B003B0W1QC EBOK (13 page)
Authors: Dossie Easton,Catherine A. Liszt
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A Special Chapter for Helping Professionals
This chapter is dedicated to the doctors, nurses, therapists and other helping professionals who have taken care of us when we were sick, and been gracious and supportive about our bruises, welts, tattoos, piercings and so on. Hearts of gold, nerves of steel.
In this chapter, we will review the issues that come up for health professionals in treating kinky patients. We think we can offer you some useful ideas about how to care for kinky people, and at the same time make going to the doctor, or looking for a therapist, a safer occupation for practitioners of S/M and other kink.
For the medical professional
. If you are a doctor, nurse practitioner, physician’s assistant, chiropractor or other medical professional, you are certainly used to seeing naked bodies, and have probably long since lost any sense of modesty or embarrassment that nudity may once have caused you. But when kinky people take their clothes off, their private life ceases to be private, and you, the health professional, may be shocked, embarrassed or confused by evidence, in the form of bruises, welts, piercings, etc., of a very different lifestyle.
. If you are a doctor, nurse practitioner, physician’s assistant, chiropractor or other medical professional, you are certainly used to seeing naked bodies, and have probably long since lost any sense of modesty or embarrassment that nudity may once have caused you. But when kinky people take their clothes off, their private life ceases to be private, and you, the health professional, may be shocked, embarrassed or confused by evidence, in the form of bruises, welts, piercings, etc., of a very different lifestyle.
From where we sit, this is a dilemma. We do not want to embarrass you, frighten you or cause you any discomfort. We would never dream of requiring you to understand our most arcane sexual practices if we had, for instance, met you at a cocktail party.
But, when we are sick, we have to get examined, and then we are telling you about our sex lives without either your consent or our choosing. We are telling you about floggings, fistings, spankings, canings, cuttings, tattoos, piercings temporary and permanent. You might see little rows of bruises from clothespins, or other marks on the body that you might never figure out. We know this can be awkward for you, and we also know, from personal experience, that it is terrifically awkward for us.
Please remember that your kinky patients are probably both embarrassed and fearful. To show our marks to outsiders could be dangerous. Some of us have been hospitalized without our consent or separated from our children by well-meaning folk who think we are not safe when we are. More often we get treated as inferior, or perhaps a little crazy, or with that subtle prejudice that means that doctors and nurses will doubt us when we describe our symptoms, or assume that we are substance abusers or otherwise screwed up. Diagnosticians who think we’re crazy may assume that the medical symptoms for which we are seeking treatment exist only in our (obviously confused) heads. The consequences for us can be unfriendly and potentially negligent medical care: we might have trouble getting a prescription for pain medication that another person would receive routinely. (Obviously, we don’t feel pain like everybody else, right?)
What can you do? Treat the kinky person who comes into your office exactly the way you treat anyone else. Do your best to let your patient know you see her as a person, an individual, not a categorical pervert.
Know that surface-level bruising and welts is normal to S/M play: many people who enjoy the sensation of whips can’t get the level of stimulation they like without some bruising or welts. Painful or intense stimuli that kinky people enjoy on purpose differ from the pain of injury by much more than just a state of mind. S/M players explore a specific set of sensations to get a specific pattern of intense sensation, carefully timed so the body can respond in a pleasurable way. It feels - and, we believe, is - very different from the frightening and uncontrolled pain that accompanies illness or injury.
If you are looking at bruised or cut skin, take a deep breath and disengage any initial emotional reaction you might be feeling. You may not understand your patient’s pleasure, but you do have the medical knowledge to determine if this person’s practice was safe. S/M “marks” should be surface level and designed to heal easily without complications. So ask yourself: are bruises and welts on well-padded body parts, where they will easily heal? Are there underlying organs that could be endangered? It is commonly accepted among players that buttocks and thighs, shoulder and chest muscles, are safe parts of the body, well-padded with muscle and fat, with skeletal protection for the organs underneath.
Dossie gets her annual pap smear around the time of her birthday, which helps her remember, but if she can’t get an appointment until after her happy birthday spanking... (One doctor inquired if she had been riding horses. She answered, “No.”) Another asked directly about the bruises, and seemed accepting when she told him it was her birthday. This was all much easier in the good old days of medicine when you could choose your doctor and go back to the same one every year. Modern medicine requires that we expose ourselves to so many people!
A friend of ours tells about the time she forgot to remove her labia ring. A nurse-practitioner dealt with her surprise very nicely by exclaiming, “Oh, what a cute little ring!” Our friend apologized for not forewarning her, and reassured her that the piercing was healed and that nothing about the exam would hurt it.
Most of the injuries involved in S/M play are comparable to those that may happen during sports like touch football or hobbies like woodworking - shallow cuts and bruises, sore or strained muscles. Again, your knowledge of anatomy can inform you about what is safe, what will heal readily, and what might be ill-advised.
If you have a question about the safety of any marks you see on a person or any practices your patient may describe, ask the patient what safety precautions they have taken. Unless you, the medical professional, have made an in-depth study of this subject, your patient may know more about it than you do, and might be able to explain how it is safe. If you still don’t think it’s safe, than you can discuss it with your patient like two responsible adults.
What you can do to be supportive.
- Let your patient know that you accept and respect her.
- We are physiologically no different from you, and you could probably learn to enjoy the same things we do if you wanted to, and it’s fine if you don’t.
- Nonjudgmental questions are not a problem.
- Prescribe all medications, particularly for pain, as you would with anyone else. We do not enjoy pain from illness or injury any more than you do.
- For further information, we recommend you read “Health Care Without Shame” by Dr. Charles Moser, listed in the Resource Guide.
- If you are still perplexed by something you do not understand, and your patient can’t explain it to you to your satisfaction, you can always seek consultation. In our Resource Guide you will find the information to access Kink-Aware Professionals, a list of doctors and therapists who are knowledgeable about kink, in every state and some foreign countries.
- It is not a crime to not know how something works. If you have no experience of S/M or kink, then you have little or no idea of how it works. As long as you understand that, and seek more information when you are confused, you will do just fine at treating your kinky patients with care and respect.
- Remember that you do not know how many people you see who have kinky sex lives. You can only identify those few who have visible marks on their bodies at the time you examine them, or who talk to you about their alternative sexual practices. Most of your patients try very hard to conceal their kinkiness from you. We worry about this: we’ve heard from too many kinkyfolk who are reluctant to seek medical care when they need it for fear of discovery and judgment.
- If you want to do a small-scale statistical study of your own practice, compare the incidence and severity of injuries caused by S/M that you treat to the injuries suffered by those who ski. Then compare your feelings about them.
Psychological professionals.
You may have clients, in your private practice or in community service work, who are practitioners of S/M or other kink. Kinky people seek therapy for the same reasons that anyone else would: anxiety, depression, conflict in a relationship, recovery from chemical dependency, healing from childhood abuse, etc. Your kinky client’s needs may have little or nothing to do with his sexual practices, or they might, or perhaps your client wants to feel safe talking to you about all aspects of his life.
You may have clients, in your private practice or in community service work, who are practitioners of S/M or other kink. Kinky people seek therapy for the same reasons that anyone else would: anxiety, depression, conflict in a relationship, recovery from chemical dependency, healing from childhood abuse, etc. Your kinky client’s needs may have little or nothing to do with his sexual practices, or they might, or perhaps your client wants to feel safe talking to you about all aspects of his life.
Since Krafft-Ebing, many psychological theorists have assumed that kink is universally caused by underlying psychopathology. All forms of sexual variation have been defined as sick, and it is only recently that we have begun to accept gay, lesbian and bisexual people as sane.
The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, usually known as the DSM-IV, has changed the criteria for diagnosing paraphilias, including fetishism, transvestism and sadomasochism, to indicate that sexual behaviors involving consenting adults are only to be considered pathological if: “The behavior, sexual urges, or fantasies cause clinically significant distress or impairment in social, occupational or other forms of functioning.” “...A Paraphilia must be distinguished from the nonpathological use of sexual fantasies, behaviors or objects as a stimulus for sexual excitement in individuals without a Paraphilia.”
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The alternative sexual behaviors we describe in this book are now comparable to oral sex thirty years ago, when it was included in many legal definitions as “sodomy” (which is still true in some states), and believed to be degrading and disrespectful. Today, sexual variation is actively coming out of the closet. The changes in the DSM-IV definitions were made after extensive lobbying from the various kink communities.
Tolerance is not the same thing as understanding. Safe, sane and consensual kink is not, and should not be, self- or other-destructive. Sexual abuse does happen, and is pathological, whether the participants are wearing leather and chains or cotton and sweats. The abuse part lies in the mistreatment of one person by another, and, sadly, happens in all forms of relationships from the far out to the conventionally married. Thoughtful practitioners of kink are not responsible for all the bad sex in the world.
Dossie once had a young woman come to her who had questions about S/M practices she had been introduced to. She told Dossie that her top had put her in a bathtub with a six-volt car battery. Dossie says, “I bit my tongue. Being an experienced player myself, I strongly felt that this was not okay. But I didn’t want to shake my finger at her and make her feel bad. So I asked her if she felt that this was safe. She responded that she didn’t, and that’s why she was seeking therapy, because she knew that she was doing things that weren’t healthy for her. I think if I had lectured her instead of asking for her opinion, she would not have felt safe enough with me to work on her issues.”
What is hard for outsiders to understand is that kinky people have figured out ways to enact fantasies, stimulations and psychodramas safely within the boundaries of scene space. So while what they do might look dangerous - indeed, they might go to some lengths to make their play appear dangerous - they work hard all the while to keep things safe both physically and emotionally... sort of like sexual stuntpersons.
Theories and reductionism.
Kinkyfolk do enact archetypes, myths, and all kinds of stores. Psychoanalytical theorists often try to analyze these stories to tease out an underlying psychodynamic. This is fine when you are endeavoring to understand the individual, but it can be a real problem if you are predisposed to find pathology, or resistant to the possibility of health.
Kinkyfolk do enact archetypes, myths, and all kinds of stores. Psychoanalytical theorists often try to analyze these stories to tease out an underlying psychodynamic. This is fine when you are endeavoring to understand the individual, but it can be a real problem if you are predisposed to find pathology, or resistant to the possibility of health.
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