William A. Henkin: THE MYTH OF SEXUAL ADDICTION

[I did not read Patrick Carnes’s book Out of the Shadows until Layne Winklebleck, then editor of Spectator, asked me to write about it, but I was unable to contain my remarks to a simple book review. This essay appeared originally in Spectator, in 1989; it was subsequently reprinted in the Journal of Gender Studies and elsewhere, and I used it as part of a reply to a question in “Ask the Therapist,” my advice column published in Growing Pains, newsletter of the Society of Janus. Recent research in neurochemical functioning has shown brain correlations where addictions and compulsions are concerned that have led some people to conflate the two, but in my reading of some of that research I do not find it alters my underlying premise.]

God grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.

-- the prayer of Alcoholics Anonymous

Failure is an opportunity.

If you blame someone else,

there is no end to the blame.

Therefore the Master

fulfills her own obligations

and corrects her own mistakes.

She does what she needs to do

and demands nothing of others.

-- Tao te Ching,

translated by Stephen Mitchell

I. Sex

However natural and innate the physiology of sex acts might be, the way their practice is seen in humans depends as well on cultural norms. More than 20 years ago, anthropologist Donald Marshall wrote that on the Polynesian island of Mangaia, “There is no social contact between the sexes, no rendezvous that does not lead directly to coitus – copulation is the only imaginable outcome of heterosexual contact.” From childhood on, he reported, Mangaians were trained to enjoy sex and to assure sexual pleasure to their partners.

At about the same time, an entirely different view of sex was provided by John C. Messenger, who studied an Irish island he called Inis Beag. There, not just partnered sex, but any kind of sexual expression “such as masturbation, mutual exploration of bodies, use of either standard or slang words relating to sex, and open urination and defecation – is severely punished by word or deed.”

As Havelock Ellis demonstrated nearly a century ago, social comparisons need not take us to remote islands. Concerning modesty, for instance, Louis XI was greeted upon his first entry

into France by three naked women representing Sirens; they “were greatly admired by the public.” Similar welcomes were accorded royalty elsewhere in Europe in the 15^th and 16^th centuries. In 18^th century France and Prussia members of royalty and the intelligentsia alike often welcomed to their homes the lovers of their wives and husbands, men and women bathed nude together in Russia, and women bared their chests in Italy’s warm summers. As Edward Brecher has pointed out, nude bathing was common on some of England’s popular beaches well into Victoria’s 19^th century.

We cannot reasonably understand sex or sexuality without recognizing the extent to which sexual mores express the specific sociology of a particular people in a particular time and place. While a Mangain youth might regard one fuck a night, every night, as sexual poverty, her Inis Beag counterpart might equally regard one fuck a month as sinful, or at least pathological.

Closer to home, in 1952, when the American Psychiatric Association published the first Diagnostic and Statistical Manual of Mental Disorders, homosexuality, promiscuous sexual activity, fellatio, cunnilingus, and masturbation were all officially designated mental illnesses. 28 years later, in 1980, the third edition of the DSM included none of these ailments. If the Kinsey, Hunt, and Hite reports can be believed, Americans’ behaviors had not changed very much in those times: our provincial human judgments had. And judgment is what the vogue for sexual addiction is all about.

II. Addiction

According to the Oxford English Dictionary the word addiction derives from Roman law, and originally meant a formal surrender by sentence of a judge. Over time, the word came to mean devotion to a habit, place, person, or idea, or the pursuit of some special interest. Since it implied a preference, inclination, or penchant, people were said to be addicted to reading, art, their trades, melancholy, virginity, or thoughts of the next life, as well as to wealth, strong drink, and the devil. Addiction as such was not considered a bad thing, although one person might disapprove of what another was addicted to.

During the 20th century psychiatrists adopted addiction and made it specific to biochemistry. The Psychiatric Glossary of the American Psychiatric Association defines addiction as:

Dependence on a chemical substance to the extent that a physiologic need is established. This [need] manifests itself as withdrawal symptoms... when the substance is removed.

The Psychiatric Glossary cross-references addiction to drug dependence, which it defines as:

Habituation to, abuse of, and/or addiction to a chemical substance.... The term thus includes not only the addiction (which emphasizes physiologic dependence), but also drug abuse (where the pathologic craving for drugs seems unrelated to physical dependence).

The glossary offers as examples of the drugs upon which a person might become dependent:

alcohol; opiates; synthetic analgesics with morphine-like effects; barbiturates; other hypnotics, sedatives, and some anti-anxiety agents; cocaine; psychostimulants; marijuana; and psychotomimetic drugs.

By the time the psychiatric establishment appropriated addiction and relegated to it a state of chemical dependence, the idea that devotion to or interest in books, politics, or money could be addicting had lost its currency. Though people do periodically attempt to “cure” themselves or others of habits such as nail-biting and leaving closet doors ajar, the only sorts of non-chemical dependencies modern doctors seriously endeavor to treat are better thought of as compulsions. According to the Psychiatric Glossary a compulsion is

An insistent, repetitive, intrusive, and unwanted urge to perform an act that is contrary to one's ordinary wishes or standards. Since it serves as a defensive substitute for still more unacceptable unconscious ideas and wishes, failure to perform the compulsive act leads to overt anxiety. Compulsions are obsessions that are still felt as impulses.

The large importance of the small semantic distinction I am making lies in the difference between a condition and a behavior. A condition, such as addiction, describes the way one is, however temporarily; a behavior, which one may or may not perform compulsively, is

something one does. Many kinds of psychotherapy treat compulsive behaviors, but apart from hypnosis and the grosser forms of behavior modification, no strictly medical or psychological program has ever clearly demonstrated success in treating addictions. Regarding addiction, Stanton Peele, author of Love and Addiction, observes that “Self-cure can work, and depending on someone else to cure you usually does not.” In-patient rehabilitation facilities, recognizing what combination of efforts can enhance success in treating addiction, have made self-help concepts the core of their programs. The understandings that underlie all such self-help approaches began to take shape in 1935, when Bill W. met Dr. Bob and the seeds of a fellowship were sown that soon became known as Alcoholics Anonymous, or AA for short.

III. Close Encounters of the Anonymous Kind

Friends, if you are not now and never have been a problem drinker; if you have never even known someone who was a problem drinker: nonetheless, AA has probably touched your life. And if booze is not a significant feature of your personal landscape, then it is increasingly likely that the part of your life AA has touched has to do instead with sexuality.

Twelve-step programs like AA help more addicts recover than any other method known in part because they provide external systems that specifically support people in staying away from their chemicals of obligation while the physical addiction fades and they develop the internal resources they need to cope with psychological dependence or habituation. Though chewing gum instead of smoking does not provide the group support of people sharing a problem and a goal in common, it does provide a similarly alternative habit into which an addict can channel some of his or her craving during withdrawal. Gum and groups have been pejoratively described as crutches for people who cannot resolve their habits on their own, but using a crutch to support a fragile freedom from an addiction may be as critical as using a crutch to support the body’s weight while a broken leg bone heals. After all, the addict is wrestling with chemical dependence and its concomitant withdrawal symptoms. Suddenly removing the addictive substance can provoke sweats, tremors, convulsions, hallucinations, and even death. Whatever can reduce that strain, short of giving in to the addiction itself, can help the addict struggle free. Group support is one such valuable aid.

Freedom from chemical dependency and the kindness of strangers may not be the end, however. “Addicts may switch not only from one chemical substance to another, but from a chemical to a social ‘high,’” says Stanton Peele; and in any kind of self-cure, the “key word is self: taking charge of your own problem.” If your own problem is not based in biochemistry or genetics, as chemical dependency often seems at least in part to be, then what is restrained by participation in an Anonymous addicts group may not be a habit at all. It may be, instead, exactly what is supposed to emerge after the addiction has been overcome: your self, and along with it the concomitant freedom to take charge of your problem.

Participation in almost any support group has the potential to alter a person’s behavior. Peer pressure, the insights afforded by other people’s autobiographies, and the pleasures of belonging all conspire to bring a person into line with the edicts of the group he or she has chosen. In recent years programs based on AA’s precepts have been devised for people who feel dependent not only on chemicals, but on just about every kind of foible that could ail a human mind or body, including, of course, sex. The problem with sex addict groups is that they conspire to identify as addictions behavior patterns that may be compulsions and may be no more than shame responses to presumptions of social pressure. In either case, peer pressure, insights, and the pleasures of belonging encourage people to relinquish hope of achieving the kind of mastery over themselves, and control over their own free choices, that they joined those groups in order to discover.

IV. The Myth of Sexual Addiction

In a 1986 presentation to the American Psychological Association, Martin P. Levine and Richard R. Troiden addressed “the newly discovered ‘conditions’ of sexual addiction and sexual compulsion from the sociological perspective of symbolic interactionism.” In the revision of their paper, published in the Journal of Sex Research, they demonstrate that the definitions are conceptually flawed and that the criteria for these “conditions” are subjective and value laden. There is nothing inherently pathological in the conduct that is labeled sexually compulsive or addictive. Rather than referring to actual clinical entities, sexual addiction and compulsion refer to learned patterns of behavior that are stigmatized by dominant institutions.

In the United States, the authors observe, three distinct sexual scripts or erotic codes co-exist; since the ideals that underlie them are mutually exclusive, the codes are in competition. For that reason it is not even a person's sexual behavior, but rather the prevailing script that determines whether “a behavior is labeled as a psychosexual disorder or as sexually normal.” Levine and Troiden call the three sexual scripts they discuss procreative, relational, and recreational. The first holds that

sexual expression is dirty, sinful, and wrong except when it occurs in marriage and for reproductive purposes.... Casual sex and frequent sexual intercourse are defined as pathological conditions....

The relational script, on the other hand,

regards sexual activity as a means of expressing and reinforcing emotional and psychological intimacy.... Any act is appropriate in the relational context, provided that both partners mutually approve.

The recreational script

perceives mutual pleasure as the chief purpose of sexual activity, [and] endorses sexual contacts between mutually interested partners, even if they are total strangers, and permits them to engage in any agreed-upon act that enhances sensual pleasure....

These three scripts have different definitions of control over erotic conduct. The procreative code views any nonmarital or nonprocreative sexuality as indicating a lack of sexual control and the relational code regards nonrelational sex as indicating a lack of sexual control, whereas issues of control are irrelevant in recreational scripts, which define only nonconsensual sex as deviant.

According to Levine and Troiden, the procreative ethic was this nation's primary erotic code in the middle of the 20^th century, when psychiatrists perceived evidence of mental disorder in nonprocreative sexual acts. Once reproductive sex lost its holy patina, relational and recreational scripts gained ascendance, and in the 1960s and 70s large numbers of Americans “came to view nonmarital sex, mate swapping, one-night stands, homosexuality, and the use of pornography as viable sexual options.”

By 1980, not only had masturbation, oral sex, and ego-syntonic homosexuality disappeared from the Diagnostic and Statistical Manual: at the same time, therapists discovered a whole new collection of sex pathologies, including premature ejaculation, failure to achieve orgasm, fear of sex, and low levels of sexual desire. Whereas in 1952 Americans were considered sick for wanting too much sex, by 1980 we were sick for wanting too little. Once again, the specific nature of our behavior had not changed: people who wanted to fuck a lot still wanted to fuck a lot, people who were bored by sex remained bored by sex. What had changed was the sexual script – the human judgment – favored by the people who dominated social thinking in those years.

In the 1980s sexual revisionism set in with a vengeance. Herpes, hepatitis, and AIDS; the rise of radical religious and social movements, and, perhaps, the inevitable return swing of the cultural pendulum: any or all might be blamed or credited for the shift. But if the procreative script shared pre-eminence with the relational script, the recreational script was out in any case. Soon, self-help groups founded on the same premises and steps that made AA successful appeared in order to help people conquer this whole new battery of nominal disabilities. As anti-sex became a hot topic in the dailies, some sex-negative groups assumed the Anonymous mantle. They espoused heterosexual monogamy with a kind of holy zeal and sought to recast mate-swapping, cruising, and other recently popular behaviors as disorders that required therapy – or as addictions best served by self-help groups.

But wait: however pumped up some people get on their fantasies or hormones, sexual behavior is still not a substance, nor does the unsatisfied need for sexual expression provoke physiological withdrawal symptoms. Sexual behavior is a highly charged facet of human experience, however, which affects and is affected by biochemical changes in the body and brain that are associated with emotions. Consequently, sexual behavior also has a history of frightening some people so badly that rather than labor to understand it, they seek to suppress it in themselves as well as in others. Throughout the centuries people have rationalized their sexual fears, and hidden their resulting bigotry behind the skirts of bureaucratic religions, legal proscriptions, and pseudo-scientific authority. To 18^th century Western physicians masturbation was a well-known cause of insanity; to their 19^th century counterparts it was clear that women had few sexual desires. So, as the 20^th century draws to a close, a conspicuous number of psychologists seem to know that human beings can be addicted to their own erotic behaviors. Now: whether the subject is masturbation, flashing, or rape – or eating, jogging, or watching television, for that matter – any behavior can be done compulsively. While I do not wish to imply that child molesters and rapists are free of pressing problems, I object to denominating those problems as addictions.

First of all, to do so is to raise the value of a transitory social ideology above the variety of ongoing human experience; second, it offers a simplistic explanation for an issue that deserves detailed attention. At one end of the psychological spectrum compulsions may reflect a person's shame or guilt for having feelings – in this case for having sexual feelings specifically – at all. At the other end they may represent a single facet of a complex character disorder. Perhaps the pathology that does not change with the winds of social reformation lies in the need some people have to meddle in other peoples’ affairs. As Levine and Troiden write, there is nothing intrinsically pathological in the behaviors the DSM defines as psychosexual disorders, whether the definitions are taken from the category that prevailed in 1952, the category that prevailed in 1980, or the category that prevails in the DSM-IV today. Instead, sexual behaviors

are defined as pathological only because they violate prevailing erotic norms. Rather than referring to actual clinical entities, psychosexual disorders denote forms of stigmatized erotic conduct. In this sense they are value judgments cloaked as pseudoscientific diagnosis. By inventing and treating these “conditions,” that is, by “medicalizing” morality, mental health professionals and sexologists pathologize non-normative sexual practices; they function as social control agents, enforcing conformity to culturally hegemonic erotic standards....

As used currently, the terms “sexual addiction” and “sexual compulsion” employ prevailing cultural standards as the basis for determining erotic control or deviance.

V. The Death of Sex

The man who put sex addiction on the map is Patrick Carnes. In the Preface to his book Out of the Shadows, originally published in 1983 as The Sexual Addiction, Carnes explains how the book grew out of a paper he wrote in 1976, based on his experiences treating sex offenders for two years. Although he reports that his paper was influential and circulated widely, he refrained from formal publication for several reasons: not everyone he regarded as a sex addict was a sex offender; he did not yet have adequate data to support his belief that sexual acting out could constitute an addiction; and there was no network of programs in place – no Sex Addicts Anonymous, Sex and Love Addicts Anonymous, Sexaholics Anonymous, or the like – to help people troubled by their alternative sexual urges. “Most of all,” however, Carnes explains, “I was afraid of the public reaction which is always unpredictable in sexual matters. In short, it was an idea whose time had not come.”

Indeed. In 1976 American society was still in the throes of a recreational sex script. By 1983, though we were not ready to resurrect the procreational scripts promulgated by foes of abortion, homosexuality, and extra-marital intercourse, at least the nation seemed ready for a change. Before a relational script could dominate the scene, however, the ruling recreational scripts had to be overthrown. In the fine tradition of American clinical psychiatry, the simplest way to overthrow those scripts was to medicalize the behaviors that defined them.

No one person can redefine entries for so Biblical an opus as the Diagnostic and Statistical Manual of Mental Disorders. So far, each revision has required huge committees of experts and more than a decade of debate. But one influential person can spearhead a movement that redefines a social ideal, and can thereby profoundly alter the context in which a DSM committee sits.

Carnes and his followers attribute addiction to behavior. This revisionist judgment is not written in stone, and it is not written in biochemistry, but it may be written in a future Diagnostic and Statistical Manual of Mental Disorders, as oral sex and masturbation were in DSMs of the not-so-distant past. Carnes does not claim that every person who engages in any behavior represented in his schema is a sex addict in need of rehabilitation. As he writes, “behavior by itself does not make an addict.” Instead, it is Carnes's contention that “addicts are people who cannot stop their behavior which is crippling them and those around them,” and that, by implication, behaviors that are damaging and out of the actor’s control are addictions. The script he would put in place lays the ground for a social ideology that dictates which erotic pleasures you may take tonight and which you had best foreswear; and if you do not like the limits of that tolerance, Carnes warns, your discomfort or rebellion itself suggests that you may be the new sex addict on your block.

VI. Addiction to the Myth

Perhaps we should start to contemplate the meaning of our society’s “addiction” to addiction terminology. Psychological health is advanced through increased awareness of personal responsibility for one’s feelings, thoughts, beliefs, and behaviors. By couching sexual behavior in terms of addiction, the psychological meaning of a person’s erotic experience is diminished and his or her personal responsibility for that experience is demeaned.

On an individual basis the lack of personal responsibility that is thus encouraged, formalized by organizational structures, and given credence by professional caregivers with a great deal to gain by identifying a whole new bailiwick of illness, encourages people who are distressed or confused by their sexuality to think of themselves as impotent in the face of their own problems.

Socially, rapists and other sexually abusive individuals are provided with a sanctioned legal defense for their dangerous practices – “I couldn’t help it, I’m an addict” – while people who read erotic literature or watch erotic theatre are stigmatized for their harmless ones. Thus, the safety, psychological health, and civil liberties of us all are jeopardized by a cultural ideal that encourages both the suppression and the repression not only of people's behaviors, but of their thoughts and feelings as well, in private and in public, in the names of social service and our own good.

If we accept the idea of sex addiction we give up the rights to our own erotic processes. If we relinquish the rights to suffer our own pains and ignominies, we give away the rights to learn from them, and to grow into increasingly responsible adult human beings. And as history shows, if we do not embrace our own responsibilities, others will readily do so for us.

Laws are already in place regarding sexual activities that clearly have victims: activities, in brief, that are non-consensual. Whether those laws are adequate, whether they are appropriately enforced, and whether their enforcement is or can be effective are all questions beyond the purview of this paper. Here, the question boils down to whether the food is to be blamed if I overeat.

After 20 years of relative freedom it has once again become the vogue to legislate morality and to usurp individual rights, sexual and otherwise. But it is precisely those processes by which sexual freedom among consenting adults is denied that the life of one person and the life of a whole society is suppressed, because it is precisely those processes that infantilize a person and a people: first by relieving them of hard choices, next by witholding their responsibility for making those choices, and finally by taking away their power to make them altogether.

This is why the debate about sexual addiction is not a debate about whether sex is good or not. It is a debate about who shall determine which of us shall be free.

RESOURCES

Alcoholics Anonymous. New York: Alcoholics Anonymous World Services, Inc., Box 459, Grand Central Station, New York, NY 10163, 1976 (1936).

American Psychiatric Association, The American Psychiatric Association's Psychiatric Glossary. Washington, DC: American Psychiatric Press, Inc., 1984.

“Are You Addicted to Addiction?” Utne Reader, No 30, Nov-Dec 1988. Special section including:

Berenson, David, “Alcoholics Anonymous: From Surrender to Transformation,” (reprinted from The Family Therapy Networker);

Bufe, Charles, “AA: Guilt and God for the Gullible,” (reprinted from The Match);

Collett, Lily, “Step by Step: A Skeptic's Encounter with the Twelve-Step Program,” (reprinted from Mother Jones);

Fingarette, Herbert, “Alcoholism: The Mythical Disease,” (reprinted from The Public Interest);

Herman, Ellen, “The Twelve-Step Program: Cure or Cover?” (reprinted from Out/Look);

Peele, Stanton, “On the Diseasing of America,” (excerpted from The Diseasing of America: How the Addiction Industry Captured Our Souls, by Stanton Peele);

Perrin, Pat, and Wim Coleman, “Is Addiction Actually a Misguided Move Toward Wholeness?” by (reprinted from New Realities);

Schaef, Anne Wilson, “Recovery as Process,” (excerpted from an essay based on material from Escape from Intimacy, by Anne Wilson Schaef);

Utne, Eric, “Editor's Note.”

Carnes, Patrick, Out of the Shadows: Understanding Sexual Addiction. Minneapolis: CompCare Publishers, 1983.

Frayne, Gabriel, Jr., “The Cult of Recovery,” San Francisco Chronicle: This World, Jan. 22, 1989, p. 20.

Hubner, John, “In Love with Porn,” San Jose Mercury News: West, Jan 22, 1989, pp. 11 - 18.

Levine, Martin P. and Richard R. Troiden, “The Myth of Sexual Compulsivity,” Journal of Sex Research, Vol 25, No 3, Aug 1988, pp 347 - 363.

Marshall, Donald S., “Too Much Sex in Managia,” Psychology Today, Vol 4, No 9, February, 1971, pp 43-44, 70, 74-75.

Messenger, John C., “Sex and Repression in an Irish Folk Community,” in Marshall, Donald S. and Robert C. Suggs (eds), Human Sexual Behavior: Variations in the Ethnographic Spectrum. New York: Institute for Sex Research, Basic Books: 1971.

Peele, Stanton, “Out of the Habit Trap,” American Health, September/ October 1983, pp. 42 - 47.

Schneider, Jennifer P., Back from Betrayal: Recovering from His Affairs. New York: A Harper/Hazelden Book, Harper & Row, 1988.

“Sex Addicts,” from Recovering, March-April 1988, quoted in Journal of Sexual Liberty, Vol 4, No 4, May 1988, p. 3.

“The Bill W. - Carl Jung Letters.” Grapevine, January, 1968 (1963).

SIDEBAR

The Twelve Steps are reprinted with permission of Alcoholics Anonymous World Services, Inc.

1. We admitted we were powerless over alcohol -- that our lives had become unmanageable.

2. Came to believe that a Power greater than ourselves could restore us to sanity.

3. Made a decision to turn our will and our lives over to the care of God, as we understood him. (Italics in the original.)

4. Made a searching and fearless moral inventory of ourselves.

5. Admitted to God, to ourselves, and to another human being, the exact nature of our wrongs.

6. Were entirely ready to have God remove all these defects of character.

7. Humbly asked Him to remove our shortcomings.

8. Made a list of all persons we had harmed, and became willing to make amends to them all.

9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

10. Continued to take personal inventory and when we were wrong promptly admitted it.

11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out. (Italics in the original.)

12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.