In 1992, a political skirmish took place in the field of medicine, which has discouraged deeper
understanding of human
sexuality. According to David E. Smith MD, past president of the American Society of
Addiction Medicine (
ASAM), doctors bartered away the recognition of
sex addiction as a pathology in order to address a more immediate risk. Smith, by the way, founded the free Haight-Ashbury medical clinic in San Francisco during the Summer of Love (1967). He has worked tirelessly ever since both to educate the medical profession about the plastic
brain changes behind addiction and recovery and to treat addicted patients. He is the author of numerous books and journal articles.
According to Smith, here's what happened: Jess Browley and he were the Delegate and Alternate Delegate, respectively, to the American Medical Association's House of Delegates in search of endorsement of a new specialty: addiction medicine. It became clear that the AMA wouldn't agree to approve the new specialty unless sex was excluded from the list of possible addictions. So, they tossed 'sex addiction' under the bus.
This exclusion was not based on science or Smith's own clinical experience—both of which suggested that sexual behaviors indeed have the potential to become addictions under some circumstances. This is hardly surprising, as sexual arousal is the most compelling of all natural rewards and it arises in the brain's reward circuitry (seat of all addiction).
The reason was strategic. Doctors were bent on snuffing out the tobacco manufacturers' spin. Big Tobacco was pulling out all the stops to prolong the illusion that "smoking is not addictive." It claimed that the addiction experts' evidence should be ignored because, "the experts are saying everything's addictive."
Excluding sex demonstrated that doctors weren't saying everything is addictive. Besides, sex addicts were rare, while smokers were everywhere and suffering unnecessarily. Moreover, behavioral addiction brain science hadn't reached today's levels of reliability and conclusiveness.
Unforeseen repercussions
Carving sexual behaviors out of the addiction field has had perilous repercussions. Nearly two decades after experts extinguished the Smoke Spin, beginning with the tobacco papers published in the Journal of the American Medical Association (1994), we're still in the Dark Ages of understanding sexuality.
The ASAM-AMA deal inadvertently shielded sexual addiction from the inquisitive eyes of the very medical researchers who could have shed the most light on sexual excess: neurobiologists. Why study something which, by medical fiat, does not exist? Therefore, there has been almost no direct investigation into the neurobiology of sexual excess. (In contrast, many studies confirm the existence addiction-related brain changes in other behavioral addicts.)
Instead, medical research has focused almost entirely on hyposexuality (lack of sexual responsiveness). Accordingly, we have sexual enhancement drugs and medically-prescribed vibrators and erotica. Doctors are even testing orgasm-producing implants for women's spines.
Yet if a patient complains of inability to control behavior, porn tastes morphing in unsettling ways, or the need for increasing sexual stimulation—many a therapist will assure him that hypersexuality doesn't exist. This is true even if he self-identifies as an addict. One academic sexologist proudly recounted that he told a guy masturbating to Internet porn for six hours per day that he didn't have an addiction, but rather a procrastination problem. It's theoretically possible, but....
Therapists who courageously point out that hypersexuality can lead to addiction, and attempt to treat clients accordingly, are either dismissed or shamed by their more dogmatic peers. In keeping with this mindset, the authors of the upcoming DSM-5 intend to banish the section on hypersexuality to the appendix.
Such tunnel vision is due, in part, to the historic pact discussed above. A generation of textbooks claims that (1) sexual repression is the prime threat to healthy sexuality, and (2) sexual behaviors cannot cause addiction. Academic training has not yet caught up with the radical changes of highspeed Internet and brain research on behavioral addicts.
For example, we asked a psychology professor and sex researcher what he thought about news of an Italian survey ordered by urologists, which confirmed what we've seen reported in hundreds of forum threads across 25 countries—namely that young, heavy porn users are developing erectile dysfunction, which reverses itself within months of stopping porn use. He scoffed at the possibility of excessive consumption of porn causing desensitization (an addiction-related brain change):
Why are so many silly news stories generated on this topic? Hmm, does it represent excessive concern about something that doesn't exist, like excessive concern about unicorns?
His response is comprehensible. After all, he has probably been drilling into his students for years the unexamined assumption that sexual behaviors, including Internet porn use, can never cause addiction processes in the brain. Since this position is not supported by actual brain science, circular explanations are common: "Internet porn is a masturbation aid...and there can be no such thing as too much masturbation (because sex can never be an addiction)... so there can be no such thing as too much porn use."
