The central element of the "syndrome" is the pursuit of the physiological effects of insufficient oxygen supply to the brain. This can be achieved in a number of ways: hanging and strangulation, suffocation (with plastic bags and the like), blocking the respiratory organs, compressing the chest, and chemically through the use of narcotics. The stimulation of the "high" might be enjoyed for it's own sake, but is often accompanied by masturbation when it is induced as a means to sexual gratification. In addition, sexually motivated smothering frequently goes hand in hand with other "perversions", or "paraphilia", as they are now referred to in medical literature. There is a high frequency of cordophilia (the pleasure of being bound and sometimes hung in ropes and chains); sexual bondage in the form of tight dresses and hoods (latex, leather), rain boots, blindfolds and gags; masochism with clips in the nipples, bodypiercings, branding of the genitals and other selftortures; fetishism (stimulation by the sight and touch of certain materials and objects like pieces of clothing); more or less complete transvestism; voyeristic usage of pornography (often of sado-masochistic orientation); and narcissistic mirroring or selfportrayal with cameras or video which has resulted in recordings of fatal accidents. Typically, one or more of these autoerotic practices are part of the clinical picture presented by sexual asphyxia.
Generally the cause of death is asphyxiation due to strangulation, narcotics, and similar accidents involving deficient oxygen supply. Further, it can occur indirectly in connection with other forms of autoerotic stimulation, i.e. hearth-failure due to high blood pressure, perforation of the bowel wall, broken necks as a result of falling from selfbindings, or hypothermia occuring when the person is unable to free himself from intricate knots in natural settings. Schackwitz describes a case in 1931, where a 37 year old shop assistant was found dead in his bed. He was lying under the covers, gaged with hankerchiefs, the head tightly wrapped in a towel. His legs were tied with towels, the hands tied up behind his back. He was clutching a nail-scissors in his left hand to free himself, but the arteries were cut up by the tight laces around the wrists, and he bled to death. Many deaths occur during sexual stimulations with electricity, putting the genitals into a bowl of water together with both ends of a live wire, or touching the penis wrapped in tin-foil with one end of a wire, while the other end is held in the hand. Putzmann describes the death of a 15 year old electrician apprentice utilizing a complicated installation that connected the mains with a tea-spoon in his anus and an aluminum cord around the penis via a glim lamp in his mouth. Perhaps the most unique of all autoerotic fatalities, The Love Bug, was published by Rupp in 1973, actually involving an "auto". In this case, a 40 year old pilot from the U.S. Airforce had put on a selfmanufactured harness, and let himself be drawn naked in chains behind his Volkswagen sedan, set to circle in the first gear in a deserted parking lot. On one occasion, though, the chains got tangled with the backwheel, and he ended up being squeezed to death against the car. This behavior could very well be seen as an answer to Jean Rosenbaums book, published the same year, Is Your Volkswagen A Sex Symbol?.
Sexual asphyxia is the most fascinating, when it appears together with the secondary "paraphilia" in intricate autoerotic rituals displaying the excessive inventiveness of desire. They sometimes suggest torture machines from the Middle Ages, constructed for the production of intense polymorphic pleasures through selfbindings, hangings, torments, oral, anal, and genital stimulations of every concievable kind. For the same reason, autoerotic practices were referred to as "bachelor machines" by Michel Carrouge in his influential book on sexual politics and esthetics Les machines celibataires (1954). This term is a very appropriate one, in so far as the actual practitioners might be anything between 8 and 80 years old, but on average they are in their mid twenties, and almost exclusively men.
In continuation with the sexual liberation and the critique of bourgeois morals and gender roles in the sixties and seventies, Carrouge's book formed the basis for an exhibition under the same name in Venice in 1975. It showed sculptures like the bicycle inspired "bachelor machines" by Marcel Duchamp ("Mariee ...") and Robert Müller ("La Veuve du coureur"), side by side with documentary photographs of autoerotic practices, for instance a naked man strapped on an oversize bicycle wheel ("Masturbation with complicated machinery"), taken from the forensic textbook by Weiman and Prokop, Atlas der gerichtlichen Medizin (1963).
The same textbook furnished the materials for a series of paintings by Heike Ruschmeyer, "Artists" and "Acrobats", exhibited in Berlin in 1983. She uses photos of autoerotic fatalities, presenting the human body as dead, physical matter, deprived of emotional and symbolic content. She counteracts the public's rejection, and brings the dead bodies as well as the spectators "back to life" by stimulating emotional investments and identification through iconographical enlargements of the pictures, painted over in the brilliant colours appropriate for the polymorphous sexuality. She states in the catalogue: "I have long since left the cult of the death drive behind me, and revived Prokop's corpses in flying cadmium-red angles and lemon-coloured androids." By doing so, she takes the practitioners of sexual asphyxia away from the realm of medicine, criminology, pathology and social taboo, and recontextualizes them as artists belonging in galleries and circuses to be viewed, acknowledged, even admired by the public.
This use of forensic photos might provoke and shock by confronting the spectators with realistical representations of the body, sexual practices and death transgressing esthetic and behavioral norms. Beyond the shock value lies the intention to transform these conventions themselves, bringing about a social recognition of hitherto unacceptable and excluded subjects. For the last two hundred years, art was supposed to transcend carnality and low sensual desires that tie human beings to the physical world. On the contrary, modern art and especially the avantgarde movement has focused on the body and the mental moldings of its desires as the source of art and symbolic systems. First and foremost, this has been the domain of performance and bodyart, involving the artists themselves in sensual explorations that sometimes come indistinguishable close to autoerotic rituals.
Again, Vienna was in the forefront in the early sixties, when Hermann Nitsch presented a series of outrageous performances that would later be turned into the OM (Orgies Mysteries) Theatre. They expressed the desire to constitute something like an animistic or Dionysian oneness with nature within a "desensitized" and "alienated" civilization, as the slogans of the times went. In 1965 he formed the Wiener Aktionismus group together with Otto Mühl, Rudolf Schwarzkogler, and Günter Brus. Much in the same vein, their work was devoted to catharsis and liberation through the performance of taboo acts that were extremely violent and abject. For instance, Brus would appear dressed in a woman's black stockings, brassiere, and garter belt, slash himself with scissors till he ran with blood, vomit, defecate, eat his own excrement, and so on. Within the licensed context of art, they tested the limits of their own and the public's tolerance in "Aktionen" that more often than not were received with shock and disgust, occasionally even shut down by the police.
In the following decade, the acts of self-mutilation and taboo breaking in bodyart were met with the same reaction, whether it was Linda Montano inserting needles around her eyes (Mitchel's Death, 1978), Kim Jones cutting himself with a razor blade twenty-seven times in a pattern suggesting the body's circulatory system, or Paul McCarthy, who showed up in a wino hotel wearing a blond wig, black lace panties smeared with blood, and proceeded to fornicate with piles of red meat and ground hamburger with his penis painted red, a hot dog shoved up his rectum (Sailor's Meat, 1975). The performances were committed to a social and esthetical emancipation and redefinition of sensuality within frames of reference that spanned ancient bacchanalia and sacramental rites, shamanic magic, Hindu ascetics and on to the notion of the artist as the artwork himself in Romantic or Abstract Expressionst art. From an alternate viewpoint, though, many of these acts only differ from autoerotic, masochistic and other polymorphously perverse sexual practices in context and intent. This even goes for a case as special as The Love Bug, which got its artistic counterpart, when Chris Burden had himself shot in the arm and crucified to the roof of a Volkswagen in 1971 and 1974.
The resemblance is perhaps most striking in the works of bodyartist Fakir Musafar. He is a part of the sado-masochistical subculture, an early advocate of body piercings with Gauntlet Enterprizes, and a practitioner of torturous trials and body modifications as an artform. In the act Suspension (1964), for instance, he was placed naked in front of a mirror, hanging from a rack, suspended in his own skin, the wires hooked through the breasts, clips in the nibbles, the penis tied up with a string, and tight belts around the legs, the waist, the arms. Down to the domestic setting, and the little, improvised step-ladder of books, the act presents a picture so close to the scenery of some autoerotic fatalities that it is distinguished only through secondary information.
The literary history of sexual asphyxia followed much the same development as the visual arts. In the 19th century, the subject is absent save for a few instances. A hanging scene, similar to the one in Justine, takes place in Gamiani, ou Deux Nuits d'Exces (1833), a novel filled with sadism and bestiality, often attributed to Alfred de Musset. Further, death by sexual hanging occurs in a mainstream novel by Karl Ferdinand Gutzkow, Der Zauberer von Rom (1859-61). With the advent of moderism, realistic representations of sexuality found their way into high literature, including erotic hanging, and it is fittingly present in Ulysses (1922), where James Joyce decribes the aftermath of the hanging of the Croppy Boy: "He gives up the ghost. A violent erection of the hanged sends gouts of sperm spouting through his dead clothes on to the cobblestones. Mrs. Bellingham, Mrs. Yelverton Barry, and the Honorable Mrs. Mervyn Talboys rush forward with their handkerchiefs to sop it up."
The most consistent and enthusiastic poet of sexual asphyxia must be William Burroughs. Cities of the Red Night (1981) is practically dedicated to Ix Tab, goddess of the hanged in Mayan culture, so much so the review in New York Times was entitled Pleasures of Hanging. Nevertheless, he is only serving leftovers from Naked Lunch (1951), where hanging is a regular on the menu. With a great deal of empathy he describes the sensations of a boy who is stimulated sexually while being hanged: "Green sparks explode behind his eyes and sweet toothache pain shoots through his neck down the spine to the groin, contracting the body in spasms of delight."
Burroughs envisioned the human being as a "soft machine": an uncentered sensitivity with completely unbound and liquid cathectic energies that could take on all shapes and forms and always be ready for new pleasures. This fantasy was seized by Gilles Deleuze and Felix Guattari in Anti-Oedipus (1972), an academic outgrowth of the french students revolt in the sixties. They celebrate the triumph of the pleasure principle and partial drives over the determination of gender, gentials and social reality through "bachelor machines". The concept of the human subject as a "machine" for the production of unrestricted satisfaction implicated a psychotic suspension of repressions and the objective world. Highly inspired by anti-psychiatry and especially Laing, this hymn to psychosis and eternal flux might be attractive on paper. In real life, though, it is a questionable thing, as was experienced by Kurt Vonnegut's oldest son, Mark. Having spend considerate time in mental institutions, being diagnosed as a schizophrenic after "three major breakdowns and a few minor ones", he wrote with some irritation about Laing's and his disciples' exalted view on the condition in "Why I want to bite R. D. Laing" (Harper's, April 1974):
"He said so many nice things about us: we're the only sane members of an insane society, our insights are profound and right on, we're prophetic, courageous explorers of inner space and so forth .... But what I felt when I found myself staring out of the little hole in the padded cell was betrayal: I did everything just like you said, and look where I am now, you bastard."
If not to the point of psychosis, the emotional and cognitive models that were tried out as transgressions within the context of art have none the less been accepted to some degree by society. The stance towards the body, its functions and desires has become less rigid, and the repertoire of social and gender roles is much broader than it used to be. The arbitrarity of the signifiers of sexual difference (clothes, gestures, etc) is not restricted to the realm of the "deviant" or avantgarde, and there is a considerable cross-over to mainstream culture even from sexual undergrounds like sado-masochism.
By and by, even the extremes of bodyart have become less offensive and out of bounds through sheer repetition, conditioning of the audience, critical acclaim, institutional acceptance, and because of the widespread change in attitudes and modes of reception that the artists themselves participated in bringing about. A few years ago, a crane suspended Stelarc from fishhooks in his skin and lifted him above (of all things) The Royal Theatre in Copenhagen. Likewise, sexual asphyxia is a regular in crime novels, since P. D. James described the alteration of a death scene to make it appear like an autoerotic fatality in An Unsuitable Job for a Woman (1972), and it is the subject of an entire sexological thriller by J. Money, G. Wainwright and D. Hinsberger, The Breathless Orgasm.