Saturday, November 20, 2010


This piece caught my attention since it exemplifies how vague and elastic diagnoses can become the site of entrepreneurial activity by ‘therapists’ and ‘experts’.

As is my method, I’ll simply go through the article picking out SO-relevant elements.

The therapist apparently received her basic professional training in marriage and family therapy. In 1997 she began advertising herself as a ‘sex addiction’ therapist. It’s not clear if she came directly from her training in marriage-and-family and decided for whatever reasons to set up in sex-addiction instead, or whether she had practiced in her specialty (not to be taken in the far more extensive sense used in describing doctors’ specialties) before, for whatever reasons, she decided to expand into the sex-addiction work.”For-profit” , by the way.

But at this point she has expanded her operation into a full-blown corporate business.

“Celebrities have been the greatest evangelists for treatment” she says, and her practice wouldn’t exist without them. And THAT is a revealing comment. There’s something disturbing and dangerous about blending the ‘evangelistic’ (not to say the ‘religious’) and the professional therapeutic.

‘Evangelism’ as it is used here bears the weight of hucksterism, that type of Elmer-Gantry self-assured confidence-man ‘ministry’ that cockily led to a false paradise those who were weak and gullible enough to jump onto the bandwagon.

This for-profit type of enterprise is “booming” now, thanks to the well-publicized troubles of various celebrity figures. Americans, it seems to me, are becoming increasingly susceptible to all manner of these frenzies. In large part, I would say, because they are growing up now with no sense of Mastery of themselves, no knowledge, and no genuine sense of Meaning, Purpose, direction, or perhaps even of an abiding ‘Self’ beyond whatever vitality can be dissipated into consumer-addled and primal-instinct-driven skittering along the hard surfaces of life’s appearances like fat globules on the surface of a hot iron skillet.

Americans have always been predisposed to some amount of this sort of thing, but there had always been some level of cultural, societal, and religious organization that could provide a supportive exo-skeleton or Trellis to help the energetic but undirected human vine achieve some sort of Shape, as individuals and as a cohesive social group. But the past few decades of sustained targeted ‘deconstruction’ of culture, society, and religion has profoundly weakened all of those ‘old’ supports.

And all that exists before the crystallization of forces and ‘interests’ under the ‘pressure’ of which legislators, jurists, prosecutors and law enforcement, ‘therapists’ and assorted ‘experts’ have all been cut in for a share of the action in a Mania that yet reveals a diabolically shrewd distribution of the many dollars the Beltway has made available. In a way it reminds me of the Cold War Pentagon strategy of military production: spread it out over as many States and electoral districts as possible to create the widest possible ‘support’ and ‘interest’ in Congress .

And all this has provided a lot of folks – ‘challenged’ in such competencies as relationships, self-mastery, and dealing with complexity, unpleasantness, and unhappiness – with a whole new arena for creating some excitement, movement, even – however falsely – direction in their days. Because ‘sex addiction’ “has led a growing number of Americans to conclude that they – or in many cases their spouses – needed treatment”.

There was a time when ‘you need to get your head examined’ was just an everyday barb tossed out, jokingly or in the middle of an argument. Now it is a magic coin that will play the interlocked juke-boxes of Law, Media, and Medicine (well, ‘therapy’ anyway).

AND all this despite the fact that “sex addiction [is] a controversial diagnosis not recognized by the medical establishment”. Come to think of it, neither is “sex offender”.

But it’s all led to “an increasing demand for services and the potential money to be made”. Now here you have a dubious diagnosis, a whole lotta people who through ‘empowerment’ feel authorized to be making some significant charges, and a whole bunch of licensed persons who stand to make a great deal of money by taking whatever is pushed toward them verrrry seriously.

THAT sounds disturbingly familiar.

As a result of recent corporate maneuvering you will soon be able, if you wish, to get yourself signed into a deluxe residential program at a treatment center that may resemble nothing so much as a 4-star resort, or you can sign up for a two-week outpatient program if you can’t afford the 4-star route. And there will be a national network of these things, so anybody who cares to sign up – or get somebody else signed up – won’t have too far to drive.

According to the entrepreneur-in-chief, “you have a backlog of people who need this treatment”. Of course.

But the article’s author is respectably skeptical: she points out that “just how many people are seeking treatment is unclear”. Still, that’s not going to help if this becomes a craze and there are more than enough factors in place for that to happen.

Especially since all this “exponential” expansion is taking place “without the government regulation that exist in drug and alcohol treatment”.

Now this IS a little different from the experience of the SO community, but then again maybe not. In the SO Mania Regime there’s been an awful lot of government involvement – legislation, programs, prosecutions, registrations, and lotsa lotsa shrewdly distributed government cash*.

But then again, although there has been much government involvement, there has been little government ‘regulation’, at least in the sense that any ordinary Citizen might expect: the government will use its bucks to engage the services of competent folks to make sure that services are provided that are accurate, cost-effective, and basically honest. (Government has not been providing THAT kind of regulation very much at all, as the economic situation clearly indicates.) The Mania laws are based on grossly inaccurate Findings, the programs are based on hugely dubious ‘science’ and ‘therapy’, the prosecutions are achieved through hugely dubious legal chicanery, the registrations need no introduction to the SO community, and the only good news is that the cash is running out and the pols are getting kinda twitchy (sorta similar to, I like to think, Italian government functionaries after mid-1943).

This article respectably provides the insights of a Boston psychiatrist, versed in the research of “compulsive sexual behavior”, who notes that there is “serious disagreement in the scientific community over whether humans could be addicted to sex in the same way they could be to alcohol or drugs”.

We are in – who can be surprised? – the murky, swampy, shadowy precincts of Definitions, an area that has been having a hard time of it these past few decades. The formal medical (and ‘scientific’, if you wish) definition of addiction includes a rather serious bit about addiction requiring a clear and verifiable physiological tolerance, built up over time, the withdrawal from which causes serious and very clear physiological problems.

And you don’t get that with ‘sex’. Which is probably why – who can be surprised? – there is “a lack of data” demonstrating such difficulties among ‘sex addicts’.

But of course, this won’t make any more difference to the entrepreneurs that it has to the assorted principals who designed and still maintain the SO Mania Regime.

Without any regulation, it’s now been “left to the industry to define sex addiction”, and I can’t imagine you’re going to get any more careful a result from the ‘industry’ than the country’s gotten from the architects and stewards of the SO Mania Regime.

The net is cast wide: the definition at this point is “any sexually related, compulsive behavior which interferes with normal living and causes severe stress on family, friends, loved ones and one’s work environment”. You’ll note that the definition is itself defined in significant part by another poorly and widely defined thing called ‘stress’.

There is and has always been a tremendous difficulty with the entire concept of ‘stress’ as a reliable diagnostic term. When does ‘unpleasant’ or ‘undesired’ shade over into ‘stressful’? What objective symptoms, observable to trained others and not susceptible to mimicry or manipulation, conclusively establish the presence of ‘stress’? What distinguishes the experience of frustration or dissatisfaction from ‘stress’ and what reliable diagnostic indicators are there? How can one establish a case of legitimate ‘stress’ from something merely perceived as or asserted-to-be ‘stress’?

And the “stress on family, friends, and loved ones” means that pretty much anybody you know can suddenly declare ‘stress’ and YOU are the Problem. Imagine a football game where anybody on the field is a Deputy Ref and can throw a flag or blow a whistle. Imagine driving in a city where any driver can ‘say’ whether s/he thinks the light is red or green; or where any driver can give another driver a ticket. Or, to use an example from an acquaintance well-traveled in a certain large and recently-modernizing country, any driver on an 8-lane freeway can stop wherever and whenever s/he pleases and open up the brown-bag for lunch. You see where this type of thing can quickly go.
These are not bickering trivialities; until they can be answered there is serious if not profound difficulty accepting the conceptual validity of the term.

From a business point of view, of course, an elastic or vague definition simply means that more folks are going to be stopping by to pick up a brochure or submit to an ‘initial test’ (which probably is going to find ‘stress’). Insurers will have to pick up the tab, although as a ‘medical’ expense it might also be used as a tax deduction so taxpayers will fund it indirectly.

But the ‘business’ or ‘numbers’ aspect of the SO Mania Regime did – as it were – quite well, consistently posting ‘good numbers’. And THAT seems to be the only aspect of the Regime that has been performing well.

There is even a “group” that “certifies” sex therapists, called impressively enough the International Institute for Trauma and Addiction Professionals (IITAP). In addition to the highly-fraught ‘addiction’ you also see those old deceivers, the “trauma” professionals. As you may recall from a recent Post about Dr. Paul McHugh, the ‘recovered memory’ professionals have now largely backed off that cottage-industry, claiming that they were – wait for it – taken out of context, misinterpreted, and that it was all “metaphorical” and never intended to be taken seriously. (Who can forget Rosanne Rosannadanna’s superb Nevvvvvvvvvvverrrrrrrrr Miiiiiiiiiind on ‘Saturday Night Live’?) And they have reinvented themselves as ‘trauma professionals’ (and, of course, ‘trauma’ can be whatever the therapist – or even the patient – wants it to be, and the whole thing becomes the Mad Hatter’s Tea Party held in and for the County of Through The Looking-Glass).

I recall that H.L. Mencken observed sometime in the early 1930s that even car-salesmen and realtors now had a ‘code of professional ethics’ but he still didn’t advise taking them at their word when you were making a big purchase.

Naturally, “some in the field say that 3-5% of Americans are sex addicts, while others say the proportion is probably greater”. Five percent of 300 million is 15 million; collect $7,500 bucks minimum (for the two-week outpatient option; 40K per month for the 4-star option) from each one and you can see how venture capital might be attracted. And the 7,500 is only going to get you in the door and doesn’t include further therapy and purchases in the gift shop (tee shirts, ball caps, relevant encouraging posters and bumper stickers, perhaps colored ribbons – if there’s still a color in the spectrum that hasn’t already been taken for this or that cause, besides some delicate shade of mauve or jade).

But you can be assured, the article drily reports, that someone who simply had one or two extramarital flings would never be diagnosed as a sex addict. Of course not. And Saddam had WMDs and we would be greeted as liberators and it would be a cakewalk and would only cost a couple-three billion max and sex-offenders are ravenous stranger-monsters with huge recidivism rates and – you could pray with Yul Brynner’s King of Siam – “et cetera et cetera and et cetera”.

I’m not so sure. Look at the bunches of folks classified as ‘sex offenders’ now. And the entrepreneurial therapy industry wouldn’t even have to adhere to such Constitutional requirements as are still, though holed like Swiss-cheese, standing like decayed speed-bumps against the road-rage of SO convictions and Registration.

What the entrepreneurial therapist types are looking for are the folks with “hundreds of sexual contacts and years and years of a double life”. Yes, that would be the more serious end of the spectrum, but there are a lot of less-serious cases.

And what if courts, even if in a well-intentioned effort to avoid imprisoning ‘sex offenders’, started mandating ‘therapy’ at one of these centers? Who’s going to pay for it? There seems to be a trend toward making the convicted SO literally ‘pay’ for his imprisonment or his Registration expenses, especially now that government agencies at all levels are running out of cash and nobody wants to admit that the SO Mania Regime should be dismantled.

Can your ‘medical records’ from these therapy sites be accessed for legal action and prosecutions? Do such ‘therapists’ (another verrrry broadly defined term) enjoy legal immunity like doctors do? Are possible sex-crimes still covered by ‘confidentiality’ in the first place? If one of these businesses is getting referrals from a court, will it protect your confidentiality if quietly threatened with a loss of official referrals?

Such are the complications in a time of Mania Law. Neatly, the effect is that everything said about ‘sex’ to anybody, and especially if notes are taken, must be considered from the point of view of turning up on a prosecutor’s desk for consideration as a possible ‘case’. This is the civilian version of the awful Catch-22 of prison ‘rehab’ programs: if you don’t participate, you won’t be considered for parole, and if you do participate anything you say can wind up on a desk for legal review with an eye to further charges and prosecution.

Indeed, “therapy often includes full disclosure of sexual encounters to spouses, including names, dates and locations, and a search for an underlying problem, such as childhood trauma or depression”. If your sex has caused a troubled marriage, and your spouse gets this information … give that some thought. Or if you name a partner, what are the chances that that partner will then claim s/he was ‘raped’ or ‘assaulted’ in order to save face?

Rent some videos of old World War 2 movies where Resistance agents are in the clutches of the Gestapo or the SS, or are trying to figure out what can be said in front of whom in a conversation (recall that in some cases your own kids can accidentally set the Gestapo in motion with chatter on a school playground).

Funny, too, is that the Boomers and cultural ‘liberationists’ were sure that once you could have sex whenever you wanted and however you wanted and as often as you wanted then you would truly be ‘free’ and no longer a boring, conformist stooge of (pick one or several: the system, the establishment, capitalism, imperialism, bourgeois phony morality).

Even more troubling is the fact that “more people think they have it”. Which is hardly surprising: since a) there are so many people who thought that ‘sex’ was somehow liberating and that they didn’t need to ‘mature’ because that was ‘oppressive’; and b) the definitions of symptoms are almost as broad and whacky as the old ‘self-tests’ to determine if your daddy abused you from 25 years ago (if you are nervous around hot coffee then you were abused by your daddy because daddies drink coffee – see, it’s science!). **

Even more worrying is the fact that although “sex addiction is not considered a legitimate psychiatric diagnosis [this fact] appears irrelevant to clients. They are finding rehab centers and outpatient programs through Google searches rather than referrals from their family doctors”.

Things have gotten so vague, fuzzy and mushy nowadays that everybody feels ‘empowered’ to decide when they 'have a diagnosis' and need therapy – which, of course, the for-profit therapy crowd will do little to prevent. I can’t help but think that folks have gotten this impression from watching the government declare that just about anybody can be a ‘sex offender’, and you shouldn’t let piffling matters like accuracy and objectivity get in the way of that.

“It is absolutely consumer-driven” says one of the entrepreneurs. Which was what the government said when it started the SO Mania Regime: it was simply providing a ‘service’ to folks who needed to know who and where were the SOs in their community (although anybody in the world could look up any State’s Registry or save time and trouble by conveniently browsing the one big central federal Registry comprised of all the States’ Registries).

You can take a computer-quiz online to see if you qualify. One of the questions is Has sex become the most important thing in my life? Without God, Meaning, Purpose, Family Responsibility, Maturity, or smoking … well, you can see how many folks might have fallen back on something more ‘basic’ and readily to hand (so to speak). And for that matter, does daily self-abuse make one a ‘sex addict’? If you want it to, I’m guessing the answer will be Yes.

“There are no independent studies on recidivism in sex addicts, but practitioners describe it as extremely high.” Well, what would you expect them to say? And since the government has been insisting on this for two decades now, in the face of all the evidence, then why would any entrepreneur burden a business with too much truth, accuracy, and reality? There are times, to paraphrase H.L. Mencken again, when businesspersons must “rise above principle”. Oy. (H.L. originally made the comment about politicians, which is also relevant here.)

The article decently points out a major conceptual problem: “For an alcoholic, sobriety is abstinence, but the goal for a sex addict is more amorphous: a healthy sex life. Part of therapy is reaching a personal definition of sobriety, and it is often a trial-and-error process”. What is ‘too much’ sex in a society where the individual is ‘totally autonomous’ in defining the quality of his/her life? If you have what once was quaintly called an ‘open marriage’ back in the Swinging Fifties and early Sixties, then on what grounds can X-amount of sex be labeled (or diagnosed) as too much by somebody else?

"It's really difficult in terms of people being able to get traction for recovery. Relapse is the norm" says a Marin County psychologist who treats sex addicts. Note that Marin County is that fabulously well-off enclave just north of San Francisco. Note also that since some amount of sex is natural – to say the least – then avoiding ‘relapse’ is going to be problematic. But it offers marvelous prospects for repeat-business.

Most of these operations get their business from the Web. You don’t have to bother with trained clinicians and face-to-face meetings; it’s like buying a car online, only this time you’re not going online to avoid a salesman but rather to open yourself up to one without any obstructive interference from actual trained professionals.

A shrewd marketing move.

“Although the overwhelming majority of those treated for sex addiction are men, the sites often seem geared toward their wives, with photos of couples engaged in deep conversation and women with pained expressions”. This is a shrewd reportorial observation. And a shrewd business move. And it reinforces a long-standing suspicion that somehow there’s a bit of the gender-war fueling this whole thing.

I wonder if they won’t soon be offering equally expensive ‘support’ programs for wives. Oops, they already do.

But it gets worse: “One Houston counselor promises follow-up polygraph tests so wives will know whether their husbands have changed”. The possibilities for mischief here are endless.

And what does it say about the relational competence and maturity of American adults that they require ‘therapists’ to administer lie-detector tests in order to somehow maintain the marital relationship?

The more reputable providers (as these things go) are concerned that the more whacky providers will give everybody in the business a bad name. Hence, they want government regulation (thus to assure the reliability of ‘the brand’ as the business schools like to say).

Otherwise "it sets up the potential for treatment to be delivered from a business milieu rather than what is in the best interest of the client", said one provider. And yet the SO Mania Regime’s safeguards and respect for the treatment of SO’s has been a nasty business from the start.

The same provider said that, in her experience, recovery took two or three years and that many people needed several types of treatment as well as regular attendance at 12-step meetings. I’m going to imagine that if you’ve got what is primarily a maturity problem (as opposed to a formal and genuine addiction problem) and a self-mastery problem is not going to be easy to resolve. And this will be as true for the younger generations who have grown up in a loosey-goosey culture of ‘total autonomy’ and profound Shapelessness as it ever was for the ‘macho’ generations of yore. A sex-therapist is going to need some serious competence in basic developmental psychology (and its repair) as in ‘sex’ (whatever that may mean in the therapeutic setting).

"We should be making it very clear upfront that a two-week program is not even scratching the surface," she said. I don’t think she realizes how very accurate she is.

All in all, this ‘sex addiction’ craze is surely a spin-off of the SO Mania Regime and all the shady stuff that underlies it.

I have the greatest respect for genuine therapy. I most certainly believe that every human being, male or female, is as responsible for the mastery of his/her sexual energies as a warship commander is responsible for the competent mastery of his vessel and its capabilities.

But I would be very judicious in how or even whether to make use of the type of entrepreneurial services being developed here. As is now clear from the misadventure in Iraq, good intentions and a trust in ‘business’ did not suffice to work well for the efforts in that wracked country.


*If you have a moment take a look at this excellent site put up by RSOL; one of the reports analyzes in a single page just how the SO Mania programs have been constructed to seduce States to maximize their ‘numbers’ – very much by hook or by crook, as used to be said – in order to maximize federal funding.

**Don’t laugh. Although the two female authors of that frakkulent book (“The Courage to Heal”, see here) later back-pedaled, they brought out a 20th Anniversary edition (on top of the 3rd edition).

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