Navigating Kink, BDSM, and Disabilities Through an Occupational Therapy Lens

Updated: 4 days ago

People with disabilities are often confused as asexual beings or viewed as people who do not desire any forms of sex. This assumption stems from the idea that disabled people cannot be independent in their occupations and have received the social status of someone who needs help with a negative connotation. This mindset further takes away their locus of control, the ability to express themselves authentically and exercise their sexual freedom.

There have been instances when people with disabilities were labeled agender (neither masculine nor feminine) to prevent disabled people from reproducing.

Medicalization of sexuality and gender as mutually exclusive elements not only creates dysphoria but also gives in to the fact that people with disabilities indeed are not sexual beings.

To top it all, a lack of understanding and resources within healthcare that can enable them to express their sexual freedom is scarce. We’re here to bring a shift in the paradigm of thought of disability, not as a stigma, but as an embodied identity.



DISABILITIES, KINK, AND BDSM


BDSM stands for Bondage, Discipline, Dominance, Sadism, and Masochism- covering a broad range of erotic practices alongside other forms of kink, such as fetishes or fantasy play.


What underpins the different expressive forms of BDSM is the exchange of power, communication, expression, and sensory play. These practices are valid forms of sexual expression and preferences that go beyond the general idea of orgasm-focused or penetration-only sex. It is one of the few sexual practices that highlights and emphasizes the unique sensory experiences of individuals first.


Kink and BDSM, just like other forms of chosen sexual practices, were earlier considered as sexual dysfunctions or maladaptive sexual behaviors because of irrational emotional and thinking patterns. In recent years, there have been more conscious and collaborative steps taken towards including these practices as therapeutic modalities. In 1992, disabled American activist and author Anne Finger argued that:

"Sexuality is often the source of our deepest oppression; it is also often the source of our deepest pain. It’s easier for us to talk about – and formulate strategies for changing – discrimination in employment, education, and housing than to talk about our exclusion from sexuality and reproduction."


One of the reasons the BDSM and kink community has a significant representation from disabled individuals is because they do not preach hegemonic, ableist ideations. Instead, their focus is on pleasure and inclusivity! The under-representation and marginalization of people with disabilities in ableist sexual practices have opened doors for many to the revolutionary world of expression, autonomy, and engagement in intimate occupations through emotional and psychological healing while being a part of the kink and BDSM community.


THERAPEUTIC EFFECTS OF BDSM AND KINK


Pathologizing kink, BDSM, and fetishes aren’t uncommon. When the idea of deserving pleasure itself is so scarce and shamed, experimentation and exploration often takes a backseat in the car of sexuality. However, what we have overlooked all these years is the therapeutic power of fetishes and their capability to positively channelizing our emotions, feelings, and sensations.


Before I dive deeper into how fetishes can be of importance in Sexuality based Interventions to Occupational Therapists, I want to establish its therapeutic effects with supporting studies to keep the basis of this text evidence-informed and not subjective to my experiences as a Sexuality and OT practitioner.


Assaultive or Therapeutic? :


Kink and BDSM, in their very core, require communication, consent, and vulnerability, making it an essential part of the healing process for people with disabilities by giving them the power to call shots. All the three elements are directed towards improving autonomy and building trust in a structured & controlled environment “similar to yogic or meditation-based sessions”, according to an article by Nichole Lane.


Physiological and Psychological Effects :


For any activity to have a therapeutic effect on our body means it needs to bring changes at cellular and emotional levels. To explore how these activities had any effects on the physiology and psychology of an individual, Dr. Brad Sagarin collected data on whether these effects differ for tops (people providing the structure, orders, or stimulation) and bottoms (people who are bound receiving stimulation, or following orders) before and after BDSM activities. And the results?


Both tops and bottoms showed an increase in relationship closeness, decreased psychological stress, and pleasurable altered states of consciousness. However, the difference in the type of altered state they appeared to enter is characteristic of how experiences of kink and BDSM activities can be different for everyone.


Variations in Tops v/s Bottoms :


Bottoms show evidence of an altered state associated with a temporary impairment of the brain’s executive function capability accompanied by feelings of floating, peacefulness, time distortion, and living in the here and now. They often refer to this altered state to as “subspace” within the BDSM community.


Tops, in contrast, appear to enter an altered state aligned with psychologist Mihaly Csikszentmihalyi’s concept of flow, a highly pleasurable mental state associated with focused attention, a loss of self-consciousness, and optimal performance. The term often used for this altered state is “topspace”.


These effects show reductions in stress, improved intimacy, and the facilitation of pleasurable altered states of consciousness — point to the positive impact of kink and BDSM activities. Additionally, it helps people with disabilities to function best with their abilities/limitations and explore many aspects and elements of their personalities or fun/play through engagement in kink and BDSM activities. While it might be a way of play for some, it can also be a way of processing and healing for others.


BDSM & KINK AS MEANS TO INTIMATE OCCUPATIONS


When I view kink and BDSM from an Occupational Therapy lens, there are so many brilliant things that talk and reflect purpose, intimate occupations, structure in play, communication, and a multi-sensory experience.


As Occupational Therapists, we can integrate the teachings and techniques of kink and BDSM activities as means to intimate occupations for persons with disabilities by:

  • Using their abilities, autonomy, needs, values, and beliefs to enhance a sense of sexual being and pleasure, and

  • Offering and applying our knowledge in the areas of activity analysis, adaptive equipment & low cost/DIY aids, positioning aids, task modifications, and regulating sensory & physiological systems.


Some ways I incorporate and recommend these ideas in practice for people with disabilities include:


  • Experimenting, enhancing and modulating sensory experiences using sensory deprivation and regulation techniques through pervertible or any other types of equipment.

  • Use consent and interpersonal communication (verbal and non-verbal using cues) to build intimacy and co-regulation to discuss ways in which the partner(s) wants to receive pleasure (intensity, frequency, pressure, etc).

  • Positional aids and pervertible (low cost/DIY aids) to position and stabilize the partner in the least painful/restrictive/uncomfortable position. These could include use slings, belts, neckties, bed headboards, etc.

  • Pervertible (spatula, ties, etc) or fetish pieces of equipment (slings, feathers, nipple clamps, etc) as adaptive equipment/modifications to enhance pleasure, desire, and arousal response. In fact, some recent literature encourages use of restrains and bondage to release spasm and provide deep pressure.

  • Subjective goal setting for activities that are not penetration-oriented/orgasm-focused but emphasize on mindful intimacy- seeking and giving pleasure. Eg: Mindful breathing exercises (solo or partnered), non- genital focused massage, sensual stretching techniques, to name a few.

  • Scheduling pleasure to increase anticipation and enhance desire and arousal towards the intimate and sexual acts. Moreover, scheduling pleasure activities can further help people with disabilities to accommodate and adapt physically and psychologically to these activities.

  • Facilitating self and co-regulation using sensory-based play in a consensually agreed structured, controlled environment.

And these are just some of them. I have trained clients for improving their ROM using whips, help fine motor flexibility by manipulating cuffs, and even added guided imagery using Virtual Reality headsets. The reason I added these experiences and examples is not to show I creative I am, but how creative and differently sensory seeking people can be for pleasure. Kink and BDSM is not the solution, but a valid sexual practice people often indulge in.


Occupational Therapy, in its very core, has an inclusive and client-centered approach. Clients are the core of our treatment model as they are the ones who challenge our biases, help to explore our values, and channelizing our creativities into something that serves meaning and purpose for them. Hence, do not underestimate what every one of your clients with visible or invisible disabilities offers in the treatment plan. They can help us guide through how they want and need things to be done for maximizing safer engagement in activities that bring them pleasure and purpose. The moment we normalize this sexual expression and practice is the time we truly start accepting and respecting people and their choices with pleasure.


In the end, remember this,

Sexuality and Intimacy are valid occupations of daily living that may look different for EVERYONE, but equally serve the purpose of sexual freedom and empowerment.



References and Resources:

  1. https://www.theatlantic.com/health/archive/2015/10/when-bdsm-is-therapeutic/412249/

  2. https://onlinelibrary.wiley.com/doi/abs/10.1111/jsm.12192

  3. https://www.dropbox.com/s/28vud0iod10f4rc/Sagarin%20Cutler%20Cutler%20Lawler-Sagarin%20Matuszewich%20(2009).pdf

  4. https://www.vice.com/en_us/article/nee9yg/bsdm-can-provide-profound-healing-experiences

  5. https://hellogiggles.com/lifestyle/health-fitness/how-use-bdsm-cope-trauma-sexual-assault/

  6. https://www.theguardian.com/commentisfree/2015/feb/09/bdsm-good-for-you-fifty-shades-of-grey-relationship


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