THE DOOR TO THE BOY'S BEDROOM was locked. His father knocked, waited, knocked again.

Hearing nothing, the father broke open the door. He saw his son hanging from a closet door, a cloth strap around his neck.

The boy, 16 years old, a natural athlete, seemingly happy, the youngest of four children in a strict, Roman Catholic, blue-collar family, was dead.

But his death was not another of the teen-age suicides that have become epidemic in some areas, although some newspapers and television stations in the Midwestern community where he lived reported it that way. The death was an accident.

The boy died trying to enhance sexual arousal by briefly choking off his breathing.

The boy died trying to enhance sexual arousal by briefly choking off his breathing. The resulting lack of oxygen in the brain, for as little as 60 seconds, can produce an altered state of consciousness that some people find pleasurable, researchers say.

1,000 a Year?
The authors of a recently published study of 150 cases of autoerotic asphyxiation, the most comprehensive scientific examination of the practice to date, estimate that from 500 to 1,000 such deaths occur annually in the United States.

Interest in the phenomenon is growing as a result of the attention being focused on teen-age suicides.

As many as 25 percent of teen-age suicides may be misreported autoerotic deaths, said Lt. Vernon Geberth, a homicide specialist with the New York Police Department.

The typical reaction from people who hear for the first time about autoerotic death is astonishment.

Sometimes the inaccurate reporting is the result of efforts by families to conceal autoerotic deaths by dressing the victims and hiding photographs and sexual equipment, Geberth said. The typical reaction from people who hear for the first time about autoerotic death is astonishment.

Mostly White Males
The father whose son died of autoerotic asphyxiation said he had never heard of the practice, but he realized what must have happened because the boy was partly undressed and had placed photographs of nude women in front of him.

The father spoke to a reporter only on condition that his family not know he was doing so, fearing his wife would be troubled by the publicity. In deference to his request, some of the details in this account were changed, but his words are recorded as he spoke them.

Lt. Geberth, who deals with autoerotic deaths in courses he teaches to police and social workers, said its victims are most often white males. Most die from asphyxiation with a rope or cloth noose. Beyond that, the variations are endless.

Many are found elaborately tied with ropes and chains. Men are frequently dressed in women's clothing. Sexual stimulation is provided by everything from hard-core pornography to newspaper lingerie advertisements.

One woman was found dead beside her bed, a rope around her neck. A slip knot intended to release the noose had become tangled in her long hair.

FBI Courses
Her face and head were bruised; to the untrained eye she looked like a murder victim. Geberth explained that the wounds were from her struggle to free herself.

An officer who'd taken the FBI course accidentally hanged himself while on duty.

Neil Purtell, an FBI agent in Madison, Wis., teaches FBI courses on autoerotic deaths but does so with some trepidation. "We're always afraid to give these courses because somebody is going to go out and try it," he said. "It's happened."

Geberth told of a police officer who worked nights and had taken such a course. He was found one morning in an empty warehouse. He had accidentally hanged himself while on duty.

Geberth said he believes the spread of information on autoerotic asphyxia can be helpful. He said people who practice autoerotic asphyxia and their parents must be told how dangerous the practice is.

Park Dietz, a psychiatrist at the University of Virginia, is one of the authors of "Autoerotic Fatalities," a book that analyzed 150 cases of autoerotic death, 132 of them by asphyxiation.

Abnormal Preferences
Dietz said he does not think that autoerotic asphyxia is primarily a learned behavior. He said most but not all people who derive pleasure from asphyxia have innate abnormal sexual preferences.

"By puberty, boys who are going to be masochists have identified that they like it when they are held down in a fist fight, or when their mother shames them in public," Dietz said.

These individuals may experiment with slicing their skin, inserting needles into themselves, giving themselves electrical shocks and constricting their necks.

"They usually don't die by cutting their skin or inserting needles," Dietz said, "so those cases don't show up in a study like ours."

People with normal sexual feelings would not find their pleasure enhanced by asphyxia, which produces an "altered bodily state" due to oxygen deprivation in the brain, said Dietz.

"Most people find the experience of hypoxia (a shortage of oxygen) intensely unpleasant. Anyone who has choked at the dinner table and survived can describe the experience," he said.

Boys Experiment
Dietz said people who do enjoy it have a predisposition toward masochism or toward a flirtation with danger. That does not mean that every victim of autoerotic death is a sexual deviate, he added.

"It's also true that boys experiment with things even though they have no predilection for it," he said. "We know of one case in which a boy who was masochistic taught another boy, and the other boy died from it, although he may not have been a masochist and probably wasn't."

"It's important to recognize that for adolescents it may be nothing more than experimentation of what they regard as a harmless nature without any conscious sexual or erotic purpose," Dietz said. He noted that many adults who die from autoerotic practices appear to be of above-average intelligence.

It's always surprised investigators that the adults tend to be architects, engineers, professionals.

"It's something that everyone who has looked at these cases has observed," he said. "It's always surprised death investigators that the people tend to be architects, engineers, professionals."

Symptoms to Note
Professor Burgess said there are symptoms of autoerotic asphyxia that parents and relatives can watch for. Among the signs are marks on the neck; bloodshot eyes; episodes of "spaced out" behavior, indicating oxygen deprivation; an interest in ropes, and a habit of spending time alone locked in a secret place.

"If they have any suspicion their child is practicing it, they should clarify with the child how dangerous it is," she said.

Behavior therapy is one solution. The other is drugs that reduce the sex drive.

If the practitioners of autoerotic asphyxia could be identified, they could be treated, said Dietz. Behavior therapy, in which a person is trained to prefer less harmful sexual activities, is one solution. The other is the use of drugs that reduce the sex drive, he said.

The problem that remains is identifying the practitioners while they are still alive and can be treated.

Omaha Policeman Sees No Problem Locally
Autoerotic asphyxiation is "not a problem in Omaha, Nebraska," Police Department Capt. John F. Mitchell said.

Mitchell said he was aware of only a couple of cases in recent years.

"It's not a common practice among our teens," he said. "But it does crop up every once in a while."

One New York City police official estimated that as many as 25 percent of teen-age suicides there might be misreported autoerotic deaths. Mitchell said that figure is way too high for Omaha.

"It would certainly be less than 1 percent," Mitchell said. Autoerotic deaths in Omaha would be classified as accidental deaths, not suicides, he said. However, details may be kept out of news reports, he added. "Some of the intimate details might be put in reports not available to the press," Mitchell said.

AFTERWORD:

On October 25, 1985, after deliberating 5¹/2 hours over two days, federal jurors in Houston, Texas awarded Diane Herceg and Andy Vines $182,000 in damages against Hustler magazine for the death of Herceg's son and Vine's best friend, Troy Daniel Dunaway, age 14. Dunaway had been found hanged with a belt in a bedroom closet Aug. 6, 1981. At his feet lay a copy of Hustler magazine open to an article entitled "Orgasm of Death", which described autoerotic asphyxiation.

Although the jurors would not comment on how they reached their decision, Michael M. Essmyer, attorney for the plaintiffs, had argued that because their publication caused a fatal injury to a child, violating a Texas law, Hustler is not protected by First Amendment freedoms. "We have the right of freedom of speech, but it needs to be responsible," Essmyer said.

Two years later, in April 1987, the 5th U.S. Circuit Court of Appeals reversed the decision. Judge Alvin Rubin, writing on the panel's behalf, pointed out that an editorial note placed prominently on the page, as "the first text the reader will read," as well as several instances within the body of the article, sufficiently emphasized the dangers of the practice and recommended that readers "DO NOT ATTEMPT this method." They also held that the Hustler article neither advocated the practice nor incited its readers to attempt it.

In a refreshingly lucid and perceptive interpretation of the First Amendment — one that is often lost in the passion of debate — Judge Rubin reminds us that:

The constitutional protection accorded to the freedom of speech and of the press is not based on the naive belief that speech can do no harm but on the confidence that the benefits society reaps from the free flow and exchange of ideas outweigh the costs society endures by receiving reprehensible or dangerous ideas.

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