So, if treatment for an addiction, whether that is newly discovered or a relapsed condition, is to be longer-term, as in longer than a month or ninety days in a rehab, and intensive (meaning, multiple sessions per week), then that in part addresses one area of contention in the field: what should be the scope and duration of treatment. Linked to the scope of treatment is an area of treatment for addiction–and next I will specify sex addiction treatment–that is aimed at partners of sex addicts. This is an important if problematic area of treatment whose most prominent models espouse perpetrator/victim labeling that inclines participants towards splitting defenses which thwart in-depth or nuanced thinking, instead privileging fixed idea responses. This is further problematic if one considers that the assessment of sex addiction is yet to be codified across the medical or psychiatric establishment, which means that associated conditions or assumptions predicated on such assessments are in turn questionable. I’ll address that issue more fully in a later blog about betrayal trauma, but for now pose a question that lies within but also beyond medicine or psychiatry into the realms of culture and philosophy: what is addiction?
As suggested in previous entries, and of course in mine and Joe Farley’s forthcoming book, Getting Real About Sex Addiction, the matter can be addressed with metapsychological assumptions: epistemological (seeking to understand, or know), ontological (helping the patient emerge a state of being—who they are), or medical/scientific “problem-solving”, means-end analysis (as in achieving sobriety by any…), or utilitarian assumptions (going for the “greatest happiness”), which might mean privileging what is deemed most important by an arbitrary authority, or the needs of the victimized, which makes treatment about justice for the impacted. Notwithstanding the importance of those assumptions and hypothesized priorities, there are several psychoanalytic ideas, or “assumptions” if you prefer, that we explore in our book.
Firstly, because addiction is a cultural term and not in itself a scientific construct denoting a physiological phenomenon, we consider that addictive behaviors plus “addictive thinking” or “addictive personality” contain the following intrapsychic purpose: avoidance of conflict. Like the neurotic, the addict represses, displaces, sublimates (goes to work, or “keeps busy”), or exhibits reaction formations (shame/guilt self-loathing: “I’m such a piece of — for doing…”), but paradoxically continues the problem behavior, usually in secret. Reaction formation is a less popular artifact of psychoanalytic thought. By and large we don’t like the imputing of a reversed motivation beneath a virtuous surface. There are too many “nice” people who needn’t be troubled by assignments of concealed lechery, corrupt and self-serving motives relating to money; unconscious bias, racial and gender isms. The problem in another sense is one of thinking, of not thinking integrally. By that, I mean the difficulty of weighing matters, considering pros and cons, conflictual emotional states, or seemingly irreconcilable contingencies. Self-identified addicts tend to decry thinking, calling it analysis-paralysis, and usually confuse thinking with obsession. They fear their own minds, say things like, “I need to get out of my own head”, or “my head is a dangerous place to be”. There’s a deceptive humility in these expressions, as if the extinguishing of thought were a submissive act.
My wife doesn’t want me anymore, the sex addict laments. Or she does, but there are conditions that complicate sexuality, render it difficult. Well, addiction simplifies. Porn actresses, prostitutes, or “sex workers” want; they are accommodating, un-demanding; they appear to enjoy you, appreciate you. Depending upon how often you lease their services, they may even depend on you. And they’ll never criticize you for wanting too much, or wanting “it” too often, for their bodies are there for your use, and yet the maintenance of those bodies isn’t even your concern. This kind of person is irresistible psychologically, no matter how “hot” she might be. As a result, she may graduate to the level of affair partner, 21st century style. Actually, I don’t know how old the next phenom is: a man enjoys his regular sex worker for a spell; then she starts calling him “boyfriend”, which he starts to take seriously—he starts tipping her a bit more, maybe adding even more $ when she starts talking about her life, especially the aspects she wants to escape from. Soon, an enmeshment emerges, one that blends her desire to use you, plus your desire to be used…as a hero. This is power of a fragile kind, one that can easily be exploited, paradoxically, by those in underprivileged positions. How often does this happen? I don’t know. I’ve just met a lot of couples who began life as affair partners—that’s all—oh, except that many of the women were sex workers at the time of meeting.
So, you may be thinking this is all very phallocentric so far; that my assumptions are cisgendered, heteronormative, and privileging of heterosexual—wait, would it really privilege heterosexual men if a stereotyped image of their sex addiction elicited wide contempt, leading to pigeon-holing theories of intervention? Because that’s what has happened. The sex addiction treatment sub-field, contrary to the beliefs of some, is not exactly peopled with apologists who think that sex addiction is to be indulged. This is not 1959. Three quarters of our mental health proletariat is female, and the remainder of men are more or less compelled to patronize concepts like “toxic masculinity”, which is aimed at sex addicts, not just rapists or coarse men who loudly say things like, “yo, bro, what’s your problem?” in public places when someone is calling them out.
Share the average sex addict profile with the average observer, professional or not, and observe the rising judgement. Such figures are exploitative, sexually lazy, or guilty of relational cowardice, most will opine. Meanwhile, narrowing traditionalist circles, pockets of locker room talk, may continue to sanction the seemingly masculine habit of attaching to things versus people, or people-as-things; the practice of outsourcing frustrated sexuality to sex workers and such. But the above-ground world of progressive orthodoxy is having none of this. Theoretically, most clinicians are aware of the concept of splitting—the Freud/Kleinian idea that a mind keeps separate good and bad—and thus creates what today we call “compartmentalized” worlds in which the civilized ego is protected from the timeless desires of the id; a traumatized mind undisturbed by complexity. As a patient of mine who wrestles with his dilemmas has put it: “If I act out (sexually), I’ll kill off the intimacy between me and her, my best friend. But if I don’t act out, I’ll just grow to resent her”. Note the impossibility of resolving conflict, or even living with a problem, without the valve of release. The “solution” is in the escape, this person believes. The “problem” is in the escape, this person believes.
I believe that most of my colleagues in this field, even the angry and strident ones, are reasonably nice and compassionate with the sex addicts who stir their countertransference (psychoanalytic-speak for hate). They are professional, empathetic; sometimes patronizing; they use terms like “insecure” to denote an underlying neurosis to addiction—that reservoir of soft feeling that many just have not learned to share in our modern world. Putting aside the strained expressions of concern, the activist among us reserve their hard comments for the consulting office, or for networking, coffee-talk circles: rigorous, pamphlet-wielding exercises, no doubt. Within this field there are assumptions and politics—sorry, the intersecting social context and treatment strategies—that either inform or contaminate approaches depending on your point of view. Don’t split on that thought, however.