Why you’re (probably) not addicted to sexby Elle Hunt
With increasing numbers of people being diagnosed as sex addicts, Elle Hunt went looking for what’s really going on.
If you have seven or more orgasms a week, you’ve crossed the threshold into hypersexuality, according to a 2009 paper by psychiatrist and Harvard Medical School professor Martin Kafka, one of the leading researchers of “paraphilia-related disorders” such as sexual addiction.
You’re probably not alone in counting on your fingers right now. But even if you’re onto your second hand already and wondering whether you’re about to be classed as a sex addict, this is no time to panic.
Kafka’s definition throws up a question central to the diagnosis and treatment of sex addiction: if one person’s healthy sex life might be another’s hypersexual disorder, who’s to say how much is too much?
Not the American Psychiatric Association, which rejected Kafka’s 2010 proposal to have hypersexual disorder recognised in the fifth edition of its bible, The Diagnosis and Statistical Manual of Mental Disorders, known as DSM-5.
The prevalence of sex addiction is almost impossible to determine. The American Association for Marriage and Family Therapy says there are 12 million sex addicts in the United States alone, although it doesn’t say how it reached that figure.
Nevertheless, the fact that most don’t question the existence of such a disorder is testament to how powerful the narrative has become in a relatively short time. The link between sex and addiction was entertained in popular culture in the late 1950s and 1960s, and took root in the self-help culture of the 1970s.
Today, it exists to most of us most palpably through popular culture – think breathless tabloid headlines, apologetic press conferences, the “nymphos” of pulpy paperbacks and the tragic heroes of gritty cinema.
But three history lecturers at the University of Auckland have scrutinised the cultural touchstones held up in support of sex addiction and found disturbingly little there of substance. Does sex addiction exist? Or is there only sex that society disapproves of?
“FIRST REAL DEMOLITION JOB”
According to Barry Reay, Nina Attwood and Claire Gooder, their book Sex Addiction: A Critical History is the first socio-historical analysis of the “phenomenon”. For an academic text, it’s surprisingly strident in its conclusion that sex addiction is “a problem that need not exist” and may even be “mythical”.
Reay says although other academics have reached similar conclusions, A Critical History is the “first real demolition job”. He admits he was surprised at how little evidence he found in support of sex addiction, given how entrenched it is in Western culture. “The deeper we got into it, we kept thinking, ‘Well, there might be some substance.’ But the only substance was the fact that it’s become so widespread and accepted.”
Even the most high-profile alleged cases – Rob Lowe, Michael Douglas, David Duchovny, Charlie Sheen, Dominique Strauss-Kahn – were mostly “diagnosed” by the media. In some cases, their checking into rehab was reported as evidence of a sex addiction, but it turned out to be for alcohol or drug abuse.
The extent to which it has become entrenched shows the power of a simple idea, says Reay. “Everyone always says, ‘But I know someone. It’s a couple, and the wife says, ‘He’s a porn addict.’ Then you can say, ‘Well, who says? Does he say he’s a porn addict? Does the wife? Has he been diagnosed?’ When you start probing, it disintegrates – but people still cling to it.”
A Critical History finds portrayals in popular culture partly to blame, with Steve McQueen’s acclaimed drama Shame and the 2012 comedy Thanks for Sharing being two that come under scrutiny. The former, Reay thinks, is “a brilliant film”, but not one about sex addiction – “even though that’s what the director would say … I just think that cheapens it”. The latter is “just awful … it could have been made as part of the sex addiction programme”.
Reay is more scathing of the “less-than-critical media … You can go to any newspaper and there’s some account of usually a very extreme example, and a link to a help centre at the end of it. It’s just not questioned.”
At the time of our interview, a Sunday Times article headed “I sexualise every man I set my eyes on”, about a 23-year-old woman who “thinks about it all day, every day – and just can’t stop”, has crossed Reay’s desk: “If you read it carefully, it’s ludicrous,” he says.
The simplistic understanding of sex addiction coupled with the absence of hard-and-fast diagnostic criteria makes for a “perfect storm”, he says. “People can self-diagnose, or members of their family will diagnose them, or they’ll get medical advice from a doctor who doesn’t really know much about the subject but has probably been exposed to the same kind of media stuff.”
MY BIG FAT SEX-ADDICTION TEST
Reay suggests I take a self-help test, although he warns me, “You’ll end up an addict.”
After our interview, I take the “Sexual Addiction Screening Test” on SexHelp.com, the first Google result of its kind. My answers to five pages of questions – most about pornography, one about sex with minors – are found, “on a basis of six criteria [to] indicate sex addiction is present”. This is despite my ticking to confirm the statement “I have no concerns about my sexual behaviour but am curious how I would score”.
Another click reveals SexHelp.com to be the website of an institute founded by American psychologist Patrick Carnes, a leading proponent of sex addiction, sometimes even described as its “founder”.
Carnes’ “centrality, for better or worse” to sex addiction is referenced repeatedly in Reay’s Critical History, but a promotional quote about him from 1983 is a useful summary: “the acknowledged expert in a field that until recently didn’t exist”.
The Society for the Advancement of Sexual Health, which awarded Carnes its Lifetime Achievement award, recognises sex addiction as a “persistent and escalating pattern or patterns of sexual behaviour acted out despite increasingly negative consequences to self or others”.
But as Reay and his co-authors point out, “the range of what constitutes such acts or desire is endless; each individual decides what they feel is problematic sex”. In the absence of extreme examples – like those defined by Carnes as Level Two or Three, which involve a victim or violate “some of our most significant boundaries” – how is it possible to diagnose sex addiction when what’s normal is subjective, what’s disgusting is relative, what’s illegal is conservative?
“I don’t know – you tell me,” says Reay. “But they do. And it drives you crazy because it’s just so slippery. Then again, that’s an attraction, isn’t it. There’s a certainty in believing that the concept exists, and then a slipperiness in how you self-define or how you’re defined by others.”
“THE NUMBERS ARE GROWING”
But this ambiguity is nothing new, says Mary Hodson, as sex therapists have had to grapple with it professionally for decades. She’s a clinician and regional director of Sex Therapy New Zealand, which recognises not sex addiction per se but “out-of-control sexual behaviour”, defined as such when it interferes with well-being at work or relationships. “The numbers are growing,” she says, especially in bigger cities.
Hodson says she’s “on the fence” about whether it’s possible to be addicted to sex in the same way that it is to drugs or alcohol. “In the therapy world, there’s been a huge amount of debate for some years about whether [it] actually exists or not.”
She says research suggests it could be possible to be addicted to oxytocin, the “feel-good hormone” linked to orgasm and sexual closeness. “Will we one day in the future look at oxytocin as the chemical component of an addiction? I don’t know.”
In most cases, the “out-of-control sexual behaviour” is masking an underlying disorder that guides her plan for treatment. A study of sex addicts in the 1990s, quoted by Reay, found that almost 80% had been psychiatrically diagnosed for another mental illness, depression being the most common.
“Occasionally I’ve been quite stumped and thought, ‘I can’t actually say this person’s got anxiety or depression or OCD, nor can I put any other name to it’,” Hodson says. “It doesn’t happen very often, but sometimes I sit there and think, ‘Maybe there is a disorder here, and we just haven’t been able to pin it down yet.’”
Whether or not it constitutes an addiction, sex can have significant negative effects on people’s lives, Hodson says; many of her clients seek help because the problem is no longer manageable. “I can think of many who would say this is definitely an addiction. They have really struggled with it for a long time, maybe a year or two, before they’ve got control back to a point where it isn’t interrupting their life any more.”
Again, there’s what Reay calls that “slipperiness”: for every self-identifying sex addict who sees something wrong in his or her behaviour, there might be others doing the same who don’t. Who’s to say what’s wrong, anyway?
CELEBRITIES AND SEX
Reay lists celebrities who have had – by all accounts, not least their own – a lot of sex but have never identified as addicts, along with those who had less but did. “Where there is no shame, there is no diagnosis,” he and his co-authors write in A Critical History, pointing to an anecdote in Bill Wyman’s autobiography, detailing a wild night in the Rolling Stones’ heyday: “In 1965 we sat down one evening in a hotel and worked out that since the band had started two years earlier, I’d had 278 girls, Brian 130, Mick about 30, Keith six and Charlie none.”
The conservative forces at play in how we think about sex addiction are no more apparent than on the occasions it’s used – knowingly or otherwise – as an “easy explanation” for infidelity and other behaviour that society finds unpalatable. How many partners caught out with Ashley Madison memberships have claimed powerlessness over their disease?
A Critical History details how Russell Brand, once better known for being a sex addict than a political commentator, was persuaded to enrol in rehab by his management, who convinced him that his “sexual behaviour might become damaging to [his] career”.
(The stint in rehab, in fact, turned out to be quite the opposite, with Brand noting in apparent wonderment that he wrote his daily diary “in the sort of style which suggests I knew that a couple of years later I’d be reading it out in front of a live audience”.)
Tiger Woods’ infidelities cost him US$22 million in endorsements, and though he did not refer explicitly to sex addiction in his self-lacerating public apology, he was photographed at the door of Patrick Carne’s Pine Grove treatment facility. That was held up as evidence of his seeking help for his problem – but given the blow dealt to his public image, a cynic might have seen it as the first step in a public relations plan that, half a decade later, seems to have been largely successful.
SHAME AND CONTROL
The reality is sex addiction serves “a great many social purposes”, says David J Ley, a clinical psychologist based in Albuquerque, New Mexico, and one of the most vocal critics of the “pseudo-disorder”.
“It is, at the same time, a way for media to scare people [and] create anxiety … a way to support a self-sustaining sex addiction treatment industry and community of sex addicts; a way to shame, suppress and control sexual behaviours such as homosexuality, bisexuality, infidelity, porn use and masturbation; and a way to excuse men from personal responsibility for sexual behaviours.”
What we now think of as sex addiction was once thought of as nymphomania or its male equivalent, satyriasis, says Ley. Those behaviours aren’t new; they are simply more prominent and less stigmatised.
Sex addiction – its depiction, its diagnosis, its treatment – is “just the latest in a long, long history of the attempt to pathologise sexual expression where a person’s sexual desires contrast with society’s sexual values”, which are often heteronormative and conservative.
“What’s truly maddening is that media, marketing and society are all sexually obsessed … but when someone likes sex ‘too much’, we spank them and tell them they’re sick,” he says. “It’s crazy-making.”
Because of self-selection bias, “so-called tests” for sex addiction measure only libido and sexual guilt, he says. “So, if you like sex and feel guilty about it – and it’s hard not to in our society – then these will diagnose you as an addict. I’m not real sure what that is, but it’s not health care.”
Unsurprisingly, Ley is a target for sex addiction therapists and sufferers; in his experience, they tend to be one and the same: “That says something, doesn’t it?” He says he has received death threats and is the subject of libel and slander “on a regular basis”; David Duchovny’s lawyer threatened him with a lawsuit if he did not stop using the celebrity’s name in association with his book The Myth of Sexual Addiction.
“When I challenge the validity of sex addiction, they see it as a personal attack on their self-perceived ability to control themselves and on their own identity … It’s sad. It’s why I call sex addiction a ‘belief system’, rather than a true health-care concept. It’s closer to a cult.”
All the diagnosis achieves, he says, is to cast guilt and shame over normal behaviours and feelings. He rejects connections between addiction and abuse as “abhorrent”, pointing out that Ariel Castro blamed an addiction to porn for his abduction, imprisonment and rape of three women in Cleveland over a decade.
“This is why media and society must reject the idea of sex addiction, so that we can prevent sex addiction being used to shame and control people, and so that we can expect and require people to take personal responsibility for their behaviours. Treating sex as though it is an addiction is just more of our social obsession with sex.”
CONFESSIONS OF A "SEX ADDICT"
But one self-identifying sex addict argues the opposite – that society’s fixation on sex could be construed as condoning his behaviour. A 36-year-old father-of-three based in Auckland, he declined to be named in this story, but has blogged anonymously about his experience of sex addiction and treatment through the Sex and Love Addicts Anonymous programme since July 2014. He says popular culture actually describes his experience of sex addiction, citing specifically Sam Smith’s song Stay With Me, the male lead in the film Made of Honour and the increasing prominence of open relationships. “So if media was of any influence, it would suggest that I am all right, my behaviour is acceptable and everyone else does it, so I’ve got nothing to worry about.”
Asked to respond to Reay and Ley’s findings that sex addiction is a social and media construct, he’s blunt: “I honestly don’t care much.” It is not the only view of sexual addiction, nor is it even the prevailing one. “What I care about is that through identifying this behaviour as addiction, through admitting that I am powerless over that addiction [step one of the 12 steps of Sex and Love Addicts Anonymous] and through working the programme of recovery, my life is improving.”
A LEARNT HABIT
But the belief that addicts are powerless in the face of their addictions goes against the findings of cognitive neuroscientist Marc Lewis, whose new book, The Biology of Desire, challenges the medical model widely applied to addiction. Lewis says categorising it as a disease does not adequately take into account the brain’s ability to change with intense experience, especially that which is repeated and rewarding.
Rather, Lewis writes, addiction stems “from the motivated repetition of the same thoughts and behaviours until they become habitual”, rewiring the brain. Food, love, money, power, adrenaline sports, religious fervour, any kind of “extreme behaviour” – all can be addictive, and addiction, even to alcohol and drugs, becomes something much more prosaic: a particularly bad, particularly learnt habit.
“Addiction is unquestionably destructive, yet it is also uncannily normal: an inevitable feature of the basic human design.”
Speaking over Skype from Toronto, Lewis says throwing out the medical model does not stigmatise or trivialise addiction, but it does have consequences for society’s treatment of addicts and addiction. One is that if addiction is a habit like any other, entrenched through a decrease in self-control, overcoming it starts with self-directed change.
Addiction can sometimes be used as a “get out of jail free” card, agrees Lewis, who spent most of his twenties addicted to illegal drugs. “When people do things that are in some way reprehensible to society, should we let them off the hook because they say they’re addicted? I don’t think so. We don’t have to be moralistic about it; we can say this person has a serious problem and we have to protect ourselves if that problem leads to trouble for others …
“There are no hard and fast lines; there’s no index or measure of addiction. It’s really the tendency to continue to pursue short-term goals at the expense of long-term goals.”
It sounds so simple, but throwing out the disease model altogether would be a radical move for the medical community, especially in the current culture of what Reay calls “addictionology”, in which psychological cures are turned to reflexively. “It would be surprising if there hadn’t been sex addiction, given everything else that’s become to be seen as addictive behaviour.”
In that light, the American Psychiatric Association’s refusal to recognise sex addiction or hypersexuality in The Diagnosis and Statistical Manual of Mental Disorders – which tallies more than 350 mental illnesses, compared with 180 in the 1968 – seems significant. But as more people claim to suffer from sex addiction and more therapists claim to treat it, “it may only be a matter of time” before it is endorsed in a future edition, write Reay and his co-authors.
With endorsement in the DSM comes diagnostic criteria, medical legitimacy and “the psychotherapist’s password for insurance coverage”, to quote Herb Kutchins and Stuart Kirk, the authors of The Selling of DSM.
For a disorder of such questionable validity, the implications of endorsement are enormous – not least because of the associated involvement of pharmaceutical companies. Says Hodson, “The answer is that no pill is ever going to fix emotional problems.”
A starting point might be asking what, in fact, we are trying to treat.
SEX ADDICTION: A CRITICAL HISTORY, by Barry Reay, Nina Attwood and Claire Gooder, (Polity, A$35.95); THE BIOLOGY OF DESIRE, by Marc Lewis (Scribe, A$29.99).
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