The Sex Myth: Why Everything We're Told Is Wrong (8 page)

She also told me about some encounters with residents who had trouble understanding what was and was not sexually appropriate. There were patients she had to remind not to masturbate in public,
not to say whatever sexual thought was on their mind in crowded places. Because this was in the US, she carried a Taser in case of attack. One of the patients had allegedly tried to sexually attack
one of the staff in the past. It probably goes without saying that people in this facility had little in common with our average celebrity with a roving eye.

In the situations she described, however, what seemed to be at work was not addiction so much as an actual difficulty understanding which actions were inappropriate. This version of
hypersexuality I heard described was far different, both in type and degree, from the behaviour of most of the people claiming ‘sex addiction’.

It’s likely that most self-proclaimed sex addicts are not really experiencing a severe and specific sexual disorder. The people who are, are people who might be diagnosed as psychotic,
sociopathic, or character-disordered. Or their inappropriate actions might be part of a larger developmental disorder, such as Prader-Willi syndrome. These people don’t need to be confused
with Tiger Woods having an introspective retreat and twice-daily group sessions. They need deep therapy, medication, interventions, or other intensive treatment, and a label like sex
‘addiction’ is simply not relevant. The same mechanism is not operating with these people as it is with someone who ‘feels bad’ after sex, or masturbates ‘too
much’.

Nymphomania has long been a term applied to women thought to have too great an interest in sex. But there is a word that was applied to an even greater proportion of the female
population, and is still used as an insult even today: hysteria.

Up until the seventeenth century, hysteria referred to a condition thought to be caused by disturbances of the uterus (from the Greek
hystera –
uterus). In the
second century, the Roman physician Galen described hysteria as a disease caused by sexual deprivation. Nuns, virgins, and widows were especially susceptible. Some sources as recently as the 1850s
claimed 25 per cent of all women suffered from the disease; other sources list dozens of supposed symptoms of hysteria.

Women who suffered from hysteria in medieval or Renaissance periods were prescribed intercourse if married, and pelvic massage – masturbation to you and me – if single. Naturally,
since touching yourself is a sin, a midwife would have to do it. Ooh er, matron! Other cures included bed rest, bland food, and sensory deprivation.

Over time, doctors became more involved in treating hysteria. The invention of massage devices became more common, with hydrotherapy devices available in Bath. By the mid-nineteenth century,
such treatments were popular at bathing resorts worldwide. Wind-up vibrators were available for physician use by the 1870s.

By the twentieth century, widespread electricity brought the vibrator to the home market, and it became a popular home appliance. In fact, it was widely available years before either the
electric vacuum cleaner or the electric iron. A Sears catalogue from 1918 includes a portable vibrator ‘with three applicators . . . very useful and satisfactory for home service’.

Because hysteria had so many potential symptoms, it was possible for any unidentifiable ailment in a woman to be called hysteria. As medical fashions changed and diagnostic techniques improved,
the number of cases steadily decreased. For instance, before the introduction of electroencephalography, epilepsy was frequently confused with hysteria. Some cases that would once have been
labelled hysteria were reclassified by psychiatry as anxiety or other disorders. Today, some of the more severe symptoms once attributed to hysteria fall under diagnoses such as schizophrenia,
conversion disorder, and anxiety attacks.

But the idea that there is such a thing as
too little
sex continues regardless. On Patrick Carnes’ website he describes a companion diagnosis to sexual addiction that he calls
‘sexual anorexia’. And, what’s
more, a large number of small-scale, limited studies and press releases have recently been making the rounds, convincing
people that there is a biological origin to this ‘widespread problem’.

‘Women with low libidos “have different brains”,’ said the
Telegraph.
⁴⁰
‘Libido problems “brain not
mind”,’ claimed the BBC.
⁴¹
The reports were in response to a study conducted in the US claiming to demonstrate a difference between
‘normal’ women and those with the ‘hypoactive sexual desire disorder’ (HSDD) diagnosis. The BBC recently implemented a policy of linking to original research papers when
reporting about science, and yet no such paper was linked in their coverage of his claim . . . probably because it was only a planned conference presentation, and hadn’t even been written up
and submitted for review.

So, what were the results? The researchers took nineteen volunteers with a clinical diagnosis of HSDD and seven with ‘normal sexual function’. The women watched television for half
an hour, with programming switching every minute between a blue screen, everyday programmes, and erotic videos. Brain activity was monitored by MRI (magnetic resonance imaging).

According to the press releases, ‘women with normal sexual function had greater activation in superior frontal and supramarginal gyri’, whereas ‘women with HSDD exhibited
greater activation in the inferior frontal, primary motor, and insular cortices.’ But how each region of the brain relates to arousal in women is actually unknown. And as always, correlation
is not causation – proving that would take far, far more work than a short-term study of twenty-six people.

As far as these things go, the amount of attention in the press seems out of proportion to what is clearly a small and prospective study. And as the only study to suggest this kind of aetiology
for lack of sexual desire, surely far more needs to be done before saying for certain whether the disorder is physiological in origin – or if it even exists at all.

When it comes to diagnosing medical problems, everything we know starts with small observations. Over time, these are confirmed by larger studies, covering longer time periods, of more people.
Epidemiology goes hand in hand with experimental research to help a picture start to form. With a combination of approaches, over time,
scientists can start to tease out the
potential causes of an identifiable problem. A single study that recruited twenty-six people? And the relationship between what was found and the criteria for subjects to be included? It’s
not enough.

So, just what is HSDD, and how were the afflicted volunteers diagnosed? The disorder is listed under the Sexual and Gender Identity section of the DSM-IV and was known as inhibited sexual desire
disorder in earlier versions. Claims are made that it can be diagnosed using just five yes-or-no questions.

The diagnostic questions include asking whether someone is receptive to their partner’s come-ons, ever loses interest in sex once it begins, and whether they feel sexual desire.

As before, there are no time parameters given on any of the questions, and no measures of frequency or severity.

If these questions seem vague, that’s because they are. The DSM estimated that about 20 per cent of the population had HSDD, and with such a blunt diagnostic tool, that high number is
unsurprising. And HSDD can be ‘acquired’, or in other words, a person might have felt desire before, but doesn’t any more. With such broad criteria, and a lack of wide-scale
study, it’s possible any number of claims could be made about the origin of a lack of sexual desire . . . but it doesn’t make them proven.

Combine this with the extensive search for a ‘female Viagra’, and the utter failure of pharmaceutical companies to find one, and you start to wonder if HSDD even exists at all.

HSDD fits into a history of attempts to give strict guidelines to what is ‘normal’. The diagnosis ignores the social factors that can influence expression of sexuality, not to
mention relationship context – I would consider myself highly interested in sex, but have definitely gone off it when having relationship problems. Is that really a good basis for diagnosing
a mental disorder?

While nymphomania and hysteria have fallen by the wayside as medical diagnoses, it seems we are unwilling to let go of a tendency to define what is the ‘right’ amount of sex. With
more and more clinical interest in ‘sexual addiction’ and ‘hypoactive sexual desire’, it’s hard to see how exactly things have changed.

Bermuda, 1961. At the nuclear arms summit, Prime Minister Harold Macmillan was mortified to discover an intern of President Kennedy’s tucked in the back of a
limousine, waiting to service JFK. Kennedy’s excuse? Withdrawal symptoms. ‘If I don’t have a woman for three days, I get terrible headaches.’
⁴²

But do the rich and famous really have an illness, or is their behaviour more a result of opportunity?

American feminist author Gloria Steinem called President Clinton a ‘sex addict’ after his affair with Monica Lewinsky. ‘He’s sick – he’s got an
addiction’, said former president Gerald Ford. ‘He needs treatment.’
⁴³

This kind of judgement is pure speculation. Steinem is not a therapist, and neither is Ford. What the realities are of why he cheated on his wife, we may never know. The handful of known affairs
he has had hardly seems outside the norm. Is it addiction? Are any of us actually in a position to judge that from the outside?

Jack Morin, author of
The Erotic Mind
, theorised why people with a lot to lose still engage in what seems to be – from the perspective of the viewer at home – risky behaviour.
‘The adrenalin and other chemical charges pump up the excitement . . . It’s so common in the sex lives of everyday people that it would be a huge mistake to pathologize it. This is
mainstream sexual behavior.’
⁴⁴

For these celebrities, is it an addiction at work, or simply a common desire for immediate or intense gratification? Probably most young men would struggle to turn down a sudden abundance of
female attention. That much hasn’t changed. What people say when they’re caught out has changed.

In the past, a famous person embroiled in a sex scandal might have owned up to simple bad decisions. Take Hugh Grant, who, after the Divine Brown fiasco, went on
The Tonight Show with Jay
Leno
and said, ‘I think you know in life what’s a good thing to do and what’s a bad thing, and I did a bad thing.’ Quite simply, he acknowledged that the temptation
might have been difficult to resist – but that is a far cry from claiming it’s impossible.

According to Dr Philip Hopley, an addiction specialist at the Priory, ‘The major concern is where sex-related problem behaviour is labelled an “addiction” when in fact poor
decision-making and/or
impulse control lie at the root of the problem.’ When people talk about what is normal, average, or healthy when it comes to sex, these are not
concepts that are well defined. There are no recommended limits for adults with data to back it up as there are for alcohol. And even Patrick Carnes, the ‘man who wrote the book’ on sex
addiction, admits that 83 per cent of currently diagnosed sex addicts have some other kind of addiction. The real problem those patients face probably goes far beyond the symptom of sex.

It seems to be that in the case of true compulsive behaviour there are other factors at work. Alcohol and drug misuse are relevant, because they can have a significant disinhibiting effect. With
a number of the celebrity cases in the media, accusations of drug or alcohol misuse seem to go hand-in-hand with the sex ‘addiction’.

Calling compulsive sex an addiction blames bad choices on a disease. Real, physiological addiction to alcohol and chemical substances has long been demonstrated. Making the leap from a set of
well-established mental and physical maladies to something like this seems like a misuse of the term in all but a minority of cases.

Phillip Hodson from the British Association of Counselling and Psychotherapy has pointed out the differences between something we have a biological urge to pursue, like sex, and something like
drugs or alcohol. Sex is hard-wired in us; having a three-martini lunch isn’t. ‘It’s the same with eating. You cannot really be “addicted” to normal drives.
What’s the cure – to stop procreating or eating?’

Criticism of the ‘sex addiction industry is not new, either – but coverage of the criticism rarely makes it into the mainstream press. In 1988, it was being written in peer-reviewed
journals how ‘sexual addiction and sexual compulsion represent pseudoscientific codifications of prevailing erotic values rather than
bona fide
clinical categories.’
⁴⁵
In other words, the diagnoses represent not real problems, but perceived problems, as defined by what society thinks is right at that particular time. But the
number of people promoting the idea of widespread sex addiction continues regardless, with more than 1000 citations for the paper that first named the phenomenon – the one that claimed more
than 40 per cent of people may suffer from the affliction.

The reasons for such potentially ‘false epidemics’ are numerous. They address societal unease with changing modes of behaviour: we
know previous generations
probably had less casual sex, and almost all of us had at least some religious indoctrination condemning it. They benefit a set of practitioners: people who get in early and become
‘names’ can add to their case studies and overall prestige. Where pharmaceutical treatments can be developed, epidemics are profitable for drug companies. And inclusion in the DSM is
the gold seal: if patients’ problems can be named, their psychiatric care will be paid for by insurance.

Sex addiction implies that there are limits to healthy sex that are universal. For instance, masturbation is okay, but more than once a day is suspect. Is there evidence for this seemingly
arbitrary line? Anyone here ever been a teenager in the first grip of hormonal changes? The belief seems to be that sex is only healthy when it is confined and in a relationship, or sporadic and
tame. It promotes an idea that the goal of sex should always be intimacy and that sex needs love to give it meaning. Enjoyment of sex for its own sake is verboten.