Altered states of consciousness in BDSM

One of the most fascinating aspects of BDSM is its ability to induce altered states of consciousness. Lately this has gathered a lot of attention in FetLife.com, but unfortunately it has also generated a series of pseudoscience myths and dubious techniques to induce endorphin release and attain that coveted sub-space. In this article I want to use my experience as both a BDSM practitioner and a scientist doing research on pain neurophysiology to shed some light on all this confusion. I must start with a warning: there is practically no scientific research on the neurochemical phenomena that occur in sadomasochistic scenes. Moreover, there are reasons to think that these phenomena are quite different from ordinary pain responses, so much of what I am about to say here is speculative. However, although at the moment we are not ready to talk about what happens in the brain during a scenes, we still can use scientific evidence to debunk some of the existing myths and set the foundation for some serious research.

A great book about consciousness

What is an altered state of consciousness? Consciousness is the fact of being aware of everything that happens, both in the outside world and inside our mind. Our consciousness flows like a river of experiences that forms the story of our lives. From our subjective point of view, our consciousness is everything. Of course, objectively there is an external reality unaffected by what we make of it. What I’m pointing at is that our state of consciousness shapes and colors the events of our everyday lives. The reality that we perceive is altered by the filter of our consciousness: it disappears when we sleep and takes an exceptional intensity in situations of danger in which our brain becomes more alert to our surroundings. The quality of our consciousness determines to a great extent our capacity to be happy. This is because our consciousness is shaped by our emotional state, which is able to make our world look like hell or heavens. Since the dawn of our species, we humans have tried to alter our consciousness by consuming certain drugs or by undergoing certain extreme experiences. BDSM is an example of the second. Of course, not every BDSM activity is going to produce an altered state of consciousness, but those which do will likely leave us an unforgettable memory.

Here I want to propose a classification of altered states of consciousness that can be reached in a BDSM scene. This classification is based on my own experience, on discussions with other people that practice BDSM and on my knowledge of neuroscience.

•    Endorphin release. Endorphins are a family of almost 40 different neuropeptides that are able to activate the same receptors as morphine and other opiates. There are four opioid receptors, three named with the Greek letters mu, delta and kappa, which decrease pain, and the fourth called the nociceptin / orphanin receptor, which actually increases pain. Apart from their analgesic effect (pain inhibition), mu and delta receptors induce a sensation of well-being or euphoria. In contrast, kappa receptors produce a state of emotional distress called dysphoria. Endorphins are released into the bloodstream from the pituitary gland, but this does not produce analgesia or an altered state of consciousness because endorphins in the blood cannot cross the blood-brain barrier to have an effect on the brain. The only endorphins that can induce an altered state of consciousness are those that are released by neurons inside the brain. In addition, it should be noted that endorphins are independently released in different brain areas , so that we cannot speak of a generalized state of “endorphin release” but of multiple states depending on where they are released. In any case, we can safely say that endorphin release during a BDSM scene decreases pain and induces a feeling of calm, relaxation and even sleepiness. The submissive turns his or her attention inward, disconnecting with the surrounding environment and entering a fantasy world. Endorphin release can be triggered by gradually increasing pain intensity in an environment of emotional support in which the submissive can absorb the sensations without having to give a response. Endorphin release can be monitored as a decrease in heartbeat.

•    Nor-adrenaline release. Nor-adrenaline or nor-epinephrine is a neurotransmitter that, like the endorphins, is released by pain-controlling neural pathways and produces analgesia. I suspect that many states of decreased pain sensitivity sadomasochist scenes that are attributed to endorphins are in fact generated by nor-adrenaline. As in the case of the endorphins, we shouldn’t confuse the release of adrenaline in the blood with the release of nor-adrenaline by some specific neuronal pathways in the brain, although both things often happen at the same time. Nor-adrenaline is released when pain is coupled to fear in a situation that demands a response from the submissive. There are inhibitory connections between endorphin and nor-adrenaline pain-controlling pathways, which ensure that endorphin and nor-adrenaline release do not happen simultaneously. Although both states produce analgesia, in other things they are very dissimilar. Nor-adrenaline release produces a state of increased awareness to external stimuli, which appear more intense. The submissive cries, moves, reacts. Her heartbeat increases. Nevertheless, this state can be as euphoric and pleasant as that produced by endorphin release.

•    Sub-space. The term “sub-space” is often used indistinctively to refer to any of the altered states of consciousness described above. However, I would like to propose that ‘sub-space’ should be used only to refer to Dominance-submission scenes and not to sadomasochistic scenes, that is, to states generated by pain. I would define sub-space as a mental state in which the attention of the submissive is completely focused on the Dominant and the feelings of surrender and obedience that She or He evokes. From the point of view of neuroscience, it seems likely that sub-space is related to the release of oxytocin, a “social hormone” that induces trust and bonding. It may also involve dopamine release in the so-called “pleasure pathway” linking the ventral tegmental area of the striatum with the nucleus accumbens. The accumbens is the site of action of most drugs that produce addiction, like the opiates, cocaine, amphetamines and nicotine. Serotonin, a neurotransmitter of complex actions due to its multiplicity of receptors, could also be related to this state of calm surrender. In contrast to endorphin and nor-adrenaline release, sub-space is much more than a simple reflex response. Instead, it seems to be an emotional state in which one enters largely at will and that is subject to many variants and levels. Achieving a deep sub-space may require a period of training, building of trust and bonding between the submissive and the Dominant.

•    Top-space is not mentioned as often as sub-space, but there is little doubt that it exists and is as important for the Top as sub-space is for the submissive. One of the things that make a good Top is to be able to read the physical reactions of the bottom and deduce from them his or her mental state. Both the Top in a sadomasochist scene and the Dominant in a D/s relationship have to focus all their attention on the person they are playing with, feeling empathy and establishing a tight bond with the bottom. Therefore, Top-space probably shares many physiological features with sub-space. Perhaps in it oxytocin release is accompanied by the release of vasopressin, another social hormone that induces feelings of possession and territoriality in males. In sadomasochist scenes in which the Top inflicts a lot of pain to the bottom, a substantial release of nor-adrenaline may occur in the Top because of empathy, which probably strengthens His or Her focus and control on the scene.

•    Sub-drop. Many submissives and bottoms complain of entering a period of low energy, apathy and dysphoria after an intense BDSM scene. This may be due to a withdrawal effect to the release of euphoric neurotransmitters during the scene. However, sub-drop may have more complex causes, because on a closer examination it seem to be different states that vary from person to person. Some people never experience it, while is quite strong in others. Also, there seem to be at least two types of sub-drop, one that happens immediately after the scene and that can be addressed with aftercare and another that happens two or three days after the scene and can last several days. It is important, I think, that we do not accept sub-drop as something normal and unavoidable. Perhaps the scene has stirred some deeply buried emotions from the past that the submissive should examine. Using the information that I gave above, the submissive should consider whether the scene has involved endorphin release, nor-adrenaline release or sub-space, and how sub-drop relates to each of this mental states. Perhaps this way we can start building up information on how sub-drop relates to the different altered states of consciousness.

We should not treat the altered states of consciousness that we reach in a BDSM scene in a frivolous fashion, like BDSM was just one more drug. After all, if all we want is to get high perhaps we should just take drugs, instead of going through the painstaking process of doing a scene. I think that altered states of consciousness in BDSM are valuable because of their context, that of a profound personal relationship between the people involved in the scene. Hence, it is not so much a question of whether we release this or that neurotransmitter, but of the meaning that the scene has brought to our lives… Maybe a catharsis, maybe the surfacing of psychological issues buried in our minds for a long time and that had been released by the scene. Maybe we have encountered a part of ourselves that we didn’t know before. More and more people understand BDSM as a process of self-discovery and personal transformation that enriches our lives and contributes to make us happier and self-fulfilled.

Endorphins and adrenaline - What science really says

The following is in response to this article
https://fetlife.com/users/2529856/posts/1968359

Which apparently was first posted here
http://friskybusinessboutique.com/news/blog/the-endorphin-levels-in-bdsm-a-short-primer-on-sending-a-submissive-into-hyperspace

Basically, the article claims that endorphins are released in discrete “loads” and that it takes the body about 10 min to replenish the load before it can release it again. Then it proposes a method in which the bottom is beaten hard at 10 min intervals to taken him or her to increasingly high endorphin “levels” until a state of stupefied bliss is achieved. It also makes some claims on how adrenaline release balances the endorphin release, and gives instructions on how to minimize adrenaline release and maximize endorphin release (which is supposed to be the goal).

There are two different issues with that article. The first one is that it claims that all this is based on science. The second issue is whether the states that it describes really can happen to a bottom during a SM scene. I will address here the first issue only. Concerning the second, there are abundant testimonies of altered states of consciousness occurring in bottoms during SM scenes. However, the physiological basis of those states of consciousness, their value and the best ways to achieve them are highly debatable.

PET images showing the areas of the brain where endorphins are released by pain: the prefrontal cortex (PFCTX), the anterior thalamus (A TH), the right anterior insula (INS), the hypothalamus (HYPO) and the amygdala (AMY). From Zubieta et al. (2001), Science 293: 311.

I am a neuroscientist who has been doing research on pain for several decades. In particular, I have been investigating endorphin release in rats. Based on my knowledge, I am going to argue that the article cited above has no scientific basis whatsoever. The issue of endorphin release is enormously complicated, so I am going to summarize here the points most relevant for this discussion.

The first thing I need to explain is the blood-brain barrier. Blood is highly toxic to neurons, so there is a barrier between the capillaries that supply the brain with oxygen and nutrients and the nervous tissue. Most substances cannot cross the blood brain barrier without the “permission” of the gate keepers cells that form it. In particular, endorphins, adrenaline and other hormones secreted into the blood do not cross the blood-brain barrier, which means that the amounts of endorphins and adrenaline in the blood have no effect whatsoever on the mind. These substances need to be released inside the brain to do anything to your mood or your consciousness.

Second, you may imagine the endorphins as forming a sort of soup that bathes the brain all over. That is completely wrong. Endorphins are released by very specific neural pathways and affect only very small brain areas. This means that the effect of the endorphins depend on where in the brain they are released. For example, endorphin release in a small area of the brain stem called the nucleus raphe magnus inhibits pain; their release in the nucleus accumbens produces a state of bliss mediated by dopamine; their release in the insula produce positive emotions, and so far and so forth.

Third, what I have been calling until now “endorphins” are really a collection of about 40 different peptides encoded by three different genes and classified into three different families: endorphins, enkephalins and dynorphins. The endorphins and enkephalins bind to mu opioid receptors and delta opioid receptors, whereas dynorphins bind to kappa opioid receptors. All three receptors produce analgesia (meaning “a decrease in pain”), but only mu and delta receptors produce euphoria (a sense of pleasure and well-being). Kappa receptors, on the contrary, produce dysphoria, a profoundly unpleasant sensation of being sick and unhappy. Therefore, not all “endorphin” release will lead to a state of bliss. Like endorphins and enkephalins, dynorphins are released by pain, particularly when is accompanied by distress. This can happen, for example, in an adverse social environment or in unpleasant situations over which we have no control.

Images showing where in the human brain endorphins decrease the unpleasantness of pain: the anterior cingulate cortex (A CING), the thalamus (THA) and the nucleus accumbens (N ACC). From Zubieta et al. (2001), Science 293: 311.

Now, going back to that post, it is not true that endorphins are released in “loads” and that it takes the body 10 min to replete the load once is released. From what I have said above you can deduct that this is an enormously naïve and simplistic view of what in reality is a tremendously complex system. The final effect on our state of consciousness and on our mood would depend on whether endorphins, enkephalins or dynorphins are released, and most important, where in the brain they are released. Since the levels of endorphins in the blood do not affect the brain, to study endorphin release we need to have a technique that would allow to detect them inside a living brain. As incredible as this may seem, it was actually done by a scientist named Jon-Kar Zubieta. Using positron emission tomography (PET), he is able to measure the binding of an opioid drug, carfentanil, to the mu opioid receptors. He published a number of papers using this technique (I list some of them at the end) that show where in the brain endorphins are released (actually, where they bind to the mu opioid receptor, displacing carfentanil) during pain or in some particular emotional states. Unfortunately, he did not study masochists being beaten into a pulp in a SM scene. There is no indication whatsoever in his studies that endorphins are released in “loads”, or that the loads need to be replenished every 10 min. This also does not agree with what we know about the mechanisms by which endorphins are synthesized and released.

What about adrenaline? Actually, the brain uses a similar compound instead, nor-adrenaline (often called nor-epinephrine or simply NE). NE does a lot of things in the brain - again, depending where it is released an which of its many receptors are activated. It is true, however, that NE released into the spinal cord inhibits pain. This is driven by a neuronal pathway that originates in several parts of the brain stem (the nuclei called A5, A7 and nucleus coeruleus) and then travels down the spinal cord. The A5, A7 and coeruleus nuclei are activated by stress in the fight/flight response, which is well-known to produce analgesia. So adrenaline can complement endorphins to reduce pain during an SM scene.

How all this applies to an SM scene is anybody’s guess. I don’t know of any scientific studies done on sadomasochists, although it would be fascinating to do them. But in view of the complexities of these systems, how much they vary from person to person and how strongly they are influenced by social interactions and the ambient, we can guess that there is no simple formula to induce the release of endorphins or adrenaline in a person. The top has to fly by the seat of his pants, read the bottom very carefully and stay on the safe side when inducing altered mind states on the bottom. We are playing with fire here, and even though things may seem to fine during a scene, nobody knows what unforeseen consequences it may have in the future.

References:
Zubieta, J. K., Y. R. Smith, et al. (2001). Regional mu opioid receptor regulation of sensory and affective dimensions of pain. Science 293(5528): 311-315.

Mason P (1999) Central mechanisms of pain modulation. Curr Opin Neurobiol 9:436-441.

Hunt SP, Mantyh PW (2001) The molecular dynamics of pain control. Nat Rev Neurosci 2:83-91.

Zubieta JK, Smith YR, Bueller JA, Xu Y, Kilbourn MR, Jewett DM, Meyer CR, Koeppe RA, Stohler CS (2002) mu-opioid receptor-mediated antinociceptive responses differ in men and women. J Neurosci 22:5100-5107.

Zubieta JK, Ketter TA, Bueller JA, Xu Y, Kilbourn MR, Young EA, Koeppe RA (2003) Regulation of human affective responses by anterior cingulate and limbic mu-opioid neurotransmission. Arch Gen Psychiatry 60:1145-1153.

Apkarian AV, Bushnell MC, Treede RD, Zubieta JK (2005) Human brain mechanisms of pain perception and regulation in health and disease. Eur J Pain 9:463-484.

Ribeiro SC, Kennedy SE, Smith YR, Stohler CS, Zubieta JK (2005) Interface of physical and emotional stress regulation through the endogenous opioid system and mu-opioid receptors. Prog Neuropsychopharmacol Biol Psychiatry 29:1264-1280.

Wager TD, Scott DJ, Zubieta JK (2007) Placebo effects on human mu-opioid activity during pain. Proc Natl Acad Sci U S A 104:11056-11061.