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The New York Times
March 27, 1984
Late City Final Edition
Section C; Page 1, Column 5; Science Desk

'AUTOEROTIC DEATH' OF YOUTHS CAUSES WIDENING CONCERN
By JANE E. BRODY

FORENSIC and psychiatric scientists are becoming increasingly concerned about the use by teen-age boys and others of an extremely dangerous sexual practice in which self-induced erotic pleasure is enhanced by near asphyxiation, usually induced by a noose around the neck.

In a small but significant number of cases, the researchers say, consciousness is quickly lost or some other mishap occurs and the person dies before he can restore his oxygen supply. In many cases, the researchers believe, these deaths are mislabeled suicide, sometimes after horrified parents have removed all evidence of the sexual nature of their child's death.

At least one of a recent wave of self-inflicted deaths among teen-agers was such an accident. Although initially thought to be a suicide, the medical examiner's office later ruled that the boy's death was not intentional. The mother of one 16-year-old victim of autoerotic asphyxia in Ohio has called the phenomenon ''history's best-kept secret.'' She said: ''We have been caught in a skein of cover-up. It's time to bring this horrendous conspiracy of silence to an end. Adolescents and others should be warned of the dangers of this practice and parents should know how to detect the warning signs before more young lives are needlessly lost.''

Although autoerotic asphyxiation is known to many forensic pathologists as well as to readers of ''serious'' erotica and practitioners of sexual bondage, its occurrence is virtually unknown to the general public and autoerotic deaths are nearly always a shocking discovery to families, physicians and even to the police and professional counselors.

Researchers for the Federal Bureau of Investigation estimate conservatively that 500 to 1,000 such deaths occur each year in this country, but that most are misdiagnosed as suicide or homicide or covered up by the family because of the social stigma that surrounds a sexually motivated death. According to a spokesman for the Metropolitan Life Insurance Company, some 250 of its policyholders die this way each year.

In fact, however, there is currently no way to get an accurate count of the number of autoerotic fatalities. The code by which coroners classify deaths contains no such category and, even when the cause of death is accurately determined, it may be listed under one of five different categories.

A study of all adolescent suicides in a four-year period in Massachusetts showed that hanging was the second most frequent method, used in 30 percent of the cases. ''An enormous preponderance of the hanging deaths were among males, whereas jumping and gassing deaths were evenly divided among males and females,'' Dr. Eva Deykin of Harvard Medical Center said. ''I wouldn't be at all surprised if some of those hangings were really accidental autoerotic deaths.''

Studies have shown that the vast majority of victims of sexual asphyxia are young males, mainly teen-agers and young adults, but ages of victims have ranged from 9 to 77 and include a small percentage of females. When the death is initially deemed a suicide, it typically stupefies members of the family and community because the victim in no way seemed suicidal or even depressed, was getting along well in life and was looking forward to the future.

According to a report to the American Academy of Child Psychiatry, victims are typically ''happy, well-adjusted people'' who are ''found hanging by the neck, often wearing women's clothing, apparently having died while masturbating.'' In their report, Dr. Stephen Rosenblum and Dr. Myron M. Faber note that ''the risks of sexual asphyxia are not well-known, and it could therefore be viewed as no more pathological than driving a car or motorcycle at high speeds.''

Robert R. Hazelwood, a behavioral scientist at the Federal Bureau of Investigation Academy in Quantico, Va., and other investigators recently studied 132 autoerotic deaths by asphyxiation among 127 males and five females. They found that many of the victims had periodically used the tech nique to heighten orgasm in masturbation. Until the last time, however, they had been able to rescue themselves before death occurred. Typically, various rescue devices, such as a knife to cut the cord or a key to unlock a chain, are found near the victim's body.

In their recently published book, ''Autoerotic Fatalities'' (Lexington Books), Mr. Hazelwood and his colleagues also described cases in which other people had rescued unconscious victims of autoerotic asphyxiation, but the rescue had occurred too late to prevent permanent brain damage.

''Most people don't realize how easy it is to lose consciousness when pressing on the neck,'' Dr. Robert Litman, a psychiatrist and suicidologist in Los Angeles who studied the problem a decade ago, explained in an interview.

''There is an extremely sensitive area of the carotid artery,'' he said, referring to the main artery in the neck that feeds the brain. ''Just turn the wrong way and you become unconscious. You may do it right 40 times, but on the 41st, you may make a wrong move and die.''

 
Study Reveals Diverse Group

By placing an advertisement in an underground newspaper, Dr. Litman was able to study adults who said they practiced autoerotic asphyxia. He said he found them to be ''a very diverse group, with no common denominator in their childhood.'' However, in contrast to children who use the technique, the adults he studied tended to be very lonely and depressed people. Other experts note, however, that these adults were self- selected readers of underground newspapers, and that many adult victims have been happily married men who were in no way deprived of sex or companionship.

Ann Wolbert Burgess, a professor of nursing at the University of Pennsylvania who participated in the study with Mr. Hazelwood, said that for many parents, an autoerotic death ''is more stigmatizing than suicide.''

''Most parents had no idea their kids were into this behavior,'' she said, ''and they usually ask, 'Where did he learn it?' ''

According to Dr. Litman, there are three main sources of information on sexual arousal induced by asphyxia: pornographic literature, other practitioners and personal discovery and experimentation. For example, Professor Burgess said, some boys discover that high-risk activities that cause breathlessness, such as riding on a roller coaster, trigger strong erotic feelings. Playboy magazine once explained the sexual practice in explicit detail, answering a question sent to its ''Playboy Adviser'' column, and warned of the dangers involved. ''It's dangerous to do alone - pass out and you may well pass on,'' the magazine said. Indeed, the pornographic literature, including the writings of the Marquis de Sade and more recently, William S. Burroughs, contains graphic descriptions of eroticism enhanced by asphyxiating techniques that are used by couples as well as by individuals. Several movies have also depicted the phenomenon, among them ''The Ruling Class,'' which opens with the erotic hanging of the Earl of Gurney, and ''In the Realm of the Senses,'' a Japanese film in which a woman routinely asphyxiates and ultimately fatally strangles her husband as part of their sexual acts.

 
Practice Depicted by Mayans

According to Dr. Park Elliott Dietz, a specialist in behavioral medicine at the University of Virginia who is a co- author of the book on autoerotic deaths, autoerotic asphyxia is a relatively common sexual practice among Eskimo and Far Eastern couples. He said he had even found evidence of this among the ancient Mayans, as depicted by stone statues dating back to A.D. 1000.

Erection and orgasm are also known to occur among many men who die by hanging, and some people mistakenly interpret this result of the abrupt loss of oxygen to the brain to be a pleasurable experience. However, experts say loss of consciousness and death precede the sexual effects of hanging.

A number of the mass murderers of boys and young men are known to have strangled their victims in the midst of sexual activity, presumably to induce orgasm in their terrified victims. It is not known, however, whether some prison hangings are sexually motivated.

The hallmarks that often delineate the scene of an accidental sexual asphyxiation were described by Dr. Rosenblum and Dr. Faber: There is no suicide note; the victim is partly or totally undressed or wearing women's underclothes; asphyxiating devices are arranged so that the victim could have applied and released them; a towel or cloth is around the neck to prevent burns and marks; pornographic material is nearby; extremities may be bound with ropes or chains; masturbation apparently occurred; there may be evidence that the behavior had been done repeatedly in the past; the victim is found suspended by the neck either with his feet on the floor, sitting in a chair or lying on a bed; the act appears to have been performed alone, usually behind a locked door.

Professor Burgess said she participated in the study of autoerotic deaths to learn more about how to help parents prevent such deaths and to come to terms with those that occur. She warned parents to be alert to such signs in their sons as frequently bloodshot eyes; marks on the neck; foggy or disoriented behavior, especially after having gone off alone for awhile; and possession of or fascination with ropes, chains or other forms of inducing partial asphyxiation, such as plastic bags, gags or gas inhalation devices. In suspicious cases, she advised parents to seek prompt professional counseling, preferably from someone familiar with the practice of autoerotic asphyxia.

The Ohio mother of an asphyxia victim rues the fact that she failed to heed the warning signs. ''Yes,'' she said, ''I saw marks, a rashlike redness on his throat - 'an allergy,' he said. Yes, he did take long showers, but all boys do and besides, we read 'Portnoy's Complaint' and we respect privacy. Yes, I saw all the signs and yes, I and my husband ignored them because we had never heard of adolescent sexual asphyxia.''

She continued, ''After our son died, we called his school to tell them what really happened. We begged them to warn other students, but nothing was ever done. And the next year another boy in the school diedin exactly the same way.

''It's time to tell people this horrendous thing exists and that children can be saved if we know the cues and if we take action.''