A much talked about new film tackles the very modern illness of sex addiction. But one leading psychologist has been attacked for suggesting that it isn’t an illness at all – it’s a weakness
A few years ago, a 33-year-old man called Tom came to see me for therapy. Sandy-haired and nervous, he worked as an accountant and came to the appointment with his attractive young wife, Sarah. Tom looked like a man in trouble. Sarah had caught him coming out of a sex shop and, after being caught, Tom had admitted he’d been going there once a week to have sex with other men in the video booths.
Tom blamed himself for his poor choice, saying he had “got horny and didn’t think”. But Tom’s wife disagreed: “That’s addiction, right?” she said to me. “He’s addicted to this, to going to these creepy places and having sex.” Sex addiction is the psychological disorder du jour. When powerful men — from the golfer Tiger Woods to the actors Charlie Sheen and Michael Douglas – are caught sleeping with women who are not their wives, their standard response is to hold up their hands in rueful acknowledgement, check into a therapy centre and announce they’re embarking on a course of treatment for sex addiction.
In Woods’s case, this reportedly involved a period of celibacy, behavioural therapy, trauma work, “relapse prevention counselling” and one-to-one sessions on shame reduction and “setting sexual boundaries”.
And these things don’t come cheap. A month’s treatment at some residential centres can cost more than $37,000 (£23,600). In California, a church called New Life Ministries charges $1,400 (£900) for its three-day “Every Man’s Battle” workshops (for men who believe pornography and lust have taken over their lives) and runs a website that sells books, compact discs and DVDs for men, women and adolescents who have “failed in their battle for sexual purity”.
There is even a kit for soldiers, shipped in a camouflage box, designed to help men resist sexual urges while deployed in the military. In 2009, this organisation made nearly $8 million (£5 million) from selling its self-help material and running its seminars and workshops.
Sex addiction is big business. And, thanks to the British director Steve McQueen’s film Shame (released this Friday), which shows a sex-addicted executive played by Michael Fassbender grimly trawling the streets of New York in search of his next “fix”, it’s a hot topic once again – an “epidemic”, according to more than one headline. But despite all this, there is no evidence whatsoever that sex addiction is a valid psychiatric disorder. And there probably never will be.
For more than a decade, I’ve worked as a psychologist, treating issues of sexuality in my clinical practice, in several states in the American south west. I’ve seen scores of patients who have what most people would consider to be a highly active sex life, but I haven’t diagnosed anyone, ever, as being “addicted” to sex. I’ve publicly challenged the validity of sex addiction, and this has brought me trouble. I’ve been accused of being “evil”, “dangerous” and “heartless”. Sex addiction therapists have attacked me — I’ve even been accused of being a sex addict myself, told that I am in “denial” about the danger of my own sexual desires.
But the fact is, there’s no standard definition of sex addiction. It hasn’t been recognised as a bona fide disease by the Diagnostic and Statistical Manual of Mental Disorders, the medical profession’s bible when it comes to mental health, so, instead, there are a dozen or so competing definitions and no two psychotherapists who apply the concept in the same way. A diagnosis is based on a therapist’s own idea of what constitutes an excessive amount of sex. But the mistake all these “experts” make is to try to apply the characteristics of drug and alcohol addiction to sex, claiming too much sex works like a drug, causing cravings, withdrawals, tolerance (the need for increasingly powerful “hits”) and a downward spiral in which sex “takes over their life”.
There are many embedded moral concepts in these definitions, all of which suggest that sex is dangerous, shouldn’t be “enjoyed too much” and that something that creates imbalance in a person’s life is inherently unhealthy. However, people like Mahatma Gandhi and Mother Teresa made single things the overwhelming focus of their lives — and yet these lives of “imbalance” are not judged unhealthy. Some “experts” have argued that sex addiction is more like a compulsion, others that it’s a reaction to sexual trauma, though there are many people who’ve been abused and have none of these problems, and many people who have sexual problems but were never abused.
Most importantly, unlike those who’ve become dependent on alcohol or drugs, an individual who has been labelled a sex addict faces no serious physical consequences if he or she suddenly goes “cold turkey”. Nobody in history has ever died from wanting sex and being unable to have it. Wanting something that you don’t have and being dissatisfied, even sexually, is a condition that people around the world deal with every day. They cope with it without losing control, without lying, cheating and manipulating, and without proclaiming themselves an addict.
Most in vogue is the theory that people can become addicted to pornography and, in particular, internet pornography. Men are supposedly lost to the powers of the internet, “clicking” themselves out of jobs, marriages and finances.
I don’t deny that porn is a powerful stimulant. It directly targets aspects of male sexuality that have driven men to seek sexual variety throughout the aeons. But is this addictive? There are no studies that say so. Porn exposure is almost universal in men and if it had the destructive effect that doomsayers claim, we would be awash with sex crime, and every day would look like the erotic chaos of Carnival and Mardi Gras. In fact, as porn access has increased, sex crime has decreased. We cannot say porn has caused this decrease, but we can say that the availability of porn through the internet does not cause inevitable, unstoppable loss of sexual control.
No one proves this point better than Phil Varone, a rock musician who used to play the drums for a band called Skid Row. As well as being an accomplished drummer, Varone has also been branded a sex addict — he has admitted to having sex with more than 3,000 women. But, on an American reality show, Celebrity Rehab, Varone denied he was an addict. “I never considered myself a sex addict because sex never screwed up the rest of my life or my ability to function at a high level,” he said.
Whatever one might think of Varone, you have to give him credit for one thing: he’s prepared to accept full responsibility for his actions. It’s the way a diagnosis of sex addiction is used to somehow absolve men and women (though mostly men) of all responsibility for their actions that is, in my opinion, the most malign feature of the sex addiction industry. Many of the true believers reject all the science and research that confronts their theories and work desperately to find ways to justify foolish, self-destructive choices and sexual behaviours. They blame these choices on neurochemicals, porn, a history of sexual abuse and myriad other factors, all of which can help us to understand how and why people make the choices they do, but none of which, ultimately, takes away control or personal responsibility.
In 2007, a 52-year-old Illinois public official called Felice “Phil” Vanaria pleaded guilty to misconduct and bribery after telling a massage worker that, if she performed oral sex on him, he would give her a job in county government. But the job didn’t exist. When she found this out, she filed charges. At trial, the official proclaimed himself a sex addict, and pleaded for treatment rather than punishment. He was sentenced to 30 months’ probation and ordered to undertake treatment for sex addiction, after which he was allowed to work again. Sex addiction is a fictional disorder, and should never be accepted as evidence in court. It’s not an excuse.
One patient of mine was diagnosed as a sex addict decades ago. Convicted of sex-related crimes, he was defended in court by a psychiatrist who said the man’s addiction to sex meant he wasn’t accountable for his behaviour. Years later, this man told me: “I don’t believe I was ever actually addicted to sex, though I think we often act impulsively, without considering the consequences of our choices.” People can choose to be in control of their behaviours. But it’s not just the supposed “sex addict” who thinks the diagnosis will make life easier. I’ve also spoken to many women who said their belief in sex addiction helped them tolerate their husband’s infidelity. It was easier for them to believe their other half was sick than to acknowledge he was selfish.
But where does this view of sexual desire — that it’s some sort of monster that cannot be controlled – come from?
In America, the centre of the sex addiction industry, it is the inevitable by-product of a long war against sex by social and religious institutions. As far back as the American Declaration of Independence, Benjamin Rush, one of the founding fathers, declared that masturbation and sex were the cause of scourges and illnesses, including blindness. One hundred years later, physicians John Harvey Kellogg and Sylvester Graham believed spicy foods inflamed the senses and encouraged sex and masturbation. Bland foods like cornflakes and Graham crackers were actually developed to reduce the urge to masturbate.
After the liberated fun of the Seventies, the next decade brought with it a very sobering and frightening aspect of sexuality. The spread of HIV and Aids gave rise to a deathly fear of sex, particularly promiscuous and secretive sex. And in that fear, sex addiction was born.
It is this part of the sexual addiction myth that is the most dangerous. Sex addiction tells people that sexual desire is a destructive, weakening thing, and that the only way men can control their sexual desire is to excise it, and ring it with fear and prohibitions.
But sex is not a disease. In fact, it’s good for you. Research shows that men who have more sex live longer. Women who have more sex don’t live longer, but those who enjoy sex more do live longer (and apparently more enjoyable) lives. The more sex people have, the fewer days they take off from work. When sex is called a disease and too much is labelled as dangerous, it takes away a healthy part of life.
The concept of sex addiction is not going to go away. It’s too convenient an explanation. But the people who struggle with their sexual behaviours deserve to know that it is something they can control. I think it does them a disservice to tell them lies.
It also damages our views of what constitutes a healthy man. If male sexuality is inherently addictive and dangerous, then a healthy male is one who has no sexuality. That’s a frightening and emasculating concept. Treating sex as evil leads to more secrets, less control and less responsibility. I help patients identify how and why they came to be a person who made selfish, self-destructive choices that involved sex. I invite them to see their sexuality as something that is in their control, just like any other aspect of their life.
Tom, the patient who had been having secret sex in video booths, eventually admitted that his behaviour had been partly a result of stress and partly a result of a failure on his behalf to admit that he liked to have sex with both men and women. Eventually he decided he hadn’t been addicted to sex, but had been making bad decisions in his life, and sex was just a part of them. He resolved to confront his problems and deal with them. “Sex,” he admitted, “was just a distraction.”