Indeed, this has a modern feel to it; there is evidence that the prefrontal regions of the brain are tuned down in sleep (Madsen et al., 1991). Freud might have been spared such nocturnal temptations, but others concur with Plato on what is surely for many a very familiar experience. For example, St Augustine recorded God’s ability to ‘quench the fire of sensuality which provokes me in my sleep’ (Confessions, X.30).
William Acton, an English Victorian ‘sexologist’, wrote extensively on the dangers of masturbation. Although few would give credence to such views today, Acton was probably right about erotic dreams (quoted by Marcus, 1966, p. 24):
if a man has allowed his thoughts during the day to rest upon libidinous subjects, he finds his mind at night full of lascivious dreams…A will which in our waking hours we have not exercised in repressing sexual desires, will not, when we fall asleep, preserve us from carrying the sleeping echo of our waking thoughts farther than we dared do in the daytime.
Since they are involuntary, an interesting moral issue can arise in the context of nocturnal orgasms. Catholic doctrine traditionally regarded them as without sin even if enjoyed, provided that they were neither deliberately induced (e.g. by prior tactile stimulation) nor consciously welcomed (Kinsey et al., 1953).
In summary
Viewing pornography can be associated with habituation and escalation in an attempt to maintain its value.
Pornography could increase the chances of trying to enact the scenes depicted.
Most people experience sexual fantasy.
Sexual fantasy is not a response to sexual deprivation but often occurs most frequently at times of highest sexual activity.
Fantasy appears to utilize some of the same brain processes as are used in sexual wanting and behaviour.
Seventeen Sexual addiction
O Lord, my helper and my Redeemer, I shall now tell and confess to the glory of your name how you released me from the fetters of lust which held me so tightly shackled and from my slavery to the things of this world.
(Augustine, Confessions, VIII.6)
The phenomena to be explained
If psychotherapists and gossip columnists had been plying their trades at the time of St Augustine, some would surely have diagnosed ‘sexual addiction’. These days, when news breaks on a sex scandal involving a public figure, pundits are sought in an attempt to answer the question: ‘Why on earth take the risk, since surely he must have known of the potentially disastrous consequences?’ The cases of Bill Clinton and Tiger Woods come to mind. Television journalists, psychiatrists and psychologists argue for and against the validity of the term ‘sexual addiction’.
Alas, such discussions are likely to descend into semantic hair-splitting. Those interviewed often cannot even agree that sexual addiction exists as a useful diagnostic category, let alone whether a particular individual qualifies for the label. (For a criticism of the notion of ‘sexual addiction’, see Ley, 2012.)
At what point, does a so-called ‘womanizer’, ‘philanderer’ or ‘ladies’ man’ become an addict?1
So, what is in a term? In this case, a great deal, it would seem. People use ‘addiction’ to serve distinct ends, pointing to an element of social construction in its meaning. Consider, for example, a woman in the divorce courts who wishes to damn her cheating husband, win a handsome settlement and gain custody of the children. To her, ‘addiction’ might mean feckless, immoral and freely choosing a selfish life-style, which makes the husband worthy of the kind of social disapproval more commonly directed to street junkies. By contrast, to a woman trying to find reconciliation, sympathy and forgiveness for an errant husband, or to a defence counsel in a criminal trial seeking mitigation, the same term might imply an unintended and involuntary course of action. Addiction is sometimes construed as a loss of control as a result of a process going seriously wrong in the workings of the brain. In the spirit of the more sympathetic perspective, to give uncontrolled sexuality the designation ‘addiction’ brings it nearer to a medical interpretation. Similarly, in using such terms as ‘shackles’ and ‘slavery’, St Augustine points to a perceived loss of control. Also, in keeping with this perspective, for people said to be addicted to sex, there are in-patient clinics, self-help books and web-sites, sufferers’ groups modelled on Alcoholics Anonymous, as well as at least one treatment-related learned journal. As far as I can discover, there exists nothing equivalent targeted to ‘philanderers’.
Use of the combination of words ‘addict’ and ‘treatment’ implies distress; something has gone seriously wrong, either for the addicted person or his family or both. Words convey subtle meanings and intentions. To a growing number in the caring professions, ‘addiction’ seems to imply something out of kilter in the body, such that the power to make free and informed choices has been compromised, if not lost. Thereby, the scales are tipped, even if only slightly, towards sympathy and help rather than moral blame and censure. The term ‘compulsion’ points the same way but perhaps even more strongly.
An observation of only the behaviour itself in terms of its type and frequency of expression might not yield a diagnosis of addiction (Orford, 2001). Rather, it is the conflict underlying the behaviour and its consequences that leads to this term or to the alternative ‘excessive appetite’. One could imagine secular contemporaries of St Augustine acting in much the same way but experiencing little or no guilt or conflict, and one might feel it inappropriate to employ the term ‘addiction’ to describe them. Conflict necessarily implies forces acting in opposite directions, that is excitatory and inhibitory. Where behaviour is excessive, excitatory factors obviously outweigh inhibitory. Inhibition might normally derive from personal guilt or social controls, such as the weight exerted by family pressure or religious institutions. This is the definition to be adopted here, but I cannot claim any absolute authority and doubtless controversy will remain.
Arguments on free choice and being ‘out of control’ often seem to come down to issues of philosophy and ethics, areas that might derive some illumination from psychology but rarely any resolution. However, we should not allow quibbles over terminology to halt progress since there exist many terms, such as ‘moral virtue’ and ‘free will’, which are equally hard to define but are nonetheless pragmatically useful. The term ‘addiction’ captures a real feature of behaviour, describing important aspects of how sexual desire can seriously malfunction. Furthermore, under this label, much distress and need for help can be subsumed.
Given that sex is one of the most intense of hedonic experiences, if not the most intense, it would be very surprising if something like an addiction were not an associated risk (Orford, 2001). Estimates of the prevalence of sexual addiction lie between 0.7 and 6 per cent of the US population (Gold and Heffner, 1998; Ley, 2012). Since sexual addiction can be associated with disease, financial and professional ruin and family breakdown, as well as, in a few extreme cases, serious crime, it is difficult to exaggerate the importance of gaining understanding of it.
Some of sexual addiction’s essential features are excitement, destructiveness and lack of one-to-one reciprocity with an ‘object’ of desire (Carnes, 2001). The rest of the addict’s life can become subordinate to the addiction, while the toll on family, social and professional spheres can be insufferable. Addicted people are usually in a situation that they would rather not be in and they dislike themselves for being in it. However, some only recognize their addiction in retrospect when they review their life histories and then feel regrets.
In each form of sexual addiction, the individual’s mind can be taken over, engrossed trance-like with the search for a specific sexual achievement. Rerunning past encounters in the imagination can yield a ‘high’ and serve as a distraction to divert the mind from current concerns, for example professional or family. The quest can take on ritualistic properties of needing to repeat a particular regular sequence of activities. As Carnes expresses it (p. 20): ‘It is the pursuit, the hunt, the search, the suspense heightene
d by the unusual, the stolen, the forbidden, the illicit that are intoxicating to the sexual addict.’ Often the addictive activity is non-threatening in one sense: there is little chance of rejection. The expectation of ultimate ‘success’ must be high, especially in the cases of watching pornography or compulsive masturbation! It must be relatively rare that sex workers reject a client, whereas pornography shops and sex theatres probably do so even less frequently. In the case of some other targets, the addicted person’s victim has little or no say concerning rejection. Paradoxically, in spite of their powerlessness in the face of the addiction, the individual has at last found a source of ‘high’ over which he has a degree of prediction and control. In some cases, he can hone and perfect his skills.
There are several related issues to be developed in the present chapter:
The discussion of whether sex can be addictive is useful in highlighting important features shared by several behaviours, some drug-related, such as heroin use, and others non-drug-related, such as sex and gambling. A few differences between drug and non-drug addictions also emerge.
A comparison of sex addiction with more uncontroversial addictions, such as those to certain drugs, reveals common underlying processes in the brain, while the subjective experiences of addicted individuals are similar (Orford, 2001).
It is difficult to perform realistic laboratory experiments on any addiction, perhaps most of all to sex, and so psychologists can gain insight by cautiously extrapolating from research on the more tractable drug and gambling addictions.
Sex addiction shows where the processes that underlie non-addictive (‘conventional’) sexual behaviour, introduced in earlier chapters, can ‘become excessive’. Thereby, excess illuminates so-called normality. In the terms of the present book, the processes involved are those of incentive motivation and levels of control, so the model suggested in earlier chapters will be applied to sexual addiction.
Addiction to sex often does not exist in isolation but can co-exist and mutually reinforce other addictions, such as to drugs or romance.
What constitutes addiction and does sex qualify?
Back to the original meaning
In the United States, the website of the National Council on Sexual Addiction and Compulsivity defines the phenomenon as:
a persistent and escalating pattern or patterns of sexual behaviours acted out despite increasingly negative consequences to self or others.
The original meaning of the word ‘addiction’ is simply that of excessive devotion to something, and is equally applicable to, say, sex, religious worship or work, as to heroin or alcohol (Alexander, 2008; Orford, 2001). However, in the first decades of the twentieth century the term came to be used mainly, if not exclusively, to refer to an addiction to drugs and this still has a pervasive influence. Later in the twentieth century, some investigators argued for a reversion to the original meaning. Thereby, excesses of feeding, sex, shopping, gambling and exercise could be included under the heading. The term ‘sexual addiction’ only emerged in the early 1980s, though such behaviour has surely been around for a very long time (Turner, 2008). So, one aspect of sexual addiction is the behaviour’s excessiveness relative to some standard of normality (Orford, 2001). Of course, what constitutes ‘normal activity’ is open to discussion, and cultural relativity is enormous.
To merit the term ‘addiction’, it appears that the activity needs in some way to be disruptive or harmful to the addicted person or others (Orford, 2001). Heroin addiction can lead to death through infection, overdose or criminal activity. Nicotine addiction can cause various diseases. Some argue that ‘addiction’ should be applied only where intake of a chemical is involved, since the other behaviours are not lethal. Is this true? Excessive sex does not, of course, usually compromise the integrity of the body, except in the cases of, say, infectious disease or violence. However, in the rare instance, a jealous partner can kill or be killed. Loss of job and family and even suicide can follow disclosure.
One way of viewing addiction is that the individual devotes an excessive (‘sub-optimal’) allocation of time and effort to a restricted range of activities or even a single activity (Brown, 1997). Normally, various behaviours compete for expression. Time is allocated to them such that each makes a balanced contribution by which our hedonic tone is more or less maintained at a reasonable level. Addictions can distort such time management by capturing decision-making. A very high incentive salience is attributed to the addictive activity. Undue time, effort and money are often allocated to gaining its short-term effects and it displaces more reliable means of raising hedonic tone over the longer term, albeit less dramatically so. Addictive activities have immediate positive effects, while the negative consequences are delayed and hence do little to undermine its potency.
Depending upon the particular individual and their addiction, different states accompany the rise in hedonic tone. In some cases, a move from a low level of arousal (‘boredom’) to a desired state of a higher arousal is achieved. Sex would be expected to fit this pattern. High arousal while engaged in the activity might normally be followed by calming. So, a desired alteration of the ‘state of consciousness’ is a common feature of addictions (Brown, 1997).
Does an addiction need to be chemical?
The logic that only chemicals could truly be ‘addictive’ was rooted in the observation of unpleasant bodily withdrawal symptoms when drug use was discontinued. Then came the realization that there could be addictions to drugs, for example to cocaine, with few if any physically evident signs of withdrawal. Rather, there was the psychological distress of a depressed mood associated with craving and the search for more drug. Conversely, a non-chemical addiction, gambling, can be associated with insomnia and such bodily disturbances as colitis, constipation, a knotted stomach and excessive perspiration (Orford, 2001). Such evidence has contributed to a reinterpretation of the criteria of addiction. A new model emerged, in which any addiction reflected an attempt to self-medicate mental distress and sex was an equally viable candidate to take the label ‘addictive’ (Alexander, 2008; Washton and Zweben, 2009).
Suppose someone argues that a necessary feature of addiction is the use of a chemical substance. In such terms, one could be addicted to chocolate or French fries but not to sex. This hardly seems a useful distinction. Furthermore, according to a contemporary understanding of brains and minds, each type of behaviour is, at the same time, both chemical and psychological. That is to say, behaviour depends upon chemical events in the brain. In turn, behaviour, whether that of taking a chemical into the body or not, alters these same chemical events. Based upon the insights of modern neuroscience (Berridge and Kringelbach, 2013), it seems reasonable to speculate that the hedonic consequence of any addiction is rooted in opioid processes in the brain (Chapter 10). Excitement is also associated with a surge of adrenalin, amongst other bodily chemicals, which could contribute to sex’s addictive potency (Carnes, 2001).
At once, psychological and physical
While acknowledging that addictions come in a wide variety, some authors distinguish between physical addictions (e.g. to heroin) and psychological addictions (e.g. gambling, sex). As a description of the target of addiction and the nature of the immediate interaction, that is either a chemical substance or non-substance, this has validity. However, as a description of the addiction itself, it is problematic. It suggests that a range of behaviours are in some sense ‘non-physical’, even though we know that they are organized in the brain and can identify the brain regions and neurochemicals involved. Conversely, it suggests that addictions to chemicals are ‘non-psychological’, yet surely craving for anything has to be psychological. Similarly, we know that psychological factors such as despair and alienation are crucially important in triggering urges to take drugs (Alexander, 2008). Social and other environmental factors play a crucial role in drug urges and relapse. So, although some addictions involve taking in chemicals and others do not, all addictions are simultaneously phys
ical and psychological.
What constitutes ‘natural’ in the twenty-first century?
Yet another argument used against the notion of ‘sex addiction’ is that, unlike taking drugs, sex is a perfectly natural activity, an essential part of our evolution. The same logic suggests that there could not be an ‘eating addiction’. This seems an illogical criterion.
By analogy, the capacity to experience, say, sadness at a social loss or fear when confronted by threats is surely ‘natural’ and a part of our evolutionary history, serving to preserve social bonds and to protect us from danger. However, when these emotional reactions take the form of clinical depression or anxiety, they can become a serious medical problem.
Just because feeding and sex are evolutionary adaptations does not mean that they are immune from pathology best described as addiction. Remember ‘evolutionary mismatch’ (see Chapter 2); we did not evolve in a world of fast food and refined sugars and surely neither did we evolve surrounded by drop-in bath-houses, sex shops and Internet porn. Both food and sex as presented in the twenty-first century constitute ‘supernormal stimuli’ to our motivational processes, making them liable to switch into an addictive mode.
Is it an illness?
Is an addiction an illness? This of course depends upon how you define an illness and I cannot arbitrate here. Former US President Gerald Ford, speaking of Bill Clinton, argued (cited in DeFrank, 2007, p. 132): ‘Betty and I have talked about this a lot. He’s sick – he’s got an addiction.’ Unlike unambiguous illnesses, such as cancer or influenza, for sex addiction there is no obvious and measurable disturbance in the body. However, the same could be said of anxiety and phobias. If distress is the criterion then the term might be applicable, provided that genuine suffering is involved.
How Sexual Desire Works- The Enigmatic Urge Page 37
