The Controversy Over Sex Addiction

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"So you think you're a sex addict?" The miserable-looking man in his first appointment looked down, took a moment as he fought back tears before finally nodding yes.

"This," I thought to myself, "is going to hurt. But," I said to myself, "this is why I get paid the big bucks."

The public has come a long way since the days of snake oil, blood-letting, and demon exorcism. Or... has it? True, no one is currently betting big on snake oil, blood-letting went out in the 19th century, and demons... well, demons still are pretty popular as evidenced by a certain president's retweet of a medical doctor licensed in a very embarrassed state of Texas. The good doctor is most noted for her — what, unique? — theories that demon sperm causes illness and that gynecological problems like endometriosis are the result of women having sex with demons. Women, what a naughty lot, who knew?

I love my profession and I am proud of the good that we do in helping people. But we in the licensed mental health fields have our own demon doctors. The Bible of the industry (pardon the expression), the Diagnostic and Statistical Manual of Mental Disorders classified homosexuality as a mental disorder up until 1973. This classification of a normal segment of the general population created countless unnecessary tragedies for thousands of patients and their families.

This sort of unscientific thinking has been quite the norm in so-called scientific circles. The reason is found in the early days of psychotherapy, where behavioral science competed with religion to develop a prevailing theory that would explain human behaviors. Religion would use science as a buttress for their arguments that God was right all along. Science often borrowed the conclusions of religion and then searched furiously for evidence that those conclusions were true. A most embarrassing (and truly pernicious) example: drapetomania, a conjecture of Dr. Samuel Cartwright, who used this fictitious "illness" to describe how slaves who wanted to escape the South had "an uncontrollable or insane impulsion to wander." Let us give thanks to the Medical Association of Louisiana for this gem.

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If the results weren't so very hurtful, this is the sort of thinking that would actually be very amusing at a certain level. This brings us to sex addiction, a notion that has been popularized by none other than (you guessed it) psychotherapists. That is, psychotherapists who are largely influenced by religion in the United States, where religion remains, now as always, in the very ether we breathe. But it remains true that, after years of research and scientific debate, "sex addiction" is not actually a recognized mental illness. True believers don't let this stop them and they are not waiting for the scientific establishment to catch up.

Like many religions, when it comes to the industry of sex addiction treatment, the love of money is the root of all evil. Do an internet search on "sex addiction treatment facilities" and you will find, well, lots of them. What they all have in common is that they take third party reimbursement (medical insurance).

But how, you ask, do these high dollar "treatment centers" bill if there is no such diagnostic category in the DSM-5? Simple. They bill for other "comorbid conditions," such as major depression or anxiety disorder. Patients are told, "But sex addiction is your primary diagnosis."

However, the backbone of the industry is made up of self-paying patients who aren't bothered with the insurance issues because their primary concern is PR management. As Betty Ford did for chemical addiction in the 1970s, so have celebrities like golfer Tiger Woods, and actors Russell Brand and David Duchovny done for sex addiction.

The upshot is that, when it comes to sex addiction, psychotherapy has become religion's dance partner. Want to save your relationship after getting caught with a porn star? Easy, just claim, "I'm sick. I have a disease. I'm not responsible and I need help." Try it. It could work.

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The industry defines sex addiction because science struggles to find it. According to a group that offers certification for sex therapists, sex addiction is “any sexually related, compulsive behavior which interferes with normal living and causes severe stress on family, friends, loved ones and one’s work environment.”

This "sexually related behavior" used to be known as having an affair, going to a massage parlor, or looking at porn. When we get caught and our behavior "causes severe stress on family, friends, loved ones, and one's work environment," then we can attribute it to a disease.

Remember Jack Nicholson's character in the 1997 film As Good as It Gets? He suffered from obsessive-compulsive disorder. He had rituals that would soothe him and help him allay his anxiety like washing his hands a certain number of times, each time with the hottest water and a fresh bar of soap. Therein lies the distinction between addiction and compulsion: Addicts have a substance too, but no one is addicted to soap.

Human beings who are hurting do what they can to feel better, and they may be tempted to engage in naughty sex because sex feels... wait for it... good. This doesn't mean you're sick. It does mean you need to figure out what you're doing with your life and how you might begin to manage your sexuality intelligently.