Chapter 1
Bears and Health
Lawrence D. Mass
[In âBooks This Fall,â October 12, 1997, Lesbian and Gay New York (LGNY) published a review by Lawrence D. Mass of The Bear Book: Readings in the History and Evolution of a Gay Male Subculture (Harrington Park Press), edited by Les Wright, in which Mass criticized the collection for not dealing with what he saw to be distinctive health issues emerging within this community. When plans came together for a sequel to The Bear Book, Mass decided to take on that challenge himself. An abridged version of Massâs review of The Bear Book first appeared in the Fall 1997 issue of the Harvard Gay and Lesbian Review. While written expressly for The Bear Book II, this chapter has also been serialized in three parts in American Bear, Vol. 5, Issue 4, December 1998/January 1999, pp. 21, 23; Vol. 5, Issue 5, February/March 1999, pp. 37-38; and Vol. 5, Issue 6, April/May 1999, pp. 38, 40. The chapter was also adapted and appeared in Lesbian and Gay New York, October 22, 1998, and has also been presented at the Gay Menâs Health Summit conference in Boulder, Colorado, July 1999.]
Before the advent of the bears, most of us who later came to self-or group-identify as bears hung out on the fringes of the leather world, never quite fitting in. Though I was never myself into leather per se, I identified most with the frankness and openness and adventurourness about sex that characterized this community and branded it as outlaw, even within the greater, more mainstream, gay movement.
It was there, as a regularâhowever outsiderly a regularâat leather bars and sex clubs that I found myself, as a physician who had begun writing about health issues in the gay community, making somewhat modest observations about health vis-Ă -vis the worlds of leather and S&M. During that time period, three pieces emerged. One was a sprawling overview for The Advocate of the tug-of-war that was going on between older psychiatric theories and newer sex research perspectives on sadomasochism. It was called âComing to Grips with Sadomasochism: Psychiatry vs. Sex Research.â A second piece, called âHandballing: High Risk Sport,â was about the health hazards of âbrachiopractic eroticism,â otherwise known as fist-fucking, and was published in the New York Native. Torn rectums were turning up in emergency rooms with enough frequency to arouse concern. But such were the political sensitivities of the community in those days, when the word âpromiscuityâ had to be put in quotes, that editors eliminated my last line as too provocative: âIf youâre going to be forearmed,â I had written, âbe forewarned.â A third piece was a call for greater scrutiny of and within the leather world for health issues, very analogous to the inquiry Iâm pursuing regarding health issues and concerns among bears.
Again, at that time, civil liberty issues were so sensitive, and criticism of gay people was considered so politically incorrect, that these writings elicited considerable hostility. It wasnât simply that I was an outsider to most leatherfolk. Itâs that I was raising critical concerns. When anthologies about leatherfolk and issues finally began to be published, I was not invited to contribute (though the Advocate piece did appear in what was the first such anthology of academic and scholarly pieces); but neither, so far as I could glean, was anyone else with critical perspectives. One prominent member of the leather community, for example, sensing or projecting condemnation from my work, asked defensively why fisting injuries should be regarded any differently from those resulting from sports.
Actually, I was and remain in complete agreement with her, and this gets to the nub of the role I have seen myself trying to play, however primitively or unsuccessfully. Where there are health issues pertinent to our subcultures or communities, we need to continue to try to characterize and address them, regardless of their timing, political correctness, or the observerâs credentials as a member or nonmember of the group being scrutinized.
In the early 1980s, at the start of the AIDS epidemic, during a time when our civil liberties were still very precarious, and the possibility of some extreme right-wing reprisal against gays was more than paranoia, discussing our vulnerabilities, our health issues, seemed provocative and controversial. In larger perspective, itâs the reaction elicited by Larry Kramer when he seemed to be so dangerously and vindictively airing all our dirty laundry in public, when he seemed to be giving ammunition to the enemy. Though social and political danger are far from vanquished, I think we have now reached a point in the development of our aggregate communities of gay culture, that we can brook criticism, even from outsiders.
Today, more than fifteen years later, talking about bears and health is more likely to elicit support than defensiveness and hostility, and that has in fact been the case. I have gotten only positive feedback. Is the same now true of the worlds of leather and S&M? Iâm not sure, though surely that level of defensiveness must be at least diminished. Meanwhile, I donât recall seeing an anthology on leatherfolk that includes a solid piece on medical and health issues and concerns.
So, with this background of my experience trying to write about health issues for other gay community subcultures, letâs move on to the subject of this chapter: bears and health.
One evening at Bear Pride 98 in Chicago, about eight of us were flopped about on the big, comfortable sofas in one of the secluded lounge areas of the Marriott Hotel that was our host. An impressive amount of hugging and caressingâphysical communingâgoes on at these events. Itâs no coincidence that so many bears sign off literally (online and in letters), as we do in person, with HUGS. More than sex, I think, the camaraderie is really what itâs all about, what most gay events are all aboutâand this grouping was typical in this regard. Heads were on shoulders and chests, arms were rubbing knees and massaging backs and necks; our entwinings probably deconstructed what was happening better than anything that was being said. But on this occasion, the conversation that developed was also worth noting for its absence in bear discourseâat bear gatherings, meetings, and in bear magazines and literature. The subject we found ourselves talking about, at my initiative, was bears and health.
By now we all know that there is no specific definition of a bear, and this fact will be important to return to in the later stages of this discussion, when I am talking about future directions. Meanwhile, I am a stereotypical bear in that I am a burly, bearded, hairy, middle-aged daddy-type and attracted to the same and to âcubs.â Despite many exceptions, I continue to be drawn, more than to anything else, to bigness in men (height and weight, to the extent of fat). As a physician, however, I have long been aware of the health hazards attendant to bignessâin myself and others. And I would propose that the bear subculture has reached a level of development at which the time is more than due to take a look at this aspect of ourselves.
So there we were on the couch. With my right hand, I was massaging the thick, meaty leg of an exceedingly handsome sex educator from San Francisco. With the left, as he lay on my lap, I was caressing a regional Mr. Bear who has done some original design work for the greater bear community. The subject got onto defining bears, and the sex educator, so typically San Franciscan in the pride with which he carries himself, and who had one intelligent insight after another, gave his own, provisional definition: âFor me,â he said, âa bear is just a man who is comfortable with himself.â Certainly thatâs who he is. But what about the question of bulk and hirsuteness that are such commonalties, if not absolutes, of bear preference, I found myself asking. Everyone more or less agreed, including the sex educator and the bald, virile, suthun-accented riverboat operator from Nashville, whom Iâll call Tennessee, who was laying in the lap of his close friend, who happened to be a thin and hairless bear lover. The conversation then reverted to its characteristic fragmentation with people variously introducing themselves, interrupting each other, talking about this and that in bits and pieces.
When I explained that I was a physician, Tennesseeâs antennae immediately perked and he wanted to tell us about his recent health crisis. He had been hospitalized with a life-threatening condition called (deep vein) thrombophlebitis. Folks like him who are on their feet all day probably have a greater tendency to develop this affliction, as do those who are overweight, I explained. In fact, I continued, I think the whole subject of bears and health is worth looking at. Thrombophlebitis is a condition Iâd never thought of before as perhaps being more common among bears, but there are others that can be comparably seriousâmajor, life-threateningâand that are unquestionably more common among us: hypertension (high blood pressure, HBP, HTN), diabetes mellitus (DM), arteriosclerotic cardiovascular disease (ASCVD) with stroke and MI (myocardial infarction, otherwise known as heart attack), arthritis, duodenal ulcer, hiatal hernia (HH), gastroesophageal reflux disease (GERD), gallstones, cholecystitis, some cancers (e.g., colorectal and prostate), and sleep apnea. When I mentioned this last, which I myself suffer from along with hypertension and arthritis, a fellow from the adjacent lounge area came over to join us, saying heâd overheard our conversation and wanted to second our observations. After years of exhaustion, falling asleep on the job, at the wheel, and other inappropriate and dangerous places, he finally underwent a sleep study, was diagnosed with sleep apnea, and now uses âthe machineâ (which will be discussed later) with excellent results. He feels that his life has been transformed. How many other bears are there out there, I found myself asking, who have no idea that they have this condition or what they might do about it?
Hirsuteness is likewise a consideration. When I said what so many of us have already learned firsthand, the hard way, that body lice (crabs and scabies) are common among bears, the regional Mr. Bear on my lap casually explained his home-remedy approach: on the last day of whatever bear event heâs attending, he treats himself with Kwell lotion, not so much unlike the way gay men who still have unprotected oral sex with multiple partners at the baths and other communal environments use prophylactic antibiotics as âmorning-afterâ pills.
Before I get into more detail on some of the specific conditions that bears should be on the lookout for, let me first address the issue of weight in broadest, contemporary perspective. Many were confused when a major medical study was published suggesting that people who have always been heavyset and who have managed to avoid common, anticipated complications of being overweight into their elder years are probably at no more at risk of morbidity and mortality (sickness and death) from these conditions than those who are not overweight (on the basis of widely accepted ideal body/ weight guidelines).1 While this may be true, and may mean that some of us who are heavyset will have no worse health than those with more âidealâ weight, it will not be true for the majority of us. For the majority of us, the health risks of being overweight will remain considerable.
The most recent estimate of the might of the diet industry in America, as cited by Jane Brody in The New York Times, is $33 billion a year.2 If there is excess anywhere, certainly it abounds within the endless, ubiquitous, manic, patently dollar-minded programs and guides and television shows that urge us to shed what some of us see as our glory, that would have us look skinny, like the gym-body types we tend to find as unattractive as they do us (though, of course, opposites also attract). That society does not recognize and affirm that diversity of physicality and desire is itself a problem. For now, letâs just say that there can be no doubt of the narrowness of Americaâs preoccupation with leanness, of its relegation or even exclusion of what it sees as less desirable body types. All this is also taking place unquestionably within an appropriate context of affirming optimum health.
Some of this came to a head recently, when the National Institutes of Health released its latest findings and recommendations. According to their statistics, an unprecedented 55 percent of Americans are currently overweight.3 This prompted an immediate response from the National Association to Advance Fat Acceptance. Appropriately, the association is worried that the new information and guidelines will result in a lot more negative energies and pressures being directed at overweight people, will drive them to repeat on-and-off diet patterns that studies have demonstrated achieve little over time, and to even be counterproductive in terms of the burden of stress they augment. But as Brody points out, however sympathetic these perspectives and claims, the fact remains that being trim is enormously more healthy, and we cannot fault the medical allied health ...