The Heart of Addiction

How psychology drives addictive behavior.

Is Anthony Weiner a Sex Addict?

And what would that mean, anyway?

As the author of two books about addiction as well as a number of professional journal articles, I get a lot of questions from patients and colleagues alike about the nature of compulsive behavior -- what drives it, what gives it its power, and especially why so many people repeat destructive behaviors in the face of overwhelmingly bad consequences.

This question has resurfaced over the last couple of weeks as pundits and politicians began speculating about the motivations and psychology of Representative Anthony D. Weiner of New York. In case you have been on a news hiatus -- and who could blame you -- Congressman Weiner recently became engulfed in a scandal over some explicit photos he sent to various women over the Internet. When the story broke, allies and foes alike promptly demanded his resignation for what they deemed inappropriate behavior. Eventually the political pressure grew so great that Mr. Weiner was forced to resign from office.

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Now, leave aside the question of whether a political figure's personal life is any of our business. I want to focus for just a second on the question so many people are asking: why? Why would a successful politician, media darling, and presumptive New York mayoral candidate sabotage his career in this way? Was it intentional? A cry for help? A daring bid to get caught? And why does this kind of behavior seem to be so common across the political spectrum? (See, for example, Messrs. Clinton, Spitzer, Schwarzenegger, Edwards, and Lee.) Is there something about politics in particular that rewards or invites sexual risk-taking, or is it simply the place where most of them get caught?

It is tempting to play parlor psychoanalyst and speculate about Representative Weiner's personal motivations, but of course such speculation would neither be fair nor appropriate. I have never met Mr. Weiner, nor would I presume to understand what goes on inside his head, let alone his marriage. But I can speak more generally to the question of why men in power may sometimes find themselves compelled to act out sexual fantasies that are almost certain to invite ridicule and recrimination.

Compulsion has certain qualities that are universal. Longtime readers of my work will recall my view that addiction arises from feelings of intolerable helplessness. This helplessness manifests differently for different people, of course -- it is subjective. But the common factor is its intolerable nature -- the kind of helplessness that goes straight to the heart of our sense of self. Most people act to repair these feelings directly when they occur, but addiction arises when this direct action is forbidden in some way -- considered by the suffering individual to be prohibited or taboo. The addiction then becomes a substitute remedy, a quick fix which works reasonably well in the moment, but which has devastating consequences over time.

In other words, addiction is neither a disease nor a pleasure-seeking behavior. It is an important act that serves a function, and understanding that function is the key to getting well.

So what does any of this have to do with Representative Weiner -- or for that matter, Clinton and the others? If their problem is not really an addiction, then maybe nothing. But it is not unreasonable to imagine that politics in general attracts more than its fair share of people deeply concerned about their value and importance. And their need for affirmation is just the sort of torment that is often driven by a deep sense of helplessness to be valued. Whether these feelings give rise to a compulsive quest for power or for sexual affirmation may not be much of a difference. I surely wouldn't be the first person to point out the strong association between power and sexuality.

As a touchstone for a broader discussion about the psychology of addiction, it bears repeating that all compulsive behaviors serve a purpose. On the surface, that purpose may look like sexual pleasure or a chemical high, but what underlies the behavior is inevitably a desperate need to repair feelings of helplessness. If someone doesn't feel enough of a powerful person, or enough of a worthy human being, he may find himself turning to reckless behavior without really knowing why. The best way to overcome any compulsion is to seek to understand its causes, and to discover more direct and healthy ways of addressing those feelings in the future.

Lance Dodes, M.D., is an assistant clinical professor of psychiatry at Harvard Medical School.

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