Monthly Archives: December 2019

Not so randomly placed in mine and Joe Farley’s book, Getting Real About Sex Addiction, are the ontological issues surrounding the term sex addiction. It’s in the title, even, this suggestion that what we’ll be doing is examining the term sex addiction more than any other mental health abstraction and therefore addressing the problem of problem sexual behaviors: is this a thing, a variously skeptical public asks? The members of Sex Addiction Anonymous (SAA) have of course made their decision on this question. Committees of The American Psychiatric Association and The World Health Organization have not quite made theirs, rejecting the proposed diagnosis Hypersexual Disorder in the case of the former body, and recently (and provisionally) accepting the diagnosis Excessive Sexual Drive in the case of the latter organization. To be clear (or not), neither of these terms are synonymous with the construct of sex addiction, but we’re in the same ball park here. The issue is complex. It is medical, psychological and meta-psychological, as in ontological: is a human being’s sexuality a function of biological drive and are problem behaviors therefore a matter of excess desire? And even if that natural conclusion is drawn, where is the role of nurture in the matter of etiology? Are we talking about an interpersonal versus an intrapsychic event, as in a phenomenon derived from early childhood development—a weaning that went awry versus a web of innate fantasy (or phantasy as Object Relations terms it) within an infantile mind? Or is the broader social and cultural environment the more prominent accomplice in a dysfunctional sexual development?

We’d prefer to think so, at least. And so we hear weary chestnuts that even the most progressive-minded observers must be tired of hearing by now: theories of pubescent or post-pubescent development wherein boys are subject to mores that encourage their essentialist aggression, their concomitant sexual freedom, with consequent pressure to conform and therefore perform when being so deterministically sexualized. Meanwhile, girls are discouraged by societies across cultures from expressing freely their sexuality; they are raised to be demur, ashamed of their sexuality, and therefore passive or possibly manipulative in their sexual expression. And even if this is changing somewhat in a millennial age (really, have you noticed?), then it is surely a reaction to those previous oppressive norms, yielding a confusing transition phase wherein girls, boys, or those along the gender fluid continuum (suggesting a flight from binaries) switch roles at times, thus conforming to a newly burgeoning if less-defined ethos. And so we observe a faction of diffident men and boys who speak of respecting the feminine as if they are resisting in their stance a combined biological and social force upon their being. And we observe women and girls who seem increasingly aggressive and entitled in their sexual freedom while proclaiming the lack of freedom that is afforded them by an arbitrary social reality. In analytic terms, this is the realm of the unconscious but not the repressed, these habits and mores that we download from the culture. By unrepressed I mean something that is not kept away. Isms and other mores may be unconscious, but as we routinely observe, they are hardly kept away. They leak and make a mess, pervading our experience.

The premises of these positions must be difficult for the average mental health professional to sustain given the contradictions of theory and life itself. Firstly, within our profession’s demographic map, that average person is likely female, white and therefore privileged in terms of race, at least. She has been raised and subsequently educated within an atmosphere that encourages or affords (not privileged—we only use that word in this context if we’re feeling critical) a social justice lens, which means supporting narratives that advocate for the underprivileged. In Getting Real, I argue that within the niche field of sex addiction treatment (and perhaps psychotherapy as a whole), this demographic phenomenon of recent generations results in a skew that targets a privileged (non-ironic diction) client population–heterosexual men—for devaluation. The aggregate of thought suggesting how males and females are socialized towards sexual behaviors and identities emphasizes the post-pubescent experience, which for some might imply agreement with an embattled psychoanalytic idea: that pre-pubescent and certainly pre-verbal sexuality is repressed, as in kept away, and for the most part is not leaked and is therefore a lesser factor in pre-teen childhood development. There is no scientific evidence of an Oedipus Complex, say critics of psychoanalysis. There is evidence of pre-verbal attachment styles, the capacity to communicate and comprehend on a pre-verbal level, thus children’s psychological development is profoundly impacted from birth onwards by events, both benign and traumatic, that occur perpetually.

The onset of sexuality is a function of hormonal development, says a medical argument—not some manner of release from childhood repression. Puberty is the psyche’s sexual alarm clock, indicating that it’s time for play of another kind; an incipiently adult kind. Feelings like joy, excitement, wonder, fear, shame, and guilt may all be observed in small children, some pre-verbal, some not. Emotional expression, proximity-seeking, may be developed or not, contingent upon the presence and consistency of a capable adult. The nature of a child’s attachment to a parent (or primary caregiver) will be internalized as a working model of attachment that will further shape development and relationships, possibly over a lifetime. That was John Bowlby speaking and writing over fifty years ago, saying something similar to what D.W. Winnicott was teaching, only with more attention to physical need than the fostering of a distinctive, creative mind. If you the reader are silently nodding in agreement, then you’re joining at least two generations of mental health providers who generally agree with these principles while implicitly thinking that sex is not part of the early attachment equation. You’ve likely been taught to believe that proximity or object seeking, plus patterns within those relational drives, are shaped interpersonally and by broader environmental norms; that we have implicit (neurobiologyspeak for the unconscious) memory of early attachment patterns, whether they were traumatic or not; that we have implicit bias (appropriating social justicespeak for the unconscious but not repressed) in relationships, yielding prejudice directed at distinct social groups. Yes, joy, creativity, and some of that bad feeling stuff is indeed fostered in a child’s development, but not sex. Not arousal, or longing. That potential is activated later…when it’s appropriate, of course.

So, why are there excesses? Why this untidy disorder, this chaos of spillage, as if life were some kind of cosmic dumping. There, says…something: here are your tools in a pile and a flood. Do with them what you will. Is addiction, for example, a blend of natural hormonal excess negatively complemented by an insecure attachment style, of weak or failing repression barriers? And if this shaping does occur both intrapsychically and interpersonally, shall we break with our profession’s current theoretical orthodoxy and resolve that sexual nurturing largely coincides with biological schedules and is dominantly imparted with the help of the cultural village? A village that also fails, perhaps. Because if this isn’t the roughly hewn plan then we must revisit what our developmental theories otherwise imply: go back to society with ideas it doesn’t want to hear and consider taboos, as in pre-teen or even pre-verbal sexual exposure, as the original source of sexual development. We’d have to imagine that arousal and longing are part of the same dyads or village-child-passing-around norms that bring food, enable good sleep, play and a spark of imagination. We’d have to imagine that breast-feeding, or the bathing of infants’ genitalia, or the physical control of their evacuations are truly antecedents of sexual desire, or that excesses in this private realm nurture later distortions of sex as much as any unconscious yet unrepressed social message conveyed via so-called modeling to a conscious mind.

Though it would likely elicit thought-blocking accusations of misogyny or homophobia, we’d need to re-think child-rearing in a way that might stir panic; contemplate sexual orientation in a way that would challenge etiological assumptions. If the excesses of sex addiction are rooted in early childhood development, trauma specialists sometimes suggest (but don’t prove) that childhood sexual abuse is an accomplice to later sexual acting out. In this way, modern psychology comes full circle, revisiting Freud’s original Seduction theory, only with a significant permutation. Instead of conversion symptoms like the paralysis of limbs, patients present with compulsive behaviors, what Freud described as repeating versus remembering, or the shorthand, repetition compulsion. Sandor Ferenczi later gave us the term and concept “Identify with the aggressor”, attempting to rescue Seduction theory from its then-exile, to denote a relational identification between victim and abuser—to indicate a kind of psychic hostage-taking. If the vast majority of sexual abuse perpetrators are male, as a mother-idolizing culture would have us presume, then why doesn’t a corresponding majority of male molestation victims report or manifest ego-dystonic feelings of same-sex attraction? Or perhaps they do and are therefore, in keeping with analytic thought, manifesting the defense of reaction formation via a false heterosexual identification. Does it seem complicated, this human development?

And what of those who mooted, like Freud, that infantile sexuality is a thing; that attempts to seek pleasure and reduce drive tension happen from the outset of life, stimulated through erotogenic zones: the oral, anal, and the genital. With odd references here and there in Getting Real, I suggest that sex addiction is derived from a period of oral excesses, a pleasure-seeking yet tension-fraught jouissance, as Lacan put it. The mother brings her eroticism to the table, some have said–no, that doesn’t mean sexual molestation. But it might mean excess arousal–something that is then repressed. Necessary, it seems. It seems to be taking longer and longer for children and young adults to grow, with the meta-tasks of an internal, interpersonal, and collectivist set of systems to navigate. I understand that some animals in the wild are able to walk within a day or an hour of their births. They grow up quickly in less complicated systems, with simple brains that are mindlessly free of sexual neurosis. Are the plainer brutalities of nature—the ubiquity of predation, or the threat of being left behind if not ambulatory—the forces that force giraffes to their feet? Do their hormones help? Or do they “grow up” quickly in other ways? What if our life expectancies were less than a decade? Would we evolve a quicker, more expedient onset of the pubescent watershed, becoming unrepressed yet thoughtless, and actively or relentlessly sexual, all because it was necessary to survive?