Once a person has developed a taste for something the pre-encounter flush of dopamine is the most intense. And this is what makes sexual compulsivity very different from ingesting a stimulant, gulping alcohol, devouring food or cutting one's arm: it only takes a thought. No need to call a dealer, to spend money, to break a promise. - Greg Rowe
by Greg Rowe, Licensed Marriage and Family Therapist
An old friend recently came to visit from
out of the country. He's someone I see rarely and with whom I know I can have
long, curiosity-driven conversations about a variety of topics. I always enjoy
We joined other friends and went to the
beach - the sun was radiant, the waves brisk, the conversation playful. But
there was something absent about him, he didn't seem very interested in talking
with me or getting to know my friends.
Suddenly he turned to me, flashed me his
little mobile screen and said, "This is the guy I have a date with
A beheaded, naked torso and crotch
appeared before my eyes - and a little jolt went through me, a multi-determined
With hindsight- here's what I think it
was saying to me :
1 - Imposed upon - I don't wanna see porn
on the beach!
2 - Annoyed - You put online sex above
me?, above our friendship?
3 - Titillated - Ooooh that image was sexy.
4 - Relieved - Now I understand why
you're so "Not here"
My private practice is almost entirely
made up of men --and some women -- who have sexual compulsions -without any
mention of it as a speciality on my Web site.
These folks experience porn, sexting,
massage parlors and/or casual hook-ups as intrusive and destructive at times
causing real life pain in one or all three of the beloved DSM IV realms:
social, professional and family.
I have spent a lot of time reading and
writing about this phenomenon. Clearly it is deeply painful. And at the same
time I read powerful arguments written by esteemed colleagues who say it
doesn't exist. Others debate whether it is an addiction or not. The DSM V team
chose to include online gambling but not online sexual compulsions.
I'd like to share some of my thinking.
According to a Stanford neuroscientist I
interviewed the brain scans millions of data in the environment for "that
which will give me pleasure in the next 10 minutes". This is called the
"pleasure seeking" part of our brain; the moth seeking a light
bulb. The simplified version is that
there are two parts of our brain that can stop the powerful pleasure-seeking
- the "punishment avoidant"
part of our brain and
- the frontal cortex, the part that
allows us to project into time, to imagine outcomes, to sense what other people
might be feeling.
Ironically the "punishment
avoidant" part of our brain is not super reliable. It communicates incredibly rapidly with the
"pleasure seeking" part of our brain and, like it, developed quite early in our
evolution - no doubt pre-mammalian. Hence its only criteria for whether or not
an organism seeks out pleasure is "How much energy will that take up?
Enough to put the organism in danger?"
If the answer is "no" it gives
the go-ahead for the pleasure seeking- behavior.
Only the frontal cortex, the part of our
brain that separates us from all other animals has the capacity to wonder about
things like values, mores, customs, law, long term priorities, past
The pre-frontal cortex over-rides the
rapid pleasure-pain dialog by asking questions such as:
- Is this a violation of a promise I made
to myself or someone else?
- Will this have long term deleterious
- Didn't I already determine that I don't
think this is a good idea and that I only feel like crap afterwards?
- Or even something as simple as....Do I really have time right now just to
do this a little before I need to be at work? (part of the executive function
process that can go offline when the reward area is activated).
Alas - and here is the rub -- having
developed much later in the evolution of our species - it is far slower than
the more limbic pleasure-punishment parts of our brain. As therapists - the frontal cortex is
where we have "leverage", it's the "muscle" we can help
people develop. On the condition that the client agrees to cut off the easy
flow of dopamine. We can't keep our clients from opening
their laptop and turning to hot ads on a Saturday night, but we can help them
explore, wonder, develop (and of course get praised for not opening up that
Dopamine - a natural euphoric which
actually represents a very small part of the brain cells but gets lots of press
- is a powerful modifier of the human body. According to Daniel Siegel it
changes --among other things-- our heart rate, our body temperature, our mood,
our decision-making capacity and what he calls our "moral compass".
The more a person repeats a behavior the more dopamine gets delivered.
It is the natural stimulant that we
animals release into our brains when we see food, something sexually attractive
or the possibility of a victory (Picture a stadium full of sports fans). We
give it to ourselves when we encounter these things but --more intensely-- we
give it to ourselves BEFORE we re-encounter one of these things.
Once a person has developed a taste for
something the pre-encounter flush of dopamine is the most intense.
And this is what makes sexual
compulsivity very different from ingesting a stimulant, gulping alcohol,
devouring food or cutting one's arm: it only takes a thought. No need to call a
dealer, to spend money, to break a promise. I worked with one client who during
a very difficult period of transition was often dissociating when I asked
probing questions. When I said "Where did you just go?" the response
I got was that basically I had just been sexualized. It's that easy.
I also think it's important to consider
the supply side of the equation: i.e. what is "out there".
We all know how the internet coupled with
cellphones bearing the capacity of last decade's desktop computers has
transformed our banking, travel, shopping and entertainment habits. It would be
naive to imagine that the same revolution is not happening with sex.
Take a twirl on Craigslist's "Men
Seeking Men" (after clicking past the warning link sending you to SF's
"Clap Clinic"). Once in a while you might come upon someone looking
for a long term relationship but most of the time the photos - rivaling any
porn mag from the 1990's - are coupled with frank explicit sexual requests and
plenty of consenting adults eager to meet those requests with a simple click.
Visit xtube.com where home-spun porn
reigns for free. These are far from the Playboy magazines dad used to hide
under his bed.
Read about "grindr", the
telephone app that allows you to see where someone sexually available is
geographically located like an efficient GPS for hot times.
For someone sexually available in today's
IT world it's hard to imagine how they might get any work done!
I find that - like with many substance
addictions - there is clearly a pattern of comorbidity amongst folks who use
sex compulsively. ADD, anxiety disorders, PTSD, and substance misuse in a
family of origin - are those I see most frequently.
But without such a stark clinical picture
there are many situations when using porn and prostitutes just makes a lot of
- A 24 year old recent college grad who
can't find work, identifies as socially awkward, isn't feeling terribly
confident and finds dating daunting.
- A 35 year old corporate player who
can't seem to find a spark with his wife, spends lots of time in hotels and
airports with a laptop, feels pressured to produce more and more in the
downturn and though outwardly is champion of his team inwardly feels inadequate
- A 40 year old whose parents divorced
early and never got along. Who always felt like an outsider, can't seem to meet
that special someone and spends weekends prowling for one off casual sex.
Unlike the difficult ambiguous dark
waters of navigating a career, a long term relationship with real intimacy or
just the ups and downs of life, porn, prostitutes and casual sex mostly deliver on their promise to be predictable,
soothing and non-committal. They are as reliable vectors of a pleasant altered
state as a good stiff whisky or a hit of marijuana.
So to get back to the moment on the
beach: My friend was in an altered state. He was less available to me because
he was under the influence of pre-encounter dopamine levels. Just a flash of
his small screen gave me a small dose of pre-encounter dopamine - taking me out
of my blissful, half asleep beach state. And the result was --in my opinion--
that we missed the opportunity to be in
the moment together - to enjoy our friendship in a more connected way.
Greg Rowe is a French and English
speaking private practice therapist happily working in San Francisco's Castro
district and in Santa Cruz. He can be reached for appointments at: 415-857-3193 or via his website.
Labels: domanine, frontal cortex, Greg Rowe, sexual compulsivity, Sexuality