Brit. J. Psychiat.

(1972), 121, 4378

A Case of Sexual Asphyxia

By JOHN

Without

S. EDMONDSON

The sexual asphyxias have, in the past, often

been described by forensic pathologists after an
apparently
accidental death has brought the
condition to light. The following case is excep
tional in that it came to light before a fatality
occurred and suggests that intense self-punitive
tendencies

may play a part

(I), Usher

a young

(2) and others,

manwomen

practicesis

never

discovered

John

neighbourhood
gangs,
being

asphyxiated

Yet the
standards

of

often

by hanging or by occlusive devices such as

plastic bags and hoods placed over the mouth
and nose. The circumstances indicate that at the
time

of death

sexual

ritual,

the man
possibly

was indulging
climaxed

by

of the

sudden

The

in some

with

a mastur

and appears accidential

a pyramid
to
quote

asphyxia

Gradwohi's

aspect

and

there

is a case where

beside

the deceased

subculture.

himself

was

on

the

borderline

of

and

other

subjects,

and

verbalized

childhood

he behaved

reasonably

well and

and sought

to manage

his relationships

feelings

to himself

and

revealed

little

outward

anxiety. His self-identity was poor and his reality

testing
approach

ability

weak.

to others

He was unaggressive
and

was

easily

in his

influenced

by

those immediately in contact with him.

About three years before his referral he had had a

the

girlfriend. Ononeoccasion

psychiatric viewpoint it must be recognized that

there is a strong death wish. An illustration

reading

and honesty'

but
to

yet from

same

with others positively. He tended to keep his thoughts

that, while these cases

accidental,

to be of the

at school showed
responsibility, initiative, reliability

Legal Medicine (3):

the legal

tended

risk of
group

whole
family
tried to maintain
better
of social conduct
than their neighbours,

patient

During

(a stool slipping on lino,

There
seems little doubt
are, from

was notable for local delinquent

poorly. (I.Q. Stanford Binet (Form L) Scale, 7585).

is obvious

of paperback
books collapsing)
from
Brittain's
contribution

with

educational subnormality; he required special help

batory
orgasm.
Pornographic
and sadistic
photographs
and literature are often placed
where he can see them. Usually the physical
mechanism

living

and although the stepfather tended to enforce these

standards with a rough and ready discipline there
appeared to be a very real affection by all members
of the household for one another.

these

most

children

and the patient

was constantly
under
drawn
into them;
his female
peer

acquaintances

in

ofsix

relationship with his stepfather, who was chronically

disabled by a condition affecting his spine. The

by

the body

engage

was one of a family

his mother and stepfather. He had formed a good

in some cases.

In the so-called typical case as described

Brittain

Fatal Termination

she had surprisedhim

in his

bedroom whilst he was changing and had thrown

her arms round him. He was distressed by this but

of this:
there was

also

sexually

excited,

and

from

this

time

onwards

found a sentence of death in judicial form on himsel1@, dated his own tendency to masturbate. This made
in hisown handwriting.
Occasionally,
too,the body

him feel guilty, and this feeling was intensified by an

may be found in such a situation or position that it is

difficult to see how the deceased could have intended
or hoped to extricate himself from it.'

adverse comment made by his mother when she

noted some girlie'
pictures in his room. As a result of
these increasing feelings of guilt the patient began to
indulge in different forms of abnormal

C.AsEHISTORY

John was referred

at theage of I4@.He had been
surprised

in his

bedroom

by

his

him lying on his back clearly

mother

who

found

in the process of

masturbating. He had a rope passing round the end

practice.

He

found that forcing something into his rectum tended

to increase his sexual excitement although it was quite
painful.
knives

Later
while

he began

masturbating,

to threaten
and then

himself with
again

in a state

of his bed and then round his neck under his chin,
and he was blue in the face. The mother, distressed

of intense guilt would bury his head in his pillow at the

moment of emission. Finally he began fixing a rope
around his neck; his objective apparently was to

by this discovery, contacted the family doctor.

hamper
437

his state of consciousness to prevent full

A CASE OF SEXUAL

438

ASPHYXIA

awareness of what he was doing. It would seem that

his feelinp

of guilt

had

led

to a need

to punish

himself.
He co-operated

well in therapy,

although

his low

intelligence and poor verbal fluency were obvious

difficulties.

It was at first necessary to outline to him in basic

terms the normal sexual functioning of the male and
then to relate this to his own problems.
Actually these simple explanations appeared to
have an initial effect, and rather more quickly than
was expected;

for after a few sessions he explained

how

he had been effectively seduced by a girl and, in

contrast to his reactions when his previous girl-friend
made a seductive approach to him, he appeared
unconcerned by this event. Unfortunately it proved

WITHOUT

FATAL

TERMINATION

It was noted that the patient's feelings of intense

guilt were markedly

absent

after

initial

therapy,

and

occurred in the absence of any formal symptoms of

depression.
Finally, this case does tend to support the
suggestion

sexual

that

these

practices

abnormal

and

result

more

may

dangerous

from

the

pervert's desire to punish himself for his sexual

behaviour than from any questionable heighten

ing of sexual pleasure resulting from the self
induced asphyxia.
AcENowaxnom.ENr
I should like to acknowledge the considerable help
given by Dr. Alan Usher of the Universityof Sheffield's

impossibleto integrate
his sexuallifeintoa total Sub-Departmentof Forensic
Pathology,
who read the

personal relationship. After leaving the structured

environment of his school he failed to settle down to
a stable job pattern

or any stable relationship.

to those more usually de

scribed cases of a young man of good intelligence and

apparent stability, although sensitivity to relation
ships may have been a common factor.

John S. Edmondson,
Keddington,

and made many useful comments.

He

always had good intentions, but gave up easily and

gradually drifted into promiscuity.
All this is in contrast

manuscript

REFERENCES
1. BEn-FAIN,

R.

P.

(1968).

TheSexual

Asphyxias.'

in Gradwohi's Legal Medicine, 2nd edition.

2. Usssaa,

A. (i@6@). Accidental hanging

abnormal
sexual practices.'
Journal, xxvii, 234.
3. B,trrr@u@, R. P. (1968). op. cit.

Ch. 35.

in relation

Xewcastle

to

Medical

MB., Ch.B., M.R.C.Psych.,Consultant in Child Psychiatry, N. Lincs. Area; Narnia',

near Louth, Lincoinshire.

(Received 3 December 1971)

A Case of Sexual Asphyxia Without Fatal Termination

JOHN S. EDMONDSON
BJP 1972, 121:437-438.
Access the most recent version at DOI: 10.1192/bjp.121.4.437

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