Inside 'S-Town's Tattoo Therapy: BDSM or Self-Harm?

John B. McLemore, subject of popular podcast, was inked and pierced repeatedly just for the physical sensation – and he's not the only one

John B. McLemore is the focus of the new hit podcast S-Town.

Warning: This story contains spoilers about the podcast S-Town.

In the final episode of S-Town – the podcast that started as a murder mystery and ended up an in-depth exploration into the psyche of an antique clockmaker in Alabama – host Brian Reed reveals that his main subject, John B. McLemore, was partaking in something that can only be described as therapeutic tattooing.

The unconventional therapy session took place in the context of a ritual he described as "church," involving his friend and surrogate son Tyler Goodson tattooing his chest and piercing his nipples.

"'Church,' according to Tyler, morphed into what was essentially an elaborate form of cutting that helped John to relieve his mental anguish," Reed narrates.

McLemore claimed that he was giving Goodson the opportunity to practice tattooing by offering him his chest as a canvas. But according to Goodson, it was more than that, likening McLemore's constant requests for more like those of a "dope fiend."

"He got enough tattoos in one year that someone could get in a lifetime all at once," Goodson told Reed in the podcast. "He got addicted fast."

At the same time, Goodson admitted that he was the one who told McLemore – who vocally hated tattoos – to consider getting one as a therapeutic, stress-relieving experience. At some point, "church" – drinking Wild Turkey whiskey, talking and having Goodson tattoo and pierce him – turned from a form of therapy into something that concerned Goodson enough to refuse to partake in the ritual.

It's not made clear in the podcast whether McLemore's requests were a manifestation of his mental health issues, a chance to bond with the person he considered a son, a pain-as-pleasure experience, therapy or a combination of the four. It does, however, raise questions over where to draw that distinction. For some people, pain is not only a distraction and release – but something that makes them feel better. The difference lies in the context.

Dr. Danielle Keenan-Miller, Director of the UCLA Psychology Clinic, says that without hearing from McLemore about his desires and experiences related to the repeated piercing and tattooing, it's impossible to know whether the "church" rituals were part of a BDSM practice or a form of emotional regulation.

BDSM – a catch-all term for a type of sexual roleplaying that can involve bondage and discipline, dominance and submission, and sadism and masochism – frequently involves an element of intentionally inflicted pain for people who find it pleasurable. Informed consent is the linchpin of the practice of BDSM: nothing can happen without all partners involved clearly stating their intentions and agreeing to specific activities. Extra precautions – like picking a "safe word" that any party can say if they'd like to stop – are built in to ensure that everything taking place is safe and consensual. 

On the other hand, self-harm involves deliberately injuring the surface of your own body, usually through cutting or burning, and it's typically not meant as a suicide attempt. It can serve several functions, Keenan-Miller explains, the most commonly reported of which is to temporarily alleviate emotional pain. Others who have self-harmed indicate that it's a way they handle being devoid of feelings and can also serve as self-punishment, a way of avoiding unpleasant responsibilities, or signaling the depth of pain to others – although the latter cause would be unusual among people who hide or keep secret their self-harm, she says.

There has been very little formal research on the possible association between self-harm and tattooing, piercing or other forms of body modification. One qualitative study from Germany suggests that people with a history of self-harm sometimes report getting tattoos or piercings for the purposes of pain or additional bodily harm, and that, in those cases, it might be considered a self-harm symptom. In that study, nearly a quarter of the participants with tattoos and/or piercings reported a history of self-harm.

Kiersten Johanna Johnson, a tattoo artist at Millennium Gallery in Fort Collins, Colorado, has many clients that come in for what she calls "pain therapy" – using tattooing or piercing as an alternative to self-harm. Sometimes she doesn't know the reason for their tattoo until she's halfway through, but she says she "absolutely loves" that she can help people feel better.

As a psychiatrist, Dr. Howard Forman, a forensic psychiatrist at Albert Einstein College of Medicine in New York City does not believe tattoos can be considered treatment for any mental illness, but "to deny that people experience a lot of positives from them would be pure foolishness."

For Johnson's clients, it's not just the physical pain that can be therapeutic, but also having someone to talk to who genuinely cares about their well-being.

"I get to laugh and cry with my clients and give them comfort," she says. "I enjoy being able to make a physical difference as well; getting tattooed or pierced causes your brain to release a lot of endorphins and adrenaline."

Johnson's pain therapy clients include a woman going through a lengthy, gruesome divorce from her abusive husband and another who is a former alcoholic and cutter and is now in the process of covering up her scars with tattoos.

"She's told me that every time she gets a scar covered, the pain of getting tattooed reminds her that she never wants to drink again, because she never wants to wake up in a puddle of blood ever again," Johnson says.

Faylin – who asked only to be identified by her scene name (a pseudonym that allows those who practice BSDM to remain anonymous) – has a personal history with mental illness and self-injury (specifically cutting), and has been unofficially part of the kink scene since she was a teenager. When she got her first tattoo at 21, she says she could recognize it as a replacement for cutting herself; it gave her a similar feeling, but without the potential for irreversible harm. She has now been self-injury free for about five years. "Unlike cutting, I have never been one to just show up for a tattoo any time I needed to fulfill that urge," Faylin says. 

The main distinction between healthy pain and self-harm, according to Johnson, is that therapeutic pain involves safety and consent. Unlike self-harm, which comes with numerous risks – including cutting too deeply, contracting an infection or even death – people who get pain therapy via tattoos do so under the guidance of trained professionals who can provide a safe, sterile environment.

Anabelle Bernard Fournier, a sex and kink writer, likens it to being able to recognize the difference between recreational drug use and addictive substance use behavior. The same is true of BDSM, Fourier explains, although she says that BDSM practices are rarely disordered because they are done within a community with certain guidelines, and many people to protect you – from others and yourself.

"John receiving 'church' from his friend is like a doctor prescribing heroin to an addict [in places like Switzerland, where it's legal] so he can go on with his life, functioning like a normal human," Fournier says.

She says that in the majority of cases, needle play and similar practices like flesh hooks are perfectly healthy, including when it's an alternative to self-harm because the fact that someone else is involved makes it inherently safer.

Similarly, Shannon Caperton, a licensed acupuncturist in Cleveland, Ohio offers acupuncture therapy as an alternative to self-harm, like cutting, in order to reduce urges for pain, taking place in a safe environment.

"Most people are unaware that they may be self medicating for depression when they engage in these activities, so helping someone understand why they may have the urge to cut, or get tattoos repeatedly may be a more therapeutic approach," Caperton says.

Unfortunately, people who don't understand BDSM conflate safe, consensual activities for self-harm all the time, Fournier says.

"The judgement of kinksters being 'broken' or 'ill' is so common, it's basically cliché," she explains.

As someone who practices BDSM, Fournier says that far from not understanding what's going on with their bodies, people who practice BDSM tend to be highly educated in physiological reactions to pain because it helps them make better decisions for themselves.

"I understand how pain works, I understand the endorphin cascade, I understand post-play drop," Fournier says.

Endorphins – neurotransmitters that act as your body's own version of opiates – are released during activities like sex and exercise and give you a feeling of euphoria. For people who practice BDSM, the combination of pleasurable pain and sexual arousal triggers the release of endorphins, giving them a variation of a "runner's high."

Faylin notes that tattooing and piercing can be included in BDSM without any connection whatsoever to self-harm. For masochists – those who get off on pain – it can come in varying forms, from "light" things like spanking, to being kicked in the ribs by a steel-toed boot, or knife and needle play, like what was described in S-Town.

"Some of us are wired differently and get off differently than others," she adds. "This doesn't mean our BDSM is self-harm."

A major difference between self-inflicted harm (like cutting) and body modification (like tattooing or piercing) is the presence of at least one other person. This is where consent becomes a defining factor of the interaction.

"Consent is an absolute non-negotiable must," says Forman. "Any paraphilic behavior that takes place outside of consent is not a fetish. It's a crime."

For celebrity tattoo artist Zoey Taylor, owner of the Warren in Los Angeles – whose clients include A-listers like Sofia Vergara – consent has not always been an option. During her more than 15 years of tattooing, she says that she has been an unwilling participant in multiple clients' sexual experiences.

Taylor says that people who get tattooed for the pain don't necessarily do it more often, but they do take something away from their session that most don't. Because of that, she declines to work with clients whose goals in getting tattooed are sexual.

"I strongly believe that a client whose goal in getting tattooed is sexual, should find a consenting artist," Taylor says. "Finding out that someone is getting off while I'm working feels exactly the same as if they were jacking off in front of me."

Once, a man came very close to walking out of the Warren with an unfinished tattoo until he agreed to stop describing his sexual release and the fantasies he was having about Taylor. She says that she felt violated because she had not agreed to be a part of his sexual experience.

"Everyone has the right to their preferences, and everyone should have the right to consent," Taylor adds.

According to Fournier, the consent process is similar for all BDSM activities, including needle play. This involves the needle "top" discussing their ideas and intentions with the "bottom," the one receiving the tattoo, and the bottom telling them about the areas they want or don't want pierced. In addition, there would be a safe word chosen and everyone involved would share freely with each other and stick to the negotiation

In the situation between McLemore and Goodson described in S-Town, that negotiation was not effective. Goodson tells Reed that, despite the fact that he was the one who first suggested getting tattoos as a stress reliever to McLemore, after a while he grew hesitant to honor his requests to re-pierce his already-pierced nipples and continue to tattoo his heavily inked chest and back.

Goodson became uncomfortable and started to become wary of McLemore's many requests, at one point, telling him that he would not continue to pierce him. That lasted for a few weeks, but resulted in a major depressive episode for McLemore and eventually, Goodson gave in and ended up doing it again. In fact, he pierced his nipples the day McLemore killed himself.

Although McLemore's aversion to tattoos was discussed in early episodes, listeners were not introduced to their therapeutic aspect until the final episode of S-Town. While making people aware of this as something people may find beneficial, it is important to remember that the decision to experience pain is a multidimensional as McLemore himself. This means not putting all intentionally inflicted pain in the same category. There is a difference between safe, healthy and consensual BDSM activities and dangerous self-harm behavior. We'll never know all of McLemore's motivations behind the "church" ritual, but like the rest of the podcast, he has given us plenty to think about.