NYC Therapist Talks: Mental Illness, Sex Addiction & The Symptom Pool

NYC Therapist recommends the book  “Crazy like Us: The Globalization of the American Psyche” by Ethan Watters. Watters discusses the concept of the “symptom pool”, which is what informs the manifestations of mental illnesses like anorexia, for example.  In other words, we express our internal conflicts in ways that make sense to those around us, and that whatever time period and whatever culture we are in, these may change.  In the 19th Century, the mental illness of the day was hysteria.  Hysteria, as it was studied, debated, presented and “treated”, took hold in the public unconsciousness, and included symptoms ranging from day blindness to fainting to leg paralysis (think fainting couches).  Eventually, hysteria presented at the therapist or doctor’s office with so many symptoms, that it wasn’t a valid way to express internal strife anymore, so it sort of died out.

Modern mental health clinicians shudder when thinking of those dark times in mental health, yet the same thing seems to exist today.  I’ll let you read the book to get Watter’s examples, but my favorite quack diagnosis is sex addiction, which in the DSM- V may come to be known as hypersexuality.  Through the years, sexually driven behavior has been known as nymphomania, furor uterinus (how DARE women have a sex drive?!), Don Juanism (they had to butch it up for men), satyriasis, sexual compulsion, and the list goes on.  The problem with this is when therapists and the rest of the mental health community lets itself become confused with the self-help/12-step community in the eyes of the media and the public, or when mental health professionals themselves begin to add to the public unconsciousness ways in which to express internal conflict with sexuality, then people will start to behave in those ways.
Okay that wasn’t my favorite paragraph, but let me clarify.  Billy is sexually confused and frustrated.  He is carrying around so many mixed messages about sexuality from parents, church, friends, the media, school, etc, that he has no idea which end is up (pun intended).  Billy sees stories about Tiger Woods everywhere he turns- Tiger Woods the sex addict, who has the disease sex addiction, who is being treated at a sex addiction clinic, where they treat other sex addicts.  Then there is the inevitable talking head, which may or may not use Dr. in front of his or her first name (Phil, Laura, Drew, Ruth), who pontificates about the destruction this horrible mental illness leaves in its wake and who gives some terrible statistic about the number of people possibly afflicted and the warning signs.  Welcome to the symptom pool, people.  You just told Billy and a bazillion people a moralistic, emotionally loaded opinion gussied up as psychological fact and totally informed how our Billy will present in my therapy office.  (“Dr. DeMarco – I’m married, but I had sex with someone else, so clearly I am a sex addict and need your help before it’s too late.” “Dr. DeMarco, my wife caught me watching porn and we are hear to deal with my porn addiction.  Please help. Oh yes, I am also unemployed and have nothing to do for hours on end, but it must be a cybersex addiction. Etc, Etc) So the theory is, if we start saying sex addiction symptoms may involve rainbow parties, or sexting or restless leg syndrome, then people will start coming in with those symptoms because they are unconsciously choosing what is understood in this place and time to be a valid way of expressing their internal conflicts with sexuality.  (And restless leg syndrome is just silly in and of itself – let the hate mail commence!)
Can sex be self-defeating and self-destructive?  Yes.  So can fantasy football.  So can real football.  So can getting your nails done.  This goes back to what is going on in our head and the inability to accept reality.  If the reality is you are unhappy in your relationship and are going to mount anybody except the body you chose to marry, and you’re belief is that divorce isn’t an option, then who wouldn’t have some sort of messed up behavior as a consequence of that belief.  And sex feels good, so as far as consequences go, you could do a lot worse.  In my therapy sessions, it’s about saying- okay, is this behavior causing more harm than good? Can we work on time management?  Can we work on the underlying relationship and/or sexual conflicts?  Can we work on you not beating yourself up because you have a sex drive and making that reality work for you and not against you?  Maybe the problem isn’t a high sex drive.  Sometimes the problem is being in a relationship that isn’t working. Sometimes the problem is being in a socially engineered relationship to begin with.  Regardless, the more we advertise the pathology du jour, the argument is that we aren’t finding it because we now know what to look for.  The issue is maybe we as therapists are helping to cause the pathology and shape the experience of the pathology by talking about Tiger Woods and 12 step programs so damned much!

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