muscle Dysmorphia: Could it be classified as an Addiction to Body Image? Journal of Behavioral Addictions, 4, 1-5.

  • Background: Muscle dysmorphia (MD) describes a condition characterised by a misconstrued body image in which individuals who interpret their body size as both small or weak even though they may look normal or highly muscular. MD has been conceptualized as a type of body dysmorphic disorder, an eating disorder, and obsessive–compulsive disorder symptomatology. Method and aim: Through a review of the most salient literature on MD, this paper proposes an alternative classification of MD – the ‘Addiction to Body Image’ (ABI) model – using Griffiths (2005) addiction components model as the framework in which to define MD as an addiction. Results: It is argued the addictive activity in MD is the maintaining of body image via a number of different activities such as bodybuilding, exercise, eating certain foods, taking specific drugs (e.g., anabolic steroids), shopping for certain foods, food supplements, and the use or purchase of physical exercise accessories). In the ABI model, the perception of the positive effects on the self-body image is accounted for as a critical aspect of the MD condition (rather than addiction to exercise or certain types of eating disorder). Conclusions: Based on empirical evidence to date, it is proposed that MD could be re-classified as an addiction due to the individual continuing to engage in maintenance behaviours that may cause long-term harm.

Griffiths, M.D., Foster, A.C. & Shorter, G.W. (2015). Muscle dysmorphia as an addiction: A response to Nieuwoudt (2015) and Grant (2015). Journal of Behavioral Addictions, 4, 11-13.

  • Background: Following the publication of our paper ‘Muscle Dysmorphia: Could it be classified as an addiction to body image?’ in the Journal of Behavioral Addictions, two commentaries by Jon Grant and Johanna Nieuwoudt were published in response to our paper. Method: Using the ‘addiction components model’, our main contention is that muscle dysmorphia (MD) actually comprises a number of different actions and behaviors and that the actual addictive activity is the maintaining of body image via a number of different activities such as bodybuilding, exercise, eating certain foods, taking specific drugs (e.g., anabolic steroids), shopping for certain foods, food supplements, and purchase or use of physical exercise accessories. This paper briefly responds to these two commentaries. Results: While our hypothesized specifics relating to each addiction component sometimes lack empirical support (as noted explicitly by both Nieuwoudt and Grant), we still believe that our main thesis (that almost all the thoughts and behaviors of those with MD revolve around the maintenance of body image) is something that could be empirically tested in future research by those who already work in the area. Conclusions: We hope that the ‘Addiction to Body Image’ model we proposed provides a new framework for carrying out work in both empirical and clinical settings. The idea that MD could potentially be classed as an addiction cannot be negated on theoretical grounds as many people in the addiction field are turning their attention to research in new areas of behavioral addiction.

Maraz, A., Király, O., Urbán, R., Griffiths, M.D., Demetrovics, Z. (2015). Why do you dance? Development of the Dance Motivation Inventory (DMI). PLoS ONE, 10(3): e0122866. doi:10.1371/ journal.pone.0122866

  • Dancing is a popular form of physical exercise and studies have show that dancing can decrease anxiety, increase self-esteem, and improve psychological wellbeing. The aim of the current study was to explore the motivational basis of recreational social dancing and develop a new psychometric instrument to assess dancing motivation. The sample comprised 447 salsa and/or ballroom dancers (68% female; mean age 32.8 years) who completed an online survey. Eight motivational factors were identified via exploratory factor analysis and comprise a new Dance Motivation Inventory: Fitness, Mood Enhancement, Intimacy, Socialising, Trance, Mastery, Self-confidence and Escapism. Mood Enhancement was the strongest motivational factor for both males and females, although motives differed according to gender. Dancing intensity was predicted by three motivational factors: Mood Enhancement, Socialising, and Escapism. The eight dimensions identified cover possible motives for social recreational dancing, and the DMI proved to be a suitable measurement tool to assess these motives. The explored motives such as Mood Enhancement, Socialising and Escapism appear to be similar to those identified in other forms of behaviour such as drinking alcohol, exercise, gambling, and gaming.

Maraz, A., Urbán, R., Griffiths, M.D. & Demetrovics Z. (2015). An empirical investigation of dance addiction. PloS ONE, 10(5): e0125988. doi:10.1371/journal.pone.0125988.

  • Although recreational dancing is associated with increased physical and psychological well-being, little is known about the harmful effects of excessive dancing. The aim of the present study was to explore the psychopathological factors associated with dance addiction. The sample comprised 447 salsa and ballroom dancers (68% female, mean age: 32.8 years) who danced recreationally at least once a week. The Exercise Addiction Inventory (Terry, Szabo, & Griffiths, 2004) was adapted for dance (Dance Addiction Inventory, DAI). Motivation, general mental health (BSI-GSI, and Mental Health Continuum), borderline personality disorder, eating disorder symptoms, and dance motives were also assessed. Five latent classes were explored based on addiction symptoms with 11% of participants belonging to the most problematic class. DAI was positively associated with psychiatric distress, borderline personality and eating disorder symptoms. Hierarchical linear regression model indicated that Intensity (ß=0.22), borderline (ß=0.08), eating disorder (ß=0.11) symptoms, as well as Escapism (ß=0.47) and Mood Enhancement (ß=0.15) (as motivational factors) together explained 42% of DAI scores. Dance addiction as assessed with the Dance Addiction Inventory is associated with indicators of mild psychopathology and therefore warrants further research.

unknown

Greenhill, R. & Griffiths, M.D. (2015). Compassion, dominance/submission, and curled lips: A thematic analysis of dacryphilic experience. International Journal of Sexual Health, 27, 337-350.

  • Objectives: Dacryphilia is a non-normative sexual interest that involves enjoyment or arousal from tears and crying, and to date has never been researched empirically. The present study set out to discover the different interests within dacryphilia and explore the range of dacryphilic experience. Methods: A set of online interviews were carried out with individuals with dacryphilic preferences and interests (six females and two males) from four countries. The data were analyzed for semantic and latent themes using thematic analysis. Results: The respondents’ statements focused attention on three distinct areas that may be relevant to the experience of dacryphilia: (i) compassion; (ii) dominance/submission; and (iii) curled-lips. The data provided detailed descriptions of features within all three interests, which are discussed in relation to previous quantitative and qualitative research within emotional crying and tears, and the general area of non-normative sexual interests. Conclusions: The study suggests new directions for potential research both within dacryphilia and with regard to other non-normative sexual interests.

Atroszko, P.A., Andreassen, C.S., Griffiths, M.D. & Pallesen, S. (2015). Study addiction – A new area of psychological study: Conceptualization, assessment, and preliminary empirical findings. Journal of Behavioral Addictions, 4, 75–84.

  • Aims: Recent research has suggested that for some individuals, educational studying may become compulsive and excessive and lead to ‘study addiction’. The present study conceptualized and assessed study addiction within the framework of workaholism, defining it as compulsive over-involvement in studying that interferes with functioning in other domains and that is detrimental for individuals and/or their environment. Methods: The Bergen Study Addiction Scale (BStAS) was tested — reflecting seven core addiction symptoms (salience, mood modification, tolerance, withdrawal, conflict, relapse, and problems) — related to studying. The scale was administered via a cross-sectional survey distributed to Norwegian (n = 218) and Polish (n = 993) students with additional questions concerning demographic variables, study-related variables, health, and personality. Results: A one-factor solution had acceptable fit with the data in both samples and the scale demonstrated good reliability. Scores on BStAS converged with scores on learning engagement. Study addiction (BStAS) was significantly related to specific aspects of studying (longer learning time, lower academic performance), personality traits (higher neuroticism and conscientiousness, lower extroversion), and negative health-related factors (impaired general health, decreased quality of life and sleep quality, higher perceived stress). Conclusions: It is concluded that BStAS has good psychometric properties, making it a promising tool in the assessment of study addiction. Study addiction is related in predictable ways to personality and health variables, as predicted from contemporary workaholism theory and research.

Atroszko, P.A., Andreassen, C.S., Griffiths, M.D. & Pallesen, S. (2016). Study addiction: A cross-cultural longitudinal study examining temporal stability and predictors of its changes. Journal of Behavioral Addictions, 5, 357–362.

  • Background and aims: ‘Study addiction’ has recently been conceptualized as a behavioral addiction and defined within the framework of work addiction.  Using a newly developed measure to assess this construct, the Bergen Study Addiction Scale (BStAS), the present study examined the one-year stability of study addiction and factors related to changes in this construct over time, and is the first longitudinal investigation of study addiction thus far. Methods: The BStAS and the Ten Item Personality Inventory (TIPI) were administered online together with questions concerning demographics and study-related variables in two waves. In Wave 1, a total of 2,559 students in Norway and 2,177 students in Poland participated. A year later, in Wave 2, 1,133 Norwegians and 794 Polish who were still students completed the survey. Results: The test-retest reliability coefficients for the BStAS revealed that the scores were relatively stable over time. In Norway scores on the BStAS were higher in Wave 2 than in Wave 1, while in Poland the reverse pattern was observed. Learning time outside classes at Wave 1 was positively related to escalation of study addiction symptoms over time in both samples. Being female and scoring higher on neuroticism were related to an increase in study addiction in the Norwegian sample only. Conclusion: Study addiction appears to be temporally stable, and the amount of learning time spent outside classes predicts changes in study addiction one year later.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Greenhill, R. & Griffiths, M.D. (2014). The use of online asynchronous interviews in the study of paraphilias. SAGE Research Methods Cases. Located at: http://dx.doi.org/10.4135/978144627305013508526

Greenhill, R. & Griffiths, M.D. (2016). Sexual interest as performance, intellect and pathological dilemma: A critical discursive case study of dacryphilia. Psychology and Sexuality, 7, 265-278.

Griffiths, M.D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.

Griffiths, M.D. (1999). Dying for it: Autoerotic deaths. Bizarre, 24, 62-65.

Griffiths, M.D. (2001). Stumped! Amputee fetishes. Bizarre, 44, 70-74.

Griffiths, M.D. (2001). Heaven can wait: The psychology of near death experiences. Bizarre, December, 63-66.

Griffiths, M.D. (2012). The use of online methodologies in studying paraphilia: A review. Journal of Behavioral Addictions, 1, 143-150.

Griffiths, M.D. (2013). Bizarre sex. New Turn Magazine, 3, 49-51.

Griffiths, M.D. (2013). Eproctophilia in a young adult male: A case study. Archives of Sexual Behavior, 42, 1383-1386.

To pee or not to pee? Another look at paraphilic behaviours

Strange, bizarre and unusual human sexual behaviour is a topic that fascinates many people (including myself of course). Last week I got a fair bit of international media coverage being interviewed about the allegations that Donald Trump hired women to perform ‘golden showers’ in front of him (i.e., watching someone urinate for sexual pleasure, typically referred to as urophilia). I was interviewed by the Daily Mirror (and many stories used my quotes in this particular story for other stories elsewhere). I was also commissioned to write an article on the topic for the International Business Times (and on which this blog is primarily based). The IBT wanted me to write an article on whether having a liking for strange and/or bizarre sexual preferences makes that individual more generally deviant.

it-makes-perfect-sense-that-a-politican-like-donald-trump-would-be-into-pee-golden-showers-pee-gate-fetish-kink-urolagnia-urophilia

Although the general public may view many of these behaviours as sexual perversions, those of us that study these behaviours prefer to call them paraphilias (from the Greek “beyond usual or typical love”). Regular readers of my blog will know I’ve written hundreds of articles on this topic. For those of you who have no idea what parahilias really are, they are uncommon types of sexual expression that may appear bizarre and/or socially unacceptable, and represent the extreme end of the sexual continuum. They are typically accompanied by intense sexual arousal to unconventional or non-sexual stimuli. Most adults are aware of paraphilic behaviour where individuals derive sexual pleasure and arousal from sex with children (paedophilia), the giving and/or receiving of pain (sadomasochism), dressing in the clothes of the opposite sex (transvestism), sex with animals (zoophilia), and sex with dead people (necrophilia).

However, there are literally hundreds of paraphilias that are not so well known or researched including sexual arousal from amputees (acrotomophilia), the desire to be an amputee (apotemnophilia), flatulence (eproctophilia), rubbing one’s genitals against another person without their consent (frotteurism), urine (urophilia), faeces (coprophilia), pretending to be a baby (infantilism), tight spaces (claustrophilia), restricted oxygen supply (hypoxyphilia), trees (dendrophilia), vomit (emetophilia), enemas (klismaphilia), sleep (somnophilia), statues (agalmatophilia), and food (sitophilia). [I’ve covered all of these (and more) in my blog so just click on the hyperlinks of you want to know more about the ones I’ve mentioned in this paragraph].

It is thought that paraphilias are rare and affect only a very small percentage of adults. It has been difficult for researchers to estimate the proportion of the population that experience unusual sexual behaviours because much of the scientific literature is based on case studies. However, there is general agreement among the psychiatric community that almost all paraphilias are male dominated (with at least 90% of all those affected being men).

One of the most asked questions in this field is the extent to which engaging in unusual sex acts is deviant? Psychologists and psychiatrists differentiate between paraphilias and paraphilic disorders. Most individuals with paraphilic interests are normal people with absolutely no mental health issues whatsoever. I personally believe that there is nothing wrong with any paraphilic act involving non-normative sex between two or more consenting adults. Those with paraphilic disorders are individuals where their sexual preferences cause the person distress or whose sexual behaviour results in personal harm, or risk of harm, to others. In short, unusual sexual behaviour by itself does not necessarily justify or require treatment.

The element of coercion is another key distinguishing characteristic of paraphilias. Some paraphilias (e.g., sadism, masochism, fetishism, hypoxyphilia, urophilia, coprophilia, klismaphilia) are engaged in alone, or include consensual adults who participate in, observe, or tolerate the particular paraphilic behaviour. These atypical non-coercive behaviours are considered by many psychiatrists to be relatively benign or harmless because there is no violation of anyone’s rights. Atypical coercive paraphilic behaviours are considered much more serious and almost always require treatment (e.g., paedophilia, exhibitionism [exposing one’s genitals to another person without their consent], frotteurism, necrophilia, zoophilia).

For me, informed consent between two or more adults is also critical and is where I draw the line between acceptable and unacceptable. This is why I would class sexual acts with children, animals, and dead people as morally and legally unacceptable. However, I would also class consensual sexual acts between adults that involve criminal activity as unacceptable. For instance, Armin Meiwes, the so-called ‘Rotenburg Cannibal’ gained worldwide notoriety for killing and eating a fellow German male victim (Bernd Jürgen Brande). Brande’s ultimate sexual desire was to be eaten (known as vorarephilia). Here was a case of a highly unusual sexual behaviour where there were two consenting adults but involved the killing of one human being by another.

Because paraphilias typically offer pleasure, many individuals affected do not seek psychological or psychiatric treatment as they live happily with their sexual preference. In short, there is little scientific evidence that unusual sexual behaviour makes you more deviant generally.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Abel, G. G., Becker, J. V., Cunningham-Rathner, J., Mittelman, M., & Rouleau, J. L. (1988). Multiple paraphilic diagnoses among sex offenders. Bulletin of the American Academy of Psychiatry and the Law, 16, 153-168.

Buhrich, N. (1983). The association of erotic piercing with homosexuality, sadomasochism, bondage, fetishism, and tattoos. Archives of Sexual Behavior, 12, 167-171.

Collacott, R.A. & Cooper, S.A. (1995). Urine fetish in a man with learning disabilities. Journal of Intellectual Disability Research, 39, 145-147.

Couture, L.A. (2000). Forced retention of bodily waste: The most overlooked form of child maltreatment. Located at: http://www.nospank.net/couture2.htm

Denson, R. (1982). Undinism: The fetishizaton of urine. Canadian Journal of Psychiatry, 27, 336–338.

Greenhill, R. & Griffiths, M.D. (2015). Compassion, dominance/submission, and curled lips: A thematic analysis of dacryphilic experience. International Journal of Sexual Health, 27, 337-350.

Greenhill, R. & Griffiths, M.D. (2016). Sexual interest as performance, intellect and pathological dilemma: A critical discursive case study of dacryphilia. Psychology and Sexuality, 7, 265-278.

Griffiths, M.D. (2013). Eproctophilia in a young adult male: A case study. Archives of Sexual Behavior, 42, 1383-1386.

Griffiths, M.D. (2012). The use of online methodologies in studying paraphilias: A review. Journal of Behavioral Addictions, 1, 143-150.

Griffiths, M.D. (2013). Bizarre sex. New Turn Magazine, 3, 49-51.

Massion-verniory, L. & Dumont, E. (1958). Four cases of undinism. Acta Neurol Psychiatr Belg. 58, 446-59.

Money, J. (1980). Love and Love Sickness: The Science of Sex, Gender Difference and Pair-bonding, John Hopkins University Press.

Mundinger-Klow, G. (2009). The Golden Fetish: Case Histories in the Wild World of Watersports. Paris: Olympia Press.

Skinner, L. J., & Becker, J. V. (1985). Sexual dysfunctions and deviations. In M. Hersen & S. M. Turner (Eds.), Diagnostic interviewing (pp. 211–239). New York: Plenum Press.

Spengler, A. (1977). Manifest sadomasochism of males: Results of an empirical study. Archives of Sexual Behavior, 6, 441–456.

Under the influence: Ten things I’ve learned from David Bowie

It’s now been a year since the tragic death of David Bowie and this is my fourth blog on him in that period (my others being my personal reflections on the psychology of Bowie, Bowie and the Beatles, and Bowie and the occult). Outside of my own friends and family, it’s still Bowie’s death that has affected me the most psychologically but at least I still have his music to listen to. Bowie inspired millions of people in many different ways. This blog looks at the things that I have learned from Bowie and how he influenced my career.

Persevere with your life goals – Most people are aware that it took years for Bowie to have has first hit single (‘Space Oddity’, 1969), five years after his first single (‘Liza Jane’, 1964). Even after the success of ‘Space Oddity’, it took another three years before he had his second hit single (‘Starman’, 1972) and in the early 1970s there were many who thought he would be a ‘one-hit wonder’ and a small footnote in music history. Bowie never gave up his quest for musical stardom and is arguably one of the best examples of the proverb If at first you don’t succeed, try, try again. I’ve often told others that they key to success is being able to learn from your mistakes and being able to handle rejection (which for academics is having papers rejected, grant bids rejected, and attempts at promotion rejected, etc.). Bowie personified perseverance and for this quality alone I am very grateful as it has been the bedrock of my career to date.

Encourage teamwork and collaboration – Despite being a solo artist for the vast majority of his post-1969 career (Tin Machine being the most high-profile notable exception), Bowie was (like me) a ‘promiscuous collaborator’ and much of his success would not have been possible without a gifted team around him whether it be his inner circle of musicians (Mick Ronson, Carlos Alomar, Robert Fripp, Mike Garson, etc.), his producers (Tony Visconti, Nile Rogers, Ken Scott, etc.), co-writers and inspirators (Iggy Pop, Lou Reed, Brian Eno, John Lennon, etc.), or those he jointly released music with (Mott The Hoople, Queen, Arcade Fire, Pet Shop Boys, Placebo, to name just a few). I have carried out and published research with hundreds of people during my 30-year academic career, and like Bowie, some are one-off collaborations and others are lifelong collaborations. Bowie taught me that although I can do some things by myself, it is the working with others that brings out the best in me.

Experiment to the end – Bowie was never afraid to experiment and try new things whether it was musical, pharmacological, spiritual, or sexual. Mistakes were part of the learning process and he pursued this – especially musically – until the very end of his life (for instance, on his ★ [Blackstar] album where he employed a local New York jazz combo led by saxophonist Donny McCaslin). Failure is success if we learn from it and this is one of the maxims that I live my life by. Bowie taught me that you can have lots of other interests that can be rewarding even if you are not as successful as your day job. Bowie liked to act (and obviously had some success in this area) and also liked to paint (but had much less success here than his other artistic endeavours). By any set of criteria, I am a successful academic but I also like to write journalistically and engage in a wide variety of consultancy (areas that I have had some success) and I like writing poetry (something that I have not been successful financially – although I did win a national Poetry Today competition back in 1997 and have published a number of my poems). Bowie taught me that success in one area of your life can lead to doing other more experimental and rewarding activities even if they are not as financially lucrative.

19162-1920x1080

Push yourself (even in the bad times) – One of the things I love about Bowie was his ability to carry on working and being productive even when he was not at his physical best. Nowhere is this more exemplified than working on the ★ LP while undergoing chemotherapy for his liver cancer. There are also other times in his life such as when he was at the height of his cocaine addiction in 1975 where he produced some of the best music of his career (most notably the Young Americans and Station to Station LPs, the latter of which is one of my all-time favourite records). I have had a few low periods in my life due to various health, relationship and/or personal issues but I have learned through experience that work is a great analgesic and that even when you are at your lowest ebb you can still be highly productive.

Have a Protestant work ethic – Bowie was arguably one of the most hard-working musicians of all time and had what can only be described as a Protestant work ethic from the early 1960s right up until his heart attack in 2004. I am a great believer in the philosophy that “you get out what you put in” and Bowie exemplified this. Andy Warhol told Lou Reed while he was in the Velvet Underground that he should work hard, because work is all that really matters (and was the subject of the song ‘Work’ on the seminal Songs For Drella LP by Reed and John Cale). Bowie also appeared to live by this mantra and is something that I adhere to myself (and is why I am often described as being a workaholic). While Bowie isn’t my only role model in this regard, he’s certainly the most high-profile.

Lead by example but acknowledge your influences – Bowie had a unique gift in being able to borrow from his own heroes but turn it into something of his own (without ever forgetting his own heroes and influences – his Pin Ups LP probably being the best example of this). One of my favourite phrases is Don’t jump on the bandwagon, create it”, and this has as underpinned a lot of the research areas that I have initiated and is something that I learned from Bowie. Maybe Bowie is a case of the quote often attributed to Oscar Wilde that “talent borrows, genius steals”.

Promote yourself – If there is one thing that Bowie was gifted in as much as his songwriting, it was his own art of self-promotion. Bowie always had the knack to generate news stories about himself and his work without seemingly trying. By the end of his career, it was the act of not saying anything or doing any personal publicity that was just as newsworthy. Bowie intuitively knew how to garner media publicity on his own terms in a way that very few others can. (I also argued that another one of my heroes – Salvador Dali – did the same thing in one of my articles on him in The Psychologist back in 1994). I’d like to think I am good at promoting my work and Bowie is one of my role models in this regard.

Be opportunistic and flexible – If there is one thing besides working hard that sums up my career to date, it is being opportunistic and flexible. As a voracious reader of all things Bowie since my early teens, I always loved Bowie’s sense of adventure and just following paths because they might lead you to something unexpected. Whether it was his use of the ‘cut up’ technique for writing lyrics (developed by Brion Gysin and William S. Burroughs), his use of Brian Eno’s ‘oblique strategy’ cards, or his love of studio improvisation (such as on the Berlin trilogy albums and the Outside LP), Bowie showed that inspiration for his musical and lyrical ideas could come from anywhere – from a person, from a fleeting observation, from something he read, from something he heard or saw in film or TV programme, and from his own life experiences. I too have taken this approach to my work and believe I am a much better person for it.

Be a mentor to others – Whatever career path you follow, mentors are key in developing talent and Bowie was a mentor to many people that he personally worked with (including many of the artists I named in the section on encouraging teamwork and collaboration above) as well as being an inspirational influence to those he never met (including myself).

Learn from those younger and less experienced than yourself – Paradoxically, despite being an influence on millions of people across many walks of life, Bowie was never afraid to learn from those much younger than himself and exemplified the maxim that you’re never too old to learn new things. He loved innovation and ideas and would soak it up from whoever was around him. As I have got older, this is something that I value more and am never afraid to learn from those much younger or seemingly less experienced than myself – particularly my PhD students.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Buckley, D. (2005). Strange Fascination: David Bowie – The Definitive Story. London: Virgin Books.

Cann, K. (2010). Any Day Now: David Bowie The London Years (1947-1974). Adelita.

Goddard, S. (2015). Ziggyology. London: Ebury Press.

Griffiths, M.D. (1994). Heroes: Salvador Dali. The Psychologist: Bulletin of the British Psychological Society, 7, 240.

Hewitt, P. (2013). David Bowie Album By Album. London: Carlton Books Ltd.

Leigh, W. (2014). Bowie: The Biography. London: Gallery.

Pegg, N. (2011). The Complete David Bowie. London: Titan Books.

Seabrook, T.J. (2008). Bowie In Berlin: A New Career In A New Town. London: Jawbone.

Spitz, M. (2009). Bowie: A Biography. Crown Archetype.

Trynka, P. (2011). Starman: David Bowie – The Definitive Biography. London: Little Brown & Company.

Stairing at the rude boys: A brief look at climacophilia

In a number of my previous blogs, I have mentioned sexual paraphilias that appear to have been derived from the opposite phobic behaviours. Some examples include defecaloesiophilia (sexual arousal from painful bowel movements), lockiophilia (sexual arousal from childbirth), categelophilia (sexual arousal from being ridiculed), and rupophilia (sexual arousal from dirt). Another one that I could add to this list is climacophilia (sexual arousal from falling down stairs). This particular paraphilia got a lot of media publicity a few years ago when Dr. Jesse Baring was plugging his 2013 book Perv: The Sexual Deviant In All Of Us. (which I will return to below; I ought to confess that I love reading Baring’s populist articles and Professor Paul Bloom [of Yale University] went as far as to describe him as the Hunter S. Thompson of science writing.”). Climacophilia appears to be the opposite of climacophobia. The Wikipedia entry notes that:

“Climacophobia is the fear of climbing, especially using stairs. It is a type of specific phobia. Climacophobia is distinct from bathmophobia the fear of stairs themselves. Climacophobia is usually traced back to a negative experience, like falling down the stairs or having difficult time to climb stairs. The fear is also triggered by others, like witnessing somebody falling down stairs (either in real visualization or through media) or the other people he/she knows is suffering from climacophobia. Sufferers of climacophobia, if left untreated, end up limiting their activities and avoiding occupations that require the use of stairs or ladders. Sufferers tend to rely on elevators or disability-access ramps rather than stairs…Climacophobes tend to suffer from dizziness resembling vertigo when looking down stairs…Climacophobia can be treated using cognitive behavioural therapy [CBT], either independently or in tandem with other techniques. CBT can help sufferers stop negative thoughts about climbing while changing behaviors. Other treatment options include relaxation techniques, talk therapy, and medication for people who suffer severely from climacophobia”.

unknown

In Dr. Anil Aggrawal’s 2009 book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices, climacophilia makes a seven-word entry between ‘clinical vampirism’ (arousal by drinking human or animal blood) and ‘coitobalnism’ (having sex in the bath), and is simply defined as deriving pleasure from falling down stairs. There was no mention of it all in Dr. Brenda Love’s Encyclopedia of Unusual Sex Practices. Various websites provide definitions including the Pro Boner website (Climacophilia is an intriguing paraphilia characterised by sexual arousal to falling down the stairs. Climacophiles have their best orgasms when they’re falling down the stairs”) and the Buzz IO website (“Climacophilia is being sexually stimulated by seeing someone fall down a flight of stairs”). When reviewing Baring’s book, the New York Times defined it as the erotic compulsion to tumble down stairs”. Wikipedia also has a short entry and simply states:

“Climacophilia is a rare sexual paraphilia, or fetish in which the subject experiences erotic gratification when falling down the stairs. There hasn’t been a wide body of research conducted on people affected with this particular sexual preference and/or fetish”.

All of these definitions and snippets imply slightly different things relating to the same alleged behaviour. While all involve some kind of sexual arousal from falling down stairs, the New York Times says the behaviour is an “erotic compulsion whereas most others describe the behaviour as arousing, stimulating, and pleasurable (without being compulsive). One definition involves ‘orgasm’ being involved while the rest do not. The Wikipedia entry seems to imply that the paraphilia exists (it says “rare” rather than non-existent). The entry also says there “hasn’t been a wide body of research” suggesting there is some (perhaps a narrow body of research) – but that clearly isn’t the case. There’s none.

The journalist David DiSalvo interviewed Dr. Baring for Forbes magazine in relation to his book Perv, which covers 46 different paraphilias (all of which are listed in an article in the Huffington Post) – with paraphilias being defined by Baring as being primary attraction to a target or activity outside of the statistical norm”. Although I agree that paraphilias tend to be non-normative, I’m not whether I’d ever use the phrase “outside of the statistical norm” as there are some paraphilic behaviours that the majority of sexually active individuals are likely to have engaged in at least peripherally (such as bondage and other milder forms of sadomasochistic behaviour). In relation to the paraphilias outlined in his book, baring told DiSalvo that:

“These included both exceptionally rare paraphilias (such as ‘climacophilia’ in which a person can only get off while tumbling down a flight of stairs) and the more run-of-the-mill ones that are detailed in the DSM-V, such as voyeurism, sadism, and frotteurism (which is gratification by touching people in crowded public places, such as subways). But that’s just a small sampling. The most authoritative list, cobbled together by an Indian psychiatrist named Anil Aggrawal, includes a total of 547 distinct paraphilias”.

If you type in Baring’s name and his book into Google, many articles appear which mention ‘climacophilia’. For instance, in an interview with Vice magazine, the journalist (Nadja Sayej) began her article by saying:

“You may have recently seen the soft-spoken Jesse Baring on Conan recalling the strangest of sexual fetishes. Be it arousal from falling down the stairs (Climacophilia) or feeling steamy from rolling around in stones and gravel (Lithophilia), nothing surprises the Western New York author and psychologist”.

Baring was asked by Sayej what the weirdest fetish he had come across but there was no mention of climacophilia (probably because no-one has ever come across it):

“According to a recent forensic resource by the psychiatrist Anil Aggrawal, there are 547 documented paraphilias. Some of them – actually, most of them – are quite carnival-like. But it’s important to remember that these more exotic manifestations of sexuality might be represented by just one lone figure in the universe: a single, sad, lascivious soul who can only, just to give two random examples, have an orgasm while fondling a mouse (“musophilia”) or while rolling around in ferns (“pteridomania”). It’s virtually impossible for me to pick the weirdest, since so many of them would fit the bill for truly bizarre. I’m reminded of one of my favorite quotes in this literature, from a sex research pioneer named Wilhelm Stekel – who, incidentally, coined the word ‘paraphilia‘ in the 1920s. “Variatio delectat! How innumerable are the variations which Eros creates in order to make the monotonous simplicity of the natural sex organ interesting to the sexologist”.

I have spent hours online trying to track down any evidence that climacophilia exists and I have drawn a complete blank. Yes, there are lots of mentions of it (particularly in the articles on Baring’s book) but no dedicated articles (except a satirical one that I came across on the Dumb Buzz Feed website which you can read here). There are no online forums where like-minded climacophiles congregate and there are no climacophiles that have written so much as a one-sentence confession of being sexually aroused either by falling down stairs or watching others fall down stairs. In an academic review of Baring’s book, in the journal Sexual and Relationship Therapy, Dr. David Ribner made a specific reference about Baring’s inclusion of climacophilia and said it was “incredulous…is there really someone out there who can only achieve orgasm by falling down a flight of stairs?”

Based on my own research I think I can answer that question in two letters. No.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Aggrawal A. (2009). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices. Boca Raton: CRC Press.

Baring, J. (2013). Perv: The Sexual Deviant In All Of Us. New York: Scientific American/Farrar, Strauss & Giroux.

Bergner, D. (2013). Acquired tastes. ‘Perv’, by Jesse Baring. New York Times, October 4. Located at: http://www.nytimes.com/2013/10/06/books/review/perv-by-jesse-bering.html

DiSalvo, D. (2013). Getting in touch with your inner sexual deviant. Forbes, October 24. Located at: http://www.forbes.com/sites/daviddisalvo/2013/10/24/getting-in-touch-with-your-inner-sexual-deviant/#6f0f5548568e

Dumb Buzz Feed (2015). 7 problems only people with climacophilia will understand. May 3. Located at: https://dumbuzzfeed.wordpress.com/2015/03/05/7-problems-only-people-with-climacophilia-will-understand/

Huffington Post (2013). 46 sexual fetishes you’ve never heard of. October 23. Located at: http://www.huffingtonpost.com/2013/10/23/sexual-fetish_n_4144418.html

Love, B. (2001). Encyclopedia of Unusual Sex Practices. London: Greenwich Editions.

Ribner, D.S. (2013). A review of ‘Perv: The sexual deviant in all of us’, by Jesse Baring. Sexual and Relationship Therapy, 30, 297-300.

More cock tales: A brief look at genital drug injection

The idea for this blog was initiated when I read a snippet in The Fortean Times about a 34-year old man from New York who injected cocaine into his penis and ended up with gangrene and further medical complications. It turns out that this report was based on a letter published in a 1988 issue of the Journal of the American Medical Association by Drs. John Mahler, Samuel Perry and Bruce Sutton (and subsequently reported in a June 1988 issue of the New York Times).

The man in question came in for medical treatment following three days of priapism (i.e., prolonged and painful penile erection) and paraphimosis (i.e., foreskin in uncircumcised males can no longer be pulled over the tip of the penis). To enhance his sexual performance, he had administered cocaine directly into his urethra. After three days, both the priapism and the paraphimosis “spontaneously resolved”. However, the blood that had caused the priapism then leaked to other areas of his body over the next 12 hours (including his feet, hands, genitals, chest, and back). To stop the spread of gangrene, the medics had to partially amputate both of his legs (above the knee), and nine of his fingers. Following this, his penis also developed gangrene and fell off by itself while he was taking a bath. The exact reason for the spread of gangrene was unknown but sexologists (such as Professor John Money) speculated that it may have been because of impure cocaine being used.

images

When I started to search for medical literature on the topic of injecting drugs directly into male genitalia I was surprised to find quite a few papers on the topic (but unsurprisingly all case study reports given the rarity of such behaviour). One of the earliest I located was one from 1986 in the Journal of Urology by Dr. W. Somers and Dr. F. Lowe. They reported the cases of four heroin abusers with localized gangrene of the genitalia, although only one of these had actually injected heroin directly into his genitalia, in this case his scrotum and perineum (the area between the anus and the scrotum). This latter case developed more severe gangrene and was described as a “more lethal entity” than the gangrene in the other three heroin users’ genitalia.

Later, in a 1999 issue of the American Journal of Forensic Medicine and Pathology, Dr. Charles Winek and his colleagues reported the rare case of a fatality due to a male injecting heroin directly into his penis. The cause of death was determined to be due to heroin and ethanol intoxication. More recently, in a 2005 issue of the Medical Journal of the Iranian Red Crescent, Dr. Z. Ahmadinezhad and his colleagues reported a case of heroin-associated priapism. In their paper, they reported the case of a 32-year old man who was admitted to hospital following pain and swelling after injecting heroin into his penis two weeks earlier. Unfortunately, the person left the hospital following initial consultation and never came back so the outcome of the treatment provided is unknown.

In a 2011 issue of the Internet Journal of Surgery, Dr. I. Malek and colleagues reported the case of a 35-year old long-term intra-venous drug user who injected citric acid laced with heroin into the dorsal vein of his penis. This caused worsening pain and his penis developed gangrene. Over the (non-operative) treatment period, the man’s pain became worse and he had trouble urinating (so he was catheterised). Eventually, the treatment with antibiotics led to a good recovery at three-month follow-up.

Another unusual case was reported by Dr. Francois Brecheteau and his colleagues in a 2013 issue of the Journal of Sexual Medicine. They reported the successful treatment of a 26-year old male drug addict who had injected the opiate drug buprenorphine directly into the dorsal vein of his penis. After unsuccessful antibiotic treatment on its own, they then used a number of simultaneous treatments including heparin, anti-platelet drugs, antibiotics, and hyperbaric oxygen therapy, the man made a successful recovery.

Returning to cocaine rather than opiates, a case report by Dr. V. B. Mouraviev and his colleagues in a 2002 issue of the Scandinavian Journal of Urology and Nephrology reported the case of a 31-year-old Canadian man who had injected cocaine directly into his penis. He turned up at the emergency having endured penile pain for 22 hours following the injection. Twelve hours after injecting the cocaine, the man noticed swelling and bruising starting to appear on the right side of his penis where he had made the injection. As a consequence, his penis developed gangrene (localized death and decomposition of body tissue, resulting from obstructed circulation or bacterial infection”) most probably from bacterial infection via the injection. He had to undergo reconstructive skin graft surgery and was given antibiotics. In this particular case, the treatment was successful. Other similar reports of medical complications (usually gangrene) following the injection of cocaine into the penis have since appeared in a number of papers including a 2013 paper by Dr. Fahd Khan and colleagues in the Journal of Sexual Medicine.

Cocaine and heroin aren’t the only recreational drugs to have been injected into male genitalia. A paper in a 2014 issue of Urology Case Reports by Dr. Cindy Garcia and her colleagues reported the case of a 45-year-old male intravenous drug user who developed an abscess after he injected amphetamine into his penis. The man chose a penile vein after being unable to find any other suitable peripheral vein. He was treated with intravenous antibiotics and had to have his abscess drained via a penile incision. Within a month he had been all but successfully treated. In their paper (which also included a review of the literature on penile abscesses), they concluded that:

Penile abscesses are an uncommon condition. There are multiple aetiologies of penile abscesses, including penile injection, penile trauma, and disseminated infection. Penile abscesses might also occur in the absence of an underlying cause. The treatment of penile abscesses should depend on the extent of infection and the cause of the abscess. Most cases of penile abscess necessitate surgical debridement [removal of dead or infected tissue]”.

Similarly, in a 2015 issue of Case Reports in Urology, Dr. Thomas W. Gaither and his colleagues reported two cases of men who had injected metamphetamine into their penis. The first case was a 47-year-old gay man who had a history of “methamphetamine use, prior penile abscesses, urethral foreign body insertions, HIV, hepatitis C, and diabetes mellitus”. He attended the hospital emergency department suffering from severe penile pain and scrotal swelling having injected methamphetamine into the shaft of his penis a few days before. On the same day that he went to the emergency department he was immediately taken into the operating room where an incision was made in his penis, and the abscess was drained of its “purulent foul-smelling fluid” and washed out with saline solution. The second case was a 33-year-old heterosexual male with no previous medical history (apart from a history of depression) turned up at the hospital emergency department with acute penile pain, a day after he had injected methamphetamine directly into his penis. Again, he was immediately taken to the operating room where his penile abscess was drained after an incision. Neither of the cases involved any penile gangrene and both men were also given antibiotics to treat the infected area. In both cases, the authors speculated that the abscesses formed as a result of direct contamination from repeated penile injections.

Finally, Dr. Lucas Prado and his colleagues reported a case study in a 2012 issue of the Journal of Andrology of a 31-year-old man who was admitted to the emergency department after he had injected 10ml of methadone into his penis in an attempt to commit suicide (the first case of penile methadone injection). The man had a 15-year history of drug abuse over the past year and had attempted a drug-related suicide three times. This particular suicide attempt led to acute liver and renal failure as well as erectile dysfunction. Although the man survived, ten months after the suicide attempt, the man still had complete erectile dysfunction.

Although I didn’t do a systematic review of all the literature, it is clear that the injection of recreational drugs directly into male genitalia appears to be relatively rare although all the literature I located was based on those who end up seeking treatment for when things go horribly wrong. There could of course be many hundreds or thousands of people out there that have engaged in such practices but don’t end up in a hospital emergency ward. However, I certainly wouldn’t recommend such a practice to anyone.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Ahmadinezhad, Z., Jabbari, B.H., Saberi, H., Khaledi, F., & Safavi, F. (2005). Heroin associated priapism. Medical Journal of the Iranian Red Crescent, 7(3), 67-68.

Brecheteau, F., Grison, P., Abraham, P., Lebdai, S., Kemgang, S., Souday, V., … & Bigot, P. (2013). Successful medical treatment of glans ischemia after voluntary buprenorphine injection. Journal of Sexual Medicine, 10(11), 2866-2870.

Cunningham, D.L., & Persky, L. (1989). Penile ecthyma gangrenosum: Complication of drug addiction. Urology, 34(2), 109-110.

Gaither, T.W., Osterberg, E.C., Awad, M. A., & Breyer, B.N. (2015). Surgical intervention for penile methamphetamine injections. Case Reports in Urology, 467683, doi.org/10.1155/2015/467683

Garcia, C., Winter, M., Chalasani, V., & Dean, T. (2014). Penile abscess: a case report and review of literature. Urology Case Reports, 2(1), 17-19.

Khan, F., Mukhtar, S., Anjum, F., Tripathi, B., Sriprasad, S., Dickinson, I. K., & Madaan, S. (2013). Fournier’s gangrene associated with intradermal injection of cocaine. Journal of Sexual Medicine, 10(4), 1184-1186.

Malek, I., Parmar, C., McCabe, J., & Irwin, P. (2011). Successful non-operative management of penile wet gangrene following self-injection of heroin in dorsal vein of penis. Internet Journal of Surgery, 11(1), 1-3.

Mireku-Boateng, A.O., & Tasie, B. (2001). Priapism associated with intracavernosal injection of cocaine. Urologia Internationalis, 67(1), 109-110.

Mouraviev, V. B., Pautler, S. E., & Hayman, W. P. (2002). Fournier’s gangrene following penile self-injection with cocaine. Scandinavian Journal of Urology and Nephrology, 36(4), 317-318.

Munarriz, R., Hwang, J., Goldstein, I., Traish, A.M., & Kim, N.N. (2003). Cocaine and ephedrine-induced priapism: case reports and investigation of potential adrenergic mechanisms. Urology, 62(1), 187-192.

Prado, L. G., Huber, J., Huber, C. G., Mogler, C., Ehrenheim, J., Nyarangi‐Dix, J., … & Hohenfellner, M. (2012). Penile methadone injection in suicidal intent: Life‐threatening and fatal for erectile function. Journal of Andrology, 33(5), 801-804.

Singh, V., Sinha, R. J., & Sankhwar, S. N. (2011). Penile gangrene: A devastating and lethal entity. Saudi Journal of Kidney Diseases and Transplantation, 22(2), 359.

Somers, W.J., & Lowe, F.C. (1986). Localized gangrene of the scrotum and penis: A complication of heroin injection into the femoral vessels. Journal of Urology, 136, 111-113.

Winek, C. L., Wahba, W. W., & Rozin, L. (1999). Heroin fatality due to penile injection. American Journal of Forensic Medicine and Pathology, 20(1), 90-92.

Specific limb: A brief look at ‘restless legs syndrome’

Those that know me well often comment that I have a general inability to sit still and that I am a ‘fidget’. (This is not necessarily a bad thing and in fact there are some positives to fidgeting that I outlined in a previous blog on bad behaviours that are sometimes good for you). There is certainly some truth to the observation that I fidget but sometimes the fidgeting is out of my control. Every few weeks my right lower leg appears to take on a life of its own and I will get strange (uncomfortable) sensations (such as tingling, itching, and aching, and occasionally cramp-like feelings) that force me to move my right leg and foot around. It only happens when I am in a resting and relaxing state and usually lasts about 30 minutes (but can occasionally last much longer). On occasions it disrupts my work and sleep but I find that just getting up and moving around is sometimes enough to alleviate the uncomfortable feelings.

unknown

A few years ago I Googled my ‘symptoms’ and was surprised to find that I am not the only person who appears to experience such effects and that there is a whole medical literature on what has been termed ‘restless legs syndrome’ although in my case it would be in a singular rather than plural form). I’ve had the condition for about 15 years now and it may be related to some of the medication I take for an unrelated chronic degenerative health condition that I have. According to the Wikipedia entry on restless legs syndrome (RLS):

“The first known medical description of RLS was by Sir Thomas Willis in 1672. Willis emphasized the sleep disruption and limb movements experienced by people with RLS…The term ‘fidgets in the legs’ has also been used as early as the early nineteenth century. Subsequently, other descriptions of RLS were published, including those by Francois Boissier de Sauvages (1763), Magnus Huss (1849), Theodur Wittmaack (1861), George Miller Beard (1880), Georges Gilles de la Tourette (1898), Hermann Oppenheim (1923) and Frederick Gerard Allison (1943). However, it was not until almost three centuries after Willis, in 1945, that Karl-Axel Ekbom (1907–1977) provided a detailed and comprehensive report of this condition in his doctoral thesis, Restless legs: clinical study of hitherto overlooked disease. Ekbom coined the term “restless legs” and continued work on this disorder throughout his career. He described the essential diagnostic symptoms, differential diagnosis from other conditions, prevalence, relation to anemia, and common occurrence during pregnancy. Ekbom’s work was largely ignored until it was rediscovered by Arthur S. Walters and Wayne A. Hening in the 1980s. Subsequent landmark publications include 1995 and 2003 papers, which revised and updated the diagnostic criteria”.

As well as being referred to as RLS, it is sometimes referred to as Willis-Ekbom Disease or Willis-Ekbom Syndrome. Since being ‘rediscovered’ in the 1980s, there have been a lot of scientific papers published on the phenomenon although many of these are medical case studies (I don’t think my own experiences are extreme enough or strong enough to appear in any medical textbook. The Wikipedia entry on RLS provides a good summary of what is known medically and empirically:

“Restless legs syndrome (RLS) is a disorder that causes a strong urge to move one’s legs. There is often an unpleasant feeling in the legs that improves somewhat with moving them. Occasionally the arms may also be affected. The feelings generally happen when at rest and therefore can make it hard to sleep. Due to the disturbance in sleep, people with RLS may have daytime sleepiness, low energy, irritability, and a depressed mood. Additionally, many have limb twitching during sleep. Risk factors for RLS include low iron levels, kidney failure, Parkinson’s disease, diabetes, rheumatoid arthritis, and pregnancy. A number of medications may also trigger the disorder including antidepressants, antipsychotics, antihistamines, and calcium channel blockers. There are two main types. One is early onset RLS which starts before age 45 [years], runs in families and worsens over time. The other is late onset RLS which begins after age 45 [years], starts suddenly, and does not worsen. Diagnosis is generally based on a person’s symptoms after ruling out other potential causes… Females are more commonly affected than males and it becomes more common with age…Some doctors express the view that the incidence of restless leg syndrome is exaggerated by manufacturers of drugs used to treat it. Others believe it is an under-recognized and undertreated disorder…An association has been observed between attention deficit hyperactivity disorder (ADHD) and RLS or periodic limb movement disorder. Both conditions appear to have links to dysfunctions related to the neurotransmitter dopamine, and common medications for both conditions among other systems, affect dopamine levels in the brain”.

According to a review by Dr. Richard Allen and Dr. Christopher Earley in the Journal of Clinical Neurophysiology, RLS affects 2.5-15% of the US population. In another review on sleep disorder in the journal American Family Physician, Dr. Kannan Ramar and Dr. Eric Olson reported that RLS is typically characterized by four essential features: These are:

“(1) the intense urge to move the legs, usually accompanied or caused by uncomfortable sensations (e.g., “creepy crawly,” aching) in the legs; (2) symptoms that begin or worsen during periods of rest or inactivity; (3) symptoms that are partially or totally relieved by movements such as walking or stretching; and (4) symptoms that are worse or only occur in the evening or at night”.

Various online articles and papers report a variety of potential treatments based on the notion that RLS might be caused by a dopamine imbalance in the body. Some medics advise a regular sleep routine (such as that advised for those with insomnia), and cutting out the drinking of alcohol and the smoking of cigarettes. Pharmacological treatments include the use of drugs that are also used in the treatment of Parkinson’s disease such as L-DOPA and pramipexole, and the use of magnesium sulphate therapy (as reported in a 2006 paper in the Journal of Clinical Sleep Medicine – magnesium is known to be a natural muscle relaxant). In a 2011 issue of the journal Sleep Medicine, In an online article about RLS, Dr Michael Platt, author of the 2014 book Adrenalin Dominance, claims that RLS sufferers can be treated using a progesterone cream:

“Excess adrenalin during the night can cause restless leg syndrome. People often have associated symptoms also resulting from elevated adrenalin, such as teeth grinding, the need to urinate, and tossing and turning, and they often awaken in the morning with low back pain. Characteristically, RLS patients have an excess of adrenaline, may toss and turn all night, be quick to anger, might be workaholics, will usually have fibromyalgia (aches and pains – low back, side of the hips, and grind their teeth), they might drink too much, and will be hypoglycemic (sleepy between 3-4 p.m. or when in a car), and so on. There is an associated over-production of insulin and an under-production of progesterone…[By using a progesterone cream] I have had 100% success with eliminating RLS by getting hormones into balance, often within the first week. Patients feel more relaxed, they can sleep at night, rage disappears, and they can focus more easily”.

Dr. Luis Marin and his colleagues reported a different treatment for RLS altogether. They reported the case of a 41-year-old male RLS sufferer who after being on medication for RLS discovered his own solution – having sex. Following sex, the man reported that all RLS symptoms would disappear. Marin and colleagues speculated that the release of dopamine following orgasm might alleviate RLS symptoms. This appears to be a reasonable speculation given the findings of research published in the Journal of Neuroscience by Dr. Gert Holstege and his colleagues who examined brain activation at the point of ejaculation. In their paper they reported the similarity between ejaculation and using heroin in terms of brain activation:

“We used positron emission tomography to measure increases in regional cerebral blood flow during ejaculation compared with sexual stimulation in heterosexual male volunteers. Manual penile stimulation was performed by the volunteer’s female partner. Primary activation was found in the mesodiencephalic transition zone, including the ventral tegmental area, which is involved in a wide variety of rewarding behaviors. Parallels are drawn between ejaculation and heroin rush”.

It could well be that the increase in dopamine following ejaculation acts in a similar way to the medications that are given to RLS sufferers. Of all the treatments for RLS that I have read about, I think I know which one I would prefer!

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Allen, R.P., & Earley, C.J. (2001). Restless legs syndrome: A review of clinical and pathophysiologic features. Journal of Clinical Neurophysiology, 18(2), 128-147.

Bartell S1, Zallek S. Intravenous magnesium sulfate may relieve restless legs syndrome in pregnancy. Journal of Clinical Sleep Medicine, 15, 187-188.

Chaudhuri, K.R., Appiah-Kubi, L.S., & Trenkwalder, C. (2001). Restless legs syndrome. Journal of Neurology, Neurosurgery & Psychiatry, 71(2), 143-146.

Ekbom, K., & Ulfberg, J. (2009). Restless legs syndrome. Journal of Internal Medicine, 266(5), 419-431.

Holstege, G., Georgiadis, J. R., Paans, A. M., Meiners, L. C., van der Graaf, F. H., & Reinders, A. S. (2003). Brain activation during human male ejaculation. Journal of Neuroscience, 23(27), 9185-9193

Leschziner, G., & Gringras, P. (2012). Restless legs syndrome. British Medical Journal, 344, e3056.

Marin, L.F., Felicio, A.C., & Prado, G.F. (2011). Sexual intercourse and masturbation: Potential relief factors for restless legs syndrome? Sleep Medicine, 12(4), 422.

Ondo, W. G. (2009). Restless legs syndrome. Neurologic Clinics, 27(3), 779-799.

Ramar, K; Olson, EJ (Aug 15, 2013). Management of common sleep disorders. American Family Physician, 88, 231–238.

Satija, P., & Ondo, W. G. (2008). Restless legs syndrome. CNS Drugs, 22(6), 497-518.