by Frank Tallis
In the late 1960s, the psychologist Paul Ekman undertook a study of depressed patients who were pretending to feel better. The reason for this pretence was that they wished to escape close supervision and attempt suicide. When filmed interviews with these patients were slowed down, it was possible to identify fleeting and negative facial expressions that were congruent with suicidal intention. In real time, these fleeting expressions would have lasted for a matter of milliseconds. It is possible that psychotherapists whose day-to-day work involves a great deal of looking at faces and trying to read them become sensitised to the appearance of negative micro-expressions. Such looks are perceived subliminally and produce a nebulous feeling that something is wrong. We know that this is possible from laboratory studies. Threatening images presented so quickly that the observer sees only a flicker of light can provoke physiological changes associated with fear (for example, increased sweat gland activity). What we call intuitions, presentiments and hunches might be nothing more than the by-product of pre-conscious processing: the registration of unconscious information that remains inaccessible to introspection.
We discussed Ali’s marriage.
‘Were you becoming sexually dissatisfied?’
‘No. Sex with Yasmin is great. It’s always been great.’
‘Then why did you feel the need to visit a prostitute?’
‘I don’t know—I just…’ He raised his hands and let them fall heavily on the chair arms. ‘I just don’t know.’ Again, I got the feeling that I was looking at a very anxious individual. ‘I guess I can be quite demanding,’ he continued. ‘I mean, sexually demanding. I need to have sex every day. Yasmin’s okay with that, but I really do have a very strong sex drive.’
This small disclosure carried him a little closer to confession. His perspective changed and he recognised that a burden might be laid down. ‘Even after we’ve had sex, I still feel that I need more. The need is so strong it wakes me up and I have to go to the bathroom to masturbate.’
‘How often does this happen?’
‘A lot—every night—sometimes several times a night—sometimes more…’
‘So, on average, how many times do you ejaculate over a twenty-four-hour period?’
‘About three I guess, although I don’t produce very much.’
‘Have you always been like this?’
‘Yes, since I was a kid. In some ways I was worse back then; actually, a lot worse.’
There was a time when I would have been sceptical about such claims. Once, I would have supposed that a man approaching the age of forty would have neither the desire nor the capacity to orgasm three or more times a day—but not any more.
For a short period of time I worked almost exclusively with promiscuous gay men and rent boys, a truly humbling experience for a monogamous heterosexual. In the so-called fuck room of a night club, a particular individual might have sex with ten or twenty partners and experience just as many orgasms. Pleasurable orgasmic sensations from the rectum and prostate are mediated by the pelvic and hypogastric nerves. There is a case report in the clinical literature of a man who experienced orgasmic sensations while defecating. Some individuals who suffer from epilepsy have orgasmic seizures that are triggered by brushing their teeth. One of my female patients could orgasm by popping bubble wrap—and she claimed that she could carry on having orgasms in this way indefinitely. For obvious reasons, I didn’t ask for a demonstration, but I have to admit that curiosity almost got the better of me. It is always unwise to suppose that human sexual behaviour has limitations.
Ali’s eyes, now wide open, suggested there was more to come. We had only minutes to spare. Ali rubbed his chin and said, ‘I’m sorry, but I haven’t been entirely honest.’
‘Oh?’
‘About the prostitute.’ He rotated the charm. ‘This is confidential, right?’
‘Yes.’
‘I mean—if I tell you the truth—you won’t contact my wife.’
‘No. Although that’s something we’ll have to discuss…’
‘What? Whether I tell her or not?’
‘Yes.’
‘But you won’t.’
‘No.’
A pause—a ticking sound made with his tongue—and then a much longer pause.
‘You were saying?’ I said.
He stopped turning the charm and let it go. ‘Yeah—the prostitute—you see—it wasn’t one prostitute. I’ve actually been seeing prostitutes for a while now.’ There was a sense of imminence, a sense of something coming. Ali continued: ‘It’s actually closer to three thousand—maybe more.’
‘Three thousand,’ I repeated.
‘Yes.’ Ali’s expression was difficult to interpret: guilt and shame, macho pride, juvenile glee? All were represented in varying amounts.
‘Is that possible?’
‘I don’t get up in the middle of the night just to masturbate. Sometimes I leave the house to have sex and come back again. Sometimes I have sex with several women a day.’
His wife’s discovery of a single transgression had been Ali’s admission ticket. Finally, he had volunteered his real problem—or so I thought. Actually, I was jumping to conclusions. This wasn’t his real problem at all. His real problem was far more interesting.
The term ‘sex addiction’ first appeared in the 1970s. Prior to this decade, hypersexuality was described as nymphomania in women and satyriasis in men. Richard von Krafft-Ebing’s notorious book of case studies, Psychopathia Sexualis, which was originally published in 1886, contains accounts of both: Case 193, a ‘universally respected’ farmer performed ‘the sexual act from ten to fifteen times in twenty four hours’; Case 186, a woman ‘Of good ancestors, highly cultured, good natured, very modest’, and who ‘blushed easily’, when left alone with a male of any age, ‘would strip him naked and vehemently urge him to sate her lusts’.
Is it meaningful to talk about sexual needs as addictions? If the circumstances allow, the human animal—particularly the human male—is highly motivated to seek sexual satisfaction. Emperors, dictators, Hollywood actors and heart-throb musicians have all been known to have thousands of sexual partners simply because they could. When rats can electrically stimulate the pleasure centres of their own brains by pressing a lever, they will do so indefinitely. Human beings, given the opportunity to have as many sexual encounters as they please, behave in much the same way.
Critics have suggested that the very idea of sex addiction is misconceived. They maintain that ‘addiction’ is a term we should reserve for dependencies arising from the introduction of substances—such as cocaine, alcohol or sugar—into the body. Behaviours such as sex, gambling, shopping or playing computer games cannot be understood as addictions, because nothing is being ingested, injected or absorbed. However, all behaviour has biochemical consequences and sex is associated with the production of endogenous compounds that resemble amphetamines and opiates. The adrenal and pituitary glands can manufacture hormones that deliver ‘highs’ and ‘rushes’ that are just as addictive as street drugs. As such, a restrictive definition of addiction that fails to recognise the reciprocal relationship between behaviour and biochemistry is somewhat arbitrary.
My own view is that sex addiction can be a useful concept providing the individual’s subjective state and context are taken into account.
Did Ali, for example, feel conflicted about his behaviour? Did he want to stop visiting prostitutes but feel driven to continue? Were there significant negative consequences for him and his family? Did he feel guilty? Over the course of our sessions, he answered affirmatively to all of these questions.
‘Your wife never suspected?’
‘No. She’s not like that. It’s not in her nature. She’s got no idea.’
‘She’s a trusting person.’
‘Yes. Very.’
‘How do you feel about that?’
‘Well, bad—of course. Look—I don’t want to hurt her. Why would I want to do that? That’s the last thing I’d wan
t.’
‘But if she knew the truth…’
‘She’d be…’ The scene he imagined was too awful to articulate. He sat up and perhaps it was the slender hope of redemption that spurred him on. ‘I don’t want to be like this. I started going to see prostitutes when I was in my teens. I’d go to casinos with friends and one thing would lead to another. It’s become more and more of a problem over the years—the whole thing has gotten completely out of hand. There’s stuff I should be dealing with—people I should be seeing. And instead, I’m just out there.’ He looked towards the window and the light lacquered his face with a silver sheen.
Addictive problems frequently escalate because of tolerance—a medical concept that can be employed to explain behavioural dysregulation and loss of control. The body has the capacity to adapt to drugs and sometimes larger and larger doses are required to achieve the same effects. In much the same way, the sex addict adapts to frequent sexual stimulation. Sex becomes less pleasurable, necessitating renewed efforts to reach an ever-receding goal. This effect is very pronounced in individuals addicted to internet pornography, many of whom spend hours or even days surfing increasingly exotic websites because ordinary sexual images no longer excite them. Libertines are often depicted in fiction as cynical, world weary and infinitely bored. It is a characterisation that acknowledges a paradoxical truth: the intemperate pursuit of pleasure makes pleasure hard to find.
Ali turned away from the window and continued talking as if there had been no interlude. ‘I’m in a difficult situation right now. I’ve spent a lot of money…’
‘You’re in debt?’
‘Yeah, you could say that.’ Ali studied the floral pattern on the arm of his chair and traced around the edges of a tulip with his forefinger. ‘Thing is, I think it’s all gone too far now—I don’t think I can come back from where I am.’ I wasn’t sure what he meant. Was he referring to his finances or his mental state? He saw my perplexity and added, ‘The business. Things aren’t looking good.’
‘I’m not sure I understand…’
‘Because of my habit.’ Again he registered my perplexity. ‘Some of the girls,’ he continued, ‘They’re very expensive, you know, the pretty ones—the really pretty ones.’
‘When are you going to tell your wife?’ His mouth opened and his eyebrows climbed. It was my turn to clarify. ‘Not about the escorts, about the business.’
‘I don’t know.’
‘You must have been aware that the business was in trouble?’
‘Yes. I do the books.’
‘Couldn’t you have taken preventative action?’
‘I can’t do anything now. There’s no money left.’ He pulled at his lower lip—let it go—and repeated the same words he’d offered his wife. ‘I haven’t been thinking straight.’
Sometimes, the reality of a situation makes us so anxious we simply pretend that it isn’t happening. Among the many defence mechanisms identified since Freud’s time, denial is one of the easiest to understand and it is also one of the most frequently observed. Everybody has some experience of denial. The defence is typically mobilised when symptoms appear which could be the first sign of a serious physical illness. ‘It doesn’t mean anything—it’ll go away.’ Some denial is helpful because it regulates exposure to bad news and facilitates gradual acceptance. The individual isn’t overwhelmed. Extreme denial, however, precludes rational decision-making.
‘It’s going to be very difficult,’ Ali continued. ‘Yasmin’s a proud woman and quite active in our community. You know, she does a lot of charity work—organising events, fundraising. Our family has a reputation.’
‘I’m sure it will be difficult—but presumably, the collapse of your business will have consequences that you won’t be able to hide from your wife for very much longer.’
He wasn’t really listening to me. ‘A man like me,’ he said, nodding his head slowly. ‘I’m supposed to provide. It’s expected.’
Ali’s business, established and developed over two generations, had been very profitable. I scribbled some rough figures in the margin of my notes. Even if Ali had paid for the services of over three thousand prostitutes, and a significant percentage of these liaisons had been with expensive escorts, his business should have been able to absorb the cost. Particularly given that his expenditure was spread over a period of approximately twenty years. I put this to him—and it was only then that he told me about his real problem.
‘It’s not just the sex. Things might have worked out if it was just the sex. You see, most of the money went on the other stuff.’
‘The other stuff?’
He touched his wedding ring and then his charm. I wondered if Ali was performing a superstitious ritual, but didn’t ask because I wanted him to stay focused. ‘I’m not sure I can explain.’
I waited for him to continue but he remained silent. ‘Try.’
Another extended pause—the sound of traffic—voices on the landing outside. ‘All right, all right.’ He allowed his head to roll back until his occiput found the support of a cushion. ‘Usually, you pay for sex and walk away, but there are always some girls who get to you. I don’t know what it is—how it happens—but it does.’ He massaged his chest. ‘I’d go back to see them and it would become a regular thing. And then it would become something more. We’d go on dates, like a real couple, and get to know each other. I’d take them out to nice restaurants; actually, very nice restaurants, the best, in fact, and I’d buy them gifts.’ He grimaced before adding, ‘That’s where a lot of the money went—the other stuff.’ His head was still tilted back and he seemed to be looking at an elevated point somewhere behind me. It was as though he couldn’t make eye contact. He needed to divorce himself from the inhibitory influence of reality to complete his confession. ‘With some of the girls, it got very involved. We’d make plans for the future. We’d chat about what our lives were going to be like, together. We’d go to see big houses, with an estate agent—and get really excited.’ His eyes closed—and then opened again.
‘So you did want to leave your wife…’
‘No, never.’
‘Then what were you doing? Why were you taking these women to view houses?’
‘I’ve never wanted to leave Yasmin. It’s like… with these escorts—’ He broke off and I thought he was going to add, ‘It was just a game.’ But his lips came together and he set his jaw.
‘How often did you do this?’
‘Many times.’
‘Yes, but how many?’
‘I can’t remember.’
I had become like an inquisitor, and the rapidity of my questioning had made him uneasy.
To enjoy fiction a reader must suspend disbelief and enter a world of fragile artifice. Any stylistic peculiarity has the potential to interfere with the reader’s willing complicity. An awkward phrase, odd language or accidental innuendo can jolt the reader out of the story and make him or her aware that they are not observing the earth from space or hunting a great white whale but sitting in a room, reading a book. Psychotherapy, like fiction, also requires total immersion. Ali raised his head off the cushion and was frowning slightly. I had jolted him out of the ‘flow’ and it took me some time to regain his confidence.
The conversation that followed was halting and fragmentary. Even so, a clearer picture began to emerge. ‘The sex was a means to an end, a way of getting closer. When I was younger, it was all about sex, but things changed. I wanted more. They’re so beautiful, some escorts. You look at them—and it’s like—sex isn’t enough. You want more.’
Ali wasn’t really addicted to sex. He was addicted to courtship. The candle-lit meals, the flowers, the extravagant gifts—necklaces, pearls and diamonds—eyes locked, finger tips touching across a table, the sound of violins, and a single rose on white napery—the elaborate ritual of romance. But there was still another layer to Ali’s psychopathology, one more revelation, a final twist. ‘It’s not about me falling in love with them,’ he said. ‘
It’s really about them falling in love with me.’ After the sex and the restaurants and the gifts and the shared fantasies and the house-viewing, his efforts would sometimes be rewarded by a declaration of love. This was what he craved most: the feeling of being fallen in love with. When he heard the words ‘I love you’ spoken with sincerity, the relationship had served its purpose. To achieve the same high again the entire process would have to be repeated with another woman.
‘Did any of them try to find you?’
‘I was always careful. I covered my tracks.’
The biochemistry of love is complex but we know that the rush of excitement when prospective lovers meet coincides with the release of phenylethylamine; sexual desire is stoked with testosterone; and feelings of attachment and blissful union are associated with oxytocin. When excited, dopamine—sometimes called the molecule of pleasure—spreads through the brain from the top of the brain stem, altering the responsivity of neurons in various regions, most notably the reward centres. I suspect that Ali was addicted to all of these endogenous ‘drugs’. But it was the biochemical combination that underlies the feeling of being fallen in love with that gave him his biggest hit.
Addiction lends itself to reductionist analysis. Ideas such as chemical dependency and escalating need (driven by tolerance) seem very apposite; however, every addict is a unique individual. There will be numerous psychological factors, such as learning history, thinking style, impulsivity and vulnerability to mood disturbance, which will interact in complex ways. An understanding of both levels—the biochemical and psychological—enriches understanding of addictive behaviour and its maintenance. After Ali had made his ultimate revelation, I had countless questions.
Was his addiction to the opiate of ‘being fallen in love with’ a form of self-medication for pain that he was yet to disclose? Did he derive auxiliary pleasure from manipulating and deceiving his wife and the women who fell in love with him? How was he able to feel genuine affection for his wife while simultaneously betraying her on such a colossal scale? Was he a narcissist or a closet sadist? How did his problem develop over time?