為什麼男同性戀者會做藥愛(chemsex)？

資料來源：Roger Pebody / aidsmap news / 2019年11月28日/財團法人台灣紅絲帶基金會編譯

JanGroßer在巴黎的藥愛(ChemSex)論壇上發表講話。圖片：Adam Schultz

Stéphane是法國社區組織AIDES的志願工作者，為最近在巴黎舉行的第三屆歐洲藥愛論壇定下基調，他解釋了為何繼續在性生活中使用藥物。他說，原因有很多，其中許多是別人分享的。

他說：「首先，愉悅的想法是至關重要的。」

「這也有可能是當缺乏（藥物？）…. 時擔心無法去做，就如同也有人擔心無法去達到目標。」

 「這種解禁使我一瞬間忘記了我難以接受的身體，尤其是其他人對我的看法以及他們傷害性的評論。」

「許多男同性戀者經歷的孤獨感絕對是鼓勵這種行為的一個因素。」

自首屆論壇於2016年在倫敦舉行以來，這些藥愛會議的討論一直在進行。儘管首屆論壇上有大量調查數據，但現在則對人們經驗的複雜性給予了更多關注。在最近的巴黎會議上，更有為「藥愛老手」舉行了三場閉門會議，主要會議還包括許多個人證詞。

愉悅

大多數男人對參與到藥愛都是從尋求愉悅開始的，即使並非總是無憂無慮。居住在柏林的精神病學家和活動家JanGroßer，將愉悅定義為一種正向的反饋機制激勵我們重複做某件事。除了性（身體）愉悅的內在酬償獎勵外，性也可以在聯結、歸屬和身份認同方面獲得酬償獎勵。

這些酬償可能有助於使我們了解到底是什麼讓我們成為如此獨特的個體、我們所歸屬的人，以及別人在我們身上看到的特質。在性愛冒險中，無論是一對伴侶或是一群人中的一員，我們是如何認定自我，它都可以賦予我們地位。性可以讓我們遠離日復一日的困難情境，並滿足我們的冒險和好奇心。

但是，其中一些潛在的獎勵可能會彼此衝突。他說：「您可能會感受到親密關係，也可能會經歷到被贊賞，但是很難同時經歷兩者。」「受到贊賞通常密切地關聯到表現的某些東西，而親密關係則與能夠揭露自我，並於如此做時感到安全和被接受有關。」

酬償可能是積極的（使您感覺良好）或消極的（它們消除了某些痛苦或憂愁）。Großer認為，負面酬償與性行為和物質的使用特別相關。成功地防禦內部的衝突以及由此產生的羞恥、焦慮、矛盾和孤獨感可能會帶來愉悅。

羞恥

阿姆斯特丹GGZ inGest醫院的精神病醫生和性學家Elise Nelis描述了她的一名患者。他是成長於一個小鎮有著虔誠宗教父母的家庭中，他們很少談論他們的情緒或感受。他們通常對性生活持否定態度，並且顧慮自我的判斷，直到28歲時他才以同性戀的身份露面。幾年後，他發現自己對於被診斷為HIV感到極度困難—他自責、有痛恨自我的感覺，並且害怕將不會與他人有其他的關係。他患有憂鬱症、性慾低下和勃起功能障礙。

他說，甲基安非他命終於給了他性的自信，讓他放開了自我的界限。但是，這並沒有解決他潛在的自我污名、低自我價值和孤獨感等問題。

JanGroßer表示，人們可以透過許多方式來處理羞恥感，包括將其合理化，將其投射到其他人上，發起積極的反擊（「你怎麼敢？」），尋求確認，假裝它們不存在，迴避它們到我們感覺不到的程度。藥物可以讓困難的感覺麻痺，且通常是迴避的行為。

JanGroßer說：「如果防禦成功，您甚至可能不會意識到自己正在經歷這些衝突，甚至可能感覺不到這種感覺。」，「這並不意味著這些衝突就不會出現，它們只會以其他方式發揮作用。」

逃逸

活躍於倫敦的活動家和藥愛資深人士Adam Schultz表示，服務需要關注每個人的具體問題。他說：「這個問題與性無關，與藥物無關，它是關於一個試圖逃逸的人的問題。」

他還說，從混亂的生活之角度去思考藥愛使用者是一種誤解。他說，他們常常是一生中背負著生活上許多控制的重擔，並試圖去變得「太好」。就他而言，他擁有穩定、成功的職業生涯和一段戀情。但是他不開心，想要去冒險和尋求自由的感覺。（來自第二屆歐洲藥愛論壇的新聞：孤獨和社區是藥愛的關鍵）

他解釋說：「接著藥物來了，解除禁忌使得這個不同的人出現了。」 「是因為那個人的聲音被拒絕了如此長久的時間，所以當它接手時，它便不想要放手。」

倫敦之友的Monty Moncrieff說，他的組織提供的治療上團隊工作的重要方面是，鼓勵人們彼此相互間要在情感上親密和誠實。這對於先前與其他同性戀者之互動大多是性行為的男人來說，有時候是一種新的體驗。他說：「這些會議進行方式不僅侷限於研究毒品問題。」「它關注的是身份認同、人際關係、清醒的性愛，以及圍繞在親密關係上的焦慮。」

性方面的事情

巴黎聖路易斯醫院負責藥愛問題的醫師兼性學家Alexandre Aslan博士說，就像愛滋病在流行初期改變了同性戀在性方面的事情一般，藥愛現在也正在這樣做。

他描述了藥愛如何能干擾通常的性反應週期。藥物和色情產品可能意味著男人繞過了慾望（性方面上的想法和興趣）的第一階段，而直接進入了身體喚醒的第二階段。但是，這些藥物通常會在身體喚醒階段引起勃起功能方面的問題，並使得性高潮難以達成，從而導致「高原」階段永無止境。

許多男人還發現，很難回到性愛時沒有藥物。柏林Schwulenberatung諮詢組織的ArndBächler評論道：「在經歷過藥愛的經驗之後，要協助人們忘卻強烈的藥物與性之間的聯繫是非常具有挑戰性的。」

Why do gay men do chemsex?

Roger Pebody / aidsmap news / 28 November 2019

Jan Großer speaking at the ChemSex Forum in Paris. Image: Adam Schultz

Stéphane, a volunteer with the French community organisation AIDES, set the tone for the recent 3rd European ChemSex Forum in Paris when he explained why he continues to use drugs in sexual situations. There are multiple reasons, many of them shared by other people, he said.

“Firstly, the idea of pleasure is essential,” he said.

“There is also the fear of not being able to do without, as well as the fear of not being up to the mark.

 “The disinhibition allows me to forget for a moment my body that I find hard to accept, and particularly the way other people look at me and their hurtful comments.

“And the loneliness experienced by many gay men is definitely a factor that encourages this behaviour.”

The discussions at these chemsex meetings have moved on since the first forum was held in London in 2016. Whereas there was plenty of survey data at the first forum, more attention is now being given to the complexity of people’s experiences. At the recent meeting in Paris, there were three closed sessions for ‘chemsex veterans’ and the main conference included many more personal testimonies.

Pleasure

Most men’s involvement with chemsex begins by seeking pleasure, even if it does not always remain care free. Jan Großer, a psychiatrist and activist based in Berlin, defined pleasure as a positive feedback mechanism that motivates us to repeat an action. As well as the intrinsic reward of sexual (physical) pleasure, sex can also have rewards in terms of bonding, belonging and identity.

There may be rewards in terms of helping us understand what makes us special as individuals, who we belong with and what qualities other people see in us. It may give us status, whether as half of a couple or as part of a group that sees itself as sexually adventurous. Sex can be a time away from day-to-day difficulties and satisfy our sense of adventure and curiosity.

However, some of these potential rewards may be in conflict with each other. “You may experience intimacy or you may experience being admired, but it’s very difficult to experience both,” he said. “Admiration is usually something very much linked to performance, while intimacy is something that has to do with being able to reveal yourself and feel secure and accepted in doing so.”

Rewards may be positive (they make you feel good) or negative (they remove some pain or distress). Großer argued that negative rewards are particularly relevant in relation to both sexual behaviour and substance use. Pleasure may result from successful defence against internal conflict and the resulting feelings of shame, anxiety, ambivalence and loneliness.

Shame

Elise Nelis, a psychiatrist and sexologist at GGZ inGest in Amsterdam, described one of her patients. He was brought up in a small town by religious parents who rarely talked about their emotions or feelings. They were generally negative about sexuality and, concerned about their judgement, he did not come out as gay until he was 28. He found his HIV diagnosis a few years later very difficult – he blamed himself, had feelings of self-hate and was afraid of never having another relationship. He had problems with depression, low libido and erectile dysfunction.

He said that crystal meth finally gave him sexual confidence and allowed him to let go of his boundaries. However, it did not resolve his underlying issues of self-stigmatisation, low self-worth and loneliness.

Jan Großer said that there are several ways people deal with feelings of shame – to rationalise them, to project them onto other people, to launch an aggressive counter response (‘how dare you?’), to seek validation, to pretend they are not there, and to avoid them to the extent that we do not feel them. Drug use can numb difficult feelings and is very often an avoidance behaviour.

“If your defence is successful, you may not even be aware that you are going through these conflicts and you may not even feel these feelings,” Großer said. “This doesn’t mean that these conflicts aren’t there, they will just play out in other ways.”

Escape

Adam Schultz, an activist and chemsex veteran based in London, said that services need to focus on each person’s specific issues. “It’s never about sex and it’s never about the chems: it’s about the person who is trying to escape,” he said.

News from the 2nd European Chemsex Forum: Loneliness and community are key to chemsex

He also said that it’s a misconception to think of chemsex users in terms of chaotic lives. He said they are often people who have the burden of having too much control in their lives and of trying to be ‘too good’. In his case, he had stability, a successful career and a relationship. But he was unhappy and wanted adventure and a feeling of freedom.

“The drugs came and the disinhibition allowed this other person to emerge,” he explained. “But because that person was denied his voice for so long, when it took over, it didn’t want to let go.”

Monty Moncrieff of London Friend said that an important aspect of the therapeutic groupwork that his organisation offers is encouraging men to be emotionally intimate and honest with each other. This is sometimes a new experience for men whose previous interactions with other gay men were mostly sexual. “Those sessions go way beyond just looking at the drug issue,” he said. “It’s looking at identity, relationships, sober sex, and anxiety around intimacy.”

Sexuality

Dr Alexandre Aslan, a medical doctor and sexologist leading on chemsex issues at the St Louis Hospital in Paris, said that just as HIV had transformed gay sexuality in the early days of the epidemic, chemsex was doing so now.

He described how chemsex can interfere with the usual sexual response cycle. Drugs and porn may mean that men bypass the first phase – of desire (sexual thoughts and interest) – and go straight to the second phase, of physical arousal. However, the drugs can often create problems specifically with erectile function – in the arousal phase – and make orgasm difficult to achieve, resulting in a ‘plateau’ phase that is never-ending.

Many men also find it difficult to go back to having sex without drugs. “It is very challenging to help to unlearn the connection between strong substances and sexuality after a history of chemsex,” commented Arnd Bächler of the counselling organisation Schwulenberatung Berlin.