Anthony Weiner and the Problem with "Sex Addiction"

The internet is abuzz over a recent brain imaging study on sex addiction that questions whether those with compulsive sexual behavior have real neurological differences from those who don’t. Since the diagnosis has come into fashion—and I do mean fashion—we’ve watched a vaguely ashamed procession of celebrities (David Duchovney, Tiger Woods) give sheepish press conferences and then retreat to the safety of sex addiction treatment centers. Most later return to their understanding partners.

This week’s irritating performance by Anthony Weiner, just the latest in his colorful digital escapades, begs important questions surrounding impulse, addiction, and being an asshole. Weiner’s most recent infidelity seems to indicate a certain kind of uncontrollable urge. Any sane person would ask why anyone so recently off our culture’s accepted cycle of confession/repentance/reemergence would fall prey to their compulsions so soon. Is it best to understand sexual compulsion as a legitimate addiction, similar to the cycle so often seen in drug addicts? Or is it a cop out, the latest socially acceptable excuse for behavior? Likely it’s somewhere in between.

On the science side, there's the above-mentioned recent EEG imaging study, evaluating activity on 52 individuals who self-identified as having trouble regulating how often they viewed sexually stimulating content. They could not actually use individuals in sex addiction treatment due to ethical concerns, but the participants scored similarly to “addicts” on tests to measure sexual impulsivity and consequences. They were shown four types of images: pleasurable and sexual, pleasurable and nonsexual (skydiving, for instance), neutral (boring portraits), and disgusting boner-killers (horrible stuff like dismembered bodies). Then their brain activity was measured; specifically, it was measured at 300 milliseconds following the image stimulus, a measure known as the P300 response.

The P300 response is used to quantify and evaluate similar brain activity studies for other addictions, and it tends to spike in relationship to the severity of addiction. So a heroin addict shown an image of a syringe and spoon would typically have a measurable spike in their P300 response that would be quantifiably different from a non-addict. Because the participants in this sexual addiction study varied in their measures of hypersexuality, the researchers postulated that their P300 responses would vary proportionately; the “worse” addicts (ones with less control and more compulsivity) would have higher spikes. Instead, they found no relationship in the severity of symptoms and the intensity of the P300 spikes. From the abstract:

Some have suggested that those who have difficulty downregulating their sexual desires be diagnosed as having a sexual “addiction”. This diagnosis is thought to be associated with sexual urges that feel out of control, high-frequency sexual behavior, consequences due to those behaviors, and poor ability to reduce those behaviors. However, such symptoms also may be better understood as a non-pathological variation of high sexual desire.

Weiner, too, rejects the sex addiction label when discussing his ever-growing number of online transgressions. Though he confirmed he was receiving “help” regarding his sexting behavior, he denied having an addiction. I applaud the man for that. In an era where claiming to be an addict would have earned him at least limited understanding, he straightforwardly owned his “Carlos Danger” online antics.

This interpretation of the data collected in this particular experiment differs substantially from other, more pathological interpretations of compulsive sexual behaviors that regard sexual compulsivity as more similar to a disease state. And the study itself is problematic—the results are more a call for further research than a definative statement on whether sex and porn addiction are "real." For example, the study showed participants depictions of heterosexual porn though not all participants were heterosexual. They also calculated measures of sexual compulsivity using questions on participants desire for sex (with another person), but not desire for or frequency of masturbation (one would think this is a very important measure in sexual compulsivity).

One possible way to look at this recent research is to say that they found no real reason—not within their results, at least—to consider sexual addiction as falling outside of “normal” sexuality. They posit that, at least where brain function is concerned, they weren’t able to perceive an “addiction” at work; at least not in a traditional sense. It’s a case of individuals having a lot of a normal thing (desire) but not a case of the brain working in a profoundly different way.

So what does this mean? It’s worth exploring whether those with very high sexual desire do exist on a healthy continuum and whether the consequences they experience could be linked to a social construct that pathologizes the expression of that desire. Part of how we measure how “sick” a person is has to do with how difficult it is for that person to function in society, but as society evolves, so to do the boundaries of what is considered illness. Could Anthony Weiner be a really sexual guy searching for the least dangerous way to express that impulse—say by sexting women he meets on the internet rather than carrying on a physical, sexual affair? When men and women experience sexual desire on the upper limits, how do we expect them to deal with it? Through suppression? Tactful infidelity? Is a reality where open relationships are more acceptable inevitable?

Whether we call sexual compulsivity "hypersexuality" or "sex addiction" or "a really horny person" doesn't have as much to do with the behaviors themselves as with the position we decide they occupy within our culture. The en vogue "addiction as a brain disease" model serves an important function in destigmatizing the addict, but it likely also imbues in addicts of all stripes (from alcohol to pornography) a sense of finality and a medically sanctioned absolute loss of control. When we tell people we know they can't control themselves, they believe it. So a reframing of sexual addiction might be a good thing; maybe it will actually help some people to hear that they're just really sexual and that they can take control of their actions. While extreme cases might be best understood as addiction, perhaps it's more accurate to consider milder cases as something else.

I’m not really defending Anthony Weiner here. I don’t like many things about him. But I do think his case, and how it coincides with this controversial sex addiction research, is worth a long look. Brain science, social science, and cultural mores are all inextricably tangled—all influencing the others in ways we can’t always perceive. But things tend to hit an apex and then drift back to the center; our cultural obsession with the “addiction hardwired into my neurons made me do it” biological determinism is relaxing into a more nuanced view of what brings us pleasure and how we balance pleasure seeking and our mayoral candidacy (or whatever the responsibility may be).

@kellybourdet