the sex addicted brain

Sex Addiction and the Science of Forgiveness

 

Forgiveness is the remission of sins. For it is by this that what has been lost, and was found, is saved from being lost again

~St. Augustine~

   The power of forgiveness when 'done right', is a neuropsychological process that destroys the biochemical ability of the brain to re-enact shame, the sex addicts drug-of-choice.  It re-trains the brain to learn a new level of normalcy, one without the debilitating correlates of shame.  When this occurs, the brain produces different neurochemicals that the brain interprets as healthy, and an amazing thing happens - the brain is now motivated - driven really - to keep that new level of normalcy, to keep shame out and keep serenity in.  This is the neuropsychological power of forgiveness.

   As concepts go, forgiveness has been on the scene pretty much since we have.  In fact, its opposite, Lex Talion's, is quite possibly the most fundamental construct we have.  If 'an eye for an eye' was working for us for such a long time (and still is to some), you might wonder why we need the concept of forgiveness?  Perhaps it was to modify our bloodlust, which I would imagine in evolutionary terms helped keep the peace, enabling the homo sapiens among us to flourish a little beyond the dinosaur.  It simply was not in our best interest, genetically speaking, to burn, rape, pillage, stake, and otherwise behead everybody that annoyed us for one reason or another.  I cannot speak to your family, but without some sort of built-in damper, mine might have thinned out a tad.  Or perhaps, as we shall see, it might have originated for another reason.  Forgiveness, what it means and why we have it when we do, has been a subject of much debate throughout recorded history in philosophical, theological, historical and political circles.  What I find particularly bewildering if not downright disturbing however, is why, given its topical weight in our collective conscience through the centuries, has it taken science so miserably long to catch up?  Somehow we dropped the ball.  The good news is that we are back on top and we have a lot to say about the matter. 

   Beginning with the well known Prisoner's Dilemma, an exercise in empathy and judgment set in the world of game theory circa 1950 (c.f. Flood & Dresher, 1950; or click here for a terrific cartoon video explaining it http://www.youtube.com/watch?v=aRZ_oH9Sxm4), psychology did not really take a serious interest in these matters. Constructs such as trust, betrayal, cognitive dissonance (my personal favorite), guilt, and even forgiveness were only beginning to come under scientific investigation in the late 1980s, early 1990s.  Today, forgiveness from a psychological perspective has merged with the field of social neuroscience to bring us even closer to understanding the hows and why of forgiveness.  Very exciting.  It took us a while, but what we have learned in these lo many trial-and-error decades of scientific vigor is significant and in a word, inspiring. 

   Cardinal Franz Konig, Archbishop of Vienna, in his discussion on the necessity and limits of forgiveness from a Christian orientation wrote that "The distinction between whether we can forgive and whether we may forgive still leaves unresolved the question of whether or not we should forgive" (1997).  I can answer that... 

   Those of us that clinically treat the disease of addiction have long since advocated for one model or another that can incorporate the use of forgiveness as a treatment modality for recovery.  This is not news.  It has, ironically, become the problem.  Although applied to all addictions, nowhere is it more important, neurologically speaking than for the 'process addictions', to calm, if not downright heal the portion of the prefrontal cortex (PFC) that is damaged in the sex addicted brain, before attempting this phase of treatment.  This is news.  

   The process of forgiveness requires the ability to relinquish anger, to take on or at the very least consider the viewpoint of another, "to detach him- or herself from the personal experience of having been harmed", and to acquire "highly developed emotion-management skills that enable him or her to regulate anger and related forgiveness-hihibiting emotions" (Emmons, 2000).  The problem here is that if you have a process addiction, by virtue of the disease, these are the very things you are in varying degrees incapable of doing and/or feeling.  Further, research has suggested that "people with low empathic capacity, such as those with narcissistic, borderline,antisocial, or avoidant personality disorder [or even subclinical traits thereof], are unlikely to benefit from interventions that attempt to generate empathy to stimulate forgiveness" (Worthington, et al, 2000).  It is not that these problems are irreversible, it is that much work needs to be done well before these changes can take place. So why are clinicians so quick to bypasss this incredibly fundamental component of the disease and continue with a treatment protocol that will at its best not work and at its worst, set the patient up for a lifetime of treatment failures and disappointments?  Further, if character traits such as empathy, humility, intra- and interpersonal sensitivity, the ability to walk in the shoes of another, a relinquishment of grandiosity, self-centeredness, and entitlement, and the willingness to admit fault and assign blame, are nowhere to be found in the untreated sex addict by virtue of their disease, then we have a predicament, or as the saying goes, it's a mystery; a riddle wrapped inside of an enigma and hidden inside a Chinese box. Were this a rant on all things doom and gloom, my job here would be fait accompli.  But it isn't and as such, despite these very real factual concerns, there is every good news to be had.

   Forgiveness assumes a willingness on the part of the transgressor, a genuine desire to render oneself exposed and vulnerable.  We move at warp speed when called upon to forgive others for their harm caused us.  We seem to think the ability to forgive somehow guarantees a box seat in the heavenly hereafter.  And so without much thought we say those all important words "I forgive you".  But do we?  Do we really? Have we, in that briefest of declarations, suddenly and miraculously forever lifted whatever shroud of hurt, anger, and resentment that caused harm? Surely then, a truer miracle could not compare.

   The desire to forgive presupposes the willingness to repent.  They are not synonymous.  Repentance is the 'doing' part of the forgiveness process, just like in obsessive-compulsive disorder (OCD), the obsessions are the thinking part and the compulsions are the doing of something that when applied, cause the obsessions to stop.  Like Mutt and Jeff.  Different from one another but a necessary component of the other.  Being repentant enables the forgiveness process to work.  This is where the sex addict gets stuck.

   Sex addiction, as I state none-too-often, is fundamentally concerned with unmitigated and unrelenting shame.  Not just having it, but repeating it.  Over and over and over again, as if it were a drug, which to the sex addicted person it biochemically is.  What is the source of all this shame? Toxic childhood.  As mentioned in my previous posts, if you are sex addicted, nine-times-out-of-ten, you are the victim of abuse in your childhood, nearly but not necessarily always sexual abuse.  That other one (out-of-ten) either has a disorder that impacts the PFC such as an Asperger's disorder, or there was an accidental or genetic rationale for the impairment of these brain areas.  To those other nine-out-of-ten, it means that someone has caused you grievous emotional harm during critical periods of childhood neurodevelopment, which in turn disrupted your limbic system and PFC, causing your sex addiction in adulthood.

   Robert Sapolsky, one of the stress research elite, maintains that "when humans experience transgressions, their physiology is affected... chronic physiological arousal with frequent unforgiveness has the potential to create a pathophysiological pattern, which can lead to illness or can exacerbate preexisting illness" (2005).  Worthington refers to this as the psychoneuroimmunology of forgiveness because it significantly effects our immune functioning.  Sapolsky is concerned with the changes produced by the brain in response to stress - real or imagined, past, present and/or future.  When stressed chronically or severely, and regardless of how long in the past the stressor originated, our brain is biochemically instructed to prepare itself by secreting copious amounts of various hormones such as epinephrine and norepinephrine, the glucocorticoids, most notable among them, cortisol (AKA the aging and abdominally fattening hormone), as well as increases in beta-endorphines, glucagon, prolactin, and vasopressin, while it decreases insulin manufacture and as Sapolsly states "hormones related to sexual behavior, reproduction and tissue repair, and inhibition of the parasympathetic nervous system" (2005).  In a phrase, stress is responsible for a massive onslaught of multi-systemic dysregulation.  Unforgiveness, repeated and unresolved shame-based acts and feelings, whether self- and/or other-directed, whether by choice or genuine ignorance, is indeed a stressful and disease-producing state of affairs.

   The inability to forgive oneself is the trademark of the sex addict. Treatment must, first and foremost address the problems inherent in the damaged PFC.  Only after this significant process can any lasting arousal regulation take place.  And until this stage of treatment is completed, the higher order issues of empathy and forgiveness will be impossible.

    Charles Griswold, guru of all philosophical things forgiveness-related, forewarns that "forgiveness comes with conditions attached" (2007).  Like many things worth having, there is a price tag.

   Forgiveness is neither a quick fix nor a panacea for harm and shame reduction. Rather, forgiveness is by necessity an oft painful and lengthy process; a healing process of repentance, of personal responsibility and accountability, and of respect for one's self and others, that must include apology, transparency, obligation, reparation, and restoration.  This is the redemptive power of the process of forgiveness.  But forgiveness takes time.  Without the passage of time with which to judge our having changed our offensive, forgiveness is woefully incomplete.

   The process is hierarchical.  First comes the acknowledgement of wrongdoing and the personal acceptance of having perpetrated harm.  Next comes apology; somewhat more involved.  It would be safe to say that apology is what sets the stage.

   There are two parts to an apology, including a promise that in turn has three parts. The first part of an apology is in the expressed recognition of personal wrongdoing. The second part is the expressed promise to never let it happen again.  Hannah Arendt, one of my all-time favorite writers, put it best when she wrote "promises are the uniquely human way of ordering the future, making it predictable and reliable to the extent that this is humanly possible" (1958).  The promise of a personal assurance to refrain from committing the same crime in the future, no matter what it takes, itself makes a powerful statement.  The promise categorically assumes that a) you are aware of the nature and extent of the hurt, b) that the power is within you for corrective action, and, c) that you will never forget what happened by always being mindful, present, and anticipatory.  

   It is unfortunate that a majority of people, wittingly or otherwise, skip over that last vital part of the process. This is indeed unfortunate in that this redemptive gift as I call it, has the power of having changed you in a very important and lasting way.  It has been gifted to you (although also by you) from the very victim you have hurt.  It is in a word, transformative. In the Jewish tradition it is customary when someone dies, to purchase a tree seedling to be planted in Israel, in memoriam.  Many others have followed suit with similar customs such as the request from a decedents relative for donations to be made to a favored charity.  I recall when Princess Diana died, her family requested in lieu of flowers or other such substantive outpourings of grief, that a donation be made instead to her favorite charities such as the Cluster Munition Coalition, as she was a recognized champion for landmine removal of unexploded bombs. These are examples of gifts that have redemptive value. They give us pause and help us give back in the person's honor.  These gifts from the heart honor those we have in some way injured, which in turn honors us.  The message states in so many words that 'I have caused you to suffer in some way, and as such, I will honor you and atone for that harm by giving to someone else what I have taken from you'.

   Forgiveness is a lengthy process because our repentance includes the apologetic concept of promising not to commit the harmful offense in the future. Not just to the harmed party, but to everyone, forever.  To many in the 12-step programs who subscribe to a 'day-at-a-time' ethic, 'forever' is a challenging if not antithetical concept, but I assure you it is really neither.  We obligate ourselves to never again repeat the same kind of harm to anyone for any reason in any context.  Deborah Lipstedt, PhD, professor of Modern Jewish and Holocaust Studies at Emory University in Atlanta, writes about teshuvah (in The Sunflower: On the Possibilities and Limits of Forgiveness, and a must read) on the Hebrew equivalent of repentance, wherein she notes that "those that perform teshuvah to the highest level (teshuvah gemurah), have done so only when the individual is in the same situation in which he or she originally sinned and chooses not to repeat the act" (1997).  When we enter into the forgiveness contract, and make no mistake this is really what it is, we obligate ourselves to change, and to remain changed well into the future.  That leaves us with the dilemma of knowing when the "future" has ended.  Ever?  Upon our demise?  Postmortem?  The future, as we know all too well, in a blink of an eye becomes the past.  William Faulkner said it best, "the past is never dead, it's not even the past".

   Nick Smith, author of I was Wrong; The Meanings of Apologies (2008), stipulates that "if we view a categorical apology as a promise to reform kept over a lifetime, violating the conditions of reform or redress vitiates its meaning.  An apology gains credibility as time passes without a relapse, and for this reason we can only finally judge the offender's commitment to reform over the duration of her life". Forgiveness, to be sure, is a work-in-progress.

   Hannah Arendt is also the author of my favorite phrase "the predicament of irreversibility and unpredictability".  The predicament of irreversibility refers to the state of desperately wishing we could have a do-over.  But of course there aren't any do-over's and Eve can't un-bite that rotten apple.  In the bite of that apple, we were rendered prelapsarian no more.  Arendt states that "The possible redemption from the predicament of irreversibility - of being unable to undo what one has done - is the faculty of forgiving.  The remedy for unpredictability, for the chaotic uncertainty of the future, is contained in the faculty to make and keep promises.  Both faculties depend upon plurality, on the presence and acting of others, for no man can forgive himself and no one can be bound by a promise made only to himself."  Forgiveness she writes, "is the key to action and freedom".

   Neurologically, forgiveness involves different aspects of the parietal, temporal, and prefrontal areas; the 'forgiveness triad' as it were.  Though we know that the posterior and left inferior parietal regions are implicated in the ability to self-reflect, it is particularly interesting to note that the right temporo-parietal junction is activated during moral and non-moral judgments, but the medial PFC is involved in non-moral judgment only.  No surprise here, this is the area of the brain medicated in sexual addiction.

   When the addict gets 'high', whether through the use of pornography or prostitution, the PFC is the area they are anesthetizing.  As discussed in prior posts, by shutting down this aspect of the brain's functionality, the ability to experience the Executive Functions such as judgment, attention, reason, and planning, for example, are pretty much shut down.  Shut these areas down and you shut down or dampen down arousal, and not just sexual arousal but any kind of arousal that is unpleasant.  A sex addict gets high for the same reason most addicts get high, to block as much pain, anxiety, and fear as possible.  The limbic system, where these feelings arise, feed directly into the PFC by way of dopamine-rich receptors, thus bringing on the experience of pleasure and warding off feelings that are painful or uncomfortable. How does the sex addict know to do this? The same reason that the calcium-deficient child knows to chew on blackboard chalk, which is basically like a big calcium stick.

   In a fascinating and relatively new area of research, the team of Farrow and Woodruff have conducted studies using fMRI brain scans to study the neurology of forgiveness.  The research suggests that in studying forgiveness as a concept with a biological basis, there are four particulars that the team identified as being components of forgiveness. These four areas include judgments that depend upon one's perception of cultural and societal norms, moral judgments, empathy, and what is referred to as theory of mind (ToM), otherwise known as the ability to take another person's view into account or seeing the world from their perspective.  One of the ways in which they attempted this was to compare and contrast these four indices with the types of individuals known for these abilities and those individuals known to be lacking in these measures.  For example, we know that those with an antisocial personality disorder, what we used to call psychopaths or sociopaths, are lacking in empathy, while a cardinal trait of those with Asperger's is their lack of ToM.  And so on.

   Of particular interest, the Tsuang, et al, team have demonstrated that there are genetic factors underlying the probability of whether or not a person is able or willing to forgive.  These researchers have also identified four core areas involved in forgiveness, each of which play a crucial role in understanding how forgiveness effects the brain and hence the individual.  These core areas are empathy, coping, spirituality and religion, and personality.

   Especially noteworthy are the results from these and other similar fMRI studies suggesting that individuals diagnosed with posttraumatic stress disorder (PTSD) for example, classically absent much empathy secondary to their continual 'numbing-out' (not at all, by the way, unlike sex addiction), were found to show significant changes in the fMRI scans post therapy compared to both normal subjects and more importantly, from their original fMRI scans prior to their therapy.  The type of therapy we are talking about here is neuropsychologically-driven cognitive-behavioral therapy (with emphasis on the neuropsychological part).  This is a very specific brain-based (non-invasive) cognitive-behavior therapy (CBT) regimen targeted exclusively toward healing and enriching these functions such as forgiveness.

   Are we even motivated to forgive?  If by motivation we mean the brain's innate goal to above all else, keep itself and consequently the body that comes along with it, alive and functioning up to snuff, then 'yes' we are motivated to do what it takes to feel good - about ourselves and those we interact with.  Motivation is generically defined as a drive that pushes us toward a particular goal.  But what exactly causes that drive, makes us motivated or as the case may be, unmotivated?  It should not be surprising to note that neurochemically the mesolimbic dopaminergic systems, are a significant part of the process (refer to previous posts on the role of dopamine in the reward pathway and the sex addiction link).  Serotonin is also a significant contributer.  If you have been following this blog, then you already know the role of the PFC and its relation to sex addiction.  It should come as no surprise at this juncture, to learn that motivation is also considered an Executive Function.  If that part of the brain responsible for motivational drive is damaged, then it stands to reason that our ability to actually be or become motivated is by default also damaged.

   Motivating oneself toward the lofty goal of salvation takes on a superhuman aura if the very parts of the brain that brought you to my office (sex addiction, gambling, cutting, eating) in the first place, are the very parts of the brain that are impaired. We are almost always motivated to feel better.  We are motivated to feel better because the brain, whose job it is to protect us and keep us at homeostasis (AKA home plate), is programmed to do so.  It is programmed to do so because feeling better is equated with actually being better.  This is evolutionarily hard-wired. Nothing is more motivating than to eliminate pain and experience pleasure.  This is the conundrum.  To an addict, medicating feels good.

   As mentioned, the problem here is that the sex addicted brain is not a normal brain.  It is damaged.  Not irreversibly, but damaged nonetheless.  We know this.  We know where it is damaged and how it got that way.  But remember, the job of your brain is to keep you healthy by returning you to a state of homeostasis.  Since the sex addicted brain was damaged very early on in life, the brain has compensated for this, which by the way it does astonishingly well, and has simply created a new normal, a new homeostasis. Remember shame?  Remember that shame to the sex addict is like cocaine to the drug addict.  To the sex addicted brain shame may feel psychologically devastating, but the brain thinks shame is what you are supposed to be feeling. To the sex addicted brain, experiencing shame is a return to homeostasis. Until its fixed, the sex addicted brain will do whatever it takes to cause it to feel shame.  It's arousing, not sexually, but arousing nonetheless.  An addicted brain has a significantly higher threshhold for arousal, so it will take lots of shame hits to keep the brain happy.

   Fogiveness by definition is a shame-buster. If you are sex addicted, your brain is expert on knowing the fast track to shame.  Visiting a prostitute if that happens to be your prime shame-delivery-system, is a double hit.  Not only is it generally speaking, shameful to procure their services in the first place, but then you have the pleasure so-to-speak, of reminding yourself what a horrible, low-down, low-life heathen you really are, for example.  And if you are in a committed relationship and you sneak away at every opportunity to engage in hours of cyberporn, you are also hitting a shame-based home-run.  Not only do you most likely hate yourself for having to stoop low enough to engage in watching people on a computer screen engage in various and sundry pornographic acts so that you can masturbate yourself half to death while a perfectly good significant-other lies sleeping in the next room or is at home with the kids, but then you can continue the shame-hit for hours, days, weeks, and months on end because those images now seared into your skull will be served up on a tarnished platter in what is referred to as euphoric recall every time you engage in relations with your completely oblivious SO.  Now you can shame yourself by doing nothing but thinking a thought.  And the shame cycle repeats.  This is your new homeostatic level - shame.  You may not like it, but you have unwittingly trained your brain to like it for you.

   I like cheese doodles.  A lot.  When my brain sees orange it sees cheese doodles.  I prefer cheese doodles to cheese cake.  There was a time (before my time) when those that taught used to receive the proverbial apple for a job well done.  Each semester, just before mid-terms, it's funny how piles of those delectable little cheese doodle bags wind up on my desk.  Not entirely convinced they are performance-related, but I digress... The reason I prefer cheese doodles to cheese cake is because genetically, I have more sensory taste neurons in the quadrant of my tongue that detect 'salty' better than I can detect 'sweet'.  We interpret this as preference when in reality, preference really means sensitivity.  I also know that to stay healthy, I should not be eating a lot of salt.  My dilemma therefore is either to reduce my sensitivity (and hence my preference) for salt, or to increase my sensitivity for sweet.  And because my preference is also to avoid becoming one of the hundreds of thousands of people that now have acquired adult onset (Type-II) diabetes, my pick?  Reduce my salt intake, slowly but surely until just a little bit of salt tastes to me now what a lot of salt used to taste like before.  What I have accomplished is changing my preference by changing the way my brain operates and hence perceives.  It can be said that i cured my motivation to want highly salty food. Now I am motivated to not want them as well.  Think about the relevance. 

   In his recent book (2010) Wisdom: From Philosophy to Neuroscience, Stephen S. Hall writes that "one of the hallmarks of wisdom, what distinguishes it so sharply from "mere" intelligence, is the ability to experience good judgment in the face of imperfect knowledge".  This is both true and problematic if one is sex addicted. Does that mean that sex addicts are not wise?  Yes, that is what that means. This also means that decision-making, motivation, attention, goal-directed behavior, ToM, and judgment, as I have already discussed, are impaired.  This is the sex addiction paradox.  If what is needed to get well is to first and foremost have the ability to be wise, to judge, discern, empathize, attend, become and stay motivated, and to plan for future events, all of which are emanating from an impaired brain, then how is the sex addict supposed to get in and stay in treatment?  Reminds me of the quandary one might face when applying for a job that requires experience that you do not have and cannot get because all the jobs require the same experience that you do not have.  So how on earth is a sex addict supposed to find the cognitively higher-order act of forgiveness when to do so means giving up shame and giving up shame directly contradicts what the brain thinks is normal for you to do?  It does not want to get fixed.  It wants to act out.  I remind my patients that they have a broken thinker and if they want to heal then they will need to give up their broken thinking process, and allow those of us with working thinkers to do the treatment-related thinking for them.  After all, if your car is broken don't you bring it to the shop and get a rental, or do you prefer to drive a broken clunker that never gets you to your destination because it always breaks down (surprise, surprise), which in turn aggravates you to no end, and leaves you wondering, in a fit of anger and frustration, why it is you can never get to where you are going without getting stuck in some nefarious neck of the woods?  

   Empathy is a major component of forgiveness and therefore a major component of the healing journey for the sex addict.  If however, these things are not possible in any significant way at the outset, since this area of the brain is broken, then how is it the vast majority of clinicians treating sex addiction are administering therapy and expecting their patients to reap the benefits, when they have not even remotely addressed the fact that they cannot hear you, metaphorically speaking, because they are deaf to what you are saying!  This is detrimental to the addict trying to recover.  It reminds me of a Twilight Zone episode where a guy would take the train to get home just like he always did a million times before.  For some reason however, every time he tries to exit for his stop, he steps out into a place he had never before seen, from a time way before his. Over and over again he dozes on the train and wakes up to step off at his stop and winds up at this same very bizarre place.  Every time it's the same - he cannot get home.

   Every clinician knows that the best therapy in the world is pointless at most, dangerous at worst, if you have not correctly diagnosed your patient!  A falsis principiis proficisci if ever there was one.  In order to arrive at an accurate spot-on diagnosis, it means two things at the very onset; that we are as completely entrenched in and up-to-date in the area(s) of our specialty as is humanly possible, and, that we are academically well-versed and trained enough to know what questions to ask in the first place.  If you are sex addicted and your brain has not been assessed (non-invasively) for these basic functions, then you are not going to get well.  Helen Keller notwithstanding, you cannot dance to music you cannot hear, can you?  I have a cartoon snipping of Snoopy and his bird Woodstock wherein they are both sitting atop Snoopy's dog house.  Snoopy is talking away, and Woodstock appears transfixed by what Snoopy is saying.  The cloud above Woodstock, instead of showing the words that Snoopy is speaking, shows nothing but line-after-line of exclamation marks! Clearly, Woodstock is not hearing what Snoopy is saying and neither are the wiser for it.

   In his research on how different people progress along different trajectories, Gregory Smith (2009) begins, and rightly so, with the statement that "the core marker of progress in psychological science is the degree to which our work enhances the welfare of people... In the end, the most important marker of the value of what we do, is the degree to which advances in psychological knowledge lead to the increased well-being and life success of people".  Amen.

 

 

 

 

 

 

 

 

The Disease of Sex Addiction and the Danger of Diagnostic Denial

 

Nature did not make human brains first, and then construct things according to their capacity of understanding, but she made things in her own fashion and then so constructed the human understanding that it, though at the price of great exertion, might ferret out a few of her secrets   

I believe that one of the greatest pieces of arrogance, or rather madness, that can be thought of is to say, "since I do not know how Jupiter or Saturn is of service to me, they are superfluous, and even do not exist"... oh, the presumptuous rash ignorance of mankind

~ Galileo Galilei~

 Galileo would be appalled to know that as it pertains to the search for truth, not much seems to have changed since 1625 or so.

Now that sex addiction as a diagnostic entity has begun to venture beyond the borders of its long-lived closet, it has I am sad to say, become that caricature of itself previously relegated to the alcoholism of years past - but worse, given that sex addiction happens to have of all the rotten luck, the word 'sex' in it.  Sex ADDICTION of all things, I mean really.  Concerning the exponentially exploding misinformation at best, and outright dishonesty by way of misguided personal agenda at worst, when it comes to sex addiction the public has it all wrong and it is the experts (in part) to blame - after all, most of them have it wrong as well, and neither camp is particularly interested it would appear, in getting it right.  This must change.

The Merriam-Webster Dictionary defines Ignorance as "lack of knowledge, education, or awareness", and the Catholic Encyclopedia defines it as "lack of knowledge in a being capable of knowing".  I happen to like the later.  The argumentum ad ignorantiam, AKA the argument to ignorance, states that a logical fallacy of irrelevance occurs when one claims that something is true only because it has not been proved false, or, that something is false only because it has not been proved true.  You know - like the whole is-there-a-god thing. 

We no longer put humans to death when they disagree with us, and last I heard, heresy might get you thrown out of the Church but at least you get to keep your head. The damage however that is caused to ourselves, our immediate as well as our global community, and any hope for a better life, by spreading dis- or misinformation either through ignorance or design, is nearly as dangerous.  Especially when it concerns the health and welfare of our denizens and especially when it is completely preventable.  Few things scare me more.  Or make me angrier.

As a specie, we are not tickled pink but will tolerate if we must, the others among us that are more visually appealing.  On the whole, we are not thrilled, but will put up with those that are more physically and consequently athletically endowed.  And generally speaking, we are less than pleased with those who are lucky enough to be more talented, more secure, more diplomatic, more assertive, more socially facile, erudite, resourceful, and yes, of greater wealth.  But damn it all to hell, we are a mere microscopic few that will ever tolerate anyone who is smarter then we are, education notwithstanding. But the final insult?  The most impossible of all wounds? To know that someone who may actually be more knowledgeable and disagrees with us- well, hells bells, that just won't do at all.  It does not matter one wit if they are more expert than we might be, or the most devilish of all insults, to have an expert among experts who might disagree with ones thinking.  No sir, when it comes to ones intellectual prowess, we go out of our way to prove the other wrong, less intelligent, less worthy.  And one of the ways that one goes out of their way is to spread like the plague, dis- or misinformation that can infect ones thinking, prevent ones otherwise right action, and as in the case for sex addiction, block any possible hope to heal the millions that suffer.   In Robert Wright's The Evolution of God, he quips that "In modern "secular" societies, as in "primitive" religious ones, faith in expertise is sustained by the timely disposal of experts (2009, p.34).  And that is what might happen with the deadly disease of sexual addiction. If it were a movie it would look something like Lord of the Flies meets The Stepford Wives.

Skepticism is a wonderful thing.  Skepticism maintains that one suspends judgment or belief until and unless, through the scientific method, that one's judgment or belief proves or is most likely the case, one way or another.  It is often thought that skepticism means not believing or disbelieving.  Nothing could be further from the truth.  The Skeptics Society(visit them online at www.skeptic.com) defines skepticism in part as having a "provisional approach to claims", a sort of wait-and-see attitude similar to a fact-finding mission.  That means taking the time, expending the energy to search for the truth as we may know it to be, like it or not, which in the case for the science of sex addiction, means to actually investigate what scientists may have discovered and what credentialed related others have had to say on the matter.  The Skeptics Society in its credo holds that:

...skepticism is a method, not a position.  Ideally, skeptics do not go into an investigation closed to the possibility that a phenomenon might be real or that a claim might be true...  Skepticism has a long historical tradition dating back to ancient Greece...  Modern skepticism is embodied in the scientific method, that involves gathering data to formulate and test naturalistic explanations for natural phenomena.  A claim becomes factual when it is confirmed to such an extent it would be reasonable to offer temporary agreement.  But all facts in science are provisional and subject to challenge, and therefore skepticism is a method leading to provisional conclusions...  The key to skepticism is to continuously and vigorously apply the methods of science to navigate the treacherous straits between "know nothing" skepticism and "anything goes" credulity.

If we cannot stop confusing opinion with fact and refuting something that we have no idea what we are talking about, or because of some misbegotten personal agenda in the name of some medieval religious order or such, or because it seemed politically correct to spew, then indeed we are in some considerable trouble and on so many levels greater then the one presented here.  Countless people around the world, especially in areas where even the mention of the word "sex" is painfully taboo, will not step forward, will not reach out for help, will not cease their dangerous and more-often-than-not disease-spreading, relationship-ending, brain-damaging, psychologically-impairing, legally questionable, morally-impacting and intergenerationally-spreading behaviors.  If I read one more article on how there is no such thing as a sex addiction by those that are either ignorant of the facts, non-expert in the requisite field of study to be capable of entertaining such a statement, has obviously not done their research (I think that covers it) I might actually become a little militant.

Many in the field of sex addiction treatment have a saying that goes something like this: sex addiction is not about sex.  Sounds pretty glib.  More importantly, it is not exactly true.  Sex addiction is about sex as drug addiction is about drugs, or that an eating disorder (an addiction actually) is about food.  Of course sex addiction is about sex.  However, it is about so very, very much more.  The "sex" in sex addiction is, like the poker chips to the gambler or the alcohol to the alcoholic, merely the drug-of-choice in order to reach the desired "high" and thereby medicating or anesthetizing their feared emotional and behavioral response, which, is to avoid intimacy and attachment with anyone that they might otherwise become attracted to, at any and all costs.  If alcoholism were just about stopping drinking, well, that would be easy.  But alcoholism or any other addiction is so difficult to cease and/or control for two important reasons; the neurochemistry and hence the pleasure center of the brain, and, the behavioral component involving learning, or more specifically, learned associative behavior.

Process addictions (i.e., sex, eating, gambling, cutting) however, are not quite the same as their kissing cousin the chemical addictions (i.e., drugs, alcohol) for an even more difficult, dare I say, sinister reason or reasons.  The process addictions of which sex is among them have an added neurodevelopmental component based upon traumatic attachment and associative learning and the ensuing synaptic plasticity that results, that is not found in the chemical addictions.  I have discussed these terms in previous blogs but I will expand on them here because they are vital in understanding exactly why sex addiction is an addiction and why it is considered - or should be considered by the general pop - a neurological disease process.  Once you understand these basic reasons (and you do not need a degree in biochemistry or anything else to understand them, simply stay with me here), then you will come to understand why sex addiction is real, is a neurological disease process that is serious, has deadly consequence, and is causing mass chaos around the globe in the life and lives of millions (yes I said millions) of people.  Worse still, it is more often then not passed on intergenerationally. 

Sex addiction has biological, genetic, neurochemical, and psychological components that have at its core a sociological, familial, legal, political, and financial impact around the world.  Make no mistake, this is not a made-in-America legacy.  I continue to receive email after countless email from people around the world that have read this blog and reached out for help - from Ethiopia, The Arab Emerits, Jerusalem, Brazil and Kansas, and everywhere in-between.  From Catholics, Jews, Hindus, Muslims, Buddhists, and some sects I have never had the privilege of knowing about.

You are encouraged to read the brief paper on my research at my website http://drsarahullman.com that discusses the neurology and neuropsychology of this disease if you have not already.

I have spent a considerable amount of time in the past posts on this blog discussing the making of a sex addiction, or said another way, the unfortunate recipe for acquiring a sexual addiction, from a traumatic, toxic childhood, to the persistent "hook" of live and streaming internet pornography or cyberporn and the resultant adult sexual addiction.  And by the way, there is no such thing as an "addiction to cyberporn" or "internet porn addiction".  If you are compulsively hooked and out of control in your cyber porn travels, then what you have is a SEX ADDICTION, wherein your main drug-of-choice (or method of transmission) is acquired through the watching and masturbating to pornographic images and the resultant fantasy of those images that have now seared themselves deep into the synaptic recesses of your drugged frontal lobe and sex addicted brain.

Earlier I made mention of associative learning and synaptic plasticity.  This refers to something called Hebbian Learning and the Hebbian Synapse, taken from the man Donald Hebb with whom these brilliant leaps of science were attributed.  Hebb, called the father of neuropsychology and neural networks, had what is now a famous saying.  He used to say "Cells that fire together wire together".  Hebb was interested in how learning occurs in the brain, and the differences in how a brain processes information at different developmental stages.  If you have been following this blog then you know I have repeatedly discussed the developmental stages of how certain types of early childhood trauma can blossom into an adult sexual addiction. 

In sum, Hebb demonstrated that through repetitious behavior, that behavior has now become habit because two or more things have been continually repeated together until they develop a sort of life of their own.  In other words, we know that the more you do something, the more it becomes second nature to do that same thing in the future.  We know this on a behavioral level.  But on a neuronal level, deep within your brain, the reason something becomes "habit", or said another way, when we habituate to something, we do so because the cells in our brain known as neurons actually LEARN that when a certain behavior occurs, that those cells will automatically become alert and aroused (we call this "firing") on their own even in the absence of our actually continuing the behavior - we have taught our cells to initiate the behavior on its own.  Now, the neurons in your brain automatically "fire" when they have been paired with certain behaviors.  You may not walk around constantly thinking of how your legs and arms and derriere will ride on a bike, but the split second that you hop on that bike, your legs and arms and derriere have LEARNED and now automatically know how to ride a bike without you having to do much of anything other then getting on the thing - they simply DO it without so much as another thought from you.  Thinking of a bike when not riding, or seeing a picture of a bike or having someone cook a tofurkey burger (because you smelled a tofurkey burger as you were getting on the bike for the first time), will "remind" your arms and legs and derriere to know how to ride even when there is no bike around in sight.  This is the principle behind studying something or acquiring continuing education credits in order to keep a license so that you are "reminded" or kept abreast of the important things learned in your profession.  These things will "trigger" your brain (or appendages as the case may be) to remember what it had learned previously.  It is also the principle behind many of the symptoms of the much talked about PTSD or post traumatic stress disorder that so many of our soldiers are becoming afflicted with, such as "flashbacks".  PTSD flashbacks are symptomatically speaking, the same phenomena as the triggering that occurs with a sex addiction.

When specific behaviors are continuously repeated identically or near-identically, over and over and over again, the brain begins to initiate that behavior just by a mere ASSOCIATION or just by being casually TRIGGERED by something that reminds it of that specific behavior.  This is precisely why, when one has engaged in countless hours of cyberporn, the brain has been taught to store those images such that anytime something even remotely similar to the images on the screen or even to the feelings you had when watching the images on the screen, or even a certain smell, sound, or thought that occurred during the time you were watching that porn on your screen, your brain will now become ASSOCIATED with those images.  Once this occurs, once your brain gets a mere whiff of an association to those images, no matter where you are or what you are doing, you will begin to immediately RECALL those images as if you were sitting right in front of your computer screen.  And once these images have been associated with certain sights, sounds, taste, touch, or smell, you will not likely be able to "undo" those images without professional help.  And that is a learned behavior.  Learning is another word for remembering.  When you learn something it means you have developed a memory for it.  And when learning occurs, the neurons in your brain are now wired together, such that they will remember that thing you have wittingly or otherwise taught it - and herein lies the proverbial rub - regardless of whether you want to or are trying to remember that thing.  It now has a life of its own.  As Hebb said, "when neurons fire together they wire together" - like it or not.

So far we have discussed how behaviors become, through repetition, associated or learned. It tells us that sex addiction is a REAL diagnosable clinical phenomena and how it gets that way.  This does not however,fulfill the criteria for ADDICTION.  What is addiction exactly?

Addiction is a medical term and in order for something to be referred to (accurately) as an addiction, it must meet certain very specific criteria.  Addiction is operationally defined (please refer to prior blog post for a good definition) as follows:

Addiction is a progressive neurobiological disease process that includes well-entrenched aspects of compulsion, obsession, loss of control, continuation in spite of dangerous consequence, and causes a progressive neuronal desensitization and brain-based neurochemical alteration

Addiction is considered by most, to be a "disease" process as opposed to a "disorder".  What constitutes the difference between the two?  In order for something to be classified as an "addiction" it must, in addition to the above criteria, be PROGRESSIVE.  This means that unless it is treated or goes into some type of remission (and generally, even if it does remit for a period of time), it WILL progress - it will not stay at the level it was at one time - at some often definable point - it will get worse and worse until it progresses to an "end stage".  With sex addiction, the end stage may be death or at best, catastrophic and irretrievable loss.

In addition to meeting the criteria for "addiction" a sexual addiction also includes a significant disruption, neurochemically and neuropsychologically, to mood, arousal, affect regulation (or said another way, arousal dysregulation), attachment, and Executive Functioning, a product of damage to the right, left, and/or right and left portions of the right prefrontal cortex affecting specifically, the dorsolateral and orbital frontal areas of the prefrontal cortex, as well as damage to the limbic system.

Now you know.  Next time someone says there is no such thing as a sexual addiction or that maybe it is something but certainly not an addiction, after all how can sex be an actual addiction?, tell them what you learned. 

In his book Quantum Gods: Creation, Chaos, and the Search for Cosmic Consciousness, author Victor J. Stenger wrote "...science and the ability to think critically, inside or outside science, can be learned only by diligent effort" (2009, p.18).  It is my hope that we can somehow, through effort and diligence, do it differently this time, that we can learn to stop using denial and fear, politics and the cloak of belief to prevent us from doing the right thing, allowing science and the scientific method to become the new gospel and help the millions of people worldwide that suffer this preventable and treatable disease. Cyril Northcote Parkinson reminds us that "delay is the deadliest form of denial".

Intellige ut Credas...

 

The Neuropsychology of Shame vs Guilt & Narcissism vs Psychopathy: The Sex Addicted Difference

Whoever writes on shame knows as much about pain and failure as about the healing balm of love

Few experiences in life are so pleasant as the moment of release from shame or the realization that our foibles are accepted with love    

~ Donald L. Nathanson ~

 Most people, clinicians included, have difficulty differentiating the "narcissistic"  from the "sociopathic" personality, based upon the unscientific, unproven, and ultimately false distinction of ability to experience emotional pain, sadness, or empathy, and the inability to learn from their prior bad acts.  Ok, but first, let us be clear in our terminology.  I am not referring to narcissistic people.  Most successful people are narcissistic on some level.  I am referring to Narcissistic Personality Disorder (NPD) and Antisocial Personality Disorder (APD).  Personality disorders are by definition, chronic, enduring, pervasive, and color the way in which one perceives, feels and acts upon their world and everything in it.  A personality disorder is a severe distortion of aspects of the personality, deviating widely from normal personality functioning.  It is not to be confused with "traits" or aspects of a persons personality or mood.  Having a personality disorder is serious business.  Of all the personality disorders, the "dramatic cluster" are the most difficult for clinicians to treat, and most do not.  Included in this "cluster" are the two disorders mentioned here.  

There are good reasons why most clinicians do not treat these personality disorders - of all the possible disorders, these are the two that are not in touch with having any problems, other than having to deal with the rest of the world and their problems and as such, will not generally be seen in treatment.  For what?  Those with NPD and APD are not at all aware they have a disorder of any kind and will argue this in the face of evidence to the contrary.  Part of the problem.  These folks are not going to waltz into anyone's office and ask for help.  Won't happen.  Unless of course one is being treated for a sex addiction and/or sexual offense.  I do not believe in God.  But if I did, this is where I would say how "God works in mysterious ways".

The thing (or things) that separate the two personality disorders is not, as I began by stating, a litany of traits that prevent one from feeling bad for acting bad, for hurting others, and/or not learning from prior bad behavior and repeating the error of their ways over and over and over again - all of these by the way referring to the Antisocial Personality.  A sex addicted individual is by definition someone with a Narcissistic Personality Disorder, sometimes accompanying a Borderline Personality Disorder, or traits of the later, particularly as it pertains to an intense and unrealistic fear of abandonment and perceived rejection, and characterized by highly unstable relationships of approach and avoidant behaviors.  Sex addicts and those with NPD share many commonalities as those with APD.  And in fact, anyone who has ever been involved in an intimate relationship with someone who has a NPD, with or without a sexual addiction can tell you all the war stories.   Ok, so what exactly is the difference?  First allow me to muddy the waters just alittle further...   

The psychopathic individual as we used to call these folks, are quite capable of feeling not just their pain, but pain and longing, sadness, and even empathy.  Is it true that there is a virulent version of psychopathy wherein the individual does not appear to have the ability to empathize?  Yes, with emphasis on "appear" however.  That said, there is a virulent version of NPD as well and I am not referring to what Vaknin and others call a "malignant" narcissism.  There are plenty of NPD individuals, many of which I have and do treat, that appear not to be capable of empathizing and simply go through the motions.  It isn't that they can't, it is that they don't.  And they don't because they won't - they are scared to death, very well psychologically defended, and for pretty good reason at that.  What then is the distinguishing factor between the two personality disorders?  Better yet, IS there a distinguishing factor or are they as many suggest, just two sides of the same coin? 

There is intriguing new evidence suggesting that in fact, one of the very definitive qualities that characterize the sociopathic personality - their inability to learn from their mistakes - may not at all be accurate.  I think they are on to something.  I do not think either APD or NPD individuals are  somehow hardwired to "not learn from prior acts", because neuropsychologically speaking, and from the standpoint of classical conditioning and operant conditioning paradigms, I am not certain this even makes sense to suggest that it is not possible.  So, what, are we saying ,that they can learn SOME things just not things that have to do with people being in pain? That would mean there is a very special part of the brain that can distinguish between learning related to emotional pain and learning related to every thing else.  Is this possible?  That they can learn from the "good" things they have done, but they just cannot learn from the "bad" things they have done?  Is there a part in the brain that is specific to "bad" things as opposed to "good" things?  I am not saying that NPD and APD are one and the same diagnosis and that we have gotten it all wrong.  No, I am quite aware that they are distinct disorders, but I am challenging, as have others, that the clinical distinctions we are using are not entirely all correct.  I think the problem lies in some of our faulty diagnostic criteria and the often difficult distinction between these two personality disorders.  What is that magical distinction?  Shame.  Shame is the answer and it is the answer because there IS a specialized part or parts of the brain that distinguish between these "good" and "bad" emotions and learning has everything to do with it, not just psychologically, but biochemically.

Psychopaths, or what we nowadays call the Antisocial Personality Disordered individual - sounds much tamer by comparison - has no idea, no clue that they are sociopathic.  Those around them might indeed, but trust me, they are the very last to know and in fact, until confronted with the evidence, will genuinely fight you tooth-and-nail, trying to convince both you and them, not necessarily in that order, that they are not the monsters that the word implies.  Nor by the way, do NPD individuals know they are narcissistic, and nowhere have I seen more evidence of narcissistic rage, as when I present and explain, with MMPI-2 held firmly in hand and in as soft and empathic a voice as possible, the diagnostic information.  The problem is that by clinical definition, those with APD and NPD will never provide you the opportunity to explain because they will never have stepped foot in your office in the first place.  Unless of course you work with sex offenders and/or sex addicts, both of which make up the majority of my clinical practice and research efforts.  What then brings them to the attention of the clinician is not their personality disorder as I have made mention.  Rather, it is the behaviors which are the direct byproduct of the PD.  If you are all sniffly and miserable, what you have is probably a cold or the flu (of course it could also be inhalation Anthrax or early morning symptoms of heart failure).  What brought you to the doctor's office however, was all the sniffly miserable stuff so that you can 1, be rest assured that it was not Anthrax or heart failure and rejoice in confirmation that it is in fact simply a rotten cold, and 2, that you are given a means to reduce/eliminate the sniffly miserable symptoms. and get on with your life.

In what is unquestionably the most famous and well-read account of psychopathy, The Mask of Sanity (1982), Cleckley was among the first to operationalize the psychopath.  The Mask of Sanity was a fascinating read - an eye-opener into the deep dank recesses of the mind of the psychopathic personality as it was called, even though he used the term "antisocial personality".  We are horrified by the accounts he presents of the cold, empty, emotionally vacuous shells that look just like the rest of us.  Cleckley, and his heir apparent, Robert Hare, talk about the absence of "guilt".  The problem, and how we all have such difficulty separating the two PD's, is because of our cultural difficulty distinguishing between "shame" and "guilt".  In fact, more clinicians, psychologists and psychiatrists, those that should know better, continue to this very day, to use the word interchangeably.  SHAME and GUILT are NOT interchangeable.  In fact, they could not be more different psychologically, neurologically, or biochemically.  And therein lies the proverbial rub.  Period. 

The brilliant psychiatrist Donald L. Nathanson speaks of the difference between "shame" and "guilt" in that "often shame is confused with guilt, a related but quite different discomfort.  Whereas shame is about the quality of our person or self, guilt is the painful emotion triggered when we become aware that we have acted in a way to bring harm to another person or to violate some important code.  Guilt is about action and laws" (1992, p.19).  In the most recognized and first work to distinguish between the two emotions, Lewis in 1971 described "shame" as an "acutely painful emotion accompanied by a sense of shrinking or of "being small" and by a sense of worthlessness and powerlessness.  Shamed people also feel exposed"  (Tangney & Dearing, p. 19, 2002).  While guilt-prone persons may also experience a fear of exposure, it is in a decidedly different context.  Shame-based persons are afraid of SELF exposure, whereas guilt-based persons are afraid of OTHER exposure.  Shame-based persons feel horrible about themselves.  Guilt-based persons feel horrible about what they did to harm another and what the discovery of that action or actions will do to harm still others in a dominoes-knock-the-one-down-and-you-knock-them-all-down kind of effect.  Sex addiction is a disorder of shame - more of a disease process really, in that it follows a progressive course.  Shame can FEEL lethal but to the sex addict, is generally a symptom of the larger more pervasive narcissistic personality style, such that no matter how painful or intolerable their shame may feel or be, they are expert at very swiftly and deftly detaching themselves with a cool and quite calculated precision, from the source of that shame and moving on - not healing mind you, and not necessarily absent feeling entirely, just moving on.  Individuals with NPD do not allow themselves to wallow in misery, a trait I often wish I had a tad more of.  They pay a heavy price for this particular skill mind you, but it serves them quite well in the short run.  The ability to cut loose with spectacular precision and efficiency does exact a pay-off, you must admit.  Like I said, there are times I wish I could borrow or bottle some of it. 

In all, it would be fair and accurate to say that the single most distinguishing feature between shame and guilt is that shame is about the self and guilt is about the other.  Shame is a fairly foreign concept for me - I am hard-pressed to think of anything that I feel or have felt much if any shame over, not in any outrageous way, certainly.  Guilt however, now there is something I am intimately familiar with.  Guilt definitely continues to guide my life and much of what I do, say, think, act on, and feel.  Both good and bad.  Is guilt the other side of the shame coin?  Not at all, but they are complimentary in both healthy and maladaptive ways.  As I made mention in my last post, when treating a sexual addiction, it is important to move a shame-prone person to a guilt-prone place, in order to heal their deep and painful wounds.  Although shame and guilt, alongside pride, embarrassment, rejection, humiliation, abandonment, disgust, and lust are all considered the primitive social emotions, they are in important ways, neurologically quite distinct.  They come from entirely different places and those that are shame-based think, feel, and view the world in very different ways than the guilt-based person.  The beauty, if it can be stated in such terms, is that the guilt-based person has a gift to offer the shame-based person if they can figure out a way to work together.

From a neurological perspective, different parts of the brain light up when a shame-based person experiences shame, then when a guilt-prone person experiences guilt.  Early on, Nathanson was the first to point out that "classical depression involved the thinking, the feeling, and the chemistry of guilt, and that the atypical depressionswere about shame" (1992, p. 22).  Suffice it to say, diffferent antidepressant medications work for the "classical" vs the "atypical" depressions as they target a different symptom picture.  This is rather remarkable - think about it, we are saying that clinical depresssion is different, and the brain of the clinically depressed individual is different depending on whether they are shame- or guilt-based.  Incredible!  What causes the brain to become "shame-based" as opposed to "guilt-based"?  Does brain impairment cause shame or rather, does shame change the brain?  Is this a nature-nurture thing?  Does experience decide?  And if so, then is it early childhood experience?  Is it genetics or biology or both?  Does our early childhood dictate which style we will adopt?  The answer, as Daniel J. Siegel and others tell us, is "yes".  Through the plasticity of the brain, our very earliest childhood relationships, mostly with our caregivers, interact to make us who we are and whether or not we become shame- or guilt-based adults.  Let us take a closer look...

Specifically, the orbitofrontal cortex (OFC), the anterior cingulate (AC), and the amygdala, a part of the limbic system, are involved in emotional memory, empathy, and affect regulation (especially impaired in the Borderline and Narcissistic Personality Disorders).  Additionally, the medial and the ventral lateral prefrontal cortex areas are known to be involved in the ability to perceive the mental state of others, an area impaired in the autism-spectrum disorders.  Further, the insula, a region located deep within the cerebral cortex, picks up messages bi-directionally from the cortical areas to and from the body, the limbic system and the brain stem, and integrates interoceptive states into conscious feeling states and decision-making processes that involve things like risk and reward.  All of these areas play a part, one way or another in the social emotions which of course include shame and guilt.   

The insula receives signals from the body that correspond to more intense emotions such as panic or love that the brain then interprets as such.  Of particular interest, the insula processes and gives us interpretive information about future things that have not actually happened yet enabling us to act in an "as-if" fashion, or said another way, in anticipation.  Meaning, a sex addicted individual who walks around in a fairly constant state of shame for their prior bad acts of utilizing the services of a prostitute for example, while even passing through a neighborhood or section of town that is known for prostitution, will light up their insula like the fourth of July in anticipation of seeing the prostitute, knowing, on a non-intuitive but somewhat aware level, that once the insula is lit, a deep co-mingling of sexual excitement and intense shame will be triggered based upon the memory of having visited with prostitutes before.  This is all about the "people, places, things" of the 12-step vernacular.  But which areas of the brain are more responsible, or said another way, more active, in shame versus guilt?

Stein & Kaminer (2006), Clark (2005), Farrow, et al (2001), Newberg, et al (2000), and a host of other neuroscience researchers have empirical support that the frontal-limbic areas - no surprise here - are responsible not just for the processing of guilt and shame, but for empathy and forgiveness.  Specifically however, the posterior cingulate is also involved in the self-evaluation of behaviors.  If you have been following my posts the past year, you have already learned that my research and the research of many others that have followed, all support various aspects of the prefrontal cortex as being intricately involved in being able to moderate the emotionality of the limbic areas, specifically the amygdala.  It is the role of the prefrontal cortex, and ultimately the health of the prefrontal cortex that seems to determine whether an individual can be shame- or guilt-based. 

Sex addiction is a disruption and damage of the right prefrontal cortex, mostly in the dorsolateral and orbital frontal areas of the prefrontal cortex, as a direct result of a rattled and impaired limbic system secondary to a very toxic childhood.  When the limbic system is disrupted, but there is no prefrontal damage, then an individual can experience guilt, and generally, copious amounts of it, sometimes in a pathological manner.  But shame occurs when the limbic system is disrupted AND it causes prefrontal cortex damage as well.  When the prefrontal cortex is damaged, then the higher-order emotion of GUILT cannot be expressed, and it stays at SHAME, a lower, more primitive emotion.  Shame feeds on itself in a never-ending feedback loop and so it continually self-feeds.  Sex addiction treatment as I have always maintained, should be about the healing of the frontal lobe.  When the frontal lobe is healed, then the sex addicted individual can move from shame to guilt and begin to live the life they are entitled to live, free of the ties that bind and free to feel love, free to experience forgiveness of self and others, and free to experience the range of emotions that make life worth living, then they have indeed changed their brain and the lives of all they touch.

Daniel J. Siegel reminds us that "Repeated patterns of children's interactions with their caregivers become "remembered" in the various modalities of memory and directly shape not just what children recall, but how the representational processes develop" (1999, p.5).  Healing the adult sex addicted brain is accomplished by gently and lovingly and painstakingly providing new memories, healthy, loving memories from those with expertise and in positions of primary emotional support - replacing the old with the new, and healing the brain within.  The heart will surely follow.

 

Healing The Shame in Sexual Addiction: What the Ojibwa People of Hollow Water First Nation Can Teach Us

"That this task is formidable is softened only by the fact that it takes place in a community that refuses to give up on any of its members no matter how deeply they have been wounded, nor how despicable their acts.  ...The difference in Hollow Water is that offenders face their responsibilities with the love, respect, and support which the Anishnabe people believe are due to all creatures.  ...There is no such thing as a dispensable person anywhere in this country.  We must quit treating them as such.  That is what the people of Hollow Water are saying.  They are saying that in a world of disposable cups, disposable razors, and disposable diapers, their people are not disposable."

~ Aboriginal Peoples Collection (1997) ~

 The Ojibwa of Canada are an Aboriginal people of the Metis, one of three recognized Aboriginal peoples that include the Inuits and First Nations.  They refer to themselves as Anishnawbe, meaning "the good people.  And indeed they are.  These amazing Anishnawbe have left us with a lesson so great, that we are at once reminded of just how powerful the human spirit, no matter how broken, can be - they have gifted us with a legacy so simple and so basic, that the rest of us can only shake our collective heads and marvel in its profundity.  Theirs is a story that has worldwide implication, that has in fact been implemented in most major countries around the globe and in the vast majority of states within America.  From the great Ojibwa people of Hollow Water, Canada, we have what is referred to as the Four Circles of Hollow Water, and the model of Restorative Justice.  This is the story of how one small community took matters into their own hands, confronted their greatest fear and before the eyes of the entire world, laid themselves bare with all of their horrific secrets and gapping wounds, in order that they may heal.  And in so doing, they gave themselves and the world, a gift it won't soon forget. 

Restorative Justice (RJ) is an application within the criminal justice system that is meant to replace our worn-out, dysfunctional, and corrosive system of Distributive Justice (DJ).  Whereas DJ focuses on punishment for the offender for violations against the state, RJ instead, focuses on repairing the harm done to people and the relationships that were harmed - instead of on offender punishment.  Based upon the indigenous teachings and conflict resolution of the Ojibwa and their Community Holistic Circle Healing (CHCH) model, RJ focuses on loses suffered and holding persons accountable.  RJ is based upon the principles of Reparation and Reconciliation.  One of the largest proponents of RJ in the United States is Howard Zehr wherein he stated "crime is a violation of people and relationships.  It creates obligations to make things right.  Justice involves the victim, the offender, and the community in a search for solutions which promote reparation, reconciliation, and reassurance." (1990, p.181).  The RJ way is concerned with community and advocates as a given that individuals cannot be separated from their community - when an individual commits an offense, it is committed by one human being onto another human being and to the community in which they are attached.  The indigenous peoples are not a part of their community, they are their community.  As such, when an offense occurs, it is a breach in the relationship of those two people and the community in which that relationship has been broken.  The only way to repair the broken relationship is to address the relationship with those in it, supported in loving kindness by the community of which it is connected.

This is not a topic about Restorative Justice per se.  Rather, it is posting about the concept of RJ, what it represents, and how it is applied not to the justice system, but to the types of offenses for which it was originally developed.  Restorative Justice is a model that was birthed from the desperation of the tiny community of Ojibwa peoples living in Hollow Water, Canada and their statistical designation as a community that has more sexual abuse, incest, and crimes of sexual offending, then virtually any other place in the United States of America.  Per ca-pita, their rate of sexual abuse and sexual offending was staggering.  And then, out of the blue, it happened.  Without much fanfare or particular warning, it happened.   Something so simple yet so unusual had occurred, that it would permanently change an entire community forever. 

The Ojibwa have an extraordinarily complicated and well-formed social system, with very specific and detailed rules and punishments for sexual impropriety.  As such, no public disclosure could result in anything other than shaming the entire community, with no means to do anything about it other then to incarcerate the individual which would just send that individual back to the community where it would occur again and again.  More perhaps than most cultures, the Ojibwa are a very proud people and shame is one of their most untenable pains.  It is said of the Ojibwa, that if a girl gets into sexual trouble then it is her brother that carries the most shame, followed by the remaining members of the family and then the entire community. 

And then in 1986 it all changed - the very first public disclosure of sexual abuse - and changed the community and the world forever.  Shame was out of the closet and an entire people were left to deal with a pain so great that it rocked the very foundation of every single citizen in the entire community.  They were left to deal with not one case of sexual offending, but generation after generation after generation - an intergenerational legacy of an entire community's hidden shame.  What happened as a result, the healing that occurred, that still occurs, transformed this community from one of devastation and shame, to a healed, hopeful, and spiritually aware people that the rest of the world has taken notice.

Sexual addiction, as I have made mention at virtually every opportunity, is a shame-based progressive disease process, and is almost always secondary to early childhood sexual abuse or a deeply malignant narcissistic abusive family.  This is neither new nor controversial.  Sexual addiction is so shame-based in fact, unless treatment attempts to address and eradicate the core  SHAME  component of sexual addiction, it might as well not bother.  Shame is so core to the soul of the sex addict, that the cycle of shame is the addicts greatest and most potent drug.  Further, the deep narcissistic wounds of the sex addict will not readily, if at all, allow anything close enough to get at that core of shame.  And so the dilemma in sexual addiction treatment.  What is the treatment for shame?  Deep empathy, loving attachment, moral obligation, and integrative responsibility.  In sum, Recognition, Reparation, Reconciliation.  They are indeed the Three R's of the Restorative Justice model.

The Ojibwa talk a great deal about p'madaziwin, refers to the life-long journey of living a good, healthy, productive and right life for self, family, and community.  Especially for men, but for all people, p'madaziwin is the goal one must seek and strive to acquire, it is the most central value of their culture, and is more present at various times during one's life, with stronger presence when one is engaged in right living, elusive when one engages in wrong living or "bad medicine".  When engaged in behaviors that are not in keeping with p'madaziwin, then onichine will occur.  Onichine is defined as "illness through offense".  For example, sexual addiction is seen as onichine, in that sexually addictive behaviors are in direct contrast to seeking p'madaziwin.  Further, when an individual with sexual addiction acts out, then it is, in the Ojibwa way, the cannibalistic spirit of wintikos that takes over.  Wintikos means "soul murder".  So how does one heal from shame?

The Four Circles of Hollow Water, written by the Aboriginal Peoples Collection is a lengthy document containing the work of the Community Holistic Circle Healing model, documenting in great detail, the use of these "circles" for the healing of shame caused by sexual abuses.  The circles are based upon group conferencing, family conferencing, victim circles, and offender circles that focus on reintegrative shaming.  According to Braithwaite (1989), It argues that people are deterred by two informal forms of social control: fear of social disapproval, and conscience.  Thus, consequences imposed by family, friends, and communities, are far more meaningful and effective than those imposed by the legal system or other type of authoritarian system.  As a result, the fear of being shamed by the people most intimate with an offender is the most significant deterrent possible.

The circles use cognitive-behavioral principles based upon self-justification, misinterpretation of social cues, deficient moral reasoning, moral reconation therapy, and dialectical behavioral therapy.  Sessions are not your typical 50-minute "sessions", but rather, are very, very long and arduous sessions based upon a specific mix of these and other proscribed treatments.  All of it contains treatment targeted at the most efficacious use of shame-based counter treatments to reduce not just sexual offenses in the forensic sense, but sexual offenses in the sexually addictive acting out sense of shame-based behaviors such as cyberporn, prostitution, fetishes, and other non-integrative aspects of sexually acting out one's childhood pain and using shame to prevent the integration of healthy, p'madaziwin-producing goal-directed and integrative behaviors.  

To err is human.  The inability or refusal to Recognize our mistakes leads to the prevention of Reparation.  One cannot take personal responsibility for something unless one recognizes the problem and their role in causing it.  The refusal to take personal responsibility for our actions prevents our ability to Repair the harms caused.  Not taking personal responsibility for Reparation, prevents Reconciliation from occurring.  And finally, by refusing Reconciliation, amends cannot be put in place and the offender stays sick and the victim stays victimized.  Shame must move to guilt.  They are not the same thing.  Shame is never adaptive, is always self-only focused, and shame-based people feel bad about themselves.  Guilt is adaptive, is always other focused, and guilt-based people feel bad about their behaviors, not themselves.  Shame prevents empathy while guilt is motivated by it.  Shame-based people blame others while guilt-based people blame themselves.  Shame is the fear that others know what you did while guilt is a private emotion that is not concerned with what others know, grappling instead, on the inner pain of knowing they did wrong or caused another pain.  Those of us that deal with shame each and every day, be it our own or others, owe a great deal to the spirit of the Ojibwa peoples of Hollow Water.

As the people of Hollow Water maintain, "nothing happens in isolation".  The Aboriginal Corrections Policy of 1997 commented "That the people of Hollow Water have been able to draw from their culture to begin to heal the unhealthiest in their community says much for their strength and endurance in conditions that would have tested the mightiest of us.  The Ojibwa Circle sheds light on where that strength has come from.  ...The pain of the people who are its subject matter is almost palpable.  It is nourished by its denial.  ...What is clear is that sexual abuse does not happen in isolation and it always leaves more than one victim.  ...What CHCH does - facing sexuall abuse head on - is the hardest part of all.  ...Theirs is truly a triumph of the human spirit."

                                                      W'daeb-awae'

 

 

 

 

 

 

 

 

When God is Required for Recovery: The 12-Step Program Problem.

...Crede, ut intelligas...

~ St Augustine ~

  If the 90s were dubbed The Brain Decade, then this new millennium should be called The God Decade.  In less than 10 years we have gone from our obsession with finding the G-spot to our current search for the God-spot.   Nearly every major American magazine in the past 3 months has displayed a cover page featuring God and healing. 

The more sophisticated we become on this planet of ours, the more we desire to keep it simple, to experience the basics, and to return to those things that bring us comfort - the familiar and non-complex.  The more advanced our technology, the greater our desire to know the unknowable, and the more grounded we become, the more we point to the sky for our answers.  In sum, the more complex our world and the more sophisticated our knowledge and understanding of the world, the more we feel out-of-control and yearn for basic comfort and solace.   And when that fails, when all else fails, there is always anesthesia which generally takes the form of some substance or process that we take or do that hits the pleasure center of our cortex and temporarily knocks us out of reality.  

I blog AND twitter and text and Skype regularly, and conduct a portion of my psychotherapy via webcam and laptop with patients from locations the world over, some of which use software to translate their native tongue into English.  I wonder what those in the high-tech fields are doing? When my world gets unglued I long for a cheese doodle, nothing fancy - as basic as you please.  The more we become overwhelmed, the more we return to what is basic and familiar.  To the vast majority of folks, what is most basic and familiar is God.

When those under my care begin to hit a low or feel disconnected, or become triggered, or simply have some spare time on their hands, the thing they are told to do, know to do, is to attend a "meeting" - a 12-step meeting.  There, they can connect with otherwise total strangers with whom they can relate, share their struggles, share their stories and their glories, and find friendship, fellowship, and attachment.  It makes the world a little smaller, a little more doable, a little safer.  But there is a problem.  The "program", based upon the 12 steps and 12 traditions, has not changed its verbiage - not a single word, since its published inception of the Big Book in 1939.  And what is the language?  It speaks of God.  For a program that prides itself on the language of the everyday non-religious person, this is more than a simple failing.  It is an example of saying one thing and doing another.  It is, among other things, a significant breach in the semantic commitment of scientific realism.  More on this not so unimportant concept later.

If you have ever worked in the healthcare profession, if you have ever been in a hospital for physical and/or mental health reasons, then JCAHO has meaning for you whether you know it or not.  JCAHO is the abbreviation for The Joint Commission of Accreditation of Healthcare Organizations, recently shortened to just plain The Joint Commission.  JCAHO is the most widely held and singularly most important/prestigious accreditation body for all healthcare facilities in the United States of America.  Facilities that do not "pass" accreditation requirements set forth by the JCAHO or are in violation of their established standards, can and do loose their license and eventually their ability to operate.  Did you know that one of the standards established by the JCAHO for addiction treatment facilities is the quality of the "spiritual" (almost always interpreted as "religious") component that must be incorporated into the treatment planning of every individual who attends a non-governmental regulated addiction treatment facility, which is almost everyone?  This is a problem.

The "12-steps" of AA (and "SA", "OA", "NA", "CA", and all the other "A" self-help peer-to-peer programs) were founded by members of the "Drunk Squad", AKA the Oxford Group as they have come to be called, which were members of The First Century Christian Fellowship.  Not a Jew or Hindu or atheist among them.  Not a Zoroastrian anywhere in the vicinity.  Their preaching was based upon 4 absolutes which became 6 principles which turned into the 12 steps, in the house that Bill W. built.  It was based upon known, solidly religious (not spiritual), and not just religious but Christian tenets.  Period.  Not a word has been altered.  Some of the programs based upon AA such as SLAA and others, HAVE changed some of their verbiage, but not the verbiage having anything to do with the Christian notion of God.  That verbiage remains.  The Big Book as it is called, is based on a panentheistic God.  This is a huge problem for a program whose mission is purportedly based solely on one and only one overriding criteria - the singular desire not to drink, use, or otherwise imbibe in a drug or drug-producing process such as sex, gambling, or carving one's body with a knife.  And in the sexual addiction programs - the one group whose drug-of-choice is shame - this is the most troublesome.  What is it that you think folks will feel if they cannot fully endorse the tenets of the very program whose ideals and goals are meant to lower their shame quota?  It is at best a conundrum, at worse, a shame fest.

Not all, certainly, but a majority of those that worship the scientific method, whether or not they are actually scientists in their day jobs, do not believe in god.  For example, Creationists, newly repackaged and currently renamed the Intelligent Design folks, are, by and large, deeply religious Christians.  Intelligent Designers are anti-Darwinians.  They do not believe in Darwinian/evolutionary science, and they certainly do not subscribe to the scientific method.  Despite all of this, despite the current religious fervor as featured on the front covers of a plethora of modern American magazines that have no bearing on religion per se, Atheism is on the rise more than ever!  Now, what happens to folks that have an addiction, say a sexual addiction for example, and they want to do what most experts in the field would agree is the right thing to do in such a case, and become a part of the recovering community?  Well, that means that they are obliged to join a 12-step "Anonymous" program.  Likely, the two most important factors in any 12-step program of recovery are accountability and fellowship, the one having everything to do with the other.  The problem?  The other shoe?  Have you read the 12 steps lately?  The other shoe is that the 12-steps are all about god!  What is an atheist to do?  However, if it were ONLY a theistic problem, it would pale in comparison.  The problem, the really big problem is that it is a betrayal of the very ideal that it is supposed to stand for.  What in part makes the 12-step programs work, when they work, is that it was supposed to be fashioned on that one ideal, that one criteria, and that criteria is based upon inclusion.  Meaning, that it is independent of religion, gender, and anything else exclusionary.

I am listing the The 12-steps of AA (substitute "sex" for "alcohol" for the "S" sex addiction programs) below:

1.  We admitted we were powerless over alcohol - that our lives had become unmanageable

2.  Came to believe that a Power greater than ourselves could restore us to sanity

3.  Made a decision to turn our will and our lives over to the care of God as we understood Him

4.  Made a searching ad fearless moral inventory of ourselves

5.  Admitted to God, to ourselves and to another human being the exact nature of our wrongs

6.  Were entirely ready to have God remove all these defects of character

7.  Humbly asked Him to remove our shortcomings

8.  Made a list of all persons we had harmed, and became willing to make amends to them all

9.  Made direct amends to such people wherever possible, except when to do so would injure them or others

10.  Continued to take personal inventory and when we were wrong promptly admitted it

11.  Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out

12.  Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.

As we have already discussed, recovery as it pertains to addiction, be it alcohol and drugs or the "process" addictions such as sex or gambling for example, nearly always includes serious adherence and mandatory group attendance in one of the 12-step programs modeled after Bill W's "AA"  12-step "anonymous" self-help programs.  Sponsorship, a buddy-system based upon a tight "mentoring" process is an essential element for the life-long journey of the addict, as is "working the steps", and the ultimate goal, sobriety notwithstanding, is to attain a spiritual awakening and give back to the community in a cosmic what-goes-around-comes-around Gaia sort of way.       

I have always advocated the 12-step model as an ancillary part of their treatment regimen for anyone who suffers an addictive disorder.  I "get around" the god issue by instructing those that may be offended by it to substitute something other than themselves, a "higher authority" if you will, for the word "god".  However, with every passing year I am becoming more and more concerned about the issue of "god" in recovery, and that issue is highlighted at its very core by the verbiage in the 12-step community.  It simply is not enough any more to say, hells bells, what's in a word?  Because sometimes, words, or lack thereof, are everything.  Words are everything.  To change a word is to change a meaning.

Advocates of the 12-step model of recovery maintain that it is not and has never meant to be affiliated with religion, but rather, relies on spirituality as its cornerstone.  I used to agree with that argument.  Philosophically, and psychologically, I am finding more and more evidence to the contrary.  If the program really is about spirituality and not religion, then the language must reflect that.  Sometimes all we have to go on is language.  And when language means something different to different people, then we are no longer speaking the same language and communication becomes a major stumbling block.  To wit, all of the results derived from the scientific community on the research of the efficacy of 12-step programs and recovery, would be up for grabs because of this.

One of my favorite commercials shown in the US opens with a patient sitting on a couch and telling a personal story of some existential angst that he is sharing with his psychologist.  The camera then pans to the chair where the psychologist sits with pen in hand, and before you know it, the psychologist begins to speak in French to the English-speaking patient.  The look on the face of the patient is one of utter astonishment in the realization that he has just shared his inner most thoughts with someone who doesn't even speak his language.

In science, specifically referring to the use of the scientific method in research, we are taught and believe with something akin to religious zeal, that the use of operational definitions are imperative in order to produce and replicate our findings.  Operational definitions as I tell my students, are the universal language of science.  When we define a word, the definition of that word is precise in its meaning and it means the EXACT same thing in New York as it does in Kenya, not a single iota different.  This is a hugely important concept in that the scientific literature that we count on to inform and educate us, must mean the same thing no matter who reads it or in what language.  Science, even the INTERPRETATION of scientific findings, should be equivalent no matter who is doing the interpreting.  If we know that the 12-step programs are based on the concept-of-god in its verbiage, then to change that verbiage is in fact to change the program. 

This is a stunning problem of scientific realism, specifically the semantic commitment of scientific realism that maintains that the language of scientific theories is not interpretable into language about some other domain without change in meaning, and that scientific knowledge is progressive in nature, that it builds on previous understanding.  Now before you scream about AA not being "scientific"  I wholly understand that AA and the rest of the 12-step programs are certainly not about, nor based upon anything resembling science, let alone scientific realism.  However, that does not deter the argument that a program that is supposed to do one thing while it expressly states another, is problematic, and the reason it is problematic is based upon, among other things, a scientific premise.

There are two issues here, one being the actual efficacy of the 12-step model as defined by the scientific literature based upon the concepts they espouse which is further grounded in the language they speak.  The other issue has to do with a more core problem, central to all those that are a part of it - that of a program that advocates one thing but says another.  If in fact the 12-step programs are not based upon nor steeped in religion, then they must reflect that in both the language they speak and the practices that arise out of those concepts.  Again, I am reminded of the Intelligent Design movement that says it is not creationism, while all the while saying EXACTLY the same thing in exactly the same language.  It is not enough to say GOD and then say, yeah, but we don't really mean GOD.  If you do not mean god, then do not say god.  The very word has more meaning, for better or worse, than most any single word in the English language that I can possibly think of.

It might be time for the powers that be to seriously reconsider the language, and of more importance, the MISSION of the 12-step programs - is it really about inclusion?  The same language has been used since its inception in the 1930's, but the planet, and those of us that currently inhabit it, have become much more culturally aware and have changed considerably since the early days of Bill W. and the Drunk Squad.  If the 12-step programs are to continue to offer hope and healing to those that need it most, the very purpose of all of those rooms, and certainly the two stand-outs of accountability and fellowship, then it needs to take a closer look at the words it expects hundreds of thousands if not millions of people worldwide, to live by each and every day.  Perhaps when that happens, those of us in the scientific community can finally feel more comfortable endorsing the 12-step model as an important adjunct to treatment for the many folks under our care, and one that can offer (and do so with genuine integrity), a place for ALL people in need, regardless of religious affiliation and belief.

 

 

Treating Sex Addiction: The Neuroscience of Integrity

"We are born with two selves, but what we become is the measure of our experiences.  We are our experiences.  The things we perceive make us who we are.  Our perceptions change the size and shape of our brains, they change the architecture of our immune systems, and they change the circuitry of our nervous systems.  What hasn't killed us has made us stronger.  But it is true, too, that the things we fail to perceive - perhaps inescapably fail to perceive - ensure that there are some things we can never become.  If too little is given to us, if we are saved from too much of the filth and pain and din of this world, our paths may so narrow that we are strangled by them.  No matter the mettle of the selves we began with, the paucity of our experience, the limits of our sensations can cripple us, can wither us that what remains is barely human."                                                                                                                     

~ Gerald N. Callahan (2002) ~

According to Heraclitus, "character is destiny". Ok, fine.  The problem, the real question, is what begets character?  Is it learned?  Do you inherit it from your mother?  Your father perhaps?  If character really is destiny, then is it initially acquired biologically or genetically or like the nature-nurture thing, some combination of both?  More importantly, can you get it later in life if you did not have it initially, or sadly, can you lose it if you once had it?   But wait a minute.  What is character?? 

The Josephson Institute whose mission statement is "to improve the ethical quality of society by changing personal and organizational decision making and behavior" offers "character education" based upon their definition of 6 character traits that include trustworthiness, respect, responsibility, fairness, caring, and citizenship.  Sounds like they are talking about "integrity".  Ok, so if that is character then what is integrity?  The Stanford Encyclopedia of Philosophy (SEP) (2001) defines integrity as the "quality of a person's character".  In other words, integrity is what you have when you have a have an impeccable, morally robust character.  I have always thought of integrity as the root cause, the on-going active purposeful process of thinking, feeling, and acting, in an integrous manner, that gives a person their character.  The SEP divides integrity into several different interlocking areas four of which are as follows: Self-Integration, referring to a harmonious intact whole; Identity, or being true in their commitment to something; Standing for Something, more of a social virtue, and, Moral Purpose, referring to a moral obligation.  Now that we know how to define it, what does it have to do with sexual addiction treatment?

If you have been reading this blog, then you have heard me say in myriad ways, that sexual addiction begins in trauma and without intervention, ends in moral bankruptcy.  In psychological parlance, it is an obsessive-compulsive need to medicate pain and anesthetize life.  It is about shame and the absence of grace, or said another way, dis-grace.  Like any addict, life becomes all about themselves - meeting their needs and in the truest narcissistic sense of the word, finding and hoarding other people as objects, who will constantly and consistently sing their praise or at the very least, confirm their existence.  They cannot be alone for any length of time, for they are only seemingly whole or worthwhile when in the presence of others (s.f. my previous blog posts on NPD).  Their self-worth is solely derived from others, and their days are filled with shame, despair, despondency, and moral degradation.  They are in a nutshell, leading a life devoid of integrity.  They are also sensitive, lonely, desperate, fearful, isolated, often kind, often decent, fragile human beings that through no fault of their own, usually secondary to early childhood trauma, find themselves in a world they cannot fully participate in and without the requisite skills to traverse the other side or as it were, to turn the corner.  So far, I have said nothing new - nothing I and countless others have not said before.  Certainly nothing scientific.  But wait, there is more - we have only just begun.

Sexual addiction is a crisis of faith.  Not the religious kind however.

Many scientific and neuroscientific studies have investigated the effect of such things as spirituality, meditation, religious experiences such as "callings" and "healing", prayer, and psychosis-induced religious delusions and hallucinations, since the days of Aristotle, Bacon, Galileo and Descartes were credited with using the scientific method.  We know, through changes in blood pressure, cerebral blood flow, galvanic skin response, EEG changes, and SPECT scan studies that there are indeed a host of non-random significant changes that occur deep at the cellular level, to substantiate the fact that indeed, what we think, how we feel, and how we act, can and indeed does, change our brain in a noticeable and more often-then-not, profound way.

I have always maintained, for more than two-and-a-half decades now, and my research substantiates it, that sexual addiction is a byproduct of an impaired limbic system and a damaged right prefrontal cortex, specifically the dorsolateral (DLPC) and orbital (OPFC).  For more information on this you can read the article in "the reading room" at http://drsarahullman.com.  Research tells us that spirituality and religious worship is actually linked to areas of the right prefrontal cortex, specifically the DLPC and the precuneus areas.  We also know that meditation and prayer decrease cortisol levels and blood pressure, both of which are implicated in stress and stress reactions.  PET scan analysis also revealed increase in dopamine levels in the ventral striatum (Fenwick, 2002).  The Newberg et al (2001) SPECT scan study also demonstrated changes in the left frontal lobe and hypoperfusion in the superior parietal lobe, increases in thalamic activity, and in frontal and parietal cortices during meditation.

One of the classic signs, if not the hallmark of depressive symtomatology, is anhedonia.  In scientific jargon, "an" means without and you probably know what hedonism is, so anhedonia is the psychiatric term meaning "without pleasure" or more to the point, loss of pleasure in those things that were previously pleasurable.  One of the more common complaints that I hear daily, is not just the loss of interest in things they previously found enjoyable, but a loss of joy period.  I just finished reading Kathleen Norris's book on Acedia, Acedia & Me: A Marriage, Monks, and a Writer's Life.  Norris discusses "acedia" which is akin to anhedonia, but is generally used in a religious context.  Norris describes it as "At its Greek root, the word acedia means the absence of care.  The person afflicted by acedia refuses to care or is incapable of doing so.  When life becomes too challenging and engagement with others too demanding, acedia offers a kind of spiritual morphine: you know the pain is there, yet can't rouse yourself to give a damn" (p.3).  I work with quite a lot of clergy from all denominations, the majority of which are Roman Catholic.  They understand faith, both lost and found but their struggle is none the easier and their path not necessarily quicker.  Olson (2000) wrote on The Relationship Between Moral Integrity, psychological Well-being, and Anxiety that "the Christian's moral integrity is only achieved through God's grace" (p.27).  I find that problematic at best and certainly a gigantic obstacle for those with crisis's of faith, of the religious or non-religious variety who happen to subscribe to the Christian faith.

Similar to the SEP definition of integrity, Carter's book (Integrity, 1996) discusses integrity as a three-pronged affair: moral discernment, consistent behavior, and, public justification.  I happen to agree.  The way to an integrous life begins with the very basic premise that if you are a practicing or sober but non-recovering sex addict, you are not living with integrity, and you may not know what it is or how to get it.  After that, it becomes about visualizing a life with it, after which, you will most likely want to have it.  The rest is fairly straight-forward.  It looks like service, the kind that is described in the 12-step programs about volunteering and "giving back" wherein it says A"However we do service, we receive much more than we give.  We break out of the isolation and the self-centeredness of our addiction.  We grow as we practice generosity, empathy, and humility.  We forge new bonds with others that nourish and sustain us.  And we experience the joy and satisfaction of giving something of ourselves to a larger cause" (p.60).

If it is true that sexual addiction is secondary to an impaired frontal lobe, and we know that spirituality (sans religion) changes the frontal lobe in important and positive ways, then part of TREATMENT must include both discussion and direction on how to go about living a life of integrity which is to say, a spiritual life.  It will change your frontal lobe and your life.

 

 

 

 

 

 

Cybersex and Cyberporn: The Real Danger of Sex Addicted Cybering.

"We have envisioned this as the first fragrance for the technosexual generation.  A typical line from the press materials for CK in2u goes like this: "She likes how he blogs, her texts turn him on.  It's intense.  For right now"

- Text taken from the blog "cybersoc.com" article on cybersex discussing Calvin Klein's new fragrance line -

  

It has been a good 10 years since the Cooper (1998) article Sexuality and the Internet: Surfing into the New Generation was published.  Cooper discussed his "Triple-A Engine" model of cybersex (accessability, affordability, anonymity) which he rightfully tagged as the reason d'etre for what was then the rising wave of cyberporn and what is now a massive tsunami headed your way.  A year later Young (1999) in his article Cybersexual Addiction discussed his "ACE" model (anonymity, convenience, escape) that he sees as the key players not just in cybersex but cybersex addiction.  Then in June of 2005, Cooper paired with Daneback and Mansson in one of the first-of-its-kind scientific study into the realm of cybersexual participation.  The article An Internet Study of Cybersex Participants was important on several fronts.  Of course it tackled the issues of who what when and why as it pertains to online sex surfing, but in my opinion, it actually added a piece of what those of us who study it as well as those who actually participate (and penultimately become caught up) in it, already know - but now it was in print, albeit as subtle as you please, for all the world to see - a little sentence that makes so much sense but was in sharp contrast, if not in complete opposition to what was thought to be the real truth.

So what is this little yet oh-so-important morsel that I am referring to?  Below I am printing the abstract of this study.  You tell me.

"Cybersex is a subcategory of online sexual activities (OSA) and is defined as when two or more people are engaging in sexual talk while online for the purposes of sexual pleasure and may or may not include masturbation.  Cybersex is a growing phenomenon with a significant impact on participants but very little research has been done on this subject to date.  This study is the first to attempt to delineate characteristics of those who engage in cybersex.  Data were collected through an online questionnaire in Swedish, administered through the Swedish web portal Passagen.se.  Out of the total sample (N=1828), almost a third, both men and women, reported to have engaged in demographic variables to consider when investigating cybersex.  A comparison of interval data showed those engaging in cybersex to have a higher likelihood of spending more time online for OSA and having more offline sex partners than those not engaging in cybersex" (Daneback, Cooper, Mansson, 2005, p. 321).

Did you catch it?  It's that last sentence - let me repeat it: "A comparison of interval data showed those engaging in cybersex to have a higher liklihood of spending more time online for OSA and having more offline sex partners than those not engaging in cybersex".  Therein lies that nasty proverbial rub.  Cybersex has been, generally speaking, thought of as either an online engagement of pornography or even an online sexual addiction, but one that was either limited to the web, or, more importantly, one that took place in lieu of acting out in person with real live humans.  Not so!  Not even remotely so if what you have is an actual sexual addiction.  In fact, cybering, or internet pornography viewing, if one is already a sex addict, is one of two things: either a means to act out and get one's "fix" because for whatever reason they are prevented from acting out in real time with a real object (human or otherwise), or as foreplay for the real deal.  That is precisely the lure in those infamous "chat" lines (I love how they call them "chat" lines as if your're discussing tea and crumpets or a bunch of your sweet little bff's discussing whose wearing what to school tomorrow!  Uh huh).  Make no mistake, they are a means to acquire the sexually preferential information necessary in order to actually hook-up, to arrange an actual meeting for the initiation of anonymous sex.  Again, is that always the case?  No.  But for reasons having little to do with choice.  At some point, sooner or later, a hook-up will occur.  And once it does, this venue - of using the "chat" lines to secure anonymous sex - will become the preferred modus operandi.  The majority of my patients utilize this "method" of acting out.  And should their internet be blocked to the point where they are unable to actually use the computer to "chat", they will simply use their cell phones to "chat" either because they have already acquired the numbers obtained by cybering, which are immediately seared into both their memory banks as well as their "speed dial", and/or because those that they "chatted" with have called them back.  And count on that last one - they will receive, 9 times out of 10, repeat calls from their "chat" sex partners. 

This is scary stuff to hear for anyone engaged in a relationship with a sex addict, or is a sex addict just starting out, as it were.  I think that most significant others (those loved ones that are involved with a sex addict but who are not sexually addicted themselves, either a partner or a spouse, but even a parent), have thought and still think that as bad as it may be (s.f. my previous post in this blog on "pornography"), that AT LEAST  they are not acting out live and in public somewhere.

In my previous post I briefly discussed the neuroscience behind pornography and cybering (trolling for cybersex or chat-line hook-ups) and why this particular form of pornography is so incredibly devastating and is exposing - pun quite intended - entire new generations, getting younger and younger still, to the vast and unleashed world of internet pornography.  But of equal importance, is not just the exposure itself, but what actually happens, neurologically, when that exposure is in front of your eyeballs on a computer screen versus in print or even in film.  The best most impressive and brain-activiating hits from least to most hit-producing, would be print rags (from the milder playboy to the most explicit and raunchy among them), porn films either in your local theatre or in your home or the hotel on TV or DVD, internet text pornography with non-moving images, live sex "chat" lines over the internet, phone sex with a live person, and finally to streaming videos courtesy of your lap(or desk)top computer.  True, there is individual difference and preference, but the first and last are pretty much in the correct order.  In drug addiction terms, it would be like the difference between taking a drink or a hit off of a joint to feel good, on the one end of the scale, to injecting a major dose of heroine into your veins in order to feel, think, or remember nothing whatsoever other then the rush at the moment and the abject numbness afterward.

In my previous post I discussed just how the brain reacts to those computer images of sexual content, what it does to your brain (before, during, and afterward), and why it is such a dangerous "hit".  But the Daneback, Cooper, Mansson study (2005) nailed it when they added that their finding demonstrated that "...the higher the liklihood of spending more time online for OSA and having more offline sex partners than those not engaging in cybersex" (p. 321).

Cybering to the sex addicted, is both foreplay and sexual completion and is generally engaged in most, at least to the sober sex addict, when the sex addict is already at heightened emotional  risk.  While the non-sober non-recovering sex addict as well as the sober recovering sex addict is technically always at risk, I mean to say that when the sex addict is already in an especially vulnerable, stressful, lonely, angry, depressed, arousal-producing state, for whatever reason (at which point everyone involved with them knows they are charged and extra-vulnerable, except for them), they will turn to, or increase their intake of, cybering.  Why cybering?  Because neuropsychologically speaking, it is the fasted, easiest, cheapest, most accessable, most anonymous, least risky, most convenient, and let's not forget absolutely most neurologically impacting (although consequentially impairing) hit of them all.  And did I mention that it is legal and hence virtually risk-free?  Doesn't the brain want the real deal, live and in person?  Not necessarilly.  And recall in my previous post when I discussed the cutting-edge research on how the brain is unable to differentiate the "real" from the "imitation".  In other words as it pertains to cybering, the brain gets just as much of a "hit" and sometimes more, from your laptop, as it does from the prostitute or anonymous sexual liason (meaning you got it without monetary charge, because we know if you did not pay for it then, you will certainly, on some level, pay for it later) based upon the neuroscientific evidence.

These are the real dangers of cybering.  Heck, even Calvin Klein and his marketing gurus know THAT...

 

 

 

The Neuroscience of Pornography

"With advent of the computer, the delivery system for this addictive stimulus has become nearly resistance-free.  It is as though we have devised a form of heroin 100 times more powerful than before, usable in the privacy of one's own home and injected directly to the brain through the eyes.  It's now available in unlimited supply via a self-replicating distribution network, glorified as art and protected by the Constitution"

                                                                        - Jeffrey Satinover, MS, MD -                                                             

Invited Testimony before the United States Senate, Subcommittee on Science, Technology, and Space of the Committee on Commerce, Science and Transportation, on "The brain Science Behind Pornography Addiction and the Effects of Addiction of Families and Communities"  November 18, 2004

      Without a doubt the most eloquent statement I have yet to come across on the reality of addiction, is the brief statement presented by Dr Jeffrey Satinover of Princeton University on the Senate Subcommittee addressing "the brain science behind pornography addiction..."  Without permission I take the liberty of quoting his opening statement:

"It has always seemed self-evident that pornography is nothing more than a form of "expression".  Its putative merits, lack thereof, or evils always therefore have been debated in terms appropriate to "expression", and our laws reflect as much.  We argue over the "morality" of pornographic literature; its nature as "high" or "low" art; whether it has any "redeeming value".  References to "works" of pornographic "literature" and "acts" of pornographic "dance" are enshrined at the highest levels of American constitutional jurisprudence - the words in quotation marks making it clear that the understanding of pornography as expression is foundational and unquestioned.  Senator, distinguished members, I respectfully submit to this committee that modern science allows us to see that this is an illusion: Pornography is mere "expression" only in the trivial sense that a fall from the Empire State building is a mere stumble - since it's hitting the ground that's fatal.  Or, that cigarettes don't cause cancer, it's the burning smoke that's the problem."  November 18, 2004.  The entirety of Dr Satinover's address can be found at http://commerce.senate.gov. 

In one of my favorite movies The Insider, Russell Crowe portrays the real-life corporate whistle-blower Jeffrey Wiegand who blew the lid off of the tobacco industry in the United States in their public denial of the dangers and addiction of cigarette smoking.  Weigand referred to cigarettes as being the "delivery system" for the ingestion of not just the tobacco but the myriad toxic and often unidentifiable substances they are laced with.  This it was claimed, shielded the tobacco giants who testified under oath before congress, from actually lying when they said that CIGARETTES were not addictive, since they were merely the "delivery system" and by default, a delivery system cannot be addictive much like a needle as Satinover points out in his address, is not addictive.  A needle is a needle.  The HEROIN is what is addictive.  So let us if only for a moment or two, stop all of the political meandering and stick with the actual SCIENCE.  Let us take a look at the neuroscience of pornography so that we can see it for what it really is - and what it really does...

Heroin is addictive.  Cocaine is addictive.  Gambling is addictive.  Alcohol is addictive.  Which is not to say that everyone and anyone who drinks the Koo-lade is going to become addicted.  But what it does mean is that anyone, not just those with a genetic or biological predisposition for it, will, under the right circumstances and with repeated exposure over time, develop an addiction.  In the spirit (not to mention the science) of these known substances and processes, so too is pornography addictive.  Period.  That it may also be "art" or something "redeemable" or "protected by the Constitution" is totally and completely irrelevant to the science behind it, and does not change these facts one itty bitty smidgen of an iota.  In fact, the very reason it is such a hot topic is BECAUSE it produces the neurochemicals that cause so much pleasure and anything that can produce that much pleasure will be worth fighting for if someone comes along and tries to take it away.  Neurochemicals?

Be it sex, drugs, gambling, or cybersex, all of it hits the pleasure center of the brain lighting up the reward pathway like a pinball machine on steroids.  Especially that last one.  And it does so faster than you can spell it.  In fact, nothing delivers such pleasure so fast and with such intensity.  If you do it long enough, it will hurt like hell when you stop.  You have built up a nice tolerance and your brains pleasure center will not tolerate you no longer slamming it with repeated hit after hit after hit.  In actuality, it is not the heroine or even the flashy images that are addictive.  Remember, these are the mere tools - the delivery system that enables those areas of the brain to ignite and explode like the fourth of July.  We call it the "pleasure center" of your brain because when fed, these areas and these areas predominantly will come alive, and only certain kinds of highly pleasurable things will make this happen.  Why is that? 

Certain drugs or processes (like sex or gambling) produce certain neurochemicals and specific neurochemicals are made to travel to specific parts of the brain.  It is like a key and locking system.  These brain chemicals are only produced when certain things occur and when they are produced they are like keys that only fit the lock that they were meant to open.  Neurotransmitters are specific messenger chemicals and neuropeptides are specific neurotransmitters.  These messenger chemicals produced in your brain are produced in order to do something - to send a message from one area of your brain to another.  When you open your eyes, "sensory neurotransmitters" send messages to the occipital lobe of your brain that say "eyes are open, begin seeing".  We do not see just because our eyes are open.  Your camera does not take a snapshot just because the shutter is open.  You have to actually power it on and click the button.  Similarly, when your eyes are open and you look at something, immediately a host of infra-rays shoot from your open eyes to the object your eyes have focused on, and back to your eyes where it relays a message to the sensory neurotransmitter which then speeds its way to the part of your brain responsible for vision (that would be the occipital lobe) and says "eyes are opening she is seeing something".   Same thing happens with sex, only different kinds of neurotransmitters are used and they go to different parts of the brain.   And the same thing happens with things that our brain has ASSOCIATED with sex. 

When you actually have sex, certain chemicals are produced, like dopamine and vasopressin and oxytocin and others (s.f. prior posts in this blog).  These are intensely powerful neurochemicals that shoot directly to the reward center of your brain, especially dopamine which is what sex is REALLY all about.  As I mention over and over again, it is not sex that a sex addict is addicted to, it is dopamine.  Dopamine is brain candy.  Or Cheez-its.  Dopamine makes you want to have more dopamine.  Pure and simple.  Like Pavlovs dog, we are are easily conditioned to actually feel pleasurable to things that are associated with pleasure, even if we don't eat it or touch it.  I was walking across the street the other day minding my own business when something caught my eye.  I looked down in the street to see a lone half-bitten moldy cheese doodle hanging out by the curb.  Must have been there for a week (rats must be awfully discriminating around here - I'm thinking Ratatouille).  Even so, I was pretty much done for the day.  No matter how much I may have tried (and try I did) I knew it was just a matter of time before I was going to be scrubbing the orange off those little fingers (and no, could we have just a little respect, I did not pick it up from the curb).

Images of sex are associated with sex.  As the kids would say, duh!  Looking at sex makes us want to have it.  Because we associate images of sex with actual sex, our brain begins to produce the same exact neurochemicals from the mere IMAGE or THOUGHT of sex as when we are actually engaging in sex.  Think dopamine for one.  Recent cutting edge research has demonstrated that our brain cannot distinguish the fake from the actual.  You may be able to tell the cubic zirconia from the real deal, but trust me here, it is only because you have taught your brain to begin the cognitive process of thinking or wondering about the reality of the gemstone.  To your brain, it simply goes "diamond".  The minute our eyes look at something that we have associated with sex, we are off to the races.  We cannot unring that bell.  We cannot take it back.  See the previous post on euphoric recall and you will learn about how our brain reacts not just to pictures, but we don't even need pictures, we can simple THINK ABOUT the pictures without even opening our eyes, and we are producing the neurochemicals that will make us want to have sex.  Many people can resist the urge to engage, and move on.  Sex addicts cannot resist the urge and just like the alcoholic, they are unable to move on.  They have literally become stuck in the web.

In the same senate subcommittee hearing, Dr Judith Reisman stated that "Thanks to the latest advances in neuroscience, we now know that emotionally arousing images imprint and alter the brain, triggering an instant, involuntary, but lasting, biochemical memory trail."  She goes on to state "Brain scientists tell us that in 3/10 of a second a visual image passes from the eye through the brain, and whether or not one wants to, the brain is structurally changed and memories are created - we literally 'grow new brain' with each visual experience".  So you can say "art" all you want.  May very well be so.  Go ahead, have at it.  But if you have a sexually addicted brain, you are eating a really nasty apple from the intensely poisonous tree.

Cheez-its anyone?

 

 

 

 

Fantasy and Euphoric Recall in Sexual Addiction: Are you Still Sober if it's Only in Your Head?

"Images of rapture creep into me slowly as you're going to my head

And my heart beats faster when you take me over time and time again 

But it's just a sweet, sweet fantasy baby"

- Mariah Carey -

      What is the big fat problem if you only think about something sexual but do not act on it?  I am pretty certain that if you were to ask a slew of  random folks - people whose spouse or significant other spends time - any amount of time -  traversing internet porn sites, they would say that the person is cheating on them.  More than likely they would tell you that it just feels like they are being cheated on.  That they feel insignificant or secondary and that their partner is not "present"  especially during intimacy.  And most clinicians would agree.  Now add to that scenario the fact that the person checking out porn on the net is a sex addict.  Make that a recovering sex addict.  Now you have a really big problem indeed.  And the problem is that the sex addict in recovery is no longer sober, forget recovery, if their eyeballs are mopping up pornographic images.  Be that on the net, the tube, the VCR, or in print.  It may or may not be "cheating" if you occasionally indulge in a non-secretive manner -  providing you are not also sexually addicted.

Sex, or more to the point sexual behavior, does not contrary to popular belief, emanate from the body.  Sexual arousal is neurological.  The body simply complies.  But hold that thought.

Internet porn is to the sex addict what a seat at the pub while holding a glass of liquor is to the alcoholic - but worse.  Much much worse.  The alcoholic may not have taken a drink - yet.  But chances are better than not that they will.  Worse however for the sex addict, since the act of just watching pornographic images, immediately sets off a spectacular flare of dopaminergic fireworks.  The actual visual impact triggers the sex addict.  In fact, the mere thought of getting on the 'puter as prelude before ever actually seeing an image at all, will biochemically trigger the sex addict and they are off to the proverbial brain-based pleasure center in the sky. Make no mistake, it is foreplay plain and simple.  While the alcoholic can somehow put that glass back down (uh-huh), the sex addict is less lucky at least from a recovery perspective, since the split second their eyeballs hit the screen or just think of hitting the screen, they are gushing neurochemicals and altering their brain.  Need I state of course that it is virtually unheard of (pun intended) for the sex addict to engage in net porn and not masterbate, large doses of an SSRI notwithstanding.  But even if somehow they refrained, they are still triggered, still "using", and are still "under the influence" of their altered brain chemistry.   Of prime importance behaviorally speaking, is that in both scenarios the cardinal rules of recovery were breached.  And that would be People, Places, and Things.

Let me be clear.  If a sex addict is checking out pornography, that person is not sexally sober and sure as heck is not in recovery.  They are "using".  Cheating or no cheating.  No ifs ands or buts.

What happens next to the sex addict individual after perusing the porn sites - even for no more than a few seconds by the way - is that they are in an altered state.  Meaning that the addict is now the equivalent of being stoned.  And this individual will remain stoned for quite a period of time afterward.  Which also means that the addict is walking around with these images in their head that they can (and oh so readily do) recall in a milli scintilla of a nanosecond( or less!), sometimes on purpose (to get even more stoned or to maintain the high) and the rest of the time because the images simply break through consciousness and pop up when least expected.  That said, if you are sexually addicted and you engaged in porn, then you should expect that these images will be automatically recalled willy nilly.  These images have been seared - and I mean seared - branded into the sex addicted brain and will offer a free high -  a feeling of utter euphoria  whenever recalled.  And recalled they will be, time and time and time again. 

I mentioned that sex is neurological.  It is.  Sexual arousal, just like any type of arousal, occurs when parts of the brain release arousal-producing neurochemicals.  Only then does the body respond in kind.  When the body responds you have gone from a neurochemically produced thought process to a physical behavior.  The very reason sex addiction is a subset of obsessive-compulsive disorder (OCD) is precisely for this reason - because the addicted individual has incessant recurring thoughts of either sexual activity or objectification for the purpose of sexual arousal (mental or physical), which is in and of itself arousing and anxiety producing.  When arousal and anxiety is produced it immediately triggers the need to reduce the anxiety which in the case of a sexual addiction, is accomplished by having sex.  Needless to say, OCD is itself a subset of the group of disorders collectively referred to as anxiety disorders.  And the process repeats itself, hence the recurring loop of thoughts and behaviors that seem to have a life of their own.  It seems that way because in a sense, it is that way.  Like most mental disorders, OCD is neurological in that it is a byproduct of your brain producing an overabundance of one neurochemical and not enough of another.  That would be dopamine and seratonin.  The later of which is why high doses of an SSRI (serotonin-based antidepressants) like Prozac is generally the drug therapy of choice for sex addiction.  Even though it is classified as an antidepressant, the high doses of seratonin (for those that can tolerate it) cut both libido and performance, enabling the sex addict to have a better shot at sobriety.

So.  Is fantasy and euphoric recall cheating?  Maybe.  But if you have a sexual addiction and you engage in sexual fantasy, you are not sober - you are under the influence.  Call your sponsor, talk to your psychotherapist, call the folks on your fellowship list and hit a meeting.  Because sexual fantasy which produces eurphoric recall, is simply sex you are having in your head.

What do you think?

 

 

Sex Addiction and PE (we're not talking gym class)

The Probabilistic Epigenesis model of developmental outcomes assumes that individuals of the same genotype can have different neural and behavioral outcomes according to the dissimilarity of their relevant life experiences...

- Gilbert Gottlieb -

                                        Say what?

     Bet you thought I meant "Physical Education".  No, sorry.  I meant "Probabilistic Epigenesis" or PE for short.  For quite some time now myself and a host of others in the field of psychology, psychiatry, and biology to name just a smidgeon of the various professions involved, maintain the view that human development occurs as a combination of "nature and nurture".  If you recall, the "nature-nurture" debate focuses on how much of who we are is a result of "nature" - our biology, genetics, destiny, what which is predetermined,  versus "nurture" - our environment, culture, family, learning, and the choices we make.  Meaning, that higher organisms such as us, develop, physically and mentally, through some combination of what we inherited through our gene pool, and through learning which is a product of what we acquired from our environment.  Our environment is everything outside of ourselves.  It could be within our house - what we picked up from how we were raised by our caregivers and those that shared our living space, or it could be within our community, state, continent or world - what we learned from just being on the planet.  What we did on Saturday night and with whom, where we go to school, who we associate with, etc.  You get the point.  This thinking was not always the case...

While genesis generally refers to the origins or beginning of something, epigenesis refers to the stages or steps that constitute the beginning of something.  Probabilistic refers to the statistical probability or causality of something.  In other words, what is the likelihood of such a thing happening or occuring.  Taken together, PE is a model, made known by the wonderful experimental psychologist Gilbert Gottlieb who died just last year.  According to Gottlieb and the backbone of PE, it is a developmental model of how we become the human beings we are.  PE resurrects the old nature-nurture thing by stating that there is a bidirectionality between our genes and our environment.  Not only does our biology impact our environment (i.e. our intelligence and physical appearance will impact our profession and mate selection), but our environment impacts our biology (i.e. our profession can in turn impact our intelligence and our mate selection can certainly impact upon our physical appearance and our longevity!)  Yes it does. 

Phenotypically speaking (that would be my physical appearance that is genetically expressed), I have blonde hair blue eyes and very pale skin.  Because of this color combination, or lack there-of as it pertains to my somewhat absence of skin color, I cannot tolerate the heat, but do fairly well in cold weather.  With the exception of my mother, no one else in my family has light hair eyes or skin.  My family tolerate and in fact prefer warmer weather and enjoy a good bask in the sun.  I prefer the snow, skiing, and melt in the summer months.  As it relates to PE and the issue of bidirectionality, it means that the majority of my family will live in warmer climates and I will not.  I will live in cooler climates which in turn means that my genetics will in part determine my choice of climate preference and hence where my offspring and future generations will live.  This is a prime example of my genetics effecting me and me in turn impacting my genetics, or the case for bidirectionality.

According to Gottlieb, there are 4 levels of analysis that effect PE: genetic activity, behavior, neural activity, and the external environment.  Using the example above, my phenotypic expression which is genetically determined, my behavior (avoiding the sun and hot locations), my external environment (where I choose to live), will all impact future generations and the neural activity produced as a result (i.e., all of the neurological correlates that go hand-in-hand with living in colder climates and having light coloring such as higher sensitivity to physical pain and greater possibility of developing osteoporosis).  We know and as Gottlieb points out, "there is considerable evidence that genetic activity is influenced by neural, behavioral and external environmental events..." (Gottlieb, 2007, p.2). 

In all that I state, rather ad nauseum, I maintain that sex addiction is a disorder - a progressive disease process - that is in part secondary to early childhood trauma (s.f my earlier posts in this blog).  It is something that occurs as a result of certain types of toxc childhood such that the limbic system is impacted and maldevelopes which in turn impacts and alters the predominantly right prefrontal cortex.  Sexual addiction is a prime example of a probabilistic epigenesis impacting the developing human organism during critical periods of neurodevelopment.  In sum, PE makes the case for the nature-nurture issue and the sustained impact that nurture (environmental events) can and does have on the developing nature of the human being. 

Early childhood trauma, even when there is no physical involvement, can and does alter the limbic system and exceedingly important aspects of the frontal lobe.  We know this to be true.  Parents and caregivers most definitely effect, good and bad, the actual neural code of our developing brain - how we are raised can and does impact and alter the neural networks and neural nodes in our developing brain and sets us up as adults, good or bad, for the life we will eventually lead - good and bad.  When things go well environmentally, when we are lucky enough to be the recipient of a decent, loving, and nurturing household, our brains will thrive, as will our body, all things being equal, and we will more likely reach our genetically endowed limits.  Otherwise, the reverse, having come from an abusive or malignant or toxic household, can and will limit our ability to thrive, to succeed, to achieve, and to be healthy.  And in some cases, depending upon the damage done, our ability to sustain the damage experienced, and the resultant pathology that is left in its wake, will visit us and stay until, when and if, we are able to make some changes, to the extent that it is possible.

The good news, PE is but one more example of a scientific explanation for why sex addiction is a preventable disease, and why we need, more than ever, to recognize it and take the necessary steps to do something about it.  What, exactly, will be up to you.

As always, you are encouraged to join the conversation and let me (and others) know your thoughts...

 

Sex and Love and All That Jazz: The Arousal Conundrum

  "And the day came when the risk to remain in a bud was more painful than the risk it took to blossom"

- Anais Nin -

 

     Sexual addiction in its simplest terms is a dysregulation of the pleasure, pain, and fear centers of the brains reward circuitry and a continual biochemical cocktail that feeds the pleasure centers of the brain in order to squelch the tide of unremitting pain and unmitigated fear - further fueled by the incessant out-of-control drive to seek that ever-higher dopaminergic rush, in a failed but panic-driven mixed-up effort to self-regulate, with the dream of someday finding that proverbial ever-elusive homeostatic comfort zone.  Whew!  But hold that thought for just a moment...

In sex addiction parlance, "sex" and "love" are both experientially impaired pathological events which are indistinguishable from one another.  They are each a terrific source of unbridled anxiety, the former however, far more pleasurable and acceptable than the later - the former they feverishly approach in varying amounts depending upon the addicts state of tension, and the later they avoid at all costs, period.  It would be a fair statement to say that a non-recovering sex addict has no idea what love actually is and likely has never experienced it or would recognize it as anything other than Jessica Lange in her white wedding gown seductively motioning Rory Schieder to deaths door in the movie All That Jazz -  which of course, is part and parcel of the whole damn tragedy.  Love and death, fear and joy, pleasure and pain.  All are states of arousal, and to those sexually addicted individuals, they are all scary places that the body recognizes and reacts to in exactly the same way.

In a sexually addicted brain, there is no distinction between any type of arousal.  And for good reason.  There is a song by Ani Difranco titled Falling is like this.  "like you're choosing between choking and spitting it all out, like you're trying to fight gravity on a planet that insists that love is like falling and falling is like this... one minute there was road beneath us, the next just sky".  While many of you might be thinking, "exactly!" with smile and twinkle, to the sexually addicted individual, who on a good day is filled with a barely containable quantity of anxiety, fear, dread, and shame, the possibility, no, make that the very thought of, falling - whether it is in love or from a 22-story building - is pretty much one and the same.  Why?  They both represent an out-of-control death spiral.  More like one moment there was life no matter how painful, and the next moment there was a long drop and the pavement very rapidly coming up to meet you.

Once again (c.f. previous posts in this blog) it all boils down to the limbic system, the prefrontal cortex, the brain stem, and the functions they subserve.  To say that one is "in love" is to say that one is HPA-axis impaired - surging with stress-related cortisol, filled with a gush and rush of Phenylethylamine (PEA), raging with Dopamine (DA), and sappy with Oxytocin (OT).  Sounds scary as hell just to say it all. 

Diagnostically speaking a sexual addiction is another term for a specifically impaired limbic system and right prefrontal cortex.  It means (most of the time) that you were dysregulated in your early childhood years when your budding brain systems were myelinating and coalescing and learning what "normal" homeostatic brain function was supposed to look and function like.  The limbic system, comprised primarily of the amygdala, hippocampus, and hypothalamus, make up the "emotional" brain, responsible for what my students know as the 4 Fs - feeding, fighting, fleeing, and sex.  The predominantly right prefrontal cortex, where most of the dopaminergic neurotransmitters flow in and out of via the limbic system, is considered the seat of our personality, responsible for things like judgment, attention, impulsivity, social skills, planning, goal-directed behaviors, and a host of other functions needed to keep us out of jail, the poor-house, the dog-house, divorce-court, and a sealed wooden box.  Finally, the brain stem, which abuts and innervates the limbic system, houses two critically important areas called the Nucleus Accumbens (NAcc) and the Ventral Tegmental (VT).  These two areas are responsible for the regulation of emotion, pleasure and pain. 

The limbic system is the seat of our emotions, the right prefrontal cortex is the seat of our personality, and portions of the brain stem are the seat of emotional regulation, pleasure and pain, and as such, we have now defined what has become known as the Reward Centers or circuitry of the Brain.  These are the areas that are impaired in the addictive disorders.  Pleasure, pain, emotions and the ability to regulate an emotion or emotional experience, our ability to have sound judgment, plan our life, stay out of trouble, and give oneself over to the pleasure and pain cycle of addiction - any addiction actually - represents the life of the sex addict whose limbic and right prefrontal areas became dysregulated secondary to early childhood trauma.  A double whammy if ever there was one.

The Hypothalamic-pituitary-adrenal axis (HPA-axis for short) is not so much a structureor physical place in the brain, as it is a cascading of neurochemicals synthesized and utilized by various structures like the limbic and endocrine systems.  The functions subserved by the HPA-axis and its neurochemical cocktail is to regulate stress (like the production of cortisol and corticosteroids found in abundance in both traumatic states and love!), digestion, energy output, mood, and immunological tasks.  This is why so many psychiatric disorders are secondary to, or the cause of an impaired HPA-axis.   

Phenylethylamine, or PEA, affectionately known as the "love chemical" is a kissing cousin to amphetamine (or"speed" to those of us that remember Woodstock-the event, Vietnam Nam-the war, or Watkins Glen-having nothing to do with race cars - but because we were there), which is what gives Love that Rush.  PEA triggers the flow of adrenaline and noradrenaline to your brain - again, hence the rush of love even when that person is out of sight.  It is why those in the early stages of love can't eat, can't sleep, and can't do much of anything but obsess all day and night long about the object of their desire (for more on OT and DA, please see the previous posts in this blog).  It is no wonder why non-recovering sex addicts cannot experience love.  For the sex addicted, who is ordinarily in a constant state of anxiety and panic, love represents being completely and totally out-of-control! 

So what is the answer?  The paradox, it probably will not surprise you at this point, is that love is the answer!  But like anything else, you must be willing to go there.  To somehow find a place where you feel safe enough to go there - to experience it - to be in the thick of it, and know, through nothing more than unmitigated blind faith and a desire to change, that you will not die, but rather, for the first time, come out whole and live.

As always, thanks for stopping by...             

The Butterfly Effect of Sex Addiction

                            "In science as in life, it is well known that a chain of events
                            can have a point of crisis that could magnify small changes
                              ...chaos is a science of process rather than state,
                            of becoming rather than being"
                            - James Gleick -

        
       In the 1970s, a new physics emerged called chaos theory.  In a wonderful book on chaos theory that actually became a bestseller, James Gleick's 1987 Chaos: Making a New Science, told the story of what chaos is and how it came into being.  Gleick refers to the theory as "a science of the global nature of systems...  It makes claims about the universal behavior of complexity" (p.5).  In sum, chaos has to do with dynamical systems - that would be you and I, and how these systems naturally mutate and change over the course of time.  It is how a system, say, that of a human being, begins to shift, either gradually or swiftly, away from its original, orderly state of being.  And when that system begins to move away from its original state, for whatever reason, from that balanced orderly initial state of being, it moves toward a stage of chaos.  When a system surges toward chaos, it begins to rattle and change, and fall apart into DISorder, and when it does, that system is said to be in chaos.  But even in chaos, there is order.

Ironically, chaos theory tells us that there is order in chaos.  That disorder may not be random at all.  That when something falls apart, or breaks, or becomes ill or pathological, there is an order to which that chaos occurs, in which the system breaks down.  There is order in chaos.  Change is not random.  Change is in fact, inevitable.

The Butterfly Effect, a theory serendipitously discovered by meteorologist Edward Lorenz in the 60s, is a reflection of how minute changes in a dynamic system, can influence and exact huge large-scale changes on something seemingly unrelated.  At a professional conference discussing this new discovery of his, Lorenz likened the effect of this amazing find as if "a butterfly, flapping its wings in Hong Kong, may change tornado patterns in Texas".  Until this point, physics, and the rest of humanity assumed that if left alone, nature would veer from its present course at a predictable and non-random rate, with predictable, and non-random results.  Lorenz proved us wrong.  It was demonstrated how the smallest, seemingly most inconsequential change in one little, insignificant variable, can influence other related systems, such that this seeming non-event could, in fact would, produce a catastrophic change.  The change itself might or might not be predictable.  Maybe.  But that there was change at all, is predictable.  It is said in chaos theory, that a dynamical system is defined as having "sensitivity to initial conditions".  Such as the flapping wings of the butterfly.  And speaking of "sensitivity to initial conditions", that brings me to the adult sex addict...

A sexual addiction is all about sensitivity to initial conditions.  It is all about chaos.  And sexual addiction is  nothing, if not a butterfly effect of our environment and its effect on our limbic system and prefrontal cortex.  It is precisely how the malignant abuse of a parent, say, can influence and have catastrophic effects on the structure and biochemistry of our brain as it develops.  And how this effect - this change from the initial system, now moving toward chaos, has manufactured a new normal that defines the life of the sex addict.  Why does this movement - this interplay between childhood abuse and a damaged brain - produce a sexual addiction in some but not in others?  Don't know.  Remember, we do know that changes will be produced, and that certain conditions, when ripe, will produce certain predefined effects.  But to whom?  Most likely the answer has to do with a combination of temperament, age at onset of abuse, type of abuse, duration of abuse, and strength of developed areas of cortex at time of initial aversive conditions. But we do know it will produce change.  And we do know that the change will be deleterious, long-lasting, considerable, impacting the specified areas of cortex but not others, and will produce one of many attachment impairments that comprise the symptom picture of the sex addicted brain.

According to Gleick, "Understand the laws and you understand the universe." 

 

Josef Fritzl's Addiction to Sex

                                      

"The eyes and hands are the sight of recognition. 

The parts we see least easily. 

It is the other that knows our hand and eyes the best

- Jacques Derrida -

     Sunday's article in The Independent was titled " Will Fritzl be seen as a victim of an addiction?" It was in a word, inevitable. In case you were cloistered in a galaxy far away somewhere, planet unknown, or simply cannot recognize the name, Josef Fritzl is the name of the man whose case will no doubt live on in the annals of sex crimes infamy. He is the father from Austria whose daughter he kept hidden away for decades in an unknown subterranean lair, levels below his own house, wherein he and his wife and mother of the incested girl in the basement, kept up a seemingly normal middle-class life for all the world to see.  In the interim, Fritzl made his way below the surface so-to-speak, with amazing regularity to incest his daughter and father the many, many children born to them, also kept hidden from the light of day or another human being.

We have all been waiting to hear the words that would comprise a defense for this man.  And Sunday, there it was in black and white  "I was addicted to abusing my daughter" said Fritzl.  As noted in the article by Christina Reihill (http://www.independent.ie/health/will-fritzl-be-seen-as-a-victim-of-an-addiction-142285).  The Independent goes on to say that Fritzl blames this sordid business on the fact that he "lusted after his mother", of which the author of the article claims - inaccurately might add - that it "is a case for addiction".  I doubt we are talking about drug addiction here, yet no where does the article refer to SEX addiction.  Oh?  And why is THAT? 

The article goes on to say "Of course, his repeated abuse of his daughter bears no comparison to the addictions we're used to dealing with -- alcohol, food, drugs, and/or gambling -- but that doesn't mean his behavior is not an addiction".  HELLOOOO!  Did we forget about SEX?  Yet AGAIN?  Sex is not only missing from mention, but it is so in-your-face missing as to raise both eyebrows.  After all, the "other" "process" addictions are mentioned.  Gambling?  Check.  Food?  Check.  This was a SEX CRIME.  Why are we "forgetting" to mention sex?? 

The article winds down by giving a summation of the authors ideas on the subject, wherein she writes "More theoretically, Fritzl's behavior is striking in its stunning metaphor for addictions.  Our addictions hold the secrets of our most primitive desires in the cellars in our minds, and to keep these yearnings alive requires incredible planning and attention to detail, however unconsciously that is.  The keys, the locks, the steel doors and dungeons we build, make up a labryrinth of unconscious locking systems which protect and propel our bad addictions, however hidden and harmless they may seem to be".

Whoa.  Ok first of all, we are expected to get in touch with the fact that we are talking about SECRETS OF OUR MOST PRIMITIVE DESIRES IN THE CELLARS IN OUR MINDS, but the article cannot even bring itself to use the word SEX anywhere in the entirety of the article!  I just do not get it.  This is a horrid, sordid, viscious, inhumane, nightmare of a crime whose vehicle of violence is SEX.  Not a gun or a knife.  SEX.  INCEST.  The word "addiction" is mentioned, but not SEX.  Never the word sex.  Yes, yes, I understand I am beating the horse to death here, but please, someone - ANYONE - enlighten me here.  What is the problem?

But most important - let us not for a split mini-scintilla of a nanosecond, confuse - EVER confuse, incest, torture, sado-masochism, pedophilia, and violence, with SEX ADDICTION.  None of these - I repeat, NONE OF THESE THINGS HAVE ANYTHING TO DO WITH A SEXUAL ADDICTION.  Period.

As always, I look forward to your feedback...

 

Sexual Addiction and The Damaged Brain

 

"Illusion is the price that must be paid to evolve perceptions that can keep up with a dynamic environment"

-Roy Sorensen-

 

    
     When we think of the term "brain damage", we generally experience  an instantaneous bristle - a  perish-the-thought kind of shutter and revulsion.  We run from the very imagery.  We think of half-dead wretches lying, lifeless, in some state-run institution or hospice with nuns, shoes squeaking, running amok and tending to the albeit quite limited needs of the "brain dead", whose drool out of the corner of their mouths, have a hose of some sort stuck in it, or not.  Whose fingers and toes are curled, whose nails are yellowed and long-since neglected, whose decubitis-stricken body is simply waiting for their brain to stop completely, legally, and finally.  We think of the poor Karen Ann Quinlan's and Terri Schiavo's of the world - once vital and young and the waiting world their lovely oyster, now counted among the poor souls whose body has betrayed them, lying in wait of death to take them.  

 

Ok stop!  This is BRAIN DEAD not BRAIN DAMAGE.  Not the same.  Not even close - although it can be.  If you are reading this, trust me here, chances are pretty good that you have or have had some of the later.  In fact, it is a virtual impossibility to get through life without any form of brain damage somewherein that otherwise wondrous and most likely highly functional brain of yours.  Just as it is nearly impossible to get through life without any damage, mild or otherwise, to your physical person.  Think about it. 

 

Sex addiction is another term for a specific condition secondary to a brain damaged right prefrontal cortex.  But hold that thought for now...

 

Damage does not infer permanence.  This is important so let me say it again - damage to the brain does not mean that the brain will remain damaged or that the damage was severe in the first place.  And it certainly does not infer totality.  It infers nothing other than damage.  It means that something was nicked, marred, broken, or somehow discombobulated at some level.  It might be minor, fleeting, and completely reparable.  Or not.  It means that something happened to a part or parts of your brain, directly or indirectly.  Your brain is much like the rest of your body below the neck.  Meaning, there are strenghts and weaknesses and levels of damage.  As a female, I have characteristically stronger legs than I do arms.  I happen to have a superior sense of smell and hearing than I do vision, and my right prefrontal cortex clearly outshines a portion of my parietal or temporal functions - for the most part.  Oh, and I also happen to have a very unusual and highly specialized but nonetheless permanent and unmistakable brain damage.  It happened when I was not quite 16.

 

I have a problem with numbers.  Not just any old numbers.  And not numbers in the sense of plain ol' numerals.  Numbers that involve a compound meaning or analytic calculation.  I cannot conceptualize what mathematical application to use for a specific numerical problem because that very specialized portion of my brain has been severed - or in my case, fried.  I understand what is being asked of me.  I understand the nature of what the result or answer should look like.  I just cannot for the life of me, come up with the application - it is if all of a sudden everyone stopped talking and I forgot what was just said.  The most effective way to describe the problem would be to picture yourself standing on a pedestrian bridge.  You know of course where you are standing - after all you are not blind.  And you know where you are going because you can see the end of the bridge -  therefore you know your destination.  But oddly and inexplicably, there is a gaping hole right smack in the middle of the bridge and you simply cannot figure out how to get to the other side.  So you just stand there, starring blankly, knowing something is expected of you, some action is required, but you haven't the slightest clue of what it might be or where to go to get it.  There is a complete and utter disconnect - and the rest of you is connected enough to know it.

 

In the spring of my 16th birthday a random but synergistic co-mingling of two otherwise innocuous events nearly caused my death.   That summer I was flying to Israel, and happened to be one of the last people in this country to receive a mandatory small pox injection prior to overseas travel.  Little did I know that the little boy from across the street, with whom I had direct physical contact, was incubating the chicken pox.  The incubation period while highly infectious, consists of roughly 3-weeks time  from initial exposure  where there are no apparent symptoms.  Somewhere high above the seas of the Mediterranean, the incubation period ended and my coma began.

 

I had no way of knowing that my very unusual and specific problem was due to the specificity of function of our miraculous brains.  And so I did what most people do who are ignorant of something, in the true sense of the word, meaning "having no knowledge of" - I dismissed it as something "scientific" or having the property of anything "real" and "concrete", and simply relegated the problem to the "psychological".  This is what ignorance does - it takes something that is unknown to us and pawns it off onto something insignificant or worse - something "soft" and not scientific.  Something attached to willpower or stupidity or laziness or defect. 

 

It took some 30 years post damage (and much frustration) to come upon the excellent work, still in progress, from the Parisian neuroscientist, director of the INSERM-CEA at the Cognitive Neuroimaging Unit, and professor of neuroscience, Dr Stanislas Dehaene and his amazing and ongoing work on the temporal and parietal lobes and their neural circuitry for "number" and "location".  His webpage can be found at                         

 http://www.unicog.org/main/pages.php?page=Stanislas_Dehaene.  In fact, these same but seemingly separate and distinct functions  may indeed share the same exact neural pathway!  Amazing.  Apparently it is an extremely rare occurrence to have these and only these overlapping impairments, since we did not even know they existed in such specificity nor that they were related in any way.  Apparently numbers that are associated with space and time are located very, very deep within the intra-parietal sulcus of the brain, and are quite different from any other type of "number" or "numerical" function or operation.  Who knew?  No one believed me.  No one believed it was possible for this otherwise highly intelligent and more importantly, very abstract thinker who wanted to be a physicist, who could easily comprehend advanced statistics and the theory of probability, but who looked like a deer caught in the headlights when a simple arithmetic calculation was presented to her.  What was the answer to my problem?  That it must be "psychological" of course...

 

Alcoholism was until very recently (see initial post in this blog) considered a sign of "weakness" or "character defect", and still is by many people the world over.  Ditto for sexual addiction.  But nowhere is this conundrum more problematic than it is for the case of sexual addiction. We think this when we say, sexual addiction must be a "weakness", because why would an otherwise educated or bright, or socially facile individual who seems to have it all,  in a high-profile profession, risk it all by going out one night and having anonymous sex in the park at 2:00 in the morning with a bunch of anonymous teens, moments after having kissed the wife and kiddies, snug in their bed in the burbs, "good-night"?  Such was the case one day, of a certain well-known and highly respected judge whose judgment landed him on the front page of the city paper, somewhere in America, for all the world to see?  When asked why he did it, he said with complete an utter honesty, "I haven't a damn clue".

 

For a brief but thorough summation of my frontal lobe sex addiction research, go to http://drsarahullman.com and read the article on the sexually addicted frontal lobe. 

 

When we understand the nature of the brain - how different parts of the brain function differently, and what happens when there is damage to a specific part of the brain and the result it will have on us psychologically, physically, and mentally, then we can begin to answer the question, why is it an otherwise intelligent, high-functioning, and seemingly responsible adult can act with total disregard, either physically or emotionally, toward another human being?   The answer lies within the right prefrontal cortex (PFC).  When there is damage to the neural circuitry of this area, then the functions subserved by this area are impaired.  What is subserved by the right PFC?  Things like impulsivity, judgment, reasoning, consequences, social intelligence, delay of gratification, planning, goal-directed behavior, and a host of functions that we think of when we think of "personality".  It is like drinking alcohol.  The brain might be just fine until you take a few swigs of an intoxicating substance.  That very same brain that was working just fine a few moments ago, is now, while under the influence, acting as if something pulled the plug on their ability to act like an adult!  When the brain is under the influence of sex, all of us act just a little differently.  But when a brain that is already impaired or damaged in the right PFC, has sex, then it is as if the plug has been removed, the dam bursts, and all of the functions attributed to that part of the brain become go completely or partially haywire, until such time that the brain sobers up and is no longer under the influence.  And that is why a sex addicted brain while under the influence, appears to be a Dr. Jekyll and Mr. Hyde.

 

I fully understand what it is like for the world to so completely misunderstand an important aspect of your life.  Forget the fact that I was reading Thomas Mann's The Magic Mountain at 11 - for the second time because I was bored, or that at 13, I was one of the youngest members of the Gurdjieff foundation of which I was a self-proclaimed fan.  The problem was that I could not calculate mathematical problems -  I was considered mentally slow and put into "special" classes.  And so, having had enough of what I knew could not be true but without the wisdom to prove my case,  I up and  left the 8th grade and went to college instead...  

 

I understand what it must be like when the world tells you that what you have is all in your head, and when there is nowhere to turn nor anyone to turn to for the answers.  It is amazing how we incorrectly and often dangerously surmise and whitewash those things that we fail to understand.  How we are so diligent in categorizing people no matter how incorrectly, so that they fit nicely into our prefabricated folders of how the world makes sense.

 

Sex addiction is a neurological problem that can be repaired.  Period.  Wouldn't it be nice if the world were able to see things as they really are and not how it best fits into our limited level of knowledge and understanding?  I think so, do you?

 

 

 

BACK IN THE SADDLE!

 

WELCOME BACK TO

the sex addicted brain!

 

The summer hiatus has ended - whew - and the blog is back!

In addition to regular postings, BOLO (be on the look out) for new features such as audio clips, teleseminars, and ebooks.

Keep your comments coming!

And as always, thanks for stopping by...

 

 

 

 

The Neurochemistry of Love and Attachment: The Neuroscience Of Narcissistic Personality Disorder - Part III

           "Twas in another lifetime, one of toil and blood

           When blackness was a virtue and the road was full of mud

            I came in from the wilderness, a creature void of form

                                          "come in" she said    

                                                                                 "I'll give you shelter from the storm"

                                                                                                                                                (Dylan, 1974)

Daniel Alkon, MD, wrote in one of my all-time favorite books on the planet that "...memory's permanence maintains trauma's grip on our behavior" (Memory's Voice: Deciphering the Mind-Brain Code, 1994, p.1).  In studying memory and the brain as he has for decades, he (and countless others) long since came to the conclusion that early childhood psychological trauma can structurally and biochemically damage the brain and alter both the behavior and lifestyle of a portion of those that have been abused, and while a stunning concept no doubt, is certainly neither new nor at this juncture in our rather meager scientific development, controversial.  In Parts I and II of this thread, a (really basic) overview and clinical definition of Narcissistic Personality Disorder (NPD) was discussed, with emphasis on the neurobiological correlates of NPD.  In this final portion of the discussion, we shall see how sex addiction is related to NPD, and how both disorders are the tragic consequence of a neurochemically deprived brain that leaves in its wake, among other things, a complete inability to love and bond to another human being, AKA attachment. 

What makes these disorders all the more tragic, is that they are generally borne out of the very same pathology, passed down from one generation to another, like a virulent disease that both society and to a large extent, the treatment community, seem to want no part of.  With advances in both scientific methodology, etiology, and consilliance across fields, this is beginning, thank goodness, to change.  How exactly does one become immune to love and attachement in the first place?  Technically, the answer lies somewhere between the ventral tegmental and anterior cigulate cortex areas, and the neurohypophyseal peptides oxytocin and vasopressin.  And if you happen to be sexually addicted to boot, then what you are addicted to is not sex of course, but gobs and gobs of that luscious free-flowing dopaminergic candy, made readily available by the inability to suck up enough oxytocin and vasopressin to keep you "nailed down" and out of the proverbial pantry.  "Cooledge Effect" anyone?

From the very moment of birth, our mammalian brain (that would be yours) is busy orchestrating; receiving, processing, and sending crucial information throughout our central and peripheral nervous systems which in turn enable us to act on that information in specific ways.  This information is composed of an exquisite array of biochemical signals and messages that operate like a gigantic switchboard, knowing where to go and how to get certain information, what brain "station" to send the information to, in what "language" it should be read or translated, and ultimately, how to transcribe the messages once they are received and processed at the correct "facility".  This switchboard is of course our central nervous system (CNS), and the messengers are our neurotransmitters and specialized neuropeptides.  It is these hundreds o f neurotransmitters that allow us to think, perceive, and behave in the remarkable (and sometimes not so remarkable) ways in which we do.  They tell us what to think and feel, how and when to feel what, and how and when to behave.  Even more basic then that, they tell us when we are hungry and how much and when to eat, when we are tired, and when and how much we should sleep.  They regulate every aspect of who we are and how we perceive the world at any given moment.  They are a magnificently orchestrated cocktail of neurochemical slop that can quickly become our greatest enemy in the fight to self-regulate our own body, brain, and mind.  And when this happens, one's time and energy is spent on little else, but trying desperately to self-correct a nightmarish system that has somehow turned against itself and run completely amuck.  They have become prisoners of their own self - they know they're broken but they don't know why or how to fix it.

There is a clear, and many would suggest, causal connection between states of addiction and states of physiological dysregulation secondary to psychological trauma.  Posttraumatic states and disorders of arousal dysregulation can be defined in the simplest of terms as a dysregulation of the pleasure, pain, and fear centers of the brains reward circuitry.  What is addiction if not a continual biochemical cocktail that feeds the pleasure centers of the brain in order to squelch the tide of unremitting pain and unmitigated fear?  Both processes are fueled by the incessant out-of-control drive to seek that ever-higher dopaminergic rush, in a failed but panic-driven mixed-up effort to self-regulate with the dream of someday finding that neurochemical homeostatic comfort zone - which does not exist if you are arousal dysregulated.  This is the very struggle for the traumatized individual who desperately seeks shelter form the perfect storm of constatnt assault -  of biochemical dysregulation and emotional and behavioral toxicity, left as a legacy for having survived the initial onslaught of exposure to trauma that they never ever asked to have happen in the first place.

Candace Pert appropriately dubbed the endogenous neuroamine, phenylethylamine (PEA), the "love molecule" (check out her 1997 book Molecules of Emotion: The Science Behind Mind-Body Medicine).  She's the one that also says "god is a neuropeptide", but we'll just have to save that juicy little morsal for another issue - if not another blog - altogether.   PEA, in addition to dopamine (DA), oxytocin (OT), and arginine vasopressin (AVP), are all neuropeptides (remember?  neuropeptides are the highly specialized neurotransmitters - brain messengers -  that talk to one another)  that are implicated in the feeling states related to sexual arousal and the "thrill" of falling in love.  You might think PEA sounds familiar if you tend to consume dark chocolate.  PEA  stimulates the CNS, producing  the rapid heart rate, flush, and "rush" of being in love.  Makes sense considering that it's an amphetamine!.  More importantly however, PEA releases DA, which we know to be the culprit behind sexual arousal, of which DA, post coitus, then stimulates the release of OT, also known as the "cuddle chemical", and AVP.  OT is secreted by DA in the anterior pituitary gland sending a wash of calmness over the body, and increasing the bodies sensitivity to touch.  More touching increases more OT, which then continues the cycle (see the post in this blog on "Prairie Voles").  OT is the neurochemical tie that binds.  This little cycle of neurochemistry is an extraordinarily important component of mammalian (again, that would be you)  bonding, trust, attachment, and love.  BUT...

When only PEA and more importantly, only DA are released  without the ensuing OT "cuddle chemical", there is simply sex without bonding, attachment, and love.  It is as if the system is all jacked up and in desperate addictive need of another "hit", as soon as possible.  There is no time to hang out and snuggle.  Uh-uh.  You are big-time DA  jonesing for another DA fix, and the very  thought  of hanging out and smelling the roses for an extended 'spoon' session with your significant other, is simply out of the damn question!  Further, when only DA is released and the release of OT is inhibited, then DA is continually released in the absence of OT.  If OT is attenuated or inhibited altogether, then the brain builds an actual tolerance to DA, and more and more DA is needed and sought, making OT a veritable thing of the past, and DA the drug-addicts drug-of-choice.  No OT - no attachment or love.  Period.  Only the ever-increased pursuit of sex with multiple partners (or at the very least, lots of "you" all by your lonesome) since DA seeks out novelty (and seeks to avoid anything like love and attachment that might get in its way)  and without OT, there is literally, no tie to bind!  This becomes the psychological equivalent of the Coolidge Effect personified.  It may also explain much of the addictive aspect and impairment in intimate bonding and attachment that many, if not all, sex addicts struggle with. 

Sex addiction is an addiction to shame.  They are ashamed of who they are and who they are not, of what they do, and of being seemingly incapable of controlling their own desires.  They are ashamed of having something that society perceives as deviant and in the same column as pedophilia.   Shame produces a rush of neurochemicals that  fuels the release of DA like little else.  Sex addicts act out.  Acting out causes severe shame (sex addicts are not sociopaths or antisocial, and feel tremendous amounts of guilt and shame on a continually spiraling basis).   They also sometimes act "in" as a way of preventing themselves from acting "out".  Either way, if they are sexual in inappropriate addictive ways, they are not sober (see the 1st article in this blog).  The prime consideration for sex addicts, just as it is for drug addicts, is to stop acting out.  But WHY do sex addicts act out?  Because of sex?  No.  Just like alcoholics and drug addicts,  acting out (take drugs) is a way to medicate or anesthetize their pain.  What are sex addicts anesthetizing?  LOVE and ATTACHMENT!  Because all sex addicts by definition also carry a NPD, they are attachment disordered.  Sex addiction comes about in the massive majority of all cases, secondary to a traumatic early childhood, either secondary to sexual abuse and/or malignant narcissistic assault from one or both parents or prime caregivers.  It completely disrupts their physiology, their limbic system is a total mess, and the end result is that they are scared to DEATH of becoming attached.  It represents a death knell for them.  I urge the reader to check out Dr Sam Valknins site for a remarkably thorough and easy-to-digest account of NPD as it relates to love and attachment.  So what is the "cure"?  Of course we don't use the "C" word, but learning to trust, bond, attach, and love, is the remedy.  How?  By doing so with someone who is very safe, in a safe and protected environment, and very, very slowly, without knowing what is happening!  How does this treat the sex addicted NPD?  Because it allows them to s-l-o-w down, to stop diving in for the DA hits by having lots of unattached sex, and when there is trust, attachment, and love, OT and AVP flow like the Trevi fountain.

To my patients in treatment I become the veritable love-hate object.  The more attached they become, the more resentment and anger and unadulterated FEAR they have for me.  In Freudian terms, it is the epitome of the Madonna-Whore complex in all its glory.  Male sex addicts, be they gay or straight, or somewhere in the middle, are generally petrified of women (though deny it with no small modicum of vehemence they initially do).  Why - refer to the previous post.  Women - that would be women with whom they are either attracted to or have respect for - the later part being in short supply - represent a mother that never attached to them, and/or protect them from a raging out-of-control malignantly narcissistic father.  Women are perceived as either exceedingly weak or embodying the power of some mythical goddess capable of snuffing out their existence with the mere blink of an eye.  Emotional castration on the half-shell.  Give away your power to one?  Tell them your secrets? Hell, fall in love with one?  Are you KIDDING me?? That would be the penultimate suicide, and not a quick one at that.  To be out of control and in total service to the one thing you so fear?  Therapy with this population is neither for the faint of heart or inexperienced.  So then.  Is treatment really possible?  For those willing to do the work, of course it is - possible and effective, and I dare say not just a tad humbling on my end.

Alcon likens childhood trauma to memories encapsulated in one of those familiar snow globes wherein he cautions  "Like falling snowflakes that obscure a miniature landscape under glass, the memories take time to settle down before the scene within slowly becomes visible" (1994, p.xviii).

 

 

Traumatic Attachment - The Neuroscience of Narcissistic Personality Disorder - Part II

      "Hidden inside modern biomedical science, there is a tale that each of us should know.  A tale of the starlight and the darkness inside, a tale of the sins of the father and the flame of spontaneous human combusion, a tale of madness and love, of faith and despair.  Wrapped up inside of that tale is a portrait of each man and woman in all our wonder, a portrait full of the intensity of life... you must take a step or two backward if you wish to see the mystery" (Callahan, 2002, p.xvii). 

While narcissism is not pathological per se, Narcissistic Personality Disorder (NPD) certainly is, and in Part I, a definition of a personality disorder was presented.  NPD is generally acquired secondary to early childhood trauma, more specifically, a toxic family life.  There is also a heritable component.  My parents used to have a plexiglass plaque that sat proudly on display in the living room.  One could not help but notice it as soon as you walked into the room.  The plaque read "insanity is hereditary.  You get it from your children."  Very funny.  With NPD, you mostly develop it secondary to your narcissistic parent or parents.  NPD is a disorder of arousal dysregulation in that the limbic system and the neurochemicals used to communicate with one another that flow in and out of the limbic system, become so disrupted and discombobulated, that the system breaks down and what is an abnormal condition becomes the new normal.  When a young child is exposed to the callous, self-absorbed, unpredictable, angry and often rageful antics and chaotic family life that centers around a narcissistic parent or two, that young child quickly learns several very important survival-oriented skills: life is unpredictable and people can hurt you - make certain your armor is impenetrable and your forcefield stays "on"; remain in complete control at all times when dealing with others, because clearly others have no control; make absolutely certain that you have or can quickly attain at a moments notice, a ready supply of dutiful admirers from those clearly more psychologically wounded than you; and remember; never let them see you sweat.  Narcissists do not have a clearly defined identity (psychopathology notwithstanding).  They know who they are based upon the responses and feedback received from other people.  If people laugh at their jokes they must be funny.  If they are told they are smart, or good looking or talented, then it must indeed be so.  It therefore behooves them to find people who will endlessly subjugate themselves in service to the needs of the narcissist.

Individuals with NPD are rather adept at not visiting the psychological places that most of us go to, in an attempt to understand and give meaning to our behavior and our lives.  People and the world at large for that matter, are instruments for their use, fair and square, and the object is to get their needs met at all costs, each man for himself.  In fairness, it should be added at this juncture, that individuals with NPD are not sociopaths and do not have Antisocial Personality Disorder (APD).  In fact, I never met an indivudual with NPD that did not genuinely think of themselves in anything other than vainglorious and stellar terms.  Until, that is, you begin to point out the glaring inconsistencies...  But therein lies the rub.  Those with NPD do not surround themselves with individuals that pose a threat to them - it is part of their well-defined defense system.  Should you make the horrendous mistake of even appearing to do or say something to challenge a directive, appear to criticize or correct their motives, or otherwise be less than completely beneficent, they will, with stunning alacrity. let you know in no uncertain terms (so quick in fact that it may take you awhile to realize you were just speared in the gut and that gurgling sound you hear as you walk away is the sound it makes when there is a gapping hole in your belly from where you were just impaled), that you have entered dangerous territory and you will be penalized for your obviously malicious expression of whatever it was, in a loud, clear, and bill-board-sized message that will make you instantly recoil and clearly regret whatever it was you said or did to them that they perceived as threatening - which by the way, may in actuality not have been threatening at all.  In a word, get too close and you will pay the price for it.  A veritable lifetime is spent perfecting their impenetrable armor and devising their always-on forcefield, such that when someone gets close enough to where the alarm is sounded, nuclear missiles are deployed without so much as a second thought.  Should you have gotten wounded in the attack, and make no mistake, you will, (which part of "nuclear" was unclear?), then it was absolutely and positively 110% your own fault for doing or saying something to sound the alarm in the first place.  I mean, hells bells, just what were you thinking??  Someone with NPD in psychiatric treatment?  Treatment for what?  For being well-defended?  If that were all of it, the story would stop here. 

Individuals with NPD are (more often than not unbeknown to themselves) angry, rageful (expressed or repressed), resentful, and fear exposure of being "found out".  Criticism, rejection, and abandonement are their death nell - they are to be avoided at all costs.  They cannot, or better said, will not, love.  NPD is about control - something they feel they must possess at all costs and in all situations.  And therein lies the narcissists paradox.  They are usually desperate for a REAL relationship with someone they admire and respect, but anyone they admire and respect would by definition be smart enough to figure them out, something they cannot afford to have happen.  So, they attract the individuals that they do not admire and respect, and with whom they often are contemptous of, because these are the individuals not smart enough or are psychologically wounded enough themselves, not to figure them out, and hence, they pose no threat to the narcissist and are by default, ammenable to being dominated or controlled.  So what is the big attraction?  NPDs are also unusually charming, APPEAR to attach quickly and well, and are generally more often than not, rather socially facile.  For a remarkable account of narcissistic personality disorder, it would be worth your while to visit Dr. Samuel Vaknin's cite http://samvak.tripod.com,  or read his book Malignant Self-Love.   Dr. Vaknin is neither a psychologist nor psychiatrist, but a physicist and well-diagnosed narcissist, with an uncanny ability to recognize and describe what he himself is all too familiar with.  Is NPD heritable?

Adults with NPD were at one time otherwise normal children with a heritable (genetic) predisposition that when exposed to one or more parents with NPD, their genetic predisposition in conjunction with their toxic environment, produced the very thing they were exposed to - narcissistic pathology.  Being the child of a narcissistic parent is in and of itself a traumatic experience, and make no mistake, one that can and more often then not, does, change the neurology and biochemistry of those living under the same roof.  This is one diagnosis whereby the sins of the parent really do visit upon the children.  How does all of this acutally happen?  How can being a narcissist change your brain and biochemistry?  The best scientific explanation I have yet to come across is still Cloninger's tridemensional model.  In Cloninger, C.R. (1986).  A unified biosocial theory of personality and its role in the development of anxiety states, Psychiatric Developments, 3, 167-226, Cloninger ties 3 genetically independent but functionally related dimensions (Novelty Seeking, NS; Harm Avoidance, HA; and Reward Dependence, RD), to specific neurobiological substrates and the interaction between genes and environment.  According to Cloninger, each of these dimensions, NS, HA, and RD, are associated with the neuromodulators dopamine, serotonin, and norepinephrine, respectively.  Cloninger defines each personality type as follows: Novelty Seeking individuals are those with "a tendency toward frequent exploratory activity and intense exhilaration in response to novel or appetitive stimuli" and when high in this category are said to be "impulsive, exploratory, fickle, excitable, quick-tempered, extravagant, and disorderly" whereas persons low in this dimension are "reflective, rigid, loyal, stoic, slow-tempered, orderly, and persistant" (1987, p.575).  Those described as Harm Avoidance are described as having "a tendency to respond intensely to aversive stimuli and their conditioned signals, thereby facilitating learning to inhibit behavior in order to avoid punishment, novelty, and frustrative omission of expected rewards".  Those high in HA are seen as "cautious, tense, apprehensive, fearful, inhibited, shy, easily fatigable, and apprehensive worriers" while low in this dimension is characteristic of being "confident, relaxed, optimistic, carefree, uninhibited, outgoing, and energetic" (1987, p.575).  Finally, Cloninger defined Reward Dependence as "a resistance to extinction of conditioned signals of reward or relief of punishment" and those high in RD are "ambitious, sentimental, and persistent" while those low in this dimension were described as "detached, tough minded, and irresolute" (1987, p.575).  In the last installment of this series, we shall see how dopamine specifically, is implicated in this disorder and its relation to sex addiction.

When growing up in a narcissistic household, one is exposed to chaotic, irrational, inconsistent, debilitating, verbally aggressive and/or physically assaultive behavior that may or may not be aimed directly at you, and eratic, inconsistent or totally absent messages of love, concern, or attachment.  The role of the child is to be the vessel for the desires of the parent.  There is no such thing as individuality, and you are no more and no less than an absolute conduit for the demands of the parent.  There is no negotiation, no debate, no individuation.  You are to become what the parent wants you to become, and your life as you know it is in service to those dictates.  Make no mistake, the narcissistic home is a dictatorship in a completely totalitarian state.  The child either willingly fulfills these demands, wishes, and desires, and knowingly and intently, sets their sights on fulfilling the wishes of the parent without further discussion, or else willfully fights tooth and nail, but realizes that he or she is no match for the powerful parent.  The fact that you are also angry beyond measure at your parents and the fact that you can never ever measure up in the eyes of the very parent that you sacrificed your life for or fought to change, has, in your understandably but nonetheless psychologically-limited and skewed perception of the world, nothing whatsoever to do with your childhood, your family, or your parents.  You have deeply internalized and thereby deduced that you are merely a defective, angry, resentful and hollow human being who couldn't even be a good-enough child let alone adequate adult.  And besides which, what does love have to do with it...  Or, you are the invisible child.  These are horrible internalizations that significantly damage and psychologically consumme the bearer.  The narcissist has, through repeated exposure, become exquisitely sensitive to criticism and simply cannot tolerate the thought of enduring any more of it.

For those that develop a Narcissistic Personality Disorder, chaos, which is by definition, an out-of-control condition, becomes the very thing to avoid, and the only way to avoid it is to shut down the entire system.   And so, to the individual with NPD, deep emotions are the enemy, and the biggest enemy of all, is love.  Love is a two-pronged problem.  First, it means that if you are experiencing it, you are also experiencing powerlessness over it.  To be in love is to be out of control.   Second, the love-object is the equivalent of a god or goddess as the case may be, replete with the power and strength to crush you like an itty-bitty bug at but a moments notice.  The object of one's love can not only crush you, but much worse than that - it can reject and eventually abandon you.  Therein lies the rub - a paradox if ever there was one.  To the disordered narcissistic personality, the very thing you were never given but desperately wanted more than anything else, is the one thing you are, quite simply put, neuropsychologically unequipped to handle. 

The Neurochemistry of Love and Attachment...  Please stay tuned for Part III in this 3-part series

incurvatus in se- The Neuroscience of Narcissistic Personality Disorder, Part I

"Amazing grace, how sweet the sound that sav'd  a wretch like me!  I once was lost, but now am found, was blind, but now I see" 

        How do we separate out from sight, that which we cannot see?

Back in the day, that would be a summer's day somewhere ca. 386 or so, the soon-to-be Bishop of Hippo, battling his own long-standing sexual demons, concubine indulgences, and out-of-wedlock dalliances, decided that Adam's narcissism (of Adam and Eve infamy) was to blame for all the worlds debauched struggles.  Not only was Adam's, shall we say, indiscretion, with Eve to blame for the Bishop's own cravings of the flesh, but Adam it seems, was to blame for all mankind's sexual thoughts, feelings, and behavior, until the end of time - the sins of the father, if you were to believe the tale, would indeed be visited upon the sons in a never-ending intergenerational nightmare of unbridled sexual upheaval and death.  According to Augustine, and backed to this very day without hesitation by the Roman Catholic Church, Adam, at the very moment of his great lapse in restraint, turned himself from what was considered man's natural inclination of outward focus (toward God), to that of the wholly unholy incurvatus in se - a life curved inward (and away from God) - and right smack into the dark and dank nebulous crevices of his narcissistic soul.  It was there, in that one forever frozen moment in time that humanity's assumed prelapsarian existence would cease forever - wherein Adam's fall from his apparent state of grace, would doom all of mankind to carnal chaos and certain death.  So saith Augustine and the Roman Catholic Church.  That Adam utterly objectified Eve, thought only of his own earthly desire without care of consequence, and certainly banished any trace of "God" or "Godliness" for that matter, from consideration, goes a long way toward the modern Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis of narcissistic personality disorder (NPD) - not to mention sexual addiction.  It has, unfortunately, taken us a mere couple thousand years or so, to grasp the part about genetics, or said another way, the neurobiological connection and intergenerational legacy of NPD, but more on this exceedingly important point a little later.  I like stories.  And I like allegories.  As allegories go, this one is up there among my favorites.  The bit about Pelagious's banishment (the one dissenting lone voice in the crowd - a veritable humanist that believed man has choice of whether or not to engage in good or evil) and any of his documents or evidence voicing objection to Augustine's morbidly skewed view of original sin and hereditary doom, promptly destroyed by the Roman Catholic Church notwithstanding, it is certainly central to the origins of narcissism and its place in the bowels of human suffering.  After all, it is the narcissistic incurvatus in se, and not sexual desire and temptation per se, that is said to be the Original Sin, is it not - depending I suppose, upon which side of the alter one is standing. And then there was Ovid...

Unlike Augustine's Confessions, Ovid's Metamorphosis, cleverly told in  dactylic hexameter, tells the story of the son of Leirope of Thespia and Cephisus the river god.  We all know the story of the handsome Narcissus, doomed to love only his shallow reflection, and the poor little nymph, Echo, equally doomed to love the reflection of a man incapable of loving her back.  The literature is filled with religious, psychological, and artistic interpretations of the myth of Narcissus.  For the psychologists and psychiatrists that diagnose and (albeit very seldom) treat it, and the lay persons that live with those afflicted with it, NPD by anybody's standards is certainly more Greek tragedy than myth.  While I whole-heartedly disagree with Augustine's (and the Roman Catholic Church in general) fanciful if not delusional fable of Original Sin, I do agree with the genetic legacy and the bit about the sins of the father (or mother for that matter) as it pertains to incurvatus in se, and having nothing whatsoever to do with sin, original or otherwise.  As we shall shortly see, while it is certainly possible, and more often than not is the case, that one can have a NPD without also being sexually addicted, it is only the case that if one is sexually addicted, then by diagnostic definition, they have NPD.  Treating the sex addicted individual is to treat their narcissistic personality disorder.  Nowhere can I think of a more fitting application of incurvatus in se, then those that are sexually addicted.

What does narcissistic personality disorder have to do with sexual addiction?  To the sex addict, they are one and the same.   

In psychiatric terms, we diagnose a personality disorder separate from any other mental disorder.  We do this, like we do everything else, by virtue of its operational definition.  A personality disorder is defined in large part as an enduring and inflexible, long-standing pervasive pattern of thinking and behaving that significantly impacts and impedes an individual's cognitive, affective, and interpersonal world, and one in which is deviant or abnormally different, from the basic cultural expectations of society.  A personality disorder will exacerbate and or skew any other presenting problem, perception, thought or feeling, about themselves, others, and the world at large, the individual may have or hold.  The old thinking was that personality disorders were immutable and unchangeable and the best that was hoped for would be a temporary gross symptom stabilization, otherwise known as a band-aid during flare-ups.  While personality disorders are among the most researched, written about, and discussed of the mental disorders, and while they continue to be fodder for many a lay person, media talking head, and most freshman psych-101 class, they remain the minority of actual psychological and psychiatric clinical cases.  Why?  Because generally speaking, and herein lies the awful rub, those with personality disorders do not see themselves as disordered - au contrare.  Because personality is so entrenched and tied to our very identity (go ahead, try and separate out the two, and while you are at it, do tell me what traits you are putting into which column), most of us cannot ferret out what is normal versus what is abnormal about who we are and how we see ourselves.  How does a personality become disordered in the first place?  The answer?  Not easily.  Unless of course we are talking the Cluster "B" personality disorders which include the "antisocial", "borderline", "histrionic", and "narcissistic" PDs.  This cluster, particularly the "borderline" and "narcissistic" PDs, the two I work with extensively, are more often than not, acquired during early childhood trauma.  These PDs in particular, are severe but protective reactions to equally severe and debilitating traumatic events (for more on this, you might want to refer to one of the earlier posts in this blog).  Although the following example pertains to psychosis and not personality, there is a rather poignant scene in the movie A Beautiful Mind, wherein the chief character, the real-life Nobel prize laureate and paranoid schizophrenic played by Russell Crowe, is sitting with his wife and psychiatrist, debating the demerits of going back to the psychiatric institution for further help (read: electro shock treatment).  Crowe says to the psychiatrist played by Christopher Plummer, "I can fix this thing" referring to his progressively disorganized and schizophrenically ill mind.  The psychiatrist says "no".  "No you can't".  "Why not, why can't I" says Crowe.  "Because" says Plummer, "it is your mind that is broken"...  Just exactly how does a broken mind fix itself let alone perceive itself as broken in the first place? 

Please stay tuned for Part II... 

 

Sex and the Bottom Line

Rarely does a week pass without my hearing the singularly disturbing slogan "I am sober from my bottom lines".  What does this mean - why might it be "disturbing" - and what is a "bottom line" anyway?  In the 12-step "Anonymous" fellowship vernacular, generally speaking, a "bottom line" refers to one's unique way or method of ritualized "using" behavior.  What does THAT mean?  It means, that a sex addict for example, achieves their sexual gratification by their preferred means, which is unique for that individual.  It might mean one person frequents "massage" parlors or "lingerie" shops, another sex addicted individual frequents prostitutes, and still another sexually addicted individual masturbates to a highly specific type of pornography on the internet.  Each of these are referred to as their "bottom line", which in turn signifies the absolute quintessential means of acting out and getting stoned, sexually speaking.  It is their most potent form of the drug, so-to-speak.  And if one's "bottom line" is some variety of internet porn, then their "bottom line" might mean staying off the computer entirely.  If achieved, then they have successfully abstained from their "bottom line" behaviors.  But wait just a minute here!  Let us not ever confuse "bottom line" cessation with drug-of-choice cessation or being sober!  If your "bottom line" is internet porn and you abstain from the internet, does that mean you are sober?  NO!  It means you are no longer using the internet.  If an alcoholic's "bottom line" is the local pub after work until closing, and that individual stays out of that and every bar on the planet, are they sober?  NO!  If that person does not ingest alcohol, they are sober.  Period.  Very simple.  A "bottom line" in no way infers sobriety.  If a sex addict does not engage in sexual activity, they are by definition, sober.  Period.  If they engage in sexual fantasy in their head and it does not lead to sexual activity (for the moment anyway!), then they are sober!  They are also only a stone's throw away from engaging in sexual activity, but that is another thread for another day.  Intention neither infers nor implies behavior - at least scientifically speaking and outside a court of law. 

The operational definition for sobriety, is very, very clear.  It means not having the drug in your system.  If you are an alcoholic, it means not having any alcohol (ethyl or otherwise) in your system.  If you are a sex addict, it quite simply means not having any sex (with yourself or someone other than you!).  Period.  In the scientific community "operational definitions" are essential components for communicating.  If your physician diagnoses you with a cracked rib, then what you have, is a cracked rib.  And you have a cracked rib whether or not you were diagnosed in Austria, Bolivia, or Paramus, New Jersey.  And you have a cracked rib whether or not you believe in the concept of ribs, and regardless of what religion, gender, ethnicity or culture you subscribe to.  Like it or not, a cracked rib is a cracked rib, and it is not subject to your belief to the contrary.  Period.  Even if you do not believe in doctors as I continuously hear people say (last I heard, doctors were not subsumed, nosologically speaking, under the category "belief system, but I digress...), you have a cracked rib whether you like it or not, diagnostically speaking.  Ditto for sobriety.  Sobriety is defined as not having that chemical in your system, or not having the chemical that is released by a set of behaviors released into your system.   It is tantamount to uttering the slogan in "AA" (alcoholics anonymous) that one is "sober from beer".  Sober from BEER?  Is that some sort of joke?  If one is sober in the "AA" fellowship, it can only mean one singular and overriding thing - that one has not consumed alcohol.  ANY alcohol.  Beer is alcohol.

There are some "S" programs, that apparently utilize variations on a theme.  What theme you understandably ask?  Bill W's theme of course!  Meaning, there is "AA" and then there are non-"AA" programs.  And according to "AA", and I might interject for the record, and the entire scientific community on the planet, in "AA", one is sober because one is not drinking or otherwise getting alcohol in their body.  Period.  If you are an alcoholic, you are sober if you abstain from consuming anything containing alcohol including cough syrup.  "AA" does not argue the point.  Why?  Because clarity is an essential ingredient when working with an addicted brain.  "Recovery" is another issue altogether, and more on that in another post.  But back to the basics.  If you are a member of "AA" and you claim you are sober, then you are claiming you are free from the ingestion of alcohol.  Period.  If you are a member of "NA" (narcotics anonymous) and you are claiming you are sober, then you are claiming you are free from the intake of drugs.  Period.  Pot is a drug, and if you are smoking it, eating it, or otherwise having it in your body, you are not sober.  Period.  So why all the fuss?  Because for whatever reason (and actually it is precisely the rationale that is so disturbing - but more on this later), the "S" program, some "SLAA" programs in particular, not only think it is OK to break this spectacularly crucial point of the program, but it actually  encourages it's members to  talk in terms of being sober from their "bottom lines".  This is not only a break in the operational definition of "sobriety", but it in fact, prevents the sexually addicted addict from being or staying sober in the first place!  How so?  Because one of the most common misconceptions in the entire "S" fellowship, is that it makes a difference whether or not you engage in sex with your self (AKA masturbation), or whether you engage in sex with a person other than you!  Let us be very, very clear here.  Your brain does not know the difference WHO it is having sex with.  It simply knows that a particular part of your brain lights up like a Vegas slot machine when sex occurs. 

When a sex addicted individual engages in sex, they are, so-to-speak, off to the races, such that a barrage of dopamine (among other neurochemicals) are released which in turn prevent adequate (or any) amounts of the important neuropeptides vassopressin and oxytocin from release, and the executive functions of the predominantly right prefrontal cortex becomes anesthetized or numbed, and you are, in a word, stoned.  The non-sober sex addict is dopaminergically drunk, and at that point, what you did or did not do with or to your "bottom line" could not be more irrelevant.  The "bottom line" helps the addict to recognize and understand their triggers, behaviors, and other important psychological factors.  But please, let us not use the horridly inaccurate and dangerously misleading slogan of being SOBER from a "bottom line".  The reason the 12-step programs work so well is based upon two important and overriding original concepts of Bill W.  He stated that sobriety is achieved and maintained in fellowship with other alcoholics, and that the message which must be carried to and by addicts everywhere, is simple to understand, straightforward in its intention, and standardized in its message.  He did not know about the science of the brain, just like calcium-deficient children who chew on chalk did not know they were calcium deficient (chalk from the now outdated slate chalk boards are calcium-based which is why "Tums" tastes like chalk!).  Nonetheless, the message must be that only when the sex addict has approximately 90 days of no sex, can their brain begin to heal and their recovery begin.   

Sex, Love, and the Prairie Vole

Kevin Hogan over at bodylanguageexpert.com just published a piece featuring the incredibly important 1997 article by Insel on "pair-bonding" in, of all things, the prairie vole.  But wait just a minute - what does a vole, I mean a vole of all the marsupialesque things, have to do with love, sex, and attachment?  Everything, as it turns out.  In his article A Neurobiological Basis of Social Attachment, Insel demonstrates that the little creatures operate in much the same way we do when it comes to sex, love, and attachment.  The neurochemicals dopamine, vasopressin, and oxytocin, are intricately involved in our ability (us and the voles) to mate, and bond, or as the case may, to bond and then mate.  Follow this if you will, "if mating facilitates pair bond formation and oxytocin is released with mating, does oxytocin influence the development of the pair bond?" The answer is "yes".  In other words, if we were to shamelessly inject you with a drug that would block your brain's ability to release the neuropeptide oxytocin, you would be able to engage in sexual activity (because of all that wild dopamine running around through your brain) with pretty much anyone who was remotely available and conscious and then you would be more than capable of moving on to the next available person just like you did with the first, and so on and so on - without so much as a tad of the "guilts".  In other words, "preference" or "selectivity" and "attachment" and "monogamy" would be moot points.  This is precisely what Ansel did with those marsupials.  Did you know those little critters are monogamous?  And did you know that the monogamous voles released different amounts of these neurochemicals, and distributed them to different regions of the brain, than did the voles that were not monogamous?  Oxytocin and vasopressin are neurohypophyseal peptides that are implicated in an array of complex social behaviors, attachment and bonding being among them.  Oxytocin effects or modulates maternal bonding behaviors, while vasopressin modulates paternal bonding behaviors.  Furthermore,  Oxytocin appears to regulate dopamine secretion, and dopamine secretion, without oxytocin, is like sex without any attachment.  And without attachment, the brain is free to continue producing dopamine, which directly (do not pass "go") hits the pleasure centers of the brain, with nothing to stop it or regulate it from continuing in a seemingly never-ending spiral of being dopaminergically stoned.  Think of a kid in a candy store and you understand what I mean.  Hmmm... sound like sex addiction?  Exactly like sex addiction!  And how might all of this neuropeptide soup go awry?  Since so much of it is released in the very early years of neurodevelopment to the limbic system, and since dopamine has such an abundance of projections into the prefrontal cortex (PFC), early childhood trauma can (and does!) easily dysregulate these neuropeptides.  Is it a done deal?  No.  As Kevin points out early on in his posting, there is hope.  But not just hope, actual remedy, and that is a wonderful thing...

welcome to the premiere of the sex addicted brain! blog

                          ...and oh what a ride it has been!  Who would have thought that 5 years ago - no, make that 2 years ago, an entire website would be devoted to sex addiction?  Sex addiction as a field (yes, I said "field") let alone an actual diagnosis, is today, where alcohol was less than 50 years ago - in the proverbial closet, despite the burgeoning population of alcoholics then, and sex addicts now, that were then and are now, continuing to suffer and die.  Take away the alcohol from an alcoholic and they are still alcoholic, they are simply no longer drinking.  It has taken us awhile, but we know that addiction is not about the drug or in this case the alcohol.  It is about the disease, biologically speaking, and the emotional pain they are anesthetizing.  Similarly, sex addiction is not about sex.  Rather, sex addiction is the end result, so to speak, of childhood trauma.  Make no mistake, adult sexual addiction is about early childhood trauma.  During critical period of neural development, the prefrontal cortex (PFC) is still developing, and in fact, is the very last structure of the brain to develop, through the process of myelination.  The PFC (located just above your right eye and a couple of inches inward) is the part of the brain that is responsible for the things we think of when we think of personality such as impulse control, planning, judgment, attention, social appropriateness, sexual drive, etc.  It takes the PFC at the very least, 15 years to develop, and anything untoward that might occur during this period of development can wreck havoc with the brain, and can, in fact, actually change the brain, even when there was nothing physical done to it.  What do I mean by "untoward"?  I mean trauma.  Psychological trauma in fact.  Sexual trauma certainly, extreme and out of control rage, as in growing up with a malignantly narcissistic parent for sure, and certainly physical abuse, even if the abuser never touched the child's head.  During critical periods of neural development, generally between ages 2-8 years of age, and sometimes until age 15 years, extreme and unremitting stress and psychological trauma can and does change both the structure and the chemistry of the brain!  As if that was not enough, the limbic system, that area of the brain responsible for what my students know as the "4 f's", feeding, fighting, fleeing, and sex, are also developing, much like everything else when you are a kid, and so it too, becomes disrupted and dysregulated when subjected to extreme stress.  The job of the brain and the body is to stay or return to homeostasis and that is what it will always try to do.  If your brain has become dysregulated for what ever reason, during the time it was still developing, it will do its level best to return you to that same state.  If your brain and body were traumatized during these crucial developing years, then your brain and body would think that the chaos or trauma was normal and it would always try and return you somehow, to that "normal" state.  What does all of this mean?  It means that if the brain thinks that "normal" is actually a state of emotional chaos or stress, otherwise known as "arousal",then your brain and body will continually try to return you to, or keep you at, that chaotic or highly aroused state, becuase it thinks that a state of high arousal is normal.  Sex is one of the easiest and quickest ways to achieve arousal.  It means that early childhood trauma disrupts the brain and body, and that certain types of trauma will cause certain types of adult pathology.  Early sexual trauma is responsible for adult sexual addiction.  Not always, but in many cases.  Sexual addiction is almost always about early childhood trauma.  And what is sexual addiction exactly?  It is a multifaceted co-occurring obsessive-compulsive spectrum disorder that includes varying degrees of obsessive-compulsive and impulse-control disorders, as well as significant disruption to mood, arousal, affect regulation, attachment, and executive function, and includes an axis II narcissistic personality disorder, or at the very least, traits thereof.  It is about the inability to attach in a meaningful, non-objectifying and healthy way.  It is about the addiction to the neurochemical dopamine and not enough release of oxytocin.  It is a painful way to live, made that much worse by those that do not understand it.  I remember reading about the return of the hostage, Terry Keenan when he was freed from Iranian capture back in the 80s.  Upon his release in 90, he made a statement that applies to anyone held hostage, emotionally or physically.  He said hostage is a crucifying aloneness.  It is a man hanging by his fingernails over the edge of chaos, feeling his fingers slowly straightening.  Hostage is the humiliating stripping away of every sense and fibre of body and mind and spirit that make us what we are.  Hostage is a mutant creation filled with fear, self-loathing, guilt and death-wishing.  But he is a man, a rare, unique and beautiful creation of which these things are no part. (Keenan, 1990).  Sounds like addiction to me.  Thanks for stopping by...