My Patients Come and Go, That’s the Good News

Usually, it’s the wife who calls me.

She and Joe married five or ten years ago and have a couple of kids. He’s a professional. Both are college-educated. A few days ago, she saw something on his phone – a text string, a porn trail – and confronted him. (He seemed almost relieved, she says.) Her first impulse was to leave him, but they have kids, and she’s home full time, and what does she tell her parents and their church?

The next day while he’s at work, she googles and finds my practice and calls me. That night, she lays it out: “Joe, you’re gonna see this guy.”

For the moment, he is relieved. “Finally, someone finds out, and maybe I can stop,” he’s thinking. The last thing he wants is for his marriage to end, and he comes to my office hoping he can get better. The more she thinks about it, she wants that, too, so she holds his feet to the fire.

Me? I’m after Joe, every bit as hurt and scared as his wife. The chaos in his head has gutted all pleasure or intimacy or love from sex and life, and he’s trapped. In my office he unloads, tense and in tears.

With hypersexuality, I tell him, enough despair to want to change is a process. If he’s in my office, he’s probably in the process, and he can get better. I tell him from here on, nothing gets worse than the hell he’s been in.

Joe’s Not Alone

Though the label of sex addiction is widely debated in some circles, few professionals question the groundswell of symptoms aggravated by aggressive porn and easy sex with strangers. If you miss the evidence in the next cubicle at work, you see it in splintering families or the headlines churning around names like Charlie Rose, Russell Brand, Michael Douglas, and Tiger Woods.

This year for the first time, the Journal of the American Medical Association profiled a study of “compulsive sexual behavior,” or CSB, defined as inability to control sexual feelings, urges and behaviors, causing distress and impairment. Something’s going on, all right, the study concludes, calling CSB’s high prevalence a “sociocultural problem” and significant clinical problem.

Meanwhile, on the ground level, the men living in the compulsions know that a onetime escape has become a narrow cage, and these are the men I serve.

“It’s in Your Head”

Sex addiction is a brain disease, which is good news because the brain can change. (Google neuroplasticity.) In brain canals cut deep, a sex addict’s responses flow to secret porn, anonymous sex, drugs and alcohol, even though he’s tried to change.

“I love my wife and kids and my job,” Joe says, his head in his hands. “Why do I do this?”

First, the canals didn’t form overnight, and second, the driving problem is not about sex. “Your addiction – the porn, the anonymous partners, or affairs, or whatever – is the symptom,” I tell him. “The problem is an unresolved grievance.”

Unresolved grievance means past trauma . . . or neglect, or some other form of abuse active around age 11 when Joe, confused and hurt, discovers sex, most likely through pornography, most likely in Playboy. Here’s relief, he thinks: exciting, pleasurable, and most of all secretive. Secrets are what hold addictions together.

In his addiction, what seems like high energy is Joe burning through a checklist of acting out: overachieving and turmoil, self-absorption, secrecy, grandiosity, guilt, unreasonable behavior, compulsive busyness, rage, drama and intensity. Freedom will come not overnight, but over time, but it can come. What manifested for so long as mania can re-channel into mental health, coping skills for inevitable difficulties, and a payoff in love and intimacy.

In a New Zone

Because Joe has a brain and a mind. “Renew your mind and re-channel your brain,” I tell him. As therapy opens Joe to deliberate, conscious, intentional thinking, new canals re-channel old reflexes. Like an athlete finding his sweet spot, Joe finds “the zone,” a mental place with focus, purpose, and mental control of physical impulses.

It’s possible for Joe to trust himself and his wife, to sleep and have real rest. Relationships can change; he can know his family members for who they are, and he can be present in their lives.

Joe’s problems won’t leave, but the old chaos gives way to new ways of coping. Therapy isn’t a trip to Disneyland, it’s a trip to the hospital, and that’s the good news.

His wife will back that up.

Published CdA Press Saturday, Jan. 19, 2019