In his late twenties, Ellman had a close call. He was alone, covered "head to toe in pantyhose," tied up and gasping for air, in a pair of handcuffs with a self-release switch that failed. "My left hand would always open the right cuff," he recalls. "But somehow that little switch broke." He tried to get at the switch on the left cuff, he says, but his right hand was wrapped so tightly in pantyhose, he couldn't feel the lever. He had to rip through the hose with his fingers. Then he discovered he'd tied his arms to his chest so tightly that he couldn't get the angle he needed. "That was a crazy 30 seconds," he says. But even then, he admits, it never occurred to him that perhaps he should find a less perilous route to sexual climax. "My thoughts were not that I'm never going to do that again," Ellman says, "but that I'm going to be a lot more careful."

For some, the danger is part of the appeal—and when that psychological aspect is combined with the physical, AeA's allure becomes even more powerful. According to Dietz, who studied 132 cases of death by AeA for his 1983 book Autoerotic Fatalities, fantasy plays an insidious role. "One man had elaborate fantasies that Amazon women would string him up from trees," he says. "Lots of women with big breasts." One of the most chilling accounts came from one of Dietz's few living subjects, who was so desperate to stop that he was considering the most drastic of measures—chemical castration. "He had a strong sexual appetite and a pressure to do it all the time," Dietz says. "He was afraid he was going to end up in the morgue."

Lee Harrington, a 29-year-old "alternative-sexuality educator" who teaches a course in Phoenix on "breath and blood flow in erotic life," devotes the first 20 minutes of his class to the myriad ways that AeA can kill you. Harrington himself uses Tantric breathing and gas masks to simulate the effect of AeA. Although he doesn't encourage anyone to practice AeA, Harrington explains that the damage done to the brain is no worse than what occurs during other pursuits. "It boils down to this," he says. "How do I want to lose my brain cells in this life? Do I want to do it by doing lines? By crushing heads on the football field? Or do I want to do it in the bedroom?"

A couple of weeks before his death, Chris Duchamp returned home for a weekend visit with his family, and an eerily portentous exchange took place. Jean had recently seen an alarming news segment on television.

"It was just a very brief national-news thing on the choking game," he recalls. "And knowing my son, always looking for the ultimate high, I say, 'You're not stupid enough to do something this retarded are you?' And he goes, 'No.'