BlufBear

I’m a psychiatrist. I’m also a Leatherman. This, apparently, is not a natural combination.

One of these roles allows me to diagnose and treat mental illness. The other involves tall boots, chest harnesses, and an arousal to scent and skin that doesn’t quite fit the medical textbook. But both, in their way, are about knowing people deeply, including yourself. That’s what I thought, anyway. Until I found myself on the wrong end of my own profession’s gaze.

In my early NHS career, I was struggling with depression and anxiety. I did what any reasonable doctor might advise someone else to do: I sought therapy. Unfortunately, the therapist I was referred to worked within the same organisation. And in the labyrinthine ethics of psychotherapy, confidentiality is never as neat as you’d like it to be.

Therapists have supervision. Supervision involves sharing material. In theory, this is for quality and reflection. In practice, it meant the same senior clinicians supervising my therapeutic work were now privy to the leather, the anxiety, the autoerotic asphyxiation. Not because I was unsafe. Not because I’d done harm. But because I’d dared to be honest.

No one said outright that I was unfit to practise. They didn’t need to. The raised eyebrows, the cautious sidesteps, the question marks left hanging in the air were enough. I was learning, quite viscerally, how psychiatry had treated people like me for generations.

If you want to trace the rot to its roots, look no further than Richard von Krafft-Ebing, the 19th-century sexologist and moral panic aficionado. His Psychopathia Sexualis is a veritable museum of alarm about men who liked corsets, or boots, or the smell of rubber. You could call it early sex research. You could also call it a long-winded attempt to catalogue things that gave him a bit of a funny feeling in his trousers.

According to Krafft-Ebing, fetishism was a deviation of the sexual instinct. And not just any deviation. It was a sign of hereditary degeneracy. Your fondness for a pair of leather gloves wasn’t just eccentric. It was pathological. Possibly transmissible.

Then came Freud. Now, I’ll admit it’s tricky to criticise Freud. He laid the groundwork for modern psychotherapy and gave the world a language for talking about desire. But when it came to fetishism, his reasoning took a turn down a particularly peculiar back-passage.

In Freud’s telling, the fetish is born when a young boy realises his mother has no penis. Unable to cope with this shocking revelation, he latches onto something, anything, as a substitute. A shoe, a veil, a belt. It’s all about the symbolic reassurance of a penis-that-wasn’t-there.

I’m not saying Freud was completely off his rocker. But I am saying that a man on that much cocaine might not have been the most reliable narrator. The confidence with which he explained these theories, always male-focused and almost always devoid of curiosity about the actual people involved, set a precedent. One that echoed through decades of psychiatric literature.

By the time the first DSM (Diagnostic and Statistical Manual of Mental Disorders) came out in the 1950s, fetishism was right there, tucked in alongside transvestism and homosexuality under the catch-all category of “sexual deviations”. It stayed that way for decades. A fetish wasn’t something you had. It was something you suffered from.

That’s changed, technically. The latest editions of the DSM make a distinction between paraphilias and paraphilic disorders. ICD-11 (International Classification of Diseases) has done away with the disorders from the pejorative frameworks of ICD-10, aligning more closely with sex-positive, rights-based approaches. Having a kink is fine, so long as it doesn’t cause distress or involve harm. But let’s be honest, this shift, while welcome, doesn’t scrub away a century of moralising.

And then there’s the law. The infamous Operation Spanner case in the UK saw a group of gay men prosecuted for consensual BDSM in the early 1990s. The courts decided you couldn’t consent to that kind of thing, not even in private. Apparently the state has an interest in keeping your pleasures within bounds. We’ll come back to that one. It deserves its own unpacking.

All of this, history, medicine, law, makes it easy to forget that kink, at its core, is human. Sometimes messy, sometimes transcendent. Often both. The first time I stepped into a leather bar, I wasn’t looking for enlightenment. I just wanted to be in a room where I didn’t have to explain myself.

An older leatherman clocked me immediately. When we started to explore our kinks I questioned why we were this way inclined. “Don’t try to understand it,” he said, with a seductive grin. “Don’t overthink it. It’s yours. Just enjoy it. You’ll meet some of the soundest people here. ”

And I did. Not just the flirtations, though they were there. But the conversations, the care, the irreverence. I found a world full of intelligence, humour, and a startling kind of warmth. A chosen family with rough edges and open arms.

I still carry the discomfort, of course. The sense that I’ve been watched from the wrong end of the lens. That disclosure can turn into diagnosis in the blink of an eye. But I carry pride too. Not the sanitised acceptability/corporate kind. The kind that comes from knowing that your desires are not shameful. They are deliberate. They are tender. They are yours.

Psychiatry has a long way to go. But so do we all. The point is not to run from the past, but to understand it. To tell it truthfully. And to wear our histories, like our leather, not as burdens but as armour.

Next time, we’ll look at Spanner. That one’s going to need a bit more unpacking.

And yes, I’ll still be wearing boots.

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Glossary

Autoerotic Asphyxiation
A practice involving intentional restriction of oxygen during sexual activity to enhance arousal. Often misunderstood, it has been historically pathologised in clinical literature but is part of some individuals’ consensual kink practices.

Castration Anxiety
A concept from Freudian psychoanalysis referring to a young boy’s unconscious fear of losing his penis upon realising women do not have one. According to Freud, this anxiety can lead to various sexual “symptoms,” including fetishism. Not widely endorsed today.

Fetishism
A sexual attraction to specific objects, materials, or body parts not traditionally considered erotic in themselves. Historically classified as a mental illness, fetishism is now understood more broadly as one part of normal human sexual variation.

Krafft-Ebing, Richard von
A 19th-century Austrian psychiatrist whose 1886 work Psychopathia Sexualis categorised numerous “sexual perversions,” including fetishism and homosexuality. His writings helped codify the medical pathologisation of non-normative sexualities.

Paraphilia / Paraphilic Disorder
In modern psychiatry, a paraphilia is an atypical sexual interest (such as fetishism or sadomasochism). A paraphilic disorder is only diagnosed when that interest causes distress or harm. This distinction was introduced to reduce the over-pathologisation of consensual kink.

Psychopathia Sexualis
A foundational (and notorious) 1886 text by Krafft-Ebing which categorised and medicalised a wide range of non-reproductive sexual behaviours. A mix of case study, moral panic, and early sexology.

Operation Spanner
A UK legal case from the early 1990s in which a group of gay men were prosecuted for engaging in consensual sadomasochistic sex acts. The case set a legal precedent that consent is not always a defence to bodily harm, with ongoing implications for BDSM communities.

Supervision (Psychotherapy)
A process in which psychotherapists discuss their clinical work with more experienced colleagues to ensure safe and ethical practice. While essential to training, it can create tension when the therapist and client work within the same professional network, as disclosure may circulate indirectly.

DSM (Diagnostic and Statistical Manual of Mental Disorders)
The standard classification system used by American psychiatry to define and diagnose mental health conditions. Earlier editions classified many forms of queer and kinky sexual behaviour as disorders. The most recent edition (DSM-5) draws clearer lines between consensual kink and pathology.

Freud, Sigmund
An Austrian neurologist and founder of psychoanalysis. While pivotal in bringing sexuality into modern psychological thought, his theories—particularly on fetishism and female sexuality—are now often critiqued for their heteronormative and patriarchal biases.