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Some critical notes on Jay Wiseman's "The Medical Realities of Breath Control Play"

Jay Wisemans texts are some of the best there are on the web on this subject; I wouldn't want to belittle the usefulness of his medical commentaries. Yet when it comes to his interpretation of the available literature and his estimation of the risks involved I think some of his claims are misleading. The text I'm referring to can be found at


"Additionally, there are documented cases in which the recipient appeared to fully recover but was found dead several hours later."

In all such cases I could find in medical literature the victims had been choked long after they lost consciousness. The brain damage resulting in death (several weeks later in some cases) was explicitly put down to this fact.

References: Ger66, Max87, WAR88, Hen90, AK96


"Most such deaths occur during solo play, however there are many documented cases of deaths that occurred during play with a partner. It should be noted that the presence of a partner does nothing to limit the primary danger, and does little or nothing to limit most of the secondary dangers."

The primary, almost exclusive danger in autoerotic breath control play is to lose consciousness and suffocate. This danger can be reduced by approximately one hundred percent when a responsible partner is present. The "secondary dangers" apparently are far less common than the "primary dangers"; in fact I have to find a case yet where someone died of one of the secondary dangers Wiseman mentions while playing with a partner. Cause of death in the (very few) documented cases is clearly the partner's irresponsibility or negligence.
In a private mail Jay Wiseman explains that by "primary dangers" he means the dangers to the heart and by "secondary dangers" all the others. In my opinion, if this is what he's trying to say, the original text is at least misleading. His "primary dangers" are definitely not the most common dangers; in fact they are, if anything, extremely rare as causes of death.


"There are many documented cases of as little as five seconds of choking causing a vagal-outflow-induced cardiac arrest."

I haven't been able to find a single case yet where the cause of death was unambiguously attributed to this mechanism. Wiseman hasn't been willing or able to name the "many documented cases" - and I have been asking him for references patiently for years. I have since come to the conclusion that there are no such cases - supported, amongst others, by KU+90 -, and that Wiseman knows it, too.

References: None. Ask Jay Wiseman, maybe he'll tell you. There are one or two anecdotal cases that are quoted again and again, namely the notorious "women dropping dead on the dance floor following a 'playful tweak' of the neck by their partners" (AK96), but there are no well-documented cases, let alone many of them. Wiseman usually refers to Kni96, but Knight doesn't provide any references to specific case studies, either. For the details on this theory, cf. "Carotid sinus reflex death - A theory and its history".


"For the reason cited above, many police departments have now either entirely banned the use of choke holds ..."

For several reasons these police choke holds are rather different from what we're talking about. The theory Wiseman seems to favor (the documented deaths being due to vagal or carotid sinus stimulation by the choke hold) is rejected in all texts I've read. The victims are agitated and struggling, in most cases under the influence of alcohol or drugs (often cocaine), and usually one or two policemen kneel on the victim's back. Convulsions of the already unconscious victim are often misinterpreted as further resistance and the choke hold is continued. Additionally there are rarely reliable witnesses to prove the police haven't been using excessive force. It seems rather daring to deduce any conclusions for BDSM practices from these cases.

References: Koi87, DPM90, MD90 (martial arts choke holds), RE82, Cre83, Kor86a, Kor86b, PZ+99 (police choke holds)


"While there are numerous case reports of deaths involving both solo play and partner play (far more of the former than the latter), including a report of a breath control fatality at a play party -- Brotherhood of Pain, Houston, 1985 ..."

The specific risk that makes autoerotic play so dangerous can be virtually eliminated by playing with a partner. The comparison is misleading. The mentioned fatality in Houston was caused by negligence, as were all other cases of accidents with partner I could find.

References (deaths in the presence of a partner): Sch75, Max87, MFK86, BU88, SRP97


"The risk level for doing breath control with a partner is presumably somewhere between the two (there are, after all, numerous case reports of such incidents) ..." [Wiseman is talking about the nonexistent accidents in martial arts and the numerous autoerotic fatalities on the other hand]

The first part of this statement is not very useful, the second part misleading. The risk of autoerotic play is of little concern to us in this context - claiming that the risk in playing with a partner is somewhere between staying at home and flying would be just as meaningful. It's mathematically irrefutable, just not very helpful. And the "numerous case reports" are autoerotic fatalities.


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