Stephen Morris

This paper was first published in the journal Drugs and Alcohol Today November 2018.

In a myriad of ways, the word “trauma” features in daily communication the world over. However, extending an invitation for people to consider the meaning and realities associated with the word one is, more often than not, met with resistance, a wish not to know. Trauma, by its very nature, takes us to the vulnerability of the human condition. Trauma reminds us all of our fragility and the everyday potential of our demise. It is not surprising then that we prefer not to know. Those working with vulnerability will at some point encounter trauma; vulnerability and trauma share a co-existence. This paper provides an invitation to those working with the specific vulnerabilities of chemsex and its associated populations to think about trauma. To encourage this thinking, I bring together the resources that have enabled my own thinking including psychoanalytic theory, a trauma clinic intervention model and experiences of the men I work with on a daily basis in the consulting room.

Whilst chemsex is a relatively new phenomenon, trauma is not. Freud (1920) borrowed the word from physical medicine, where it was used to describe tissue damage, and applied it for the first time as a metaphor to a psychological process by which the protective functioning of the mind can too be pierced and wounded by events. The early understanding of trauma recognised that the mind exists within a protective shield which is protected by its ability to maintain equilibrium by being highly selective of external stimuli. A traumatic event is one that breaks through or overrides this highly selective discriminating process and the mind becomes flooded with a degree of stimulation which is more than it can sense or manage. This feels like something very violent has happened or actually happened in the external world and results in a massive disruption, a breakdown of internal protective mechanisms.

Over the decades, the early understanding of traumatic experience has hardly changed. The awful truth is that despite our wishes and what we tell ourselves, the world is not safe and has never been safe. Life does on occasions massively disrupt our capacity for delusion and in doing so, we experience profound losses. Looking beyond the particular manifestation of trauma, what occurs in relation to them all is the loss or perceived loss of:

■ our established way of going about life;

■ our established beliefs about the predictability about the world;

^■ our established mental structures (i.e. our internal working models based on external influences in early development);

■ our established mental structures (i.e. how we make sense of things); and

■ our established defensive mechanisms (i.e. how we protect ourselves both physically and psychologically) (Garland, 1998).

When we refer to someone as being traumatised, it is these losses that they are experiencing, or perhaps more accurately, protecting themselves from experiencing. Indicated in this array of loss is the investment we all make in believing without question in the predictability of the world and in both external and internal protective functions. “Bad things happen to other people not me”; when this belief is breached anxieties and paranoid beliefs take over and life is not the same. Even when safety is restored the traumatised person is often unable to recognize this, their common statements are; “I’m not what I was”, “My life has just gone to pieces”, “I don’t enjoy anything these days”, “I don’t care about anything”. The main problem with trauma is that everyone else knows the incident is over but not the person who has experienced it.

Diagnosis

For many years, clinical recognition of what caused someone to experience trauma was as rigid and fixed as our protective delusions. The thinking until recently was that a diagnosis of trauma could only be considered if there had been a direct experience of a threat to life. Following much debate and a significant delay in the publication of the current Diagnostic and Statistical Manual of mental disorders the following criteria was approved. (APA. 2013)

The causes of trauma

■	Direct personal experience of an event that involves actual or threatened death or serious injury.
■	Threat to one’s physical integrity.
■	Witnessing an event that involves the above experience.
■	Learning about unexpected or violent death, serious harm, or threat of death, or injury experienced by a family member or close associate.
■	Memories associated with trauma are implicit, pre-verbal and cannot be recalled, but can be triggered by stimuli from the environment.
■	The person’s response to aversive details of traumatic event involves intense fear, helplessness or horror. In children it is manifested as disorganised or agitative behavior.

This wider criterion makes it possible for clinicians to consider the full impact of vulnerabilities such as: harassment, abandonment, abusive relationships, rejection, co-dependence, physical assault, sexual abuse, partner battery, employment discrimination, police brutality, judicial corruption and misconduct, bullying, paternalism, domestic violence, indoctrination, being the victim of an alcoholic parent, the threat or the witnessing of violence (particularly in childhood), life-threatening medical conditions and medication-induced trauma; catastrophic natural disasters such as earthquakes and volcanic eruptions, large-scale transportation accidents, house or domestic fire, motor vehicle accident; mass interpersonal violence like war, terrorist attacks or other mass victimisation like sex trafficking, being taken as a hostage or being kidnaped; long-term/short-term exposure to situations such as extreme poverty or other forms of abuse, such as verbal abuse; committing crime and involvement with the criminal justice system.

The Symptoms of Trauma

Clinicians confronted with the above can then assess the reported situation in conjunction with the following symptoms:

■ re-experiencing of the event (intrusive recollections involving images, thoughts or perceptions, recurrent distressing dreams, reliving, illusions, hallucinations, dissociative episodes);

■ avoidance (persistent avoidance, numbing of responsiveness, efforts to avoid thoughts, feelings or conversations that act as a reminder, efforts to avoid activities, places or people that arouse recollections, inability to recollect an important aspect of the trauma, marked diminished interest or participation in significant activities that used to be pleasurable, feeling of detachment/ estrangement from others, restricted range of affect, sense of foreshortened future);

■ arousal (increased arousal not present before the trauma including difficulty falling or staying asleep, irritability and outburst of anger, difficulty concentrating, hyper-vigilance, exaggerated startle response); and

■ life disrupted (significant distress or impairment in social, occupational or other important areas of functioning).

Sexuality and vulnerability

Application of this criterion specifically to men involved in chemsex is yet to become the subject of research. There is evidence indicating that the risk for incidents of post-traumatic stress disorder in the general population is 4 per cent for men and 10 per cent for women. In the LGBT population, the risk increases to 9 per cent for men and 20 per cent for women (Koenen, 2012). When considering other mental health statistics in relation to the LGBT community, the vulnerability to trauma is apparent and summarised in the following statement. “LGBT people subconsciously perceive that they are fundamentally defective and develop extremely low self-worth, manifesting in depression, suicidality and other negative feelings” (Todd, 2016). The Stonewall Gay and Bisexual Men’s Health Survey provides further indication to the levels of vulnerability; in x1 year 3 per cent of gay men and 5 per cent of bisexual men attempted to take their own life compared to just 0.4 per cent of heterosexual men. In the same period, 15 per cent of gay and bisexual men self-harmed compared to 7 per cent of heterosexual men. In total, 50 per cent of gay and bisexual men felt that life was not worth living compared to 17 per cent of heterosexual men. One out of seven gay men experience moderate to severe symptoms of depression and anxiety compared to 2 per cent of heterosexual men.

Significantly, and specifically in recognition of the causal factors for high levels of substance use within the gay male population, Felitti (2006) states that “Chronic recurring humiliation is the most damaging of all childhood trauma’s, 15% above all other trauma including sexual abuse”.

Chemsex and trauma

For those who regularly sit with gay men involved in chemsex in the consulting room, be that in a specialist counselling service, sexual health, substance use service or criminal justice context the above statistics will not come as a surprise. Within the last year, slightly different versions of the following clinical examples have presented themselves to me on repeated occasions. The first example indicates a pre-existing unresolved historical trauma and the self-medicating impact of chemsex. The second example of trauma is less complex, but caused by unpredicted events taking place in the chemsex setting.

Example (1) Anton ( fictitious name) has been in the bar for about 10 mins and has started to feel uncomfortable; so much so that he is finding it difficult to keep still. He has almost finished his drink and his reaction to the thought of going to purchase another one is an indicator that he should leave. He is shaking. Now the venue has become quite crowded and he knows what will start to happen next, especially if someone pushes against him. The last time this happened it had triggered nightmares that had continued for two weeks, the same nightmares that had haunted his childhood and reminded him that even in his sleep there was no escape from the abuse he experienced from his father. He had sought help for these feelings of “claustrophobia” as that is what it seemed to be, but nothing had worked. Now, as if to confirm that, he pushed his way to the exit and as he reached the outside breathed in the cold air suddenly feeling he was about to faint. Leaning up against the wall, he pulled his phone grasped in his hand and searched frantically for the nearest chillout (chemsex environment). With the assistance of an Uber, in an hour he could hardly recall this feeling of vulnerability and suffocation. After an extra-large bump (measure of drugs), he was flying and feeling like he controlled the world. In the months to come, Anton makes no further attempts to visit any bars and instead became a regular at local chillouts. He eventually seeks intervention; not in relation to his childhood experiences but because he has become increasingly paranoid and has stopped going to work. He only feels safe now when he has slammed (injected drugs) and that is most days.

Example (2) In the early hours of a cold December morning, Primack ( fictitious name) runs out into a deserted London street. He is naked, clutching his clothes in his hands. Aware of his vulnerability, he stops and hurriedly gets dressed looking around to check if anyone has seen him. He is shaking and trying not to cry. He is a little high; the mephedrone was ok but nothing too potent. The images that filled his mind were not the symptoms of paranoia or delusion, they were real. He had seen them only moments before. Worse than the images were the sounds which he just could not forget. He manages to dress himself and by the time he reaches the police station he is thinking clearly and determined to make sure the police take him seriously. They do; three months later he is visited by a police liaison officer who promises to support him once he has provided his evidence to the court. He does and later that week the owner of the house he ran from that December night is sentenced to three years imprisonment for the possession of indecent images of children. But that was three months ago and still Primack is not sleeping, still those images fill his mind and the sounds of the child whimpering he cannot get out of his head. He cannot bring himself to hook up with anyone; he is not enjoying life at all. Primack has always enjoyed life, has had good friends and has maintained regular contact with his family but now his motivation to do this is low.

Simple intervention

Recovery for both of these men is possible but each will require a different response. For Primack, it is possible to recognize that his trauma takes places in the context of an established lifelong secure experience of the world. Witnessing painful and distressing material broke through his safe view of the world and for a few moments confronted him with a different reality. The loss of safety, the loss of trust in others and the loss of his ability to understand resulted in his internal equilibrium becoming disturbed and unbalanced. The aim of intervention in this case is to re-establish the capacity to cope and to do this by mobilising the individual’s own resources. Men like Primack do not come for intervention wanting years of analysis. They come wanting help with an overwhelming external event and wanting things to be restored to how they were before. This is achievable by the intervention focussing on the external event, by talking about it, by gaining a perspective about it and to mourn the loss of a previously held view of the world. In relation to his use of chems, help, if he chooses, may then be required to address causal factors of the original vulnerability so as to enable choices informed by awareness and self-care. This work is possible within a four-session therapeutic consultation as established at the internationally renowned Tavistock Clinic Trauma Unit (Young, 1998). For Anton, his experience of the world is very different and founded in experiences of insecurity and the trauma of childhood abuse. Anton learned early in his development to push pain away, to be fearful of intimacy and connection and, although hardwired as we all are to seek connection, he learned a series of self-management techniques to manage it, avoid it and keep it at bay. But repression of such basic needs did not remove his yearning for it. This cycle of yearning and pushing away is informed by the repeated vulnerability of unaddressed psychological pain.

For Anton and other gay men like him, the experience is of a double vulnerability rooted in experiences associated with growing up gay in a hetero-normative world and which include:

■ disrupted or unavailable secure base because of parental rejection;

■ searching for connection regardless of risk;

■ childhood experiences of exclusion;

^■ repeated humiliation;

^■ daily homophobia;

■ shaming, rejection, social isolation; and

^■ repetition of abuse.

These common experiences create an urgent need for relief. Creative defences established in early development, although mentally draining, initially serve us well in managing the daily stressors. But when the cause is not addressed and the defences are still required in adulthood greater effort and more powerful means are required. Consequently, the means of relief become a dependent feature of daily life and regardless of its cost. Ironically these repetitive cycles (Figure 1) serve only to take us back to the very thing we are seeking to avoid in the first place.

This cycle of repeated pain will be familiar to those working with vulnerable populations. The default response in recent years to this process has become referral to therapy and often without due consideration or assessment of its appropriateness. Eventually a long-term therapeutic intervention may be appropriate but, in the early stages of someone presenting as caught up in this cycle, meeting the immediate internal and external expectations of a therapy process is often not possible. To process original trauma and to relinquish established coping mechanisms requires an extraordinary degree of courage, effort and motivation. It also requires established resources of support and resilience. A therapeutic process will highlight and bring to consciousness the pain of trauma along with an acute awareness of associated despair and shame. To contain such powerful affects, a rigorous psychological confidence is required. Few men taking the initial steps to think about trauma and involvement in chemsex will not be able to do this, it is all too painful to think about.

Hope and resilience

There are other tasks to achieve before long-term intervention is considered. These tasks are not complex and are in fact quite simple. Care is needed to avoid thinking that seemingly complex issues require complex responses. Complexity has the capacity to frighten people away and make professionals feel inappropriately omnipotent. In recognition of this, my plea is, not for therapy, but for the instillation of hope and the growth of resilience.

For the man whose coping mechanisms are beginning to fail or are becoming a problem in their own right, then growing and maintaining hope is crucial. All professionals, regardless of their role, have an important part to play in this crucial process. A service that is trauma aware does not require everyone to be a therapist, it requires everyone to give the same consistent messages and information both implicitly and explicitly. Such messages conveyed need to address:

■ recognition – the ability to witness the reality of the person concerned;

■ psycho-education – provision of basic trauma information;

■ therapeutic relationship – a non-judgmental warm and open manner;

■ trauma awareness – a knowledge base within the professional;

■ identify impact of trauma – recognition of symptoms;

■ empathy and compassion; and

■ specific intervention – referral pathways to trauma clinics as required.

It is helpful to think of hope and resilience as mineral resources; they diminish and grow depending on the conditions available. Individual practitioners, ranging from receptionist to case worker, all can assist in creating the right conditions whereby even the briefest of contact will contribute to the growth of hope and resilience. Provision of the following allows for this:

Recognition of survival skills – positive regard and recognition of daily, sometimes moment by moment, survival;

Mindfulness – simple  techniques  can  be  encouraged  using                  apps  and practicing in appointments;

Reach out and connect with others – encourage awareness of the wider community;

Care and support – can be and often needs to be practical;

Pay attention to needs and setting of boundaries;

Self-awareness and self-confidence – referral to classes and other non-statutory services working with these issues;

■ Realistic expectations and goals – small achievable steps;
■ Empathy and compassion
■ Meaning and purpose – identifying areas of life that matter and have relevance.

Services should not underestimate the holding and containment they provide just by offering a warm, relaxed atmosphere and a routine process. I have heard on more than one occasion men commenting that following an appointment at their sexual health clinic they enjoy remaining in the waiting room and are not so keen to rush off as many would imagine. It is significant, if not a sad reflection on a wider society, that the prison service is sometimes referred to as the “brick mother”. For some, it offers a longed for safety and care.

Connection

It is evident in both the causal and symptomatic indicators of trauma that its main impact is disconnection. Trauma separates a person from the world around them and from the safety of their internal world. Separation and disconnection do not allow for links to be made. The failure of linking accounts for many of the symptoms of trauma (Bion, 1967). Trauma symptoms enable its overwhelming features to be broken down into temporary manageable pieces, e.g., flashbacks of isolated bits of experience. Symptoms and coping mechanisms alike, work to keep the traumatic experience out of the flow of experience and so it never becomes part of the past. To bring someone out of the past requires safe and reassuring links and connections in the present. Chemsex provides an illusion of this process but eventually it fails miserably ending in massive disconnection. Safe connection makes it possible to think; in developing our response to chemsex-related trauma then thinking and connection need to become our essential priorities.

References

American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (DSM-V), American Psychiatric Association, Washington, DC.

Bion, W.R. (1967), “Attacks on linking”, in Aronson, J. (Ed.), Second Thoughts, Rowman & Littlefield, New York, NY, pp. 93-109.

Felitti, V. (2006), “The origins of addiction”, Evidence from adverse childhood experiences.

Freud, S. (1920), “Beyond the pleasure principle”, SE. 18, pp. 1-4.

Garland, C. (1998), “Thinking about trauma”, in Garland, C. (Ed.), Understanding Trauma: A Psychoanalytical Approach, Karnac, London, pp. 9-31.

Koenen, K. (2012), “Higher risk of PTSD in LGBT youth”, American Journal of Public Health, Vol. 102 No. 8, pp. 1587-93.

Todd, M. (2016), Straight Jacket – How to be Gay and Happy, Transworld Digital, London.

Young, L. (1998), “Preliminary interventions – the four session therapeutic consultation”, in Garland, C. (Ed.), Understanding Trauma, Karnac, London, pp. 63-77.

Consent and Crime in the Chemsex Context.

Stephen Morris – Chemsex Crime Operational Lead – HMPPS & Operational Co-Lead Metropolitan Police (Operation Sagamore)

(This paper was first published in the journal Drugs & Alcohol Today. Nov 2018).

(Operation Sagamore was launched in 2017 by Stephen Morris and Inspector Allen Davis as an operational partnership response to chemsex crime)

The title of this paper is a statement made by a man at the end of his treatment following conviction for several sexual offences. It is powerful in conveying a simple and accurate meaning of consent. Legally, consent is not complicated and can be simply defined as: permission for something to happen; or agreement to do something. The context of consent, however, is complicated and complex, none more so than when it becomes an issue within chemsex.

If we are to gain a full appreciation of consent-related complexity, we must also gain an understanding of the wider picture concerning chemsex and crime. This paper provides that wider picture. With the exception of breaching of drug-related law, not all men who engage in chemsex are committing offences but, as we are discovering, a not insignificant percentage are, and this needs to be cause for concern.

Complex and high-profile crimes are usually in the public domain for a very short time. A disturbing headline at the centre of media attention on one day will usually be replaced by an equally dramatic story the following day. The public domain is of course only part of the story; for those more closely involved – the victims, the perpetrators of crime, their families, friends, partners and those professionals who work with them – things do not pass so quickly. Crime, from whatever perspective, outside of media interest is much more complex and multi-faceted then any attention-grabbing headline. For those involved, crime is demanding and absorbing, certainly over months and maybe even years. Throughout the long dark Winter of 2017 two unconnected gay men convicted for the crime of murder filled my thoughts. In particular, it was the context of their crimes that I was not able to distract myself from. The context was new, unheard of and deeply concerning.

Both men had committed their crimes in the context of chemsex. The defining features of chemsex were present including pre-existing and present vulnerability; the substances used; the means of administration; the vehicle of connection; the motivation and environmental factors. But seldom, it appeared from existing research, had the consequences of chemsex ever been murder or any other crime, with the exception of course of drug offences. The chill of this emerging recognition motivated me to look further and look backwards. I trawled through records of previous clients I had known to be gay men. I looked closely at the assessments and court reports I had written to direct sentencing, to recommend treatment and to ensure a rehabilitative justice was afforded to them as they rebuilt their lives. I remembered their often terror filled faces as they prepared to stand before the judges, their trembling voices as they quizzed me about prison and probation officers and what should they expect. I re-read line by line the detail of their offences and there it was, in the light of my new-found awareness, crimes committed in the full definition of the chemsex context.

It was a powerful reminder of the dynamics surrounding early recognition of organised child abuse which I had experienced earlier in my career: when we do not know, we do not see. It is what clinicians hear in the consulting room that so often leads the way and invites us to think the unthinkable.

Crime Profile

Throughout the remainder of that Winter, I continued to piece together other evidence and conducted a scoping exercise across relevant professional groups. The emerging picture, that until then had not been recognised or reported, revealed criminogenic features relating to:

■ complex levels of vulnerability

■ combined victim and perpetrator experiences

■ lack of knowledge in relation to consent

■ confusion as to what constituted a sexual crime

■ little understanding of what happens if you commit a crime

■ a variety of sexual crimes

■ a variety of non-sexual crimes

■ a blurring of fantasy with reality

In relation to the crimes leading to arrest, trial and conviction, the range of non-sexual crimes included:

■ domestic violence

■ violence (GBH, ABH, assault, stealthing)

■ harassment

■ possession of an offensive weapon

■ stalking

■ robbery

■ theft

■ blackmail

■ murder

■ drug related (supply, possession)

The sexual crimes included:

■ rape

■ sexual assault

■ internet crime (downloading, making, distributing, live streaming) extreme pornography

■ child abuse

■ exhibitionism

■ outraging public decency

■ bestiality

Demographics

This challenging combination of factors was made even more explicit by listening to the men involved. Their accounts were, of course, not shaped by a professional agenda and often did not reflect professional or public held assumptions. Collectively, the overall profile of those involved revealed the following demographics. All ages were represented in a range from 21 to 60+. The larger percentage reflected a middle-class lifestyle with related careers and earnings. The majority had no previous experience of the criminal justice system. Many had experienced multiple loss, including loss of job, income, housing, partner and friends. A smaller percentage of the men had apparent vulnerabilities at the time of offending including mental health diagnosis, homelessness, unemployment and conflicted interpersonal relationships. In common, all men had negative early life experiences linked to their identification as a gay male and included varying degrees of bullying, discrimination, rejection, shaming, humiliation and violence.

The wider dynamics of consent

If we are to consider the issue of consent, then our thinking and understanding needs to be informed, not just by what we know and refer to as the “chemsex context” (Bourne et al., 2015) but by the lived experience of the men involved and by an awareness of the forensic dynamics that inform crime. Equally important is awareness of what leads men into chemsex and how, for some, the motivating factors can lead to the commissioning of offences.

Central to a forensic psychoanalytic understanding of crime is the important recognition that a criminal act is a communication, and usually a communication of something that cannot be said (Cordess, 1996). Applying this thinking to chemsex-related crime, the theme of vulnerability and denied vulnerability, with all its psychological consequences, can be understood as a significant causal factor which when not spoken about, when denied and when pushed away can increase the risk of offending.

Criminal intent and absence of intent

In relation to the perpetration of chemsex-related sexual crime it is possible to recognise that there are those who commission an offence with a seeming lack of criminal intent. They have not planned, targeted or groomed but nonetheless they have created a victim and therefore remain subject to the whole criminal justice process. The crime in this situation has usually taken place in a highly sexualised environment where disinhibition and increased libido are powerful influencing factors on thinking and behaviour. Confusion and a distortion of reality are often present in the offence accounts, as is minimisation of the offence and avoidance of taking responsibility. An example of associated confused thinking (this is a not uncommon statement) would be “someone did that to me last week and I didn’t mind”. Also indicated in this statement is the prevalence of men who have offended and also been offended against.

To commission a sexual offence, research tells us that internal inhibitors need to be overcome (Finkelhor, 1984). The overcoming of a natural locus of self-control is usually enabled by an internal process of “self-talk” which provides a series of reasons to justify committing an offence including motivation to do it, overcoming external inhibitors and overcoming the victim’s resistance. Although someone may not have intended to commit a chemsex-related offence the prosecution will recognise that even with reduced inhibitions, cognitive ability and permission-giving thinking would have all needed to be functioning for an offence to have taken place. A defence may well make a plea for mitigation, but it would be rare indeed for any evidence, for or against, to not recognise these contributing factors.

Perpetrators

It is also important to acknowledge the presence of those who have intentionally and knowingly committed offences. Although initially not recognised, over time this group of men has become identified as a significant and concerning proportion represented in both investigations and convictions. These are men who have purposely sought out or created the chemsex context in order to commission offences. They are identified as having an obvious awareness of what they have done and intended to do. There will be evidence involving pre-meditation, grooming and targeting of victims. There will be little remorse, lacking apparent guilt and there is often a previous history of offending. These men will often possess an understanding of the criminal justice system and will seek to justify their crimes. They will be aware of the vulnerability of their victims and those caught up in the chemsex scene. They will know that many victims will not report the crime to the police, due to a fear that the police will pursue investigation and prosecution in relation to the victim’s purchase and use of substances. When the latter is reality, the usual tactics and threats perpetrators use to silence their victims are not required. The silencing on these occasions has been done by the state. This is clearly a very unsatisfactory situation. Especially that the main LGBT agency working with victims of crime report that 95 per cent of victims from a chemsex situation will not disclose their victim experience to the police (Bewley, 2017).

Professionals working with men who commit sexual crime know that they often talk with each other, network and organise their criminal behaviour together. There are indicators, apparent in recent cases of chemsex crime, of networking and behaviour suggesting an organised approach to the commission of serious offences.

An informed criminal justice response

Both intentional and apparently unintentional sexual crime need to be met with an informed criminal justice response and an increase of awareness from within the LGBT community, sexual health services and the judiciary. The response that I have been responsible for developing within the London Division of Her Majesty’s Prison & Probation Service recognises the need for victims to know that those who have offended against them by inflicting often long-lasting physical and psychological harm will be subject to a relevant sentencing, and that those who have offended, regardless of intent or not, will receive appropriate assessment of risk, and opportunity for reparation and intervention to address their needs to prevent the creation of more victims.

Following conviction, care is required for all involved to not repeat the factors that have informed the development of offending behaviour. This means respect for the fact that it is the sentence that is the punishment and not how the sentence is carried out. Prison or a community probation sentence is required to be rehabilitative and not punitive in application. In recognition of this, for a full restorative justice to be applied to chemsex-related crime, the following features are required:

■ Criminal justice agencies to assist the LGBT community in increasing awareness of chemsex crime, its causes and its consequences.

■ Opportunities for agencies from both sectors to work together to increase awareness and skills that enable greater recognition of victim experiences, offending indicators, provision of preventative measures (e.g. media campaigns addressing vulnerabilities and consent) and opportunities for community inclusion for those who have been convicted on release from prison or whilst serving community sentences. ■ Information-giving briefings to criminal justice professional groups to enable a full understanding of chemsex, its causes and its context in contemporary sexual health and gay male culture.

■ A chemsex court assessment tool to enable early recognition of cases, especially where the chemsex element has not been recognised at arrest. The tool has been designed to utilise user friendly language, to encourage sensitive responses to the presence of shame and prevent repeated experiences of misunderstanding, exploitation or oppression. It also enables the provision of specific information given to sentencers with the aim of encouraging appropriate sentencing options and avoiding setting an offender up to fail due to lack of awareness of related life-style and impact of chems.

A treatment tool kit for use by probation officers enabling appropriate intervention. Existing standard programmes within many criminal justice agencies (Ministry of Justice, 2013) are characterised by heteronormative assumptions and language. On the whole they are alien to gay males, and particularly those who have committed a chemsex-related crime. They also require a group treatment modality, which for many gay men risks repeating dynamics of shaming and discrimination. The chemsex tool kit (Morris et al., 2018) has been designed to meet the requirements of a Rehabilitation Activity Requirement (RAR) (HMPPS, 2014) that can be attached to a sentence. It comprises ×36 sessions and is delivered on a one-to-one basis. The intervention covers chem use awareness; offence-focussed work; self-development; resilience; self-esteem; post-traumatic stress disorder (PTSD); and management of the criminal justice experience. Again, the provision of the tool kit will enable sentencers to consider noncustodial options and greater use of meaningful intervention within the community.

■ The provision of in-depth training to prepare identified probation officers throughout the local area to deliver the RAR intervention tool kit. As well as familiarisation with the various sections of the tool kit, those training were also provided with the opportunity to explore the construct of gay male sexuality, its discrimination, effects and an overview of trauma informed self-development.

■ A professional support structure for probation officers holding cases. The complexity and extreme nature of behaviours associated with the crimes and related issues can and do cause distress to staff. Overwhelm, not understanding and lack of experience of gay sexuality can leave staff feeling inadequate and vulnerable. A regular multi-agency professional peer support group has been operating in the London Division (Morris and Stuart, 2018) for several months and has provided a rich learning experience across the professional groups involved. It has increased networking, sharing of resources and the provision of wider resources to the men involved.

■ In relation to the above needs, the provision of individual case consultancy to officers holding cases has been an essential and useful provision. Officers without any awareness of chemsex, gay male sexuality, gay culture and the gay scene can feel out of their depth. Chemsex and its dynamics extend far beyond the principles of diversity, and unless the risk of professional limitation is recognised and remains unaddressed the impact on the case work relationship can impair the establishment of trust, the presence of a therapeutic alliance and ongoing management of risk.

■ Many of the crimes reflect the secrecy and isolation associated with chemsex behaviour. It is widely recognised that effective intervention in criminal justice needs to be based on connection and an appreciation of the unique dynamics involved in any offending behaviour and offence. Other opportunities for professionals outside of gay culture and sexual health were needed and a variety of scoping meetings, workshops, conference events were held and are ongoing to facilitate connection and to ensure replication of offence dynamics remains conscious in the professional context.

■ Connection with LGBT community events and encouragement for the men and their probation officers to attend is a practical means of addressing the causal factors of isolation and lack of awareness. Creative client supervision remains a seldom recognised but important means of intervention within probation practice.

■ What we hear in the consulting room must also lead into and inform research. As indicated, there is a paucity of research covering chemsex-related crime. I have identified a three-phase approach in our research that will evidence and inform the areas of: offender profiles and demographics, intervention and sentencing. Each of these domains will need evidence to shape and resource continued responses.

From pain to violence

At the core of forensic psychotherapy practice is an often uncomfortable landscape that reveals itself as a journey from pain to violence (DeZuluetta, 2006). We know only too well in criminal justice that unaddressed hurt continues to hurt. Those hurting will, if ignored, marginalised and rejected, eventually communicate their experiences and hurt others. In recognising chemsex-related crime, it is impossible to dismiss the degrees of vulnerability and the inherent pain that inform the associated offending behaviour.

Whilst inviting those men who have been convicted to take responsibility for their behaviour, related professional groups also need to take responsibility to develop a thinking, a way of being and a response that recognises the need and pain of those involved. We need to be mindful that despite the achieved milestones of gay liberation, the gay community holds a collective experience of trauma from all that was symbolised at Stonewall, to the AIDS crisis and, in recent years, the rise of hate crime; like it or not, experiences like these leave their mark. Such legacy remains in our collective experiences and is activated into painful consciousness millions of times in a gay life time.

Compared to the heterosexual population our demographics are not an easy read. Self-harm, depression, anxiety, PTSD, psychosis, suicide and addictions are all significant percentages higher for gay men. Such experiences repeat over and over again the vicious cycles of shame and guilt. It is hardly surprising, then, that the self-medicating balm of chemsex holds a powerful attraction. Not all will get into difficulties but for those that do, the cost can be very high indeed.

We are now approaching another Winter (at the time of writing – October 2018) and I am aware that there are currently 52* men in London serving sentences for chemsex-related crime. Another truth known all too plainly to the Metropolitan Police Service is that many crimes do not get to the court room. It is to be expected that these findings are being replicated across the UK. A national criminal justice response is at project planning stage and is further indication of a need we are only just seeing as the tip of the iceberg.

*This number had increased to over 600 men just five years later. All were assessed as high risk of causing harm and high risk of reoffending.

References Bewley, K. (2017), “GALOP – chemsex, consent and sexual assault”, presentation to the London Chemsex Network, London. Bourne, A., Reid, D., Hickson, F., Torres-Rueda, S., Steinberg, P. and Weatherburn, P. (2015), “ ‘Chemsex’ and harm reduction need among gay men in South London”, International Journal of Drug Policy, Vol. 26 No. 12, pp. 1171-6. Cordess, C. (1996), “The Criminal Act and Acting Out”, in Cordess, C. and Cox, M. (Eds), Forensic Psychotherapy: Psychodynamics and the Offender Patient (Forensic Focus), Jessica Kingsley, London, pp. 13-23. De Zuluetta, F. (2006), From Pain to Violence: The Traumatic Roots of Destructiveness, Whurr, Chichester. Finkelhor, D. (1984), Child Sexual Abuse: New Theory and Research, Sage, Beverly Hills, CA. HMPPS (2014), “The Rehabilitation Activity Requirement (RAR) Offender Rehabilitation Act 2014”. Ministry of Justice (2013), “Update on the new sex offender treatment programmes”. Morris, S. and Stuart, D. (2018), “Interagency professionals chemsex and crime peer support group”. Morris, S. et al. (2018), “Connection and Community”, Rehabilitation Activity Requirement Tool Kit for Chemsex Related Crime, HMPPS, London. Further reading Crozier, T., Evans, K. and Morris, S. (2018), “Connection and community”, HMPPS RAR Toolkit for Men Convicted of Chemsex Related Crime. HMSO (1988), “Report of the inquiry into child abuse in Cleveland

‘Hidden Worlds’ Chemsex Crime and the Wish Not to Know

This paper was presented to the chemsex crime conference held in London in 2022 by Br Stephen Morris fcc. Operational Lead for Chemsex Crime  –  HM Prison & Probation Service and Operational Co-Lead London Metropolitan Police (Sagamore)  It contains material which some may find distressing.

“Hidden Worlds’, as a title, was not plucked from the air. The two words describe perfectly where chemsex crime takes us. In criminal justice we are of course familiar with a range of the hidden worlds where crime takes place. We know that to manage the risk and dangerousness that hidden worlds pose we need to fully understand and appreciate, why they exist, how they have come into being, the needs they meet and how they function – without this awareness we cannot have a hope of protecting the public or changing the lives of the people under our management and in our care. This is especially so when a ‘hidden world’ is unique.

In relation to chemsex crime I want to address two issues; (a) what it is that makes chemsex behaviour and its hidden world unique (b) the risks this hidden world presents to criminal justice professionals. A lot has been written to address the risks it poses to those involved but we seldom recognise or think of the risks is poses to others who come into contact with this hidden world.

It is crucial that our understanding of chemsex behaviour is informed by a clear recognition of the relevance of diversity to chemsex. Chemsex behaviour is defined by and occurs in the context of experiences of diversity. It is this defining fact that makes chemsex unique and what makes the context of the associated crimes requiring of unique consideration. About chemsex behaviour must be understood through the lens of diversity and specifically diversity as experienced by gay / bi-sexual men, MSM and some within the trans community.

The term chemsex is often misused by the media and can be misunderstood by some academics who, misleadingly use the term to describe heterosexual sexualised drug use. This is a distortion. It lacks respect for the specific community in which chemsex emerged and dismisses the defining factors that make it unique to the precise sexualities involved.  

Misuse if the term chemsex implies some inaccurate assumptions by asserting, it is only the drugs that define chemsex or their use in the sexual context, the drugs used in the main have histories that pre-date the emergence of the chemsex scene and there are indications that non-gay male populations use them. No, what defines chemsex are the actual uniqueness’s of gay sex and gay culture.  It is how gay sex ‘homosex’, is responded to by wider culture / society. It is these responses often manifest as attitudes that impact powerfully, not just on how gay / bi / msm and trans people see and think of themselves.

For men who identify as gay, bi, msm and trans, societal attitudes impact powerfully on the capacity, ability, enjoyment and pleasure of gay sex. The responses having such powerful impact involve:

• Societies attitudes on homosexuality and particularly those associated with disgust
• Cultural and religious attitudes – particularly those that label gay sex as sinful, perverted, disordered, less than
• The remaining, often unaddressed, trauma and stigma of the AIDS crisis – gay sex = death
• The impact on the contemporary a gay scene of the dynamics of objectification, the marketing of ‘self’ via use of hook-up apps and the associated consequences of community displacement resulting in isolation, loneliness and distortion of connection, intimacy, love and relationships
• The emergence of a gay specific rejection culture – enabling shaming because of age, shape, race, looks, wealth, status – all the hallmarks of internalised homophobia.
• The experience of pre-existing and vulnerabilities resulting from early developmental experience involving – bullying, rejection, homophobia, hate crimes
• The impact and the often life distorting experience of growing up, developing in an invalidating environment.

Collectively and overtime the impact of such experiences make, at a deeply psychic level, disinhibited sexual pleasure and sexual enjoyment almost impossible. They impact negatively on sense of identity and particularly on the processes of relational intimacy and connection These experiences lock people into toxic shame about who they are sexually, what they do sexually and indeed who they are in the world and additionally influence a toxic perception of how the world experiences them.

Such shame is massive in its effect and implications. It is an influence that seldom gets mentioned, but it is rampant. The most significant consequence of shame is that is makes connection and intimacy almost impossible. Hardly surprising then that research finds again and again that the motivating factor behind immersion into the chemsex world is the desire, longing, and search for toxic free connection. Although of course consciously it seldom looks like that.

On the surface it appears that we are not back in the 1950’s. Liberations have been hard fought and won, but not all. Do not be seduced by the rainbow flag flying from almost every building for one week each year. No, Toxic shaming, toxic pathologizing and toxic hate still define the formative experiences for many.

There is another side to the rainbow and its dark indeed. It is evidenced in the hideously tragic rates of suicide, self-harm, depression, anxiety, mental health diagnosis and addictions. I personally know of 5 gay men who have taken their own lives in recent times. But this other side of the rainbow again is seldom talked about.

When such formative experiences and their consequences are not talked about, are not recognised, the real and full picture is denied. In such conditions the attractiveness of an alternative hidden world becomes very attractive indeed. The hidden world of chemsex is difficult to resist. It is for many a very attractive option. Those of you who have spent time listening to the experiences of those engaged with chemsex will know how quickly, immediately in fact chems reverse this experience. One slam, smoke, snort of crystal methamphetamine and the disinhibition, euphoria and pleasure is immense – totally immersive. In a nanosecond such self-medication makes everything internally and externally appear to be alright. This hidden world is experienced as an amazing alternative to the toxicity of the wider world or indeed of a shaming, rejecting gay scene. In the chemsex world all appears well … for a time ….

But like all experiences of denial our most favoured defences tend to take us back to the very thing we wish to avoid. The often-extreme harms and crimes have been evidence in my work for over seven years. My work makes clear exactly what it is that happens when the chemsex bubble bursts. A powerful reminder that denial, psychological avoidance is a dangerous thing.

The self-medication of denial does not stand still, it is dynamic in its function and changes overtime, to preserve and maintain its function.  So, we should not be surprised to hear that the chemsex world has changed, has evolved over time. What it was ten years ago is not what it is in 2025 and the lives that it hides, the lives it consumes are not ending well.

Two years ago, I was asked to review an investigation and viewed some evidence that enabled me to recognise with confidence that what was emerging was indicating all the dynamics and consequences of sub-culture. The evidence was a live recording made by a young gay man who regularly hosted chemsex parties at his home. In the days following the recorded party, this young man recognised that he was becoming unwell. He was also aware that on occasions he would become unconscious at his parties due to use of GHB. Given his symptoms he wondered if something had happened to him whilst under the effects of this powerful drug. The recording did indeed show him unconscious. He was laying on his living room floor with his hands tied and was being anally raped by four other men. To see this was of course horrifying but what I found most disturbing was the fact that in the same room were several other men, none of whom were responding appropriately too the crime that was unfolding before them. The men were looking at their mobile phones and commenting to each other.    As I processed this I was struck by an apparent level of well-established desensitisation. It was clear evidence that the chemsex sub-culture enables the normalisation and further denial of an immense range of harms. Indeed, the level of apparent callousness and paradoxically vulnerability surpasses anything I have ever come across in over four decades of working within criminal justice.

The behaviour described in the incident of chemsex rape does not stand in isolation. Neither does its normalisation. A whole lexicon has emerged harnessing a permission giving language to a whole range of harms, many criminal. A language aimed at making it ‘ok’ to do and to experience.

In London alone, I was overseeing x600 cases of men convicted of crimes commissioned in the chemsex context. I would be hard pushed to find a handful of those that did not involve extreme harms and extremes of behaviour. All were rightly assessed as high risk or very high risk of harm.

Such a high-risk cohort, needs to sound a warning to all because inherent in identifying and confronting extremes of human behaviour and that which involves abuses, is the wish not to know. Criminal justice professionals are not removed from human responses to the pain and horrors of the human condition. Our willingness and capacity to know is tested again and again, by that which we are called to investigate and manage. We too can be at risk of denial and our own wish to be seduced into not knowing. We too can be at risk from seeking a comfort zone, by avoiding instead of challenging, accepting instead of questioning, by not looking beyond what is obvious and by not having essential courageous conversations – by ‘backing off’.

We know only too well the tragedy that can unfold when criminal justice professionals choose not to know.  Those seeking to offend know that even better than we. It is they who have taught me over the years, of the importance of professionals to resist the dangers of being drawn into the dynamics of secrecy and the silence of collusion. Hidden worlds of harm, abuse, the hidden world of chemsex crime depend highly on fear, secrecy, and collusion. If we are not aware of our own resistance and what causes it there is a real risk, we can replicate all of that in a myriad of different ways.

We know how victims in the chemsex context are so often silenced and controlled by immense fear. The high price of fear usually manifests as secrecy and a conspiracy of silence. Professionals are not immune from this. We need to be acutely aware if the dynamics within ourselves that can result in us not speaking out.  What use are we to anyone but the perpetrator when that happens.      

Professional silence, if not overcome, can make the chemsex context of crime more dangerous than it already is.  If we meet any part of it with minimisation, silence, or our own wish not to know then we too become victim of the power of sub-culture and all its harms. 

The first two years of speaking about and revealing the truth about chemsex crime, was a lonely experience. In some sections of the LGBT community, I was not popular. But that was just the start. When it became clear that child sexual abuse was significant in the range of crimes being committed in the chemsex context, I became even less popular. This was response is familiar territory for me. Throughout the 80’s and across the decades that followed, I and a very few informed colleagues worked closely with the aftermath of Cleveland. We travelled the country training other professionals how to recognise the signs and symptoms of the sexual abuse of children. Our invitation at the time – ‘think the unthinkable’. We did the same in the early 90’s speaking out about the abuse of adults with learning difficulties within institutions and by the mid 90’s my work caused even more disturbance when I and very few other clinicians at the time spoke out about the realities satanist abuse.

So, when in 2022 I speak out about the sexual abuse of children within the chemsex context, I do not do so naively. I know only too well what is means to go into families, institutions, and specific communities and expose the abuse that is occurring within them. I know what it means for me, for those communities and for the victims within them.

The chemsex context of crime is full of invitations to remain silent, to tread on eggshells to not know. But to do so risks repeating the horrors that have occurred before and indeed recently.

The recent enquiry findings into the failure of Government agencies to appropriately respond to child sexual abuse occurring within a specific identified community in Derbyshire is a chilling example of the consequences when police, social services, probation council officials and others start to tread on eggshells and follow a ‘we must not upset – remain silent’ agenda, the maintaining a comfort zone. The avoidance of action in Derbyshire by those responsible for the protection of children to remain in favour with a specific community all enabled networks of sexual predators to continue to abuse a thousand plus child victims over time.

It is not unusual for me to notice similar dynamics of avoidance with those working to address the chemsex context. Officers can be nervous, frightened even of causing offence, of being accused of being homophobic. Such lack of confidence with the issues of diversity does not serve any community well. In trying to protect them from offence the risk is we increase their vulnerability and at worse we are complicit.   The message that professional silence gives to victims in such situations is chilling for is it in fact no different from the message of the predator.

Child sexual abuse is taking place in the chemsex context. I am often asked for the number of those convicted. But I am unable to recall ever being asked about the number of victims of those convicted. Behind such a question is the wish not to know, as somehow a number will give permission for the issue to be minimised, for it to be avoided, denied even, to be met with silence. For me, x1 perpetrator of CSA is x1 too many, but of course it is many more and to give an indication of the number of victims, in a recent case x1 24 year old perpetrator was found to be in possession and sharing over x14000 images of children ranging from babies to post pubescent.

My call to all professionals within criminal justice, within sexual health, within drug services and for all those with a pastoral responsibility for the GBT and MSM community is a call to arms. It is a call for the establishment of a specialist unit, national governance, development of specific risk assessment tools, but mostly from my perspective it must be a call to renewed confidence, a call to awareness and excellence in diversity practice. It most certainly is a call to knowing what we would rather not know and tragically it needs to once more be a call to think the unthinkable. It is a call to meet chemsex vulnerabilities with compassion and it is a call to meet chemsex harms and dangerousness with our ability to protect the public and enable justice.

I conclude with words from Donald Winnicott Paediatrician and child psychotherapist. From the childhood game of ‘hide n seek,’ to responding to cases of child sexual abuse, Donald knew all about hidden worlds their attraction, risks and their dangers. He said, “It is a joy to be hidden but a disaster not to be found”. Those words of Winnicott make our task abundantly clear.