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Deviant Behavior

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A Descriptive Review of Research Relating to Sadomasochism: Considerations for Clinical Practice

Jonathan Powls & Jason Davies

To cite this article: Jonathan Powls & Jason Davies (2012) A Descriptive Review of Research Relating to Sadomasochism: Considerations for Clinical Practice, Deviant Behavior, 33:3, 223-234, DOI: 10.1080/01639625.2011.573391

To link to this article: https://doi.org/10.1080/01639625.2011.573391

Published online: 10 Jan 2012.

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A Descriptive Review of Research Relating to Sadomasochism: Considerations for Clinical Practice

Jonathan Powls

Sheffield Community Brain Injury Rehabilitation Team, Head Injury Rehabilitation Centre, Sheffield, South Yorkshire, England and University of Sheffield, Western Bank, Sheffield,

England

Jason Davies

Abertawe Bro Morgannwg Health Board, ISIS, Cefn Coed Hospital, Swansea, Wales, University of Sheffield, Western Bank, Sheffield, England

This review explores literature relevant to understanding the psychological well-being of people who

have an interest in sexual sadomasochism (SM). It focuses on evaluating the traditional psychiatric

and psychodynamic perspectives of SM, which conceptualize SM practitioners as being psychologi-

cally unwell. The empirical information reviewed is inconsistent with a number of aspects of the tra-

ditional theories of SM. The validity of conceptualizing the majority of SM practitioners as being

psychologically unwell is questioned and the negative psychological impact that these traditional

theories can have on SM practitioners is noted. The implications for professionals’ working with

SM-practicing clients is considered.

Although there is no universally accepted definition of Sadomasochism1 (SM), key elements appear to include a hierarchical power structure (i.e., domination and submission), intense

stimulation (e.g., physical or emotional pain), sexual stimulation, restraint, bondage, role-play

and fantasy, usually for sexual gratification (Nichols 2006; Dancer et al. 2006).

Within the psychiatric literature, SM has frequently been characterized as a disorder. Associa-

tions have been made between sadism, rape, and murder (e.g., Ehm and Patrick 1995), and sadism

and child abuse (Ussher 1997), with SM practitioners 2 discussed in terms of their ‘‘symptoms and

case histories’’ (Taylor and Ussher 2001:294). An emphasis on the forensic aspect of SM

continues, to some extent, as revealed by research into assessment (e.g., Nitschke et al. 2009a,

2009b) and two recent reviews (Kirsch and Becker, 2007; Fedoroff 2008). Formal psychiatric diag-

nostic manuals conceptualize SM in terms of underlying pathology, for example DSM-IV-TR

Received 22 March 2010; accepted 5 November 2010. 1 Sadomasochism is sometimes discussed using the terms S=M, S&M, BDSM, D=S, and Leather, with each term having

a slightly different meaning within the SM community. For the purpose of this review the phrase SM will be used. 2 SM practitioners is the phrase used to denote those who engage in SM activity, whether or not for sexual gratification.

Address correspondence to Dr. Jonathan Powls, Sheffield Community Brain Injury Rehabilitation Team, Head Injury

Rehabilitation Centre, Albert Terrace Road, Sheffield, South Yorkshire, S6 3EB, UK. E-mail: [email protected]

Deviant Behavior, 33: 223–234, 2012

Copyright # Taylor & Francis Group, LLC

ISSN: 0163-9625 print / 1521-0456 online

DOI: 10.1080/01639625.2011.573391

(American Psychiatric Association 2000) identifies Sexual Masochism and Sexual Sadism as Paraphilias. However, some researchers suggest that there is no evidence that SM practitioners fit the criteria for a mental disorder (e.g., Moser and Kleinplatz 2005) as they do not share any

specific symptoms or functional problems (e.g., Moser 1988). Further, Nichols (2006:282) sug-

gests that unusual sexual behaviors may be abnormal in a statistical sense, but are nevertheless

‘‘pathologically neutral’’ and so ‘‘no more inherently healthy or unhealthy than mainstream sexual

practices.’’ Further, research with SM practitioners (Cross and Matheson 2006) concluded that the

‘‘submissive group’’ sampled were no more prone to psychological distress or mental instability

than controls, and that the ‘‘dominant group’’ had similar scores on measures of antisocial and

psychopathic scales to the controls.

The idea that infantile experiences can form the basis for the later development of an SM inter-

est remains active. For example, it has been proposed that sexual masochism occurs as a result of

childhood abuse, driven by irrational guilt and an unconscious desire for revenge (e.g., Ross

1997) and that sexual sadism emerges due to maladaptive unconscious processes, possibly being

‘‘symptomatic of an id-driven personality’’ (e.g., Dorr and Woodhall 1986). However, flaws

have been noted in these theories. For example, Baumeister (1988) highlights that people who

incorporate masochistic elements into their sexual behavior do not necessarily seek failure or

harm in other areas of their lives. As with the psychiatric explanations of SM, the methodological

limitations of the research upon which theories are founded have been commented on (for

example, unrepresentative samples (e.g., Reiersol and Skeid 2006; Queen 1996) and small

clinical populations (Taylor and Ussher 2001)).

Some writers have recently begun to ‘‘adopt broad, neutral or positive definitions’’ (Plante

2006:62) in their explanations of SM. One conceptual change reflects the move away from an

individualized ‘‘deviant’’ explanation of SM, toward a more sociological one (e.g., Lee 1979;

Moser 1979; Scoville 1984). Sociological theorists (e.g., Kamel and Levi 1980, 1983; Weinberg

1987) argue that, as people do not live in a social vacuum, the development of SM interests can

only be understood in terms of an ongoing process of adult socialization. Weinberg (1987:52) suggested that it is through this process of socialization that these individuals gradually come

to understand the norms and values of the SM community, and as such SM is ‘‘dependent upon

meanings, which are culturally produced, learned and reinforced in S & M cultures.’’

The purpose of the present review is to use the available empirical research to help build an

understanding of SM within the context of non-forensic clinical practice. Arguments from the

psychiatric and psychodynamic perspectives were identified for specific attention. These are

summarized as: SM represents an (1) abnormal=deviant sexuality that (2) develops in childhood as a (3) result of childhood abuse or trauma.

REVIEW STRATEGY

Three databases (PsycInfo, PubMed, and Web of Science) were searched using the terms sado- masochism, sadomasochistic, sadomasochistically, sadism, masochism, leather, SM, S=M, S&M, and BDSM. No date limits were placed on the search and only articles written in English were included. The articles identified from these searches were assessed for suitability through a review

of the abstract, and where necessary the text of the article. Articles were included if they reported

qualitative or quantitative research that addressed in some way the underlying arguments outlined

224 J. POWLS AND J. DAVIES

earlier, that formed the focus of the review. Reports of empirical information collected directly

from SM practitioners, which addressed these issues, were also included.

Each article was read and the information contained within it, relating to one of the three

arguments noted earlier (prevalence; development; childhood abuse), was recorded. Evidence

that appeared to challenge an assumption was scrutinized to understand the limitations of the

work undertaken. In addition to the a priori features being investigated, other key findings or

discussion points contained within each paper were also noted. These were later subjected to a

thematic analysis in which common themes running through the literature were noted. As a result

of this analysis, the theme of childhood abuse was broadened to childhood and the themes of

‘‘mental health services,’’ ‘‘the role of pain,’’ ‘‘positive functions,’’ and ‘‘social and psychologi-

cal functioning’’ were added. These themes are discussed in turn below. The last two themes are

particularly important for beginning to appreciate the diversity of those who engage in this form

of activity, and the factors associated with apparently healthy, non-pathological individuals.

As the focus of this review is on the development and practice of SM in the general

population any literature drawn from forensic populations has been excluded. Although this

particular area of literature draws heavily on psychodynamic and psychiatric theories in explain-

ing sadistic=masochistic behavior, it would be inappropriate to generalize from forensic samples to members of the general population, who may be engaging in consensual SM activities.

Specifically this literature tends to focus on the most extreme cases of predatory violence

(e.g., serial murder, sexual and lust murder) committed by individuals with serious personality

difficulties such as psychopathy.

This review is biased by a reliance on psychological, psychiatric and other clinical perspec-

tives and research. However, this bias is an intentional stance. It was considered important to test

the psychiatric arguments under consideration using research nestled within these perspectives.

As a result, sociological and anthropological literature that may be relevant was not included

although it is appreciated that this results in a leaning toward a nomothetic, individually located

and Western perspective to understanding the topic area.

THEMES FROM RESEARCH

Prevalence of SM Activities

Although accurate estimates of the prevalence of SM is made difficult because of the often secret-

ive nature of this community, Moser and Levitt (1987:323) suggest that, within the United States

at least, these activities are ‘‘possibly common,’’ and are perhaps practiced by ‘‘millions of

people.’’ Weinberg and Falk (1980) also point out that SM themes can be seen to run throughout

popular culture, while Weiss (2006:109) notes the saturation of SM in the mainstream U.S. media,

where it is depicted as ‘‘everyday, mundane, and conventional.’’ Similarly, Moser and Kleinplantz

(2006:2) claim that ‘‘SM is widespread enough so that mainstream movies, television shows, com-

mercials, and magazines refer to it commonly without having to explain it to their audiences,’’

while Litman (1997:256) has suggested that ‘‘sadomasochism is so ubiquitous currently in Los

Angeles that it may be considered part of the trendy popular culture.’’ Moser and Kleinplantz

(2006) used their personal experience of researching this community to put forward a rough

estimate that as many as 10% of the general population are likely to be involved in some form of SM activity, which supports the earlier 1 in 10 estimate of Crepault and Couture (1980).

DESCRIPTIVE REVIEW OF SADOMASOCHISM 225

Crepault and Couture (1980) reported that a large proportion of the 94 males they interviewed

had sexual fantasies that included elements of sexual power, aggressiveness, or sexual maso-

chism, while Donnelly and Straus (1994) found that 61% of a college student sample of 320 reported being sexually aroused while imagining or participating in mildly sadistic or masochis-

tic activities (e.g., biting or spanking). Other studies have found relatively high proportions of

female participants who have sexual fantasies involving force being used against them (e.g.,

Hariton and Singer 1974; Price and Miller 1984; Sue 1979). For example, Pelletier and Herold

(1988) reported that more than half of their female sample engaged in fantasies of forced sex.

Similarly, Strassberg and Lockerd (1998) found that 64% of the 147 female college students who completed a questionnaire reported having sexual fantasies about being either overpowered

or forced to expose their body to a seducer.

This research suggests that dominance and sadism is present among a relatively large pro-

portion of the general population, and that submission (at least in fantasy) is also commonplace.

Together these findings challenge the view of SM as deviant, instead suggesting that such

activity may be part of the normal spectrum.

Development of SM Interest

Generally the studies conducted to date reveal the relatively mature age at which respondents

report having developed SM interests. Moser and Levitt (1987) found the mean age of first

SM awareness to be 20 years, while Sandnabba and colleagues (1999) reported the median

age of first awareness, and first SM experience, fell within the 18–20 and 21–25 years age brack-

ets, respectively. Similarly, Spengler (1977) found that as many as 43% of his 245 male respon- dents only became aware of their SM interest after the age of 19, and 11% when they were 30 or over, while Brame (1999) reported that 4% of her sample did not become involved in SM until after the age of 41 years. The empirical data collected on female participants is even more indica-

tive of the late awareness of SM interests. Breslow and colleagues (1985) reported that over 40% of their 182 female respondents became interested in SM after the age of 23, with over 60% being introduced to the scene by a partner.

In addition to age, some researchers have studied the gradual development of the activities that

are engaged in by SM practitioners. Alison et al. (2001) analyzed the relationship between differ-

ent SM behaviors, and identified four distinctive clusters of activities. These appeared to indicate

the presence of four qualitatively different, although not mutually exclusive, subsets of behaviors.

Subsequent multivariate analysis of this data (Santilla et al. 2002) suggested that, over time, SM

practitioners had typically progressed within each of these categories, in a cumulative move from

the less intense to the more extreme activities. Other evidence for the gradual development of an

SM interest comes from the work of Kamel and Levi (1980, 1983) who focused specifically on

studying homosexual leathersex, which has been defined as ‘‘the eroticisation of a macho, mas- culine image, symbolised by wearing clothing and costumes derivative of the cowboy, motorcycle

rebel, etc.’’ (Weinberg 2006:20). Kamel and Levi (1980, 1983) found that, rather than reflecting

the expression of distinctive underlying characteristics, the leatherman identity actually developed through six distinct stages, with each stage being strongly influenced by social interactions.

Although the validity of these studies is threatened by their reliance on the participant’s

memory and appraisal or awareness of sexual development, the data nevertheless appears to

226 J. POWLS AND J. DAVIES

challenge the early onset of SM interests, and instead suggests a later emergence with a gradual

development influenced by social and cultural factors.

Childhood

Attachment, family configuration, and childhood abuse have all been explored in relation to SM.

However, the link between any of these factors and the development of SM is only partially sup-

ported by the empirical evidence. For example, Santilla et al. (2000) reported that the breakdown

of SM respondents’ attachment styles, to both parents, were almost identical to those found in a

non-SM Finish sample (Shaver et al. 1988), and Sandnabba et al. (1999) reported that the over-

whelming majority of their SM respondents had grown up in traditional, two-parent households.

Suggestions of a direct link between SM and childhood sexual abuse, which are particularly

prevalent within psychodynamic literature (e.g., Blum 1991; Blos 1991), have also only partially

been supported by empirical findings. Some have reported low rates of abuse among SM groups

(e.g., Breslow et al. 1986: 5.4%) while others (e.g., Nordling et al. 2000) have reported signifi- cantly more abuse in SM samples than in samples of the general population. However, these

studies have consistently found that the vast majority of SM participants do not report earlier

childhood sexual abuse, leading Nordling et al. (2000) to suggest that it is unlikely that a simple

association between sexual abuse and SM will ever be found. Queen (1996) also states that: ‘‘It

is a myth, unfortunately as prevalent within the ranks of psychotherapists as elsewhere, that

women who have been abused are drawn to S=M to recapitulate those experiences. . . . The two experiences do not go hand in hand’’ (71).

Nordling et al. (2000) found that the small proportion of SM respondents who did report

childhood sexual abuse were significantly more likely to report later physical and psychological

maladjustment. The authors tentatively suggested that these individuals may represent a specific

subgroup of the SM community, and it is perhaps this subgroup for whom the traditional

psychiatric and psychodynamic models of SM may more accurately represent.

This literature suggests that there is no simple link (if any at all) between childhood experi-

ences such as abuse and SM development.

Mental Health Services

In a recent article reporting the findings from a very large-scale study, Richters et al. (2008)

concluded that their research supported the idea that bondage and discipline, domination and sub-

mission, and sadism and masochism (BDSM) is just a sexual interest that does not indicate abuse

or sexual dysfunction in the majority of practitioners. However, the continued conceptualization

of SM as abnormal, or a psychiatric problem, has been claimed by some to be a cause of psycho-

logical difficulty. Individuals may present to mental health professionals with questions such as

‘‘am I normal’’ or ‘‘will my SM desires get out of control’’ (Moser 1988). Alternately, they may

seek professional help due to feelings of guilt about their ‘‘abnormal sexual desires,’’ or because

they are concerned that their fantasies indicate that they have serious psychological problems

(Brame 1999). Queen (1996:71) pointed out that being labeled pathological by a powerful estab-

lishment, such as the American Psychological Association, can ‘‘itself be damaging to a client’s

emotional well-being,’’ with Wright (2006:229) claiming that ‘‘the stigma of mental illness now

DESCRIPTIVE REVIEW OF SADOMASOCHISM 227

hangs over the head of every individual who practices SM.’’ Reiersol and Skeid (2006) report that

the stigma associated with SM activity can result in such psychological distress that the diagnosis

of a mental illness can actually become a self-fulfilling prophecy, with individuals being so affec-

ted that they may then require long-term psychotherapy.

Kolmes and colleagues (2006:303) suggest that mental health professionals themselves

‘‘have a long history of holding negative assumptions and stereotypes about the BDSM com-

munity, or of being otherwise ill-informed about the practices of this community.’’ Having sur-

veyed 197 SM practitioners who had received input from mental health professionals, Kolmes

et al. (2006) reported evidence of widespread negative professional views against SM practice.

This was evidenced by respondents reporting biased, inadequate, or inappropriate care from

professionals, including professionals believing SM to be intrinsically unhealthy, failing to

understand its consensual nature, or confusing SM with abuse. Some clients reported having

to agree to give up their SM practices if they wanted to continue with treatment. In an earlier

study, 32% of the SM sample who had seen a counselor, reported that the professional had not been sensitive to his=her sexual identity (Brame 1999). The importance placed on consent by the SM community (e.g., Brame et al. 1993) and the fact that violations of consent are treated

very seriously within the SM community (e.g., Taylor and Ussher 2001) have also been argu-

ments against SM as a pathological activity.

Due to the widespread nature of negative views such as these, Nichols (2006) highlighted the

need for a greater professional understanding of SM, which would prevent client’s from withholding

important information about their sexuality. Nichols (2006) suggests that a more psychologically

neutral stance be taken toward SM, while Kolmes et al. (2006) suggest that any psychologist offer-

ing input to an SM-practicing client has a professional responsibility to develop a greater under-

standing of SM. Such a requirement could have large implications for the psychology profession

given that all mental health professionals are likely, at some point, to encounter SM-practicing cli-

ents (Moser 1988). Kolmes et al. (2006) even suggest the need to develop specific guidelines for

psychologists working with SM-practicing clients, to help professionals understand the complexity

of SM, including the difference between its healthy expression and abuse. Kolmes et al. (2006)

believe that, if such measures are not implemented, mental health professionals may inadvertently

harm their SM-practicing clients, and may even put themselves at risk of legal action. A recent study

by Lawrence and Love-Crowell (2008), with therapists experienced in working with the BDSM

group, has revealed a number of knowledge areas=attitudinal elements that might be important.

The Role of Pain in SM Activity

The importance of pain within SM activity has traditionally been emphasized, although

empirical evidence has begun to question the actual role that it plays, with a number of studies

challenging its significance. Taylor and Ussher (2001) reported that their interviewees concep-

tualized pain as having only a peripheral function within their SM activities and submissives

have been noted to dislike headaches and dental work as much as anyone else (Scott 1983).

Many SM practices are not actually painful (Moser and Levitt 1987), and when pain is used

it is usually carefully limited (Baumeister 1988). Cross and Matheson (2006) suggested that

power and authority were far more important than pain in SM activity, with pain being merely

one of many tools that can be used to ‘‘establish and maintain the requisite power differential,’’

228 J. POWLS AND J. DAVIES

in order to clearly differentiate the ‘‘powerful from the powerless’’ (153). As part of this, Cross

and Matheson (2006) found that submissives were ten times more likely than dominants to pro-

vide real-life information about themselves, an action that can be seen to transfer power from the

vulnerable submissive to the dominant. Therefore, as previously suggested, it would appear that

‘‘definitions that focus exclusively on pain miss the essence of SM’’ (Weinberg 1987:60).

Positive Functions of SM

Rather than being problematic, it has been suggested that SM activities may serve a number of

positive functions. SM activities have been described as a ‘‘non-chemical way of attaining

pleasurable altered states of consciousness’’ (Nichols 2006:285), and the ‘‘natural high’’ associa-

ted with an adrenaline=endorphin rush has also been noted (Taylor and Ussher 2001). Writers have conceptualized SM as play-like behavior (Weinberg and Falk 1980), or have equated it with

physical exercise (Brame 1999), alcohol (Scarry 1985), spectator sports (Baumeister 1988), or

‘‘bungee jumping or going on a roller-coaster’’ (Nichols 2006: 285). Indeed, Weinberg (1994)

suggests that SM activities should be thought of as being healthy, while others have described

SM activity in terms of a process of healing (Califia 1979), spirituality (Nichol 2006), or as an

opportunity to learn more about oneself emotionally and physically (Lucy 1982).

Positive effects and implications of SM activity have been noted. These include preventing sex

becoming routine and monotonous (Nichols 2006); being an indicator of sexual adventurousness

(Moser 2002); functioning as prolonged foreplay, thus allowing partners to derive more physical

satisfaction from their sexual encounters (Lee 1983) and making intercourse less conformist

through providing a temporary escape from ordinary everyday life, or acting as a mechanism

for parodying normal sexual relationships (Taylor and Ussher 2001). Baumeister (1988) suggests

that pain within SM encounters may function as a means of blotting out higher order thought, with

bondage and restraint proposed to give the submissive partner temporary relief from being a

decision-making person, which Baumeister suggests can become burdensome and aversive.

Social and Psychological Functioning

Empirical data indicates that SM practitioners are generally better educated than control samples

(e.g., Breslow et al. 1985; Sandnabba et al. 1999; Spengler 1977), with reports of between 54% and 87% attaining college or postgraduate education (Breslow 1987; Moser and Levitt 1987; Brame 1999). SM participants also generally appear to have stable employment (Stoller 1991),

have greater incomes (e.g., Damon 2002; Sandnabba et al. 1999), and higher social status than

the general population. Members of the female domination subculture have been reported to

be better educated than the average American, and on higher income and occupational brackets

(Scott 1983), while sexually masochistic therapy clients were also found to be relatively success-

ful by social standards, not only professionally, but sexually, emotionally, and culturally (Cowan

1982). A number of differences in reports of self, others, and experiences were reported by Davies

and O’Meara (2007) in a small qualitative study of undergraduate students.

SM practitioners appear to feel relatively positive about their involvement in the SM scene.

Breslow et al. (1985) found that around three quarters of their respondents reported that they

rarely or never felt dirty or perverted about their SM interest, and Spengler (1977) found only

DESCRIPTIVE REVIEW OF SADOMASOCHISM 229

a small minority failed to achieve positive self-acceptance. In a study by Moser and Levitt

(1987), only 6% of their SM sample expressed any sort of distress about their SM desires. Hormonal changes have been subject to limited research. Sagarin et al. (2009) found that

cortisol rose in participants engaging in some SM practices, and those who later reported that

the SM activity went well had reduced cortisol levels and increased relationship closeness. This

area is clearly interesting; however, it requires much more study.

SM samples have been repeatedly shown to have significantly higher proportions of single

people within them, when compared with the general population (Breslow 1987; Breslow et al.

1985; Levitt et al. 1994; Sandnabba et al. 1999), which could be viewed as indicating an area of

difficulty within the social functioning domain. However, Sandnabba et al. (1999) suggest that,

rather than necessarily indicating interpersonal difficulties, the high rate of SM singles may sim-

ply reflect the logistical difficulties of finding a suitable partner with complementary SM interests.

This difficulty is likely to be compounded by evidence that the SM community is made up of a

proportionally higher number of heterosexual submissive men, and a relatively low number of

dominant heterosexual women (Sandnabba et al. 1999). Alternately, being single may simply

be one method that is used to maintain a person’s secrecy around their SM interest. In a

large-scale study by the National Coalition for Sexual Freedom (NCSF 1998), it was reported that

70% of respondents felt that it was necessary to remain at least partly closeted about their sexual desires. Nichols (2006) has suggested that individuals with an SM interest might avoid any form

of intimacy in order to conceal their desires. This desire to keep their SM interests secret may

result in the development of social problems, due to the pressures involved in leading a double

life (Moser 1988), or trying to hide sexual preferences from others (Wright 2006).

Some writers have suggested that the stigma attached to SM within society can lead to social or

psychological problems through harassment, physical attacks, and discrimination against

SM-identified individuals (Wright 2006). The NCSF (1998) reported that over 36% of its respon- dents had suffered some kind of violence or harassment as a result of their SM interests, and Keres

(1994) reported that over half of the SM oriented lesbian women surveyed reported having experi-

enced some form of physical assault or discrimination within the lesbian community. The

National Organization for Women, the largest organization of feminist activists, passed a confer-

ence resolution in 1980 that specifically rejected all SM activities as a violation of feminist

principles, despite having no empirical evidence to support this decision (Wright 2006).

Suggestions have been made that engaging in SM activity has inappropriately led to the loss

of custody of children, inheritances, and jobs (Moser and Kleinplantz 2006). As an example,

Klein and Moser (2006) describe an American case in which a mother was severely limited

in her visitation rights to her son, after the custody battle centered around her fitness as a mother

due to her involvement in an SM relationship. This was despite an investigation having con-

cluded that no child abuse had ever taken place, and that the boy was totally unaware of his

mother’s sexual behavior. In the United Kingdom, a group of gay men were convicted of assault

and wounding or aiding and abetting assaults upon themselves under the Offences Against the Persons Act (1861), after a report concluded that the consensual nature of the SM activities was insufficient defense (see White 2006) to protect them from this act.

The empirical evidence reviewed here suggests that the vast majority of SM practitioners are

‘‘socially well adjusted’’ (Weinberg 2006:37) rather than maladjusted. However, social

isolation, secrecy, and the negative impact of societal views may be potential sources of psycho-

social difficulty.

230 J. POWLS AND J. DAVIES

CONCLUSIONS

Traditional psychiatric and psychodynamic theories typically make the a priori assumption that

SM reflects an underlying pathology or maladjustment. However, these traditional theories do

not appear to explain anything more than a specific subset of SM practitioners. This review

demonstrates that many of the premises that these views are founded on cannot be substantiated

across the majority of SM practitioners.

The relatively mature age at which an interest in SM appears to emerge, and the apparent

influence of social and cultural factors on its development, appear to undermine the traditional

idea that SM can be understood purely as an individualized phenomenon. This conceptualization

is further questioned by mounting evidence of the large number of those engaging in consensual

adult SM practice. The notion of SM constituting a psychiatric disorder is also questioned by

evidence of the typically high social status and functioning of SM participants, and the generally

positive attitude that members of this community have toward their own sexual practices. Recent

research has also suggested a number of possible positive functions that SM may play in the

lives of its practitioners, further questioning the necessarily negative conceptualizations of their

sexual behavior.

The empirical data reviewed here has typically failed to find anything remarkable about the

childhoods of SM participants and, while evidence exists that supports an association between

SM and earlier abuse in a small subset, the majority of SM practitioners do not appear to have

experienced any form of childhood abuse.

IMPLICATIONS FOR CLINICAL PRACTITIONERS

As already noted, a ‘‘psychologically neutral stance’’ to SM is required among clinicians. Psy-

chiatry and society at large has a troubled history in relation to understanding and recognizing

(minority) consensual sexual practices, as reflected in the history of considering homosexuality

as a mental illness and illegal practice. Clinicians need to be mindful of the evidence here that

the majority of SM practitioners represent a non-deviant, well-adjusted, and well-functioning

majority. For those seen in clinical practice an appreciation of this information is important to

prevent further marginalization and reinforcement of stigma. Further, it is paramount that clin-

icians recognize the existence of the SM culture with its own rules and practices, which represent

no greater intrinsic deviance than celibacy, or heterosexual or homosexual sexual practices. For

example, research has highlighted the negative impact that models of SM practice as deviant can

have. Other writers highlight the potentially damaging impact of stigma toward, and misunder-

standing of, SM activity, and the implications for psychologists and other clinicians have been

noted. Therefore, in keeping with good practice, clinicians should maintain a non-judgmental

and informed stance when undertaking their work.

It is clear that more research is needed into SM sexual activities, in order to help develop a

more sophisticated and robust understanding of SM activity, and how SM may lead to difficult-

ies for some. Importantly, Barker and Langdridge (2009) caution against attempting to seek a

simple universal explanation for SM practice; however, as Queen (1996) explains, ‘‘Without

a basic knowledge of S=M sexuality (and the ability to separate myths about S=M from facts), therapists cannot provide their S=M-practicing clients optimal care’’ (65).

DESCRIPTIVE REVIEW OF SADOMASOCHISM 231

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JONATHAN POWLS is a Clinical Psychologist with the Sheffield Community Brain Injury Rehabilitation Team (SCBIRT) and Honorary Research Lecturer in Psychology at the University

of Sheffield. His main interests are in the area of Neuropsychology, particularly Acquired Brain

Injury.

JASON DAVIES is a Consultant Forensic and Clinical Psychologist with ABMU Health Board and Honorary Clinical Lecturer in Psychology at the University of Sheffield. His research

interests include personality, measuring individual change, and sadistic attitudes and behavior.

234 J. POWLS AND J. DAVIES