The Sex Myth: Why Everything We're Told Is Wrong (7 page)

The test has its flaws, but with so much celebrity endorsement of the condition’s existence, plenty of people don’t question the validity of the diagnosis. Diagnosing sex addiction
might be interpreted by some as pathologising what is probably, to most of us, reasonable sexual behaviour. There is nothing particularly telling or even unusual about having a varied sex life or a
rocky relationship history.

I’ve no doubt the questionnaire was written with the best possible intentions. But the reasoning behind many of the questions is unclear. There’s nothing in general sexuality
research literature proving any connection between some of the behaviours described and addiction. The questions are so wide open, the diagnosis is probably a matter of interpretation rather than
an objective judgement. It’s not hard to imagine how people using a self-diagnosis tool like this could be convinced they have a syndrome that they might not have. It’s also not hard to
imagine unscrupulous others looking to misuse the tool to make money out of the emotionally vulnerable or the rich and famous.

Scientific evidence for the last half-century has shown that addiction is rooted in distinct brain changes, like other mental illnesses such as depression. Cycles of desire and reward affect the
circuitry of behaviour, emotion, and memory. However, there is no scientific evidence showing sex addiction to be, like alcoholism is, a primary, chronic disease. That may be because it’s
very new. Or it may be because evidence proving its existence to that level would be all but impossible to obtain. And certainly the tools now available would not be sufficient to give the syndrome
indisputable diagnostic weight.

As a postgraduate student, I kept a toy hanging above my desk. It was a little wooden saw. I kept it there as a helpful reminder of one of the more useful sayings once common in computer
programming:
To someone who only has a hammer, every problem looks like a nail.
The saw was there as a reminder never to rely on just a hammer.

Unfortunately, the widespread popularity of such tools – and their increased acceptance – makes it difficult for researchers of mental phenomena to diversify
their toolboxes.

According to Allen Frances, MD, an emeritus professor at Duke University, ‘Periodically, the media becomes obsessed with one or another celebrity . . . the latest example is the Tiger
Woods media frenzy which will likely lead to an “epidemic” of “sexual addiction”. ’
³³

This commentary is not from a lay person, or even a minor figure in psychiatry, but the chair of the DSM-IV task force. In other words, by the person best placed to understand how and why
disorders are included in diagnostic manuals, and the potential problems of inclusion.

According to Professor Frances, ‘false epidemics’ inspired by celebrity misfortunes come and go. People don’t change very much or very quickly, but trends in what is considered
‘normal’ can and do. And he has stated concerns that hypersexuality is tipped to be the hot ‘false epidemic’ of the not so distant future.

But if psychiatry is a branch of medical science, how could this be the case? Surely the diagnostic criteria must be evidence based? Professor Frances says not always. ‘There are no
objective tests in psychiatry – no X-ray, laboratory, or exam that says definitively that someone does or does not have a mental disorder.’ This means that what is diagnosed as a mental
disorder could be influenced by professional and social forces. And with the distinction between mental disorders and ‘normality’ so fluid, rates of disorder diagnosis can rise
easily.

According to National Institute of Mental Health (NIMH) estimates, a quarter of the US population – that’s 60 million people – has a diagnosable mental disorder at any one
time. That doesn’t mean they necessarily
have
one, just that they could be diagnosed with one, if the judging criteria were stringently applied. One study found that by the age of
thirty, 50 per cent of the population met the criteria for an anxiety disorder. Another 40 per cent could be diagnosed as depressed, and a third as alcohol dependent. ‘In this brave new world
of psychiatric overdiagnosis,’ says Professor Frances, ‘will anyone get through life without a mental disorder?’

And in the brave new world of sexual openness and celebrity
obsessions, will anyone get through life without a sexual disorder?

Professor Frances is not the only person concerned about the creation of possibly bogus diagnoses. Lynn Payer, in her book
Disease-mongers,
³⁴
identifies a checklist of tactics commonly used to create suspect ‘disorders’. How does sexual addiction stand up to her criteria?

The first dodgy tactic she discusses is ‘taking a normal function and implying that there’s something wrong with it and it should be treated’. And sure enough, right on the
front page of one popular self-diagnosis website, we see statements like ‘Even the healthiest forms of human sexual expression can turn into self-defeating behaviors.’

Another questionable strategy Payer highlights is ‘imputing suffering that isn’t necessarily there’. Implying that you could have the symptoms but not know about them is one
way of doing this – again on the same website, we have ‘Often sexual addicts don’t know what is wrong with them.’

Next, Payer flags up ‘defining as large a proportion of the population as possible as suffering from the “disease” ’. In 1991, it was estimated 3-6 per cent of the US
adult population would have sex addiction.
³⁵
That would be at least 7 million Americans and a minimum of 1.35 million Britons. If this were a fatal
disease, such a high percentage of the population being affected would qualify as a Centers for Disease Control ‘Category 5 epidemic’ – the highest category that exists.

The scientific origin of that estimate is unclear, but has been repeated so often – even in peer-reviewed papers – that it is taken as fact. Even papers you expect might apply some
analysis to the frequency of the disorder, such as one titled ‘The epidemiology and phenomenology of compulsive sexual behavior’,
³⁶
repeat the
percentage exactly as it was originally stated. It is difficult to find a single paper that has any population-based justification for the estimate. That’s not epidemiology. That’s
pulling numbers out of thin air.

How about how the ‘disease’ is defined? According to one of these popular self-diagnosis websites, ‘There is a growing body of evidence that early child abuse, especially
sexual, is a primary factor in the onset of sex addiction.’ It goes on to guess that abuse leads to biological changes in the brain that heighten arousal mechanisms. That’s . . . well,
that’s just a bizarre claim.

No specific evidence is cited to support the claim. What is
interesting, though, is the striking similarity with nineteenth-century beliefs regarding nymphomania.
‘Diseased ovaries or disordered menstruation, gynaecologists argued, could lead to injury of the nervous system and of the brain and thus to mental illness.’
³⁷

There are many experts who are sceptical of the existence of sexual addiction. There is also debate about whether – even in the cases of alcohol and drug abuse – the addiction model
we are used to is really an appropriate way of thinking about how, and why, people do things.

So why is so much written about sex addiction in the general media, and why is the coverage so uncritical?

The reasons for this may be to do with the nature of journalism. Many of the people who write about science are not themselves scientists, and even fewer are educated in the relevant field. They
are limited by deadlines and column inches. Something that is straightforward to explain (most people know little about biochemistry) is a more attractive proposition than something that is
complex.

If you tell people brain chemicals are involved, even if they don’t understand the mechanisms specifically, the idea is at least graspable. It is like the ‘problem’ of female
sexual dysfunction being something that is supposedly ‘cured’ by the liberal application of hormones. But trying to tell people the causes are unknown and multifactorial, and that the
existence of the disorder is not even really confirmed? Good luck getting that across in thirty seconds at the end of the local news.

According to experts, ‘Even reductionist theories of mental illness such as of depression and schizophrenia seek to account for a general state of mind, not specific
behaviour.’
³⁸
So why are addictions believed to be down to a single factor, a kind of irresistible spell that if only we had the one single
treatment key, we could master for good?

More to the point, isn’t putting sex in this category – a single and powerful cause of ruin – simply a more modern version of the Devil putting temptations in our path to
mislead and ruin us?

These kinds of concerns about sex addiction, and related ones about the prevalence of porn, are also proving big business in some Christian churches in the US. Books targeted
at that community, such as
Healing the Wounds of Sexual Addiction
and
Eyes of Integrity: The Porn Pandemic and How It Affects You,
sell in the hundreds of thousands.

According to some of these books, sexual sin – which includes masturbation and any thoughts about sex outside of actually having sex with one’s spouse –
is a temptation that must be resisted at all costs. They emphasise that any of these actions result in lack of intimacy in marriage, and go against the biblical mandate to get and stay married.

But books aren’t the only option on the menu. Consider Pure Life Ministries, a 44-acre ‘porn recovery’ retreat in western Kentucky where treatment is $175 per week for six to
twelve months, and wives aren’t allowed to visit. Since most participants quit their jobs to relocate to the centre, it’s hard to imagine how this strengthens a marriage.

Or accountability2you, a service that dumps all the porn someone downloads into their spouse’s email inbox, as an incentive to abstain. A similar product from XXXChurch.com offers
porn-detection software that automatically emails a ‘faith buddy’ with your transgressions. All for only $7 a month.

While it’s not uncommon for the people running such programmes to have sexual addiction counselling certification from the American Association of Christian Counselors, many are not
licensed by the American Psychological Association.

Even within the Christian community, there are doubts about the diagnoses popping up thick and fast among congregations. Dr Mark Laaser, who has counselled Christians on sex matters since the
1980s, criticises such ‘pray it away’ groups. ‘The field of addiction is much deeper than opening your Bible,’ he said in a CNN interview. ‘One affair doesn’t
mean you’re a porn addict. Looking at porn occasionally doesn’t make you a porn addict. Those may be poor decisions, but they are not necessarily caused by clinical
addiction.’
³⁹

And yet there are many voices, not just those of the authors of books on addiction, supporting the sex addiction treatment process. They say they’ve been through it, and that the treatment
works. What gives?

Doctors in the eighteenth and nineteenth centuries reported success with their treatment of their unnamed nymphomania patients. And now, certainly many people seem to feel some benefit from
putting a name – sex addiction – to their behaviour and going through some kind of therapy for it.

But just because people claim that something works doesn’t mean it
works in the way they think. Treatment is comforting. I have trouble sleeping from time to time; I
find baths help. Feeling better after a hot bath doesn’t mean the bath ‘cured’ anything in and of itself. I was not suffering from a deficiency of hot water. It seems more likely
the bath is a kind of displacement activity that makes me feel less anxious, so I can go to sleep.

Whether it’s medical intervention or therapy, people seem to improve when they think something is being done. This is powerful and not to be dismissed; we know it as the placebo effect. A
pill that contains no active ingredients can produce a result in some patients, if they simply believe that it will work. Power of positive thinking and all that.

Without doubt, for nineteenth-century middle-class women diagnosed as mild nymphomaniacs, talking to someone about their thoughts and having a cool bath was very reassuring. But that approach
– and the more extreme treatments that could follow – seems to have done little for the cases observed in institutions, where there was probably a severe and underlying disorder at
work.

The National Association of Sexual Addiction Problems says, ‘Most [sex] addicts do not break the law, nor do they satisfy their need by forcing themselves upon others.’ Respected sex
therapist Marty Klein says, ‘It’s important to remind people that feeling out of control is not the same as being out of control.’ Surely if many of the so-called sex addicts were
truly uncontrollable, we’d be reading ‘Tiger Woods convicted of assault’ instead of ‘Tiger Woods, cheater’.

If sex addiction appears not to have a diagnostic basis, then why do things like the DSM-IV designation for hypersexuality exist at all?

Perhaps because unmanageable sexual urges do exist, although far more rarely than in 6 per cent of the population, and rarely in isolation from other disorders. For example, there are people
with mental disorders, and sometimes, other physiological conditions, who express sexual desire far beyond the boundaries of what is considered normal. This is quite different in degree to your
average cheater. Even a very prolific one.

A friend of mine once worked as a nurse in a care home for young people with Prader-Willi syndrome. Prader-Willi is a genetic disorder, caused by a partial deletion of chromosome 15. Features of
the
syndrome include a host of physical characteristics, as well as learning difficulties, speech and sleeping disorders, and most markedly, polyphagia – overeating to
an extreme degree. And extreme doesn’t mean ‘Oops, I finished all the ice cream, tee hee.’ She described how the home could not even have scented soap, as the patients might think
it smelled like food, and eat it. Food cupboards were naturally locked and monitored. The residents literally could not help themselves.