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The couple looked troubled. Everything that they thought they'd figured out, that had been explained by their pastor, no longer made sense. "OK, then, if it's not sex addiction, what is the problem?" A moment passed. Then another. "Well," I said, "for starters, it's worse than you think."
Sex addiction, as a pseudoscientific concept, is very emotionally appealing. First, it definitely labels the objectionable sexual conduct as a disease and nothing but a disease; really, there's no need to look any further. But the reason I told my clients it's worse than what they thought is that it's not the so-called addict who has a problem. The problem is about them as a couple.
Look closely at this definition of sex addiction: “any sexually-related, compulsive behavior that interferes with normal living and causes severe stress on family, friends, loved ones, and one’s work environment.” Sex addiction is about "any sexually related behavior." Really? How about flirting? Engaging in private sexual fantasy? Trying to talk one too many times to your partner about how sexually unhappy you are? Any sexually related behavior, like shopping for (and staring at) carrots or melons.
You might object, "That's a bit overbroad isn't it?" Sure. Absolutely. Let's narrow it down: "...which interferes with normal living." There can be no ambiguity there because, across the U.S., we all agree with what normal sexuality is. Just kidding, no, we don't agree. Sex outside of wedlock? Being gay? Availing oneself of the services of sex workers? Erotica, porn, or just steamy romance novels? Some of us think masturbation is a normal human behavior even though only 95 percent of Americans do it. (Studies indicate that the remaining 5 percent are liars.) You see where this is going. So much for normal.
This "sexually-related behavior" must "cause severe stress on family, friends, loved ones, and one’s work environment." A nice touch here. This is almost like (and easily confused with) the descriptive criteria for mental illnesses in which the disorder must "cause clinically significant distress or impairment." In other words, if a behavior doesn't cause problems then it's most likely not a problem—at least for clinicians. But if Johnny (or Suzie) persists in masturbating (when we really want them not to) and mom and dad are really upset, then there you go. You have a bona fide case of sex addiction. Or do you? The difference for clinicians is that the distress has to occur in the patient and not in the people around them. Therapy Rule #17: The person with the pain is the person with the problem.
I've had men come into my office seemingly tormented with their sexual thoughts and behaviors. They say that they don't want to think or behave this way. That these thoughts and behaviors are destroying their marriages. I suggest a thought experiment. "What if you came home one day from work and your wife, dressed provocatively, greeted you at the door with a warm kiss and a loving smile. She then looks at you kindly and admits that she was a little stuck on what to get you for your birthday and that finally, in the end, she decided to bring over her hot girlfriend so the three of you could have a great time and, right now, the girlfriend is waiting in the bedroom."
Long pause. "I'd think it was a trick." OK, but let's say it wasn't, what would you do? Long pause, "Well, I wouldn't want to be rude, I mean, it was her idea and...." There it is. The thoughts of infidelity did bother him, but only if they bothered her. If those thoughts and the related behaviors were viewed more kindly then (poof!) no more distress. This is confusing to some because it means that in marriages with frisky partners like the one above, what was a sex addiction yesterday might become today, abracadabra, a consensual sexual adventure.
When I tell my clients that sex addiction isn't the problem and that the real problem is worse than they think, what I mean is that they have a problem not having realized a sustainable form of sexuality. Most often, this problem with how they're living takes one of three forms:
1. There are people who are in committed relationships with other people and the problem is their relationship—not sex addiction. This might include men who want sex more than their partners do, women who long ago lost all interest in the stable stick-in-the-mud to whom they are married, and men and women who find their partners nice, very nice but really boring.
2. Then there are those who are trying to live according to a form of spirituality that they consider more important than the people their spirituality is meant to serve. A simple case: The woman caught masturbating in the 1990s film, The Handmaid's Tale. She was taken up by force and held with her hands outstretched while attendants burned them. Obviously a sex addict. But then, so is the teenager who masturbated seven times yesterday. Or the husband who was caught looking at adult porn after he thought his wife had gone to sleep. Part of his therapy was confessing all this in church on Sunday.
3. Finally, there are those people with personality disorders, sadly, who are simply incapable of love and for whom intimacy is a unicorn: absolutely nonexistent. Titillation, the arousal to physical stimuli, is their dialysis keeping them going. They are addicted to sex but only in the same way diabetics are addicted to insulin.
Treating any of these with the sex addiction model puts money in the hands of quacks and hopelessness in the hearts of people who really are looking for some compassionate help.
