Sex Addiction E-Book

Barry Reay

• Herausgeber: John Wiley & Sons
• Kategorie: Geisteswissenschaft
• Sprache: Englisch

Seitenzahl: 379

Veröffentlichungsjahr: 2015

Beschreibung

The concept of sex addiction took hold in the 1980s as a product of cultural anxiety. Yet, despite being essentially mythical, sex addiction has to be taken seriously as a phenomenon. Its success as a purported malady lay with its medicalization, both as a self-help movement in terms of self-diagnosis, and as a rapidly growing industry of therapists treating the new disease. The media played a role in its history, first with TV, the tabloids and the case histories of claimed celebrity victims all helping to popularize the concept, and then with the impact of the Internet.

This book is a critical history of an archetypically modern sexual syndrome. Reay, Attwood and Gooder argue that this strange history of social opportunism, diagnostic amorphism, therapeutic self-interest and popular cultural endorsement is marked by an essential social conservatism: sex addiction has become a convenient term to describe disapproved sex. It is a label without explanatory force.

This book will be essential reading for those interested in sexuality studies, contemporary history, psychology, psychiatry, sociology, media studies and studies of the Internet. It will also be of interest to doctors and therapists currently working in this and related fields.

Leseprobe

Copyright © Barry Reay, Nina Attwood and Claire Gooder 2015

The right of Barry Reay, Nina Attwood, Claire Gooder to be identified as Author of this Work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.

First published in 2015 by Polity Press

Polity Press

65 Bridge Street

Cambridge CB2 1UR, UK

Polity Press

350 Main Street

Malden, MA 02148, USA

All rights reserved. Except for the quotation of short passages for the purpose of criticism and review, no part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher.

ISBN-13: 978-0-7456-7035-5

ISBN-13: 978-0-7456-7036-2 (pb)

ISBN-13: 978-0-7456-9804-5 (epub)

ISBN-13: 978-0-7456-9803-8 (mobi)

A catalogue record for this book is available from the British Library.

Library of Congress Cataloging-in-Publication Data

Reay, Barry.

    Sex addiction : a short history / Barry Reay, Nina Attwood, Claire Gooder.

        pages cm

    Includes bibliographical references and index.

    ISBN 978-0-7456-7035-5 (hardback : alk. paper) – ISBN 978-0-7456-7036-2 (paperback. : alk. paper)    1.  Sex addiction.    2.  Sex addiction–History.    I.  Attwood, Nina.    II.  Gooder, Claire.    III.  Title.

    RC560.S43R42 2015

    616.85′833–dc23

                                                            2014045194

The publisher has used its best endeavours to ensure that the URLs for external websites referred to in this book are correct and active at the time of going to press. However, the publisher has no responsibility for the websites and can make no guarantee that a site will remain live or that the content is or will remain appropriate.

Every effort has been made to trace all copyright holders, but if any have been inadvertently overlooked the publisher will be pleased to include any necessary credits in any subsequent reprint or edition.

For further information on Polity, visit our website: politybooks.com

Figures

1    Curt Aldrich, Love Addict (1966). Author's collection.

2    William Donner, The Sex Addicts (1964). Author's collection.

3    ‘Overcoming Sex Addiction’: Android app on Google Play. Reproduced by permission of KoolAppz.

4    Sex addiction terms on Google Ngram. Google and the Google logo are registered trademarks of Google Inc., used with permission.

5    Author screening test, 17 June 2014.

6    I Am a Sex Addict (2006: Caveh Zahedi). © IFC Films/Photofest.

7    Chelsea Lately, ‘Interview with Gwyneth Paltrow’, 16 September 2013.

8    Selma Blair in A Dirty Shame (2004: John Waters). Free desktop wallpaper.

9    ‘I Booked Myself into a Sex Addict Rehab Clinic.’ Tom Scott cartoon, 2010. Reproduced by permission of Tom Scott.

10    PsycINFO terms for sex addiction publications, 1960–2013.

Mental health professionals often take the symptoms of structured disorders at face value. They create treatment centers and techniques that cater to particular disorders. Psychiatric researchers devote their careers to studying particular disorders and journals arise to publish their results. Support groups emerge to reinforce the reality of the symptoms. Disorders become aspects of social movements that invest in, create, and reinforce the reality of the conditions. Sociologists, however, need to study how these disorders come to be socially defined as real, rather than accept the taken-for-granted notion that diagnostic measures reflect natural entities.

Allan V. Horwitz, 2002

Chapter 1Introduction

In America, if your addiction isn't always new and improved, you're a failure.

Chuck Palahniuk, 20021

Daddy's Secret Cedar Chest (2013) is for the ‘children of sex addicts’. An unnamed boy discovers a huge box in Daddy's bedroom (the cedar chest of the book's title) full of magazines and DVDs with ‘pictures of women with no clothes on!’ The dad (we are not told why he has his own bedroom unless Mummy's bedroom is called Daddy's bedroom too) also spends too much time with his computer in his home office. ‘Everything Daddy did was a secret.’ The boy tells his mother, and his parents argue about his father's ‘habit’. The boy becomes unsettled – ‘I was feeling scared.’ He has bad dreams: ‘A big hairy lady monster was crawling out of the humongous cedar chest. She stood up on her big hairy legs and opened up her big empty black hole of a mouth.’ In the dream this rather clumsy metaphor swallows his father. The boy's concerned mother takes him to a therapist. Daddy moves out to seek help for his ‘habit’ and then returns home to an improved family environment. The big hairy lady monster and the chest have gone.2

Why have we come to a stage in our history and culture where it is even conceivable that ‘children ages 6 to 12’ might have to be told ‘that they are not alone in their suffering, that help is available to them, and…that they did not cause their parent's sex addiction’?3

The aim of the book that follows is to trace the history of a new sexual concept, a modern sexual invention called sex addiction, and its sufferer the sex addict. Though we will discuss definitional complexities in due course, the sex addict has usefully been described as ‘a person who is obsessed with some type of sexual behavior, and whose behavior is compulsive and is continued despite significant adverse consequences’.4 Aviel Goodman characterized it to the readers of the Journal of Sex & Marital Therapy as ‘simply the addictive process being expressed through sex, the compulsive dependence on some form of sexual behavior as a means of regulating one's feelings and sense of self’.5

The idea's beginnings are somewhat imprecise. One possible origin at a practical level was in the self-help or recovery culture of the 1970s (we will discuss the link between sex and alcohol addiction later). Sex and Love Addicts Anonymous grew out of a local Alcoholics Anonymous support group in Boston in 1976 and other national sexual-addiction recovery fellowships were utilizing the Twelve-Step programme by the late 1970s and early 1980s. Sex Addicts Anonymous (1977) had its headquarters in Minneapolis; Sexaholics Anonymous (1978) was centred in Simi Valley, California; while the New York and Los Angeles Sexual Compulsives Anonymous was operational by 1982 as were gay and bisexual sexually compulsive support groups in New York.6

We know that a linkage between sex and addiction was informally entertained in popular culture in the late 1950s and 1960s. Pulp fiction during that period included Don Elliott's Love Addict (1959) and Curt Aldrich's Love Addict (1966) (see Figure 1). The latter was about a promiscuous man so the term ‘addict’ referred to lust rather than affection.7 But it was William Donner's The Sex Addicts (1964) that can actually claim first usage of the precise words ‘sex addict’ in the correct context (see Figure 2). It was about a couple of womanizers on a cruise ship: ‘It's the way he is…Compulsive. He can't stay with a woman more than a single night, he says. At least, not if others are available…He's slept with almost nine hundred women.’8 One friend observed of the other, ‘You're compulsive. You've got a monkey on your back’, and suggested analysis. Later the man, who was close to his nine hundred, admitted ‘Monkey on my back is right. Only I'm a sex addict, not a drug fiend.’9

Figure 1

    Curt Aldrich,

Love Addict

(1966). Author's collection.

Figure 2

    William Donner,

The Sex Addicts

(1964). Author's collection.

Pulp fiction aside, we also know that homosexual psychotherapy patients were referring to ‘sex heads’ – in the sense of addicts – in the 1960s: ‘I'm not only a pot head…I'm a sex head…it's completely eaten into everything.’ In short, the term may have arisen independently at a more grassroots level.10 When we later discuss the intellectual origins and viability of the concept, it is worth recalling this evidence for its humble origins.

Conceptually, as we will see, Lawrence Hatterer and Stanton Peele in the US and Jim Orford in Britain played roles in the malady's history. The New York sex therapist Avodah Offit mentioned ‘sex addicts’ in 1981 (immediately after a discussion of nymphomania and hypersexuality), citing a link between sex and the release of endorphins: ‘Thus sex, in addition to whatever else it does, may actually reduce pain and promote euphoria in much the same fashion as small doses of the morphinelike drugs. The sex addict, then, may literally be a junkie, in one sense.’11 However, the actual term ‘sex addiction’ is most clearly associated with the work of the US psychologist Patrick Carnes and his book The Sexual Addiction (1983), republished as Out of the Shadows: Understanding Sexual Addiction (1983). Carnes's centrality, for better or for worse, will become clear in the pages that follow.

The idea of sexual addiction enjoyed varied reception in these early years, and there was already an indication that endorsements might vary. It appeared in the ‘Current Trends’ section of the journal Medical Aspects of Human Sexuality in 1985.12 A comment in the British Journal of Sexual Medicine in 1986 by a Chicago psychiatrist indicated both that the concept had arrived and a certain amount of scepticism about its usefulness:

the theory of sexual addiction as an illness is so wide a net that it has the danger of being used on the one hand as an excuse to cover or continue a whole range of inappropriate or law-breaking sexual behaviours, and on the other it is a catchall that has scooped up normal sexual behaviours as well.13

It was included momentarily in the American Psychiatric Association's Diagnostic and Statistical Manual DSM-III-R in 1987, but was absent from all subsequent editions, a struggle that we will return to later in this book.14 Psychologists discussed in the same year whether the complaint was best termed sexual addiction, hypersexuality, compulsive sexual behaviour or (their preference) sexual impulsivity.15 It was mentioned in a 1988 text on disorders of sexual desire, but without elaboration and minus its own chapter, in a book that devoted more attention to lack of sexual desire than to its excesses.16 It came to the attention too of the famous John Money, emeritus professor of medical psychology and professor of pediatrics at the Johns Hopkins University and Hospital, though not with the notice that addictionologists might have sought:

Sexual addiction…is a newly coined term for a disorder as fictitious as thirst addiction, hunger addiction, or reading addiction…Sexual addictionology does not address the specificity of addiction. Instead it decrees that the only non-addictive form of sexual expression is lifelong heterosexual fidelity and commitment in monogamous marriage. Everything else is the gateway of sin through which exits the broad road to sexual depravity, degeneracy and addiction. Within addictionology, the wheel of degeneracy has made a full turn!17

Certainly the notion of perceived, out-of-control sexual behaviour moved from a situation in 1972 where hypersexuality was proclaimed ‘a rare phenomenon’ to the moment in the late 1980s when a relatively early publication in the addictionology genre, Charlotte Davis Kasl's Women, Sex, and Addiction (1989), began with reference to the ‘epidemic proportion of addictive behavior in this country’.18 The best-selling therapist Anne Wilson Schaef echoed Kasl dramatically: ‘Sexual addiction is a progressive disease and…results in destruction and early death for addicts and often those with whom they are involved. Sexual addiction is of epidemic proportions in this society and is integrated into the addictiveness of the society as a whole.’19 However, this may merely have indicated a split between professional psychiatry and the enthusiasm of popular medicine. The New Jersey psychiatrists who edited the state-of-the-art statement on desire disorders in 1988 said of sexual addiction that they had not ‘encountered clinically more than a handful of such cases in the past decade’.20 Yet they also noted the ‘popular appeal’ of the concept and hinted at a potential clientele:

There are, however, numerous individuals who are on the high end of the desire continuum – who are sexually enthusiastic with little provocation, who never seem to become satiated, and who engage in high frequencies of both self- and partner stimulation. These individuals tend to be admired or envied rather than diagnosed!21

Sexual addiction played a part in the issues-based, sexuality studies reader Taking Sides (1989) but as part of a debate – a ‘controversial issue’ rather than an established problem – in the clashing-views format, with Carnes's uncritical acceptance of the disorder pitted against a highly critical counter-argument, ‘The Myth of Sexual Addiction’, by two sociologists, Martin Levine and Richard Troiden.22 Janice Irvine (another sociologist) summarized this early history in 1995: ‘Claims-makers for the sex addiction diagnosis have…achieved a reasonable level of success thus far.’23 Its consolidation thereafter would prove more impressive.

The historiographical starting point for what follows in this book is indeed Irvine's 1995 argument that sex addiction was a social construction, a product of late twentieth-century cultural anxieties.24 She was not the first critic to put this case. Levine and Troiden had similarly argued that ‘The concepts of sexual addiction and compulsion constitute an attempt to repathologize forms of erotic behavior that became acceptable in the 1960s and 1970s.’25 The principal facilitators in this making, these early critics argued, were an addiction discourse (gambling, alcohol) that leant itself almost seamlessly to sexual matters; a strange and momentary combination of conservative Christian and radical feminist social purity; and the initial impact of AIDS in the 1980s that so dramatically intensified such sexual apprehensions. The rapid spread of the concept was aided by its imprecision: ‘Claims about what constitutes sex addiction are so vague…that they can potentially include large numbers of the population.’26Sex addiction's success as a concept lay with its medicalization, both as part of a self-help movement in terms of self-diagnosis, and as a rapidly growing industry of therapists on hand to deal with the new disease. And the media also played a vital role: TV, the tabloids, and the case histories of claimed celebrity victims all helped to popularize this newly invented term. As Irvine wrote, ‘The power of sex addiction lay not in the number of sufferers but in the expansion of this particular narrative of sexual disease.’27

Irvine and her fellow sociologists were writing and researching in the 1980s and early 1990s. By the time her article appeared, the sexual addiction specialists had their own journal, Sexual Addiction & Compulsivity: The Journal of Treatment and Prevention (founded in 1994), and Carnes and his team were treating health professionals, primarily doctors, accused of sexual misconduct and referred by regulatory boards and health programmes (half the group were adjudged to be sex addicts).28 Carnes's Golden Valley Health Center in the Twin Cities (Minneapolis–Saint Paul) in Minnesota had treated over 1,500 alleged addicts from 1985 to 1990, around 10 per cent of whom were ministers of the church.29 As a claimed disorder, sexual addiction achieved endorsement with its own section (by Goodman) in the third edition of Substance Abuse: A Comprehensive Textbook (1997) and mention in the seventh edition of the influential psychiatric text, Kaplan & Sadock's Comprehensive Textbook of Psychiatry (2000), used by generations of medical students and practitioners. ‘In the author's view sex addiction is a useful concept heuristically because it can alert the clinician to seek an underlying cause for the manifest behavior.’30 The next edition of Kaplan & Sadock in 2005 had a chapter on sex addiction by none other than Patrick Carnes.31

Moreover, Irvine's ‘sexualized society’ was on the eve of what Linda Williams has described as ‘on/scenity’, capturing pornography's everyday visibility and presence – in huge volume – in the early twenty-first century, where sex became central to everyday discourse and representation, termed variously pornographication or pornification, ‘striptease culture’, a hypersexual society, mainstreaming sex or the ‘sexualization of culture’.32 Feona Attwood has nicely captured this cultural turn as ‘the proliferation of sexual texts’ and we will see that sexual addiction was very much one of those texts.33

Irvine's media was also a media without the power of the Internet and the ubiquity of Internet sex.34 In 1997, as a joke on an Internet bulletin board, a New York psychiatrist invented IAD or ‘Internet Addiction Disorder’ and found that it was immediately taken seriously as a syndrome.35 He was tapping into a zeitgeist. Kimberly Young, a psychologist from the University of Pittsburgh, had already raised the possibility in 1996, and announced ‘Internet Addiction: The Emergence of a New Clinical Disorder’ in the pages of the new journal CyberPsychology & Behavior in 1998, which would go on to be cited in 342 different publications.36 When the contributors to the Handbook of Clinical Sexuality for Mental Health Professionals (2003) wrote their section on sexual compulsivity, they focused on ‘online sexual compulsivity’.37 Both Jennifer Schneider and Robert Weiss featured cybersex in their chapters in the 2004 Handbook of Addictive Disorders.38 Carnes's entry on sexual addiction for Kaplan & Sadock's Comprehensive Textbook of Psychiatry (2005) referred to cybersex as the ‘Crack Cocaine of Sex Addiction’.39 The entry on sex addiction in the sexuality studies textbook Our Sexuality (2008) was paired with a think-piece ‘Cybersex Addiction and Compulsivity: Harmless Sexual Outlet or Problematic Sexual Behaviour?’40

A critic of the diagnostic value of sexual addiction, the Denver family therapist Tracy Todd, wrote that ‘More and more people are showing up at my door with it branded on their foreheads. “I learned it from a talk show”, one man told me…Clients arrive with a wealth of information obtained from the Internet.’ He was clearly impressed, though concerned, at the speed with which the label was ‘gaining popular attention and acceptance’.41 And this was only 2004.

The technological sexual temptations faced by the sex addict in 1990 were the VCR and phone sex. By the 2010s the addictionology timeline of sexual access had expanded to include chat rooms, porn sites, Craigslist, Facebook, Twitter, Sexting, GRINDR and many other sites and applications. Smartphones had replaced laptops.42 The afflicted have their own aids to counter temptation: the iRecovery app for iPhone or iPad, a kind of digital workbook with links to networks of support and charts to monitor progress, and the rather alluringly illustrated Android app on Google Play called ‘Overcoming Sex Addiction’ (see Figure 3).43

Figure 3

    ‘Overcoming Sex Addiction’: Android app on Google Play.

Reproduced by permission of KoolAppz.

If sex addiction was a response to cultural anxiety, then, a historical construction, what of its history since Irvine's 1995 intervention? What happened to its early-hinted social opportunism and diagnostic amorphism? Did the combination of therapeutic self-interest and popular cultural endorsement persevere? We know that by 2010 sex addiction had another variant, ‘hypersexual disorder’, but what of the histories in between and thereafter?

Sexual addiction was part of a wider addiction discourse. ‘In common parlance we now extend addiction to relate to almost any substance, activity or interaction’, Hatterer wrote in 1982: ‘People now refer to themselves as being addicted to food, smoking, gambling, buying, forms of work, play and sex.’44 As early as the end of the 1980s, Stanton Peele, a specialist in the area of alcohol and drug abuse, was warning against what he termed the addiction treatment industry. Although his work in the 1970s had contributed to the expansion of the concept of addiction, he was critical of the misappropriation of his ideas in the decade that followed. He was concerned about the move from alcoholism counselling to therapy for sexual addiction and the sheer expansion of the variety of such newly defined diseases – his book was called Diseasing of America (1989). It seemed as if ‘each American must have at least one such disease and, in addition, must know of many other people who altogether have a score of other diseases. It is hard to escape the conclusion that ownership of an emotional-behavioral-appetitive disease is the norm in America.’45 Sex addiction's link to other dependencies was clear from the start, as outlined in an interview with a rare creature, a lesbian sex addict:

I didn't realize that I was a sex addict until I stopped drinking and doing drugs. I was in Alcoholics Anonymous (AA) at the time. I realized that I had to stop having sex or I would start drinking again. I was using sex with men to avoid dealing with my sexual feelings about women. I decided to go to Sexual Compulsives Anonymous (SCA).

The poor woman was obviously addicted to addiction:

Yes, I've spent my whole life juggling my addictions to stay alive. I went to Overeaters Anonymous (OA) first for bulimia…Then I was sent to AA by OA. For years I substituted one addiction for another. I've been addicted to alcohol, drugs, sex, food, caffeine, cigarettes, shopping, and gambling.46

By the start of the new millennium, Eva Moskovitz was noting America's obsession with the psychological: ‘Today Americans turn to psychological cures as reflexively as they once turned to God.’47 Addiction had become identity. She listed the choice of support groups meeting during the course of a week at one Colorado church in 1990: Cocaine Anonymous, Survivors of Incest, Alcoholics Anonymous, Debtors Anonymous, Codependents of Sex Addicts Anonymous, Adult Children of Alcoholics, Sex and Love Addicts Anonymous, Adult Overeaters Anonymous, Codependents Anonymous, Self-Abusers Anonymous.48 The numbers she gave were impressive. Forty per cent of adult Americans were attending recovery meetings, around 75 million people. There were more than 3 million such groups in the USA, including 6,000 for sex addicts, and 260 different Twelve-Step programmes.49 These numbers are dwarfed by the estimates of those who actually suffered from such disorders, which Moskovitz took from the websites of the organizations involved in trying to treat them: 20 million alcoholics, 20 million gamblers, 30 million overeaters, 25 million sex addicts, 15 million compulsive shoppers, and the 80 million codependents of all of the preceding. If those estimates were accurate (a huge if ), these addicts would have comprised nearly 70 per cent of the entire 2001 US population!50 From a transatlantic perspective Frank Furedi called it therapy culture, where addiction became a fetish, with all the powerlessness, vulnerability and passivity associated with that state.51

The other crucial setting for the early history of sex addiction was the rise of madness in America, and the roles both of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) and the pharmaceutical companies in this turn to mental disorder. The DSM, the ‘Psychiatric Bible’ that has been criticized for creating mental disorder where it does not exist, can, as one commentator has expressed it, ‘in effect usher diseases in and out of existence with the stroke of a pen’.52 Homosexuality famously was excised from DSM-II in 1974.53 Disinhibited Social Engagement Disorder (a child's over-familiarity with unfamiliar adults) and Restless Legs Syndrome (an urge to move the legs) are but two interesting examples of newer inventions.54 (One enterprising neurological unit in Italy has discovered a case of pathological gambling, hypersexuality, impotence and restless legs syndrome, all in the one patient.55) It is noticeable that the move has been to include rather than exclude (sex addiction's experience notwithstanding): the DSMs have increased their tally of mental illnesses from 180 in 1968 to over 350 in 1994, and DSM-5 (2013) has maintained that upper level.56

Hence the histories of other psychiatric complaints are crucial when we consider sex addiction, especially given the relationship between the DSM and the pharmaceutical companies. ‘Once upon a time, drug companies promoted drugs to treat their diseases’, a former editor in chief of the New England Journal of Medicine has observed: ‘Now it is often the opposite. They promote diseases to fit their drugs.’57 There is an impressive list of ailments whose diagnoses and treatment have increased exponentially in recent decades in what has been termed the medicalization of society (or, less elegantly, ‘disease mongering’): Bipolar Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Autism, Posttraumatic Stress Disorder (PTSD) (added to DSM in 1980 as a diagnosis for the complaints of war veterans but then extended to describe victims of sexual abuse and domestic violence), Social Phobia and Major Depressive Disorder (MDD).58

Sociologists and cultural historians of medicine and psychiatry have outlined the ingredients for the expansion of a syndrome – whereby, say, what was considered mere shyness could, in less than a decade, become the widespread mental disorder ‘Social Anxiety Disorder’.59 First, the illness was named: for example, DSM-III's 300.23 Social Phobia, later DSM-5's 300.23 Social Anxiety Disorder (Social Phobia).60 Then it needed a drug (or the drug needed it), in this case the SSRIs (selective serotonin reuptake inhibitors) and the pharmaceutical companies to market both the ailment and its supposed cure. In the US the naming in the symptom-based DSM provided the medical legitimacy for insurance claims, and coverage, where appropriate, through Medicaid and Medicare; in short, the funding for treatment. Herb Kutchins and Stuart Kirk have dubbed DSM endorsement ‘the psychotherapist's password for insurance coverage’.61 Then there was the role of patient advocacy (consumers who already thought they knew what their ailment was) and self-help groups, therapists of various sorts, including the primary care physicians with prescribing powers (far more numerous than psychiatrists), other agents with access to possible sufferers (teachers have played a role in brokering ADHD), open-ended tests to locate the complaint, celebrity confessions, sufferers’ memoirs, self-help guides, research institutes and projects, new specialist journals, and constant promotion by a less-than-critical media.62 (It will all become very familiar.) Christopher Lane's careful psychiatric history Shyness: How Normal Behavior Became a Sickness (2007) analysed this process.63 Similarly Allan Horwitz and Jerome Wakefield's Loss of Sadness (2007) has demonstrated the transformation of sadness (an everyday social response) into an epidemic of depressive disorder.64 The facilitators and processes – the ‘diagnostic inflation’ – are almost identical.65 And this was in an environment accepting of the ubiquity of untreated mental maladies, where such disorders were taken as a cultural commonplace, what Horwitz has called ‘a shared culture of medicalized mental disorders’.66 If health policy researchers were to claim in 2005 that in the course of their lives nearly half of all Americans would meet the criteria for a DSM-IV disorder, it is scarcely surprising that sex might become part of this national inclusion.67

In her history of Alcoholics Anonymous and what she has termed the ‘recovery movement’ Trysh Travis outlined the various layers, levels or components of this culture: the addicts themselves or those in recovery, their organizations (Alcoholics Anonymous and similar groups), a ‘vast network’ of clinics, treatment centres, what she described as ‘professional therapeutic entities’, and finally a ‘subculture’ of memoirs, novels, handbooks, and TV and Internet discussion dealing with addiction and recovery.68 Unsurprisingly, for sex addiction is part of Travis's recovery movement (though not integral to her account), our book will be traversing similar territory.

Where we differ, however, is with Travis's refusal to take a position, her studied neutrality on recovery (recall that she was dealing with alcohol rather than sex addiction).69 Let us be clear about our approach. We are cultural historians, not clinicians, but we have read the clinically related literature – as contemporary history – and remain unpersuaded of the existence of this supposed malady. Why we are so sceptical will become clear by the end of the book. Though it is essentially mythical, creating a problem that need not exist, sex addiction has to be taken seriously as a phenomenon. It is a socio-psychological discourse that has taken hold on the public imagination – and proven an influential concept in academic circles too. What follows is a critical examination of the power of the idea and its cultural and (short) historical context.

Notes

  1

C. Palahniuk,

Choke: A Novel

(New York, 2002), p. 203.

  2

G. Goodman,

Daddy's Secret Cedar Chest

(Mustang, OK, 2013), no pagination.

  3

  Ibid.

  4

R. R. Irons and J. R. Schneider, ‘Sexual Addiction: Significant Factor in Sexual Exploitation by Health Care Professionals’,

Sexual Addiction & Compulsivity

, 1:3 (1994), 198–214, quote at 204.

  5

A. Goodman, ‘Sexual Addiction: Designation and Treatment’,

Journal of Sex & Marital Therapy

, 18:4 (1992), 303–14, quote at 312.

  6

G. Manley, ‘Treatment and Recovery for Sexual Addicts’,

Nurse Practitioner

, 15:6 (1990), 34–41, esp. Table 2 on 38; L. J. Hatterer,

The Pleasure Addicts: The Addictive Process – Food, Sex, Drugs, Alcohol, Work, and More

(Cranbury, NJ, 1980), pp. 119, 120; M. C. Quadland, ‘Compulsive Sexual Behavior: Definition of a Problem and an Approach to Treatment’,

Journal of Sex & Marital Therapy

, 11:2 (1985), 121–32, at 123.

  7

D. Elliott,

Love Addict

(n.p., but USA, 1959); C. Aldrich,

Love Addict

(San Diego, 1966).

  8

W. Donner,

The Sex Addicts

(n.p., but USA, 1964), p. 84.

  9

  Ibid., pp. 107, 129.

10

L. J. Hatterer,

Changing Homosexuality in the Male: Treatment for Men Troubled by Homosexuality

(New York, 1970), pp. 113 (for quote), 415.

11

A. K. Offit,

Night Thoughts: Reflections of a Sex Therapist

(New York, 1981), p. 123.

12

M. F. Schwartz and W. S. Brasted, ‘Sexual Addiction’,

Medical Aspects of Human Sexuality

, 19:10 (1985), 103–7.

13

D. C. Renshaw, ‘Comment: What is Sexual Addiction?’,

British Journal of Sexual Medicine

, 13:11 (1986), 305–6, quote at 306.

14

Diagnostic and Statistical Manual of Mental Disorders (Third Edition – Revised): DSM-III-R

(Washington, DC, 1987), p. 296.

15

R. J. Barth and B. N. Kinder, ‘The Mislabeling of Sexual Impulsivity’,

Journal of Sex & Marital Therapy

, 13:1 (1987), 15–23.

16

S. R. Lieblum and R. C. Rosen (eds.),

Sexual Desire Disorders

(New York, 1988), pp. 9 (‘hyperactive desire’, ‘sexual compulsion’, ‘sexual addiction’), 42–4 (‘Hyperactive Sexual Desire’).

17

J. Money and M. Lamacz,

Vandalized Lovemaps: Paraphilic Outcomes of Seven Cases in Pediatric Sexology

(Buffalo, NY, 1989), p. 36.

18

L. Salzman, ‘The Highly Sexed Man’,

Medical Aspects of Human Sexuality

, 6:1 (1972), 36–49, quote at 49; C. D. Kasl,

Women, Sex, and Addiction: A Search for Love and Power

(New York, 1989), p. ix.

19

A. W. Schaef,

Escape from Intimacy

(New York, 1989), p. 10.

20

S. R. Lieblum and R. C. Rosen, ‘Introduction’, in Lieblum and Rosen (eds.),

Sexual Desire Disorders

, p. 9.

21

  Ibid.

22

‘Issue 6 Can Sex Be an Addiction?’, in R. T. Francoeur (ed.),

Taking Sides: Clashing Views on Controversial Issues in Human Sexuality

(Guilford, CT, 1989), pp. 84–97.

23

J. M. Irvine, ‘Reinventing Perversion: Sex Addiction and Cultural Anxieties’,

Journal of the History of Sexuality

, 5:3 (1995), 429–50, quote at 435.

24

Irvine, ‘Reinventing Perversion’.

25

M. P. Levine and R. R. Troiden, ‘The Myth of Sexual Compulsivity’,

Journal of Sex Research

, 25:3 (1988), 347–63, quote at 349.

26

Irvine, ‘Reinventing Perversion’, 438.

27

  Ibid., 440.

28

Irons and Schneider, ‘Sexual Addiction’, 206, 208, 209.

29

M. R. Lasser, ‘Sexual Addiction and Clergy’,

Pastoral Psychology

, 39:4 (1991), 213–35, esp. 215.

30

A. Goodman, ‘Sexual Addiction’, in J. H. Lowinson, P. Ruiz, R. B. Millman, and J. G. Langrod (eds.),

Substance Abuse: A Comprehensive Textbook

(Baltimore, 1997), pp. 340–54; V. A. Sadock, ‘Normal Human Sexuality and Sexual and Gender Identity Disorders’, in B. J. Sadock and V. A. Sadock (eds.),

Kaplan & Sadock's Comprehensive Textbook of Psychiatry, Seventh Edition

, 2 vols. (Philadelphia, 2000), vol. 1, p. 1599.

31

P. J. Carnes, ‘Sexual Addiction’, in Sadock and Sadock (eds.),

Kaplan & Sadock's Comprehensive Textbook of Psychiatry, Eighth Edition

, 2 vols. (Philadelphia, 2005), vol. 1, pp. 1991–2001.

32

Irvine, ‘Reinventing Perversion’, 442; L. Williams, ‘Porn Studies: Proliferating Pornographies On/Scene: An Introduction’, in L. Williams (ed.),

Porn Studies

(Durham, NC, 2004), pp. 1–23. See also B. McNair,

Striptease Culture: Sex, Media and the Democratization of Desire

(New York, 2002); L. M. Ward, ‘Understanding the Role of Entertainment Media in the Sexual Socialization of American Youth: A Review of Empirical Research’,

Developmental Review

, 23:3 (2003), 347–88; S. Paasonen, K. Nikunen and L. Saarenmaa (eds.),

Pornification: Sex and Sexuality in Media Culture

(New York, 2007); K. C. W. Kammeyer,

A Hypersexual Society: Sexual Discourse, Erotica, and Pornography in America Today

(New York, 2008); F. Attwood (ed.),

Mainstreaming Sex: The Sexualization of Western Culture

(New York, 2010).

33

F. Attwood, ‘Sexed Up: Theorizing the Sexualization of Culture’,

Sexualities

, 9:1 (2006), 77–94, quote at 78.

34

See, for example, B. L. A. Mileham, ‘Online Infidelity in Internet Chat Rooms: An Ethnographic Exploration’,

Computers in Human Behavior

, 23:1 (2007), 11–31; N. M. Döring, ‘The Internet's Impact on Sexuality: A Critical Review of 15 Years of Research’,

Computers in Human Behavior

, 25:5 (2009), 1089–101; D. K. Wysocki and C. D. Childers, ‘ “Let My Fingers Do the Talking”: Sexting and Infidelity in Cyberspace’,

Sexuality & Culture

, 15:3 (2011), 217–39; C. Brickell, ‘Sexuality, Power and the Sociology of the Internet’,

Current Sociology

, 60:1 (2012), 28–44.

35

D. Wallis, ‘Just Say No’,

The New Yorker

, 13 January 1997; H. Kutchins and S. A. Kirk,

Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders

(New York, 1997), p. 12.

36

K. S. Young, ‘Psychology of Computer Use: XL. Addictive Use of the Internet: A Case That Breaks the Stereotype’,

Psychological Reports

, 79:3 (1996), 899–902; K. S. Young, ‘Internet Addiction: The Emergence of a New Clinical Disorder’,

CyberPsychology & Behavior

, 1:3 (1998), 237–44.

37

A. Cooper and I. D. Marcus, ‘Men Who Are Not In Control of Their Sexual Behavior’, in S. B. Levine, D. B. Risen and S. E. Althof (eds.),

Handbook of Clinical Sexuality for Mental Health Professionals

(New York, 2003), ch. 18, quote at p. 313.

38

J. P. Schneider, ‘Understanding and Diagnosing Sex Addiction’, in R. H. Coombs (ed.),

Handbook of Addictive Disorders: A Practical Guide to Diagnosis and Treatment

(Hoboken, NJ, 2004), ch. 7, esp. pp. 208–13, 214; R. Weiss, ‘Treating Sex Addiction’, in Coombs (ed.),

Handbook of Addictive Disorders

, ch. 8, esp. pp. 262–5.

39

Carnes, ‘Sexual Addiction’, p. 1995.

40

R. Crooks and K. Baur,

Our Sexuality

(Belmont, CA, 2011), pp. 510–13. First published in 2008.

41

T. Todd, ‘Premature Ejaculation of “Sexual Addiction” Diagnoses’, in S. Green and D. Flemons (eds.),

Quickies: The Handbook of Brief Sex Therapy

(New York, 2004), ch. 5, quote at p. 68.

42

R. Weiss and C. P. Samenow, ‘Smart Phones, Social Networking, Sexting and Problematic Sexual Behaviors – A Call for Research’,

Sexual Addiction & Compulsivity

, 17:4 (2010), 241–6.

43

S. J. Campling, ‘A Review on iRecovery – iPhone/iPad Application’,

Sexual Addiction & Compulsivity

, 18:3 (2011), 188–90;

https://play.google.com/store/apps/details?id=com.koolappz.EP77708470001

.

44

L. J. Hatterer, ‘The Addictive Process’,

Psychiatric Quarterly

, 54:3 (1982), 149–56, quote at 149.

45

S. Peele,

Diseasing of America

(San Francisco, 1995), pp. 140–1. First published in 1989.

46

S. R. Edwards, ‘A Sex Addict Speaks’,

SIECUS Report

, 14:6 (1986), 1–3, quote at 2.

47

E. S. Moskowitz,

In Therapy We Trust: America's Obsession With Self-Fulfillment

(Baltimore, 2001), p. 1.

48

  Ibid., pp. 246–7.

49

  Ibid., pp. 248, 252, 253.

50

  Ibid., pp. 255, 307 n. 22.

51

F. Furedi,

Therapy Culture: Cultivating Vulnerability in an Uncertain Age

(London, 2004), esp. pp. 120–4.

52

H. B. Hansen and others, ‘Independent Review of Social and Population Variation in Mental Health Could Improve Diagnosis in DSM Revisions’,

Health Affairs

, 32:5 (2013), 984–93, quote at 984.

53

Kutchins and Kirk,

Making Us Crazy

, ch. 3. See also A. De Block and P. R. Adriaens, ‘Pathologizing Sexual Deviance: A History’,

Journal of Sex Research

, 50:3 (2013), 276–98, esp. 287–9.

54

Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition): DSM-5

(Washington, DC, 2013), pp. 268–70, 410–13.

55

G. d'Orsi, V. Demaio and L. M. Specchio, ‘Pathological Gambling Plus Hypersexuality in Restless Legs Syndrome: A New Case’,

Neurological Sciences

, 32:4 (2011), 707–9.

56

For previous DSMs, see C. Lane,

Shyness: How Normal Behavior Became a Sickness

(New Haven, 2007), p. 43. See also De Block and Adriaens, ‘Pathologizing Sexual Deviance’.

57

M. Angell,

The Truth About the Drug Companies

(New York, 2004), p. 86.

58

See P. Conrad,

The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders

(Baltimore, 2007), chs 1, 3, 6, 7. See also Kutchins and Kirk,

Making Us Crazy

, ch. 4; D. Healy, ‘The Latest Mania: Selling Bipolar Disorder’,

PLoS Medicine

, 3:4 (2006), 0441–4; R. Moyniham and D. Henry, ‘The Fight Against Disease Mongering: Generating Knowledge for Action’,

PLoS Medicine

, 3:4 (2006), 0425–8; A. Frances,

Saving Normal

(New York, 2013), ch. 5; G. Greenberg,

The Book of Woe: The DSM and the Unmaking of Psychiatry

(London, 2013), ch. 5; and J. M. Pierre, ‘Overdiagnosis, Underdiagnosis, Synthesis: A Dialectic for Psychiatry and the DSM’, in J. Paris and J. Phillips (eds.),

Making the DSM-5, 2013: Concepts and Controversies

(New York, 2013), ch. 8.

59

See C. Lane, ‘How Shyness Became an Illness: A Brief History of Social Phobia’,

Common Knowledge

, 12:3 (2006), 388–409; Lane,

Shyness

.

60

Diagnostic and Statistical Manual of Mental Disorders (Third Edition): DSM-III

(Washington, DC, 1980), pp. 227–30; DSM-5, pp. 202–8.

61

Kutchins and Kirk,

Making Us Crazy

, p. 12.

62

See A. V. Horwitz,

Creating Mental Illness

(Chicago, 2002); Healy, ‘Latest Mania’; C. B. Phillips, ‘Medicine Goes to School: Teachers as Sickness Brokers for ADHD’,

PLoS Medicine

, 3:4 (2006), 0433–5; Lane,

Shyness

; A. V. Horwitz and J. C. Wakefield,

The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder

(Oxford, 2007); Conrad,

Medicalization of Society

; Frances,

Saving Normal

; J. Z. Sadler, ‘Considering the Economy of DSM Alternatives’, in Paris and Phillips (eds.),

Making the DSM-5

, ch. 2.

63

Lane,

Shyness

.

64

Horwitz and Wakefield,

Loss of Sadness

.

65

  Ibid., p. 7.

66

Horwitz,

Creating Mental Illness

, p. 213.

67

R. C. Kessler and others, ‘Lifetime Prevalence and Age-of-Onset Distributions of

DSM-IV

Disorders in the National Comorbidity Survey Replication’,

Archives of General Psychiatry

, 62 (2005), 593–602.

68

T. Travis,

The Language of the Heart: A Cultural History of the Recovery Movement from Alcoholics Anonymous to Oprah Winfrey

(Chapel Hill, NC, 2009), ch. 1, esp. pp. 3–4, 6.

69

  Ibid., p. 17.

Chapter 2Beginnings

Although sex addiction has undoubtedly been around for centuries, it is only over the past few years that we have started to fully understand it.

Paula Hall, 20131

The documentation of excessive sexual desire and conduct by sexologists of the nineteenth and early twentieth centuries has been the usual starting point for proponents of the sex addiction concept – when they have found it necessary to sketch out its history, or are not assuming that it has always existed (as with the epigraph to this chapter). ‘There is a long history of characterizing behaviorally enacted excesses of sexual behaviors as “hypersexual” ’, Martin Kafka has written, citing the famous Richard von Krafft-Ebing to support the case that his new category was ‘consistent’ with an extensive clinical heritage.2 Kafka's proposal in 2010 for the inclusion of ‘hypersexual disorder’ in the ‘Sexual Disorders’ section of DSM-5 had a brief paragraph, ‘Historical Overview of “Excessive” Sexual Behaviors’, that contained references to works by Benjamin Rush (1812), Krafft-Ebing (1892), Havelock Ellis (1905) and Magnus Hirschfeld (1948). They, he claimed, were the ‘precursors’ to the 1960s and 1970s sex researchers – Clifford Allen (1962), Albert Ellis and Edward Sagarin (1965) and Robert Stoller (1975) – who dealt with the ‘protracted promiscuity’ that Kafka saw as a type of hypersexuality: Don Juanism or satyriasis in males and nymphomania in women.3 In Kafka's article – and he was not alone there – these were scholarly references, without elaboration or discussion, to provide authority and depth to a justification for a new psychiatric category. (Havelock Ellis, for instance, actually had nothing to say on the subject.4) But how close were these sexual phenomena, Kafka's ‘excessive sexual behaviors’, to sex addiction or hypersexuality? Rather than merely using these earlier sexologists and psychiatric clinicians as scholarly paraphernalia, it is worth spending some time to consider what it was that they were actually saying.

It is true that ‘irresistible hypersensuality’ and ‘hypersexuality’ are among Krafft-Ebing's names for the condition of excessive sexual desire. But his essential category was ‘hyperaesthesia’ or ‘pathologically exaggerated sexual instinct’, what he called the ‘abnormal excitability of the imagination’.5 And he had many other terms to describe this sexual state (‘abnormally increased sexual desire’, ‘psycho-sexual extravagances’, ‘excessive libido’, ‘pathologically exaggerated sex life’, ‘priapism’, ‘satyriasis’) and for those who suffered from it (‘Don Juans’, ‘nymphomaniacs’).6 Moreover, a history of excessive sexual desires and behaviour is not the same as a history of sex addiction. This sort of conflation risks misrepresenting evidence to serve a particular narrative. The meanings of sexual categories that we take for granted today – heterosexuality, homosexuality and lesbianism – have dissolved when considered historically. Acts and desires are not transhistorical.7 Societal notions of normative and transgressive sexual behaviour have changed over time, and appreciating the complexities of specific historical, social and cultural contexts allows for a more nuanced understanding of the kinds of sexual classifications that are the subject of this book. Kafka's twenty-first-century ‘increase in intensity and frequency of normophilic sexual behaviours that are associated with significant adverse consequences’ was very different to nineteenth- and early-twentieth-century nosology.8