**Note: I wrote this piece several weeks ago but have not published it here until now.
A new UCLA study published in last week’s journal of Socioaffective Neuroscience and Psychology is being heralded as evidence against the scientific legitimacy of ‘sex addiction’:
The study (which, amazingly, is the first of its kind) measured how the brains of people who struggle with sexually compulsive behavior respond to sexual images. If sex can be addictive in the clinical sense, scientists theorized, then the neural response of sex addicts to pornography should mimic the neural responses of drug or alcohol addicts to their drugs of choice. Instead, researchers found that hypersexual brains don’t react in the same way as other addicts’ brains–in fact, the neural responses to pornography only varied based on levels of sexual libido, rather than on measures of sexual compulsivity…Degrees of sexual compulsivity did not predict brain response at all. If the results of this first study can be replicated, it would represent a major challenge to the notion that sex and pornography can be literally addictive.
It is certainly true that this study poses a significant challenge to the addiction model of sexually compulsive behavior — but one hardly needs a university-sponsored study to contest the notion of ‘sex addiction’ as pathology: its theoretical foundations are simply unsound.
‘Sex addiction’ is only one manifestation of a broader category of addiction. Mental health professionals frequently distinguish between ‘process/behavioral addiction’ and substance/chemical addiction, the latter of which encompasses physical dependence. The former is colloquially known as ‘psychological addiction,’ which I will henceforth use to refer to the idea.
Besides sex and pornography, ‘psychological addictions’ may include food, Internet use, and virtually anything else that can be considered pleasurable. Our brains are hard-wired to send us signals that we ought to repeat activities that induce pleasure. So far, so good: one can easily see how thoughtlessly engaging in sexual activity (or junk-food consumption, or Internet use, etc.) can spiral out of control. On its face, the concept is sound.
But what does a ‘sex addict’ share in common with an opiate addict? When someone who is dependent on a substance like heroin ceases his drug use, his body revolts against him; withdrawal symptoms arise within a day’s time, usually consisting of flu-like symptoms, which, on the extreme end of abuse, can result in serious medical complications such as seizures, even leading up to death. What does a ‘sex addict’ have to fear from ceasing to feed his urges? ‘Jonesing’ for something pleasurable is definitely unpleasant, but it is nothing like fever, vomiting, and seizures.
As a junk-food junkie whose weight has yo-yo’d through a nearly 100-pound range, I certainly understand the compulsive feelings associated with a pleasurable activity that has gotten out of hand. And, to be sure, there is a family resemblance of sorts between compulsive behavior and addiction: those who feel compelled to seek sex or junk food do so for approximately the same reasons that a person seeks heroin — in essence: because it feels good. But if I were to cease eating junk food tomorrow, my body would reward me, not punish me. If (as I usually do) I continue to eat junk food in spite of this knowledge, it is because I have chosen to prioritize immediate-term pleasure over longer-term gains to my health. Opiate addiction may begin in a similar manner, but it quickly degenerates into use to avoid pain rather than to induce pleasure. An opiate addict who ceases use will not be rewarded by his body. Someone like Anthony Weiner, who constantly jeopardizes his career to fuel his pleasure-seeking drives — or myself, who bombards his body with snacks despite the full knowledge of the consequences to his health — does not face this problem and simply has an unusually difficult time choosing not to consistently prioritize immediate-term pleasure. This is a legitimate problem that deserves understanding and compassion — indeed, in many people (like me), it may indicate the presence of another condition, such as Attention-Deficit Disorder or Obsessive-Compulsive Disorder — but it stretches the imagination to classify this in the same category as genuine addiction.
The concept of ‘psychological addiction’ feeds into the unfortunate contemporary drive to ‘medicalize’ common human problems. Depressingly, too many in our society — including most employers — refuse to demonstrate compassion toward a struggling person unless his problem has been officially classified as a medical condition. A false dichotomy has been constructed in which only medical problems are seen as legitimate and deserving of understanding and patience — in a word, they are seen as real. Problems in living that have not been professionally medically classified, however, are far more likely to be seen as illegitimate, or indicative of some sort of fundamental character defect — in a word, such issues are viewed as fake. ‘Psychological addictions’ are not ‘fake,’ but they are better understood as compulsions, or obsessions — not ‘addictions.’
This argument is not “just about semantics.” Our language helps to shape our reality. When we mentally categorize compulsive pleasure-seeking behavior alongside dependence-inducing substance abuse, it results in a culture of learned helplessness and blame-shifting. Common human problems are converted into medical conditions; undesirable behavior is transmogrified into ‘symptoms.’ Individual autonomy is undermined as public figures and private citizens declare that they cannot actually be held responsible for their actions; that they are instead passive victims of forces beyond their control. At the extreme end of this culture, a Swedish man has ‘earned’ the ‘right’ to government-sponsored benefits because of his ‘psychological addiction’ to heavy metal music. And why not?
At its best, the purpose of psychiatry — and counseling generally — ought to be to restore the patient to a position of autonomy, responsibility, and free agency. Those who struggle with compulsions ought to own up to their problems and seek the help of trusted loved ones. If they are honest and forthright about their issues, they deserve nothing but understanding and assistance. But they are not ‘addicts,’ and it’s time to stop classifying them as such.