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I cannot stress enough how important this book is, not just to the helping professions but to the general public who get to read and hear (incessantly) about someone famous who is called a “sex addict”. Think Jessie James, Tiger Woods, Bill Clinton, etc. The topic of sex addiction has been with us since the 1980’s, at least. Yet, as this book shows, there is no empirical scientific evidence that would confirm the existence of such an addiction. However, there was a very hard push to make this a diagnosable disease in the upcoming revision #5 of the DSM (Diagnostic and Statistical Manual of the American Psychiatric Association). Sex addiction did not make the grade, instead Hypersexual Disorder was proposed.
“In the “Rationale” section of the DSM5 workgroup’s discussion of hypersexual disorder, it is explained that there is a clinical need for this diagnosis because there is a “demand” from consumers and providers of services to recognize and diagnose the groups of people who are seeking and receiving treatment for “out-of-control” sexual behaviors. So, in other words, like the Kevin Costner film Field of Dreams, “because they came, we built it.” It’s a disturbing argument that because there is a group of people saying they have a problem, and because there is an industry and a group of people treating that problem, we should therefore create a diagnosis around it. As others have pointed out, just because there are many people who believe in alien abduction, we have not proposed creating a specific disorder for this condition.” p.27
"In the DSM5 workgroup’s justification for hypersexual disorder, published in 2010, it is stated that “significant gaps in basic knowledge remain.” p.28
Dr. Ley states “The reason why clear medical terminology cannot be created in over thirty years of effort is because this is not a medical issue but a moral and social one.” I believe it reflects our sex-negative environment where sex education is politically unacceptable and belief trumps reason when data on the high rates of sexual activity are noted. The whole idea is that sex is different, sex without a relationship is wrong, sex for pleasure is dangerous. This book explores the morality behind making a disease out of sexual behavior. It notes the comparison with the diagnosis of “Nymphomania” used in history to describe women who liked sex (more than men thought they should).
Sex addicts are often described as being out of control. There is a big difference between feeling out of control and being out of control. Saying that someone is sexually out of control is saying there is a mind/body split, the mind cannot control the body. This offers a readymade excuse for sexual behavior that one’s partner or society thinks is over the limit (whatever that is). Maybe feeling out of control might be a good feeling of pleasure, but if these feelings conflict with a person’s values, guilt or fear might be the result.
“In our culture, we rarely teach people that feeling out of control is something different from being out of control. Many people drink alcohol as a “social lubricant,” drinking it as “liquid courage,” to reduce their inhibitions in social settings. They drink it specifically to feel less in control, because they want to have fun, and they feel that their internal controls are somehow in the way.” p.80
However, in our society we are held responsible for our behavior when we are “out of control” due to alcohol. When you are drunk, there is a lot of data on the effects on the body. Sex addiction holds that self-control is not possible without professional help when we feel we are are sexually out of control, since they indicate that feeling and being are the same thing. But there is no science behind this claim.
The book discusses several other “addictions” like caffeine. While having a physical effect on the body, caffeine can create addiction-like behavior such as tolerance and withdrawal symptoms, it is not in the DSM because it was not a good idea to have 60 million people, who love coffee and drink a lot of it, wake up in the morning thinking they had a mental disorder. Yet it apparently is OK to have people who love sexual pleasure and have a lot of it think they are diseased. Enjoy watching porn and you are on the slippery slope to sex addiction!
Sex addiction is big business, there is an American Society of Addictive Medicine that says addiction is a “chronic brain disorder” but this is unsupported by research. There are many clinics where the wealthy (males) can go to be cured. About 900 people have been certified as sex addiction therapists (CSAT) at a cost of about $5000. Chapter 4 covers this well.
Check out Chapter 3, Valley Girl Science, for an interesting view of sex addiction being “like” so many other things. If you are feeling sexy, go to Chapter 6. Chapter 13 is “The Ignored Aspects of Masculinity” where the sex addiction field focuses on men as intrinsically selfish, focused on “scoring” and virility. It ignores the part of men that are seeking love and trying their best to please their partners. This is an especially powerful chapter. Actually, there are no chapters in this book that you would want to skip over.
Dr. Ley does not question the intent of the leaders of the field as much as the methods and goals.
"Patrick Carnes, Robert Weiss, Douglass Weiss, and most of those treating sex addiction are doing so from a place of good intent, trying to serve people who are desperate for help. Treatment for sex addiction often includes clinically appropriate goals of building positive self-image, addressing issues of shame, and the need for support and healthy relationships. Issues of narcissism and selfishness are often addressed, along with the development of guidelines for behaviors and choices. But within the treatment there is an intent to “separate the behavior from the person,” and to split men from their sexual desires. This is an expression of the mind-body problem described in chapter 6." p.197
Writing this book has a risk involved. Reading it might involve some risk to you if you come to agree that sex addiction does not really exist.
"The field of sex addiction is a belief system, not a scientific or medical school of thought. There are careful and thoughtful people involved, trying to carefully piece out the kernels of truth embedded in this muddy concept. But the cult of sex addiction is driven by charismatic and convincing leaders who espouse sensationalist and reactive views of sexuality that are based on their own experiences, conviction, and religious faith, not on science or valid research. As I have begun challenging and questioning these beliefs, the levels of defensiveness and anger have shocked me. Strong reactions have come from individuals and family members of the self-identified sex addicts. But even stronger reactions and ad hominem attacks have come from my colleagues, who make their livings treating and diagnosing sex addiction." p.211
If you are a teacher, therapist or just a sexual person, I cannot encourage you enough to read this book. It contains an enormous amount of data, is well written, has a great index and end notes.