ATSA Forum - Vol. XXIV, No. 3
Into this breach steps David Ley, who observes what so many others have: the idea of sexual addiction has become more popular, more widespread in the media, and more lucrative. His book examines the available science and presents numerous ethical concerns. These concerns extend well past the celebrity who gets into trouble and blames their misbehavior on being “addicted” to sex. They encompass perspectives on sexuality and gender of cultures across time around the world.
This volume begins with a history of addiction and provides new insights into how definitions of “addiction” have changed over time. The historical information is important, as it betrays just how elastic the concept of addiction has been in various locations and in recent decades. Those who believe they “know an addict when they see one” will find many reasons to reconsider.
Ley next considers why we should examine the concept of addiction. After all, why would we not embrace it if it were a helpful construct for leading a more responsible life? Ley argues that this is a false and potentially harmful perspective that lacks actual scientific support, undermines personal responsibility, and too frequently casts male sexuality in an unhealthy and dangerous light. He uses a number of case examples to illustrate how what appears to be sexual addiction may be little more than a mismatch of libidos between the client and his or her partner.
This book’s exploration of the available science will fascinate any reader. Beyond observing that there is no credible body of evidence to support the notion of sexual addiction, he describes many historical problems in attempting to define it. Ley argues that even seemingly obvious metrics, such as number of orgasms per week and level of subjective distress related to sexuality have proven disappointing. By one measure, as much as 40% of males (and 21% of females; p. 24) might meet criteria for a proposed cutoff of number of orgasms. In other instances, what has separated “sex addicts” from other men has been the level of distress they experience and the nature of the men’s relationships more than the actual amount of sex they were having.
Ley further argues that by emphasizing “addiction” and powerlessness, professionals risk taking away the things that all adults should live up to: personal responsibility, integrity, self-control, independence, accountability, self-motivation, honor, and respect for others. Although many professionals in the field of treating sexual aggression have voiced similar concerns, Ley unpacks each of these points, illustrating them with research studies and case examples. Of past scientific efforts to define sexual addiction he concludes that, “if these smart, well-meaning, well-funded folks can’t generate clear definitions in three decades, then maybe the problem isn’t in the terminology, but in the process and the goal. The reason why clear medical terminology cannot be created is . . . because this is not a medical issue but a moral and social one” (p. 28). Ley argues persuasively that we should all be concerned that it is simply too easy to pathologize and stigmatize those who evoke our ambivalent beliefs about sex and sexuality.
In recent years, as neuroscience has come to the front of our attention, many professionals have made conclusions about possible biological markers of sexual issues such as pornography usage. While the scientists themselves are uniformly cautious in reporting findings, it can be easy to draw unrealistic conclusions from the testimonials and fascinating brain scans at web sites such as “your brain on porn”. Ley’s argument is that conditions such as schizophrenia and bipolar disorder have received far more neuro-scientific research attention, and are still not diagnosed by biological markers.
Ultimately, there are many possible sexualities. Some sexual behavior is clearly illegal and harmful. Some aspects are statistically associated with re-offense risk among those who have abused (e.g., sexualized coping). The challenge for treatment providers is to separate science from morals and fact from fiction. When Sexaholics Anonymous proclaims that “any form of sex with one’s self or with partners other than the spouse is progressively addictive and destructive” (p. 115), it should be clear that this is based far more on values than on research. Certainly, anyone wishing to ascribe to this belief on their own time should be free to do so. A chief reason why Ley’s book is indispensable to practitioners treating sexual aggression is that our clients typically do not have the luxury of selecting a treatment provider and can quickly find themselves in legally tenuous situations should they hold different beliefs than their therapist.
Ley’s writing style is highly accessible and entertaining. The structure and layout are excellent. He is meticulous in providing citations for his assertions, often preferring direct quotes to summaries. The Myth of Sexual Addiction will seem an easy read, but readers will find themselves putting it down for extended periods to think about its implications. For this reason, it will be invaluable for those considering the ethics of our work.