The Choking Game

The activity has been passed down for generations in schoolyards, summer camps and neighborhoods typically by 9-15 year old boys and is responsible for a large number of deaths and permanent disabilities.
The activity is traditional and world-wide but became prominent in the United States in early 2005 when a number of deaths and injuries resulting from this activity were publicised.

HOW THE CHOKING GAME WORKS

There are actually two distinct methods involved. Both result in unconsciousness by depriving the brain of oxygen but each has a very different mechanism. The two tend to get confused or treated as one. The two mechanisms are strangulation and '''self-induced hypocapnia''' and work as follows:

1. Strangulation restricts the blood flow to the brain by compressing the Carotid Artery in the neck. This is achieved either by pressing the thumbs against the arteries on both sides of the neck simultaneously or the use of a ligature. Apart from the direct restriction of blood to the brain there are two other significant physiological responses to pressing on the neck:

Pressing on the carotid arteries also presses on Baroreceptors known as the Carotid Sinus Bodies . These bodies then cause vasodilation in the brain leading to insufficient blood to perfuse the brain with oxygen and maintain consciousness.

A message is also sent via the , a form of Cardiac Arrest that is difficult to treat. The vulnerability of the victim and speed of onset is unpredictable and not properly understood. There is a dissenting view on the full extent of this but it is agreed that pressure on the vagus nerve causes changes to pulse rate and blood pressure and is dangerous in cases of carotid sinus hypersensitivity .

The use of thumbs on the neck can be self-induced and usually stops automatically on blackout. Where an assistant applies hand pressure, and in all cases where a ligature is used, stopping at the right moment before permanent damage occurs becomes a judgement on the part of the operator or just good luck. Self-strangulation through the use of a ligature is the most common cause of death or brain damage although many schoolchildren have accidentally killed or caused permanent brain damage to their friends by all methods. It is believed that many deaths attributed to suicide by adolescents are actually solo self-asphyxiations and death was an unintended outcome.

2. Self-induced hypocapnia. This involves no compression of the neck but requires Hyperventilation for a minute, or until symptoms of Hypocapnia such as tingling, light-headedness or dizziness are felt, followed by a breath-hold. The effect is greatly enhanced if lung air pressure is increased by holding the breath 'hard', that is forcing exhalation while allowing no air to escape. This alone is enough to cause a blackout but usually tradition requires one of a number of other actions such as a bear hug given from behind or pressure applied by another person under or over the heart.
The fact that hyperventilation causes rapid Cerebral Hypoxia is paradoxical because the body should be well stocked with oxygen after overbreathing. The mechanism here is that the blood is made abnormally alkaline as a result of the excessive elimination of the CO₂ that keeps it acidic; this rise in blood PH is termed Alkalosis
The symptoms of alkalosis are: neuromuscular irritability, muscular spasms, tingling and numbness of the extremities and around the mouth, and a dizziness, or giddiness, often interpreted as a sense of euphoria. This brief euphoria is what practitioners of the fainting game seek.
Unfortunately alkalosis has other far reaching and very complex effects on the neuromuscular system and among other things it interferes with normal oxygen utilization by the brain. In the body alkalosis generally induces Vasodilatation but in the brain alone it causes Vasoconstriction . This vasoconstriction appears to be exacerbated by a sudden increase in blood pressure caused by squeezing or holding the breath ‘hard’. The alkalosis induced euphoria can be followed rapidly by hypoxia induced unconsciousness.
The sequence of events leading to unconsciousness from hyperventilation are as follows:

---1. Decrease in partial pressure of Alveolar CO₂.

---2. Decrease in partial pressure of Arterial CO₂.

---3. Increased in blood pH.

---4. Respiratory alkalosis.

---5. Vasoconstriction of blood vessels supplying brain.

---6. Pooling of the blood present in the brain at the time.

---7. Brain rapidly uses up O₂ available in the pooled blood.

---8. O₂ concentration in the brain drops.

---9. Unconsciousness from hypoxia of cerebral tissue.

₂

This mechanism is too complex to be dealt with adequately within this article, for a good treatment of the paradoxical relationship between hyperventilation and hypoxia see USAF Respiratory Physiology .

In some traditional versions the bear hug is replaced by pressure on the neck, in which case blackout is a hybrid of strangulation and self-induced hypocapnia.

Other mechanisms. Unconsciousness may be induced by other methods: Pressure over the Carotid Sinus above the heart may induce a Syncope (fainting) without any other action at all but this is difficult to reproduce and is not the basis of the game. For those people susceptible to Carotid Sinus Syncope , and most people would be unaware until it occurs, this can be an exceedingly dangerous game.

In both ''strangulation'' and ''self-induced hypocapnia'' blackouts the victim may experience dreaming or hallucinations, though fleetingly, and regains consciousness with involuntary movement of their hands or feet much to the amusement of the onlookers. Full recovery is usually made within seconds but these activities cause many deaths and invalidities every year, particularly when played alone or with a ligature. Permanent brain damage may not be immediately apparent.

EDUCATION

Formal school-based educational programs about the dangers of these activities are rare, leaving both children and their teachers and guardians ignorant of the dangers. Lack of education and the fact that the practice is legal continues to mislead children into believing that these activities are safe.

Educational programs that ensure that children have an understanding of the mechanisms and why these may be dangerous have had the best effect. Programs to educate teachers on the mechanisms are rarely included in teaching curricula. A major barrier to education is the considerable complexity of the self-induced hypocapnia mechanism, which is difficult to convey to and often beyond the understanding of the instructors and guardians themselves.

OTHER NAMES

The practice goes by many other names, such as:

''Airplaning, America dream game, Black out game, Breath Play, California Choke, California Dreaming, California High, Choke Out, Dream game, Dreaming game, Fainting game, Flatline game, Flat liner, Flatliner game, Funky Chicken, Hyperventilation game, Knockout game, Pass-out game, Passing out game, Natural high, Space cowboy, Space monkey, Suffocation game, Suffocation roulette, Teen choking game, and Tingling game.''

SEE ALSO