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Trust a Scientist: Sex Addiction Is a Myth

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By Jim Pfaus

A psychologist explains why sex addiction therapy is more about faith than facts, as told to Tierney Finster

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Self-labeled sex addicts often speak about their identities very clinically, as if they’re paralyzed by a scientific condition that functions the same way as drug and alcohol addiction. But sex and porn “addiction” are NOT the same as alcoholism or a cocaine habit. In fact, hypersexuality and porn obsessions are not addictions at all. They’re not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and by definition, they don’t constitute what most researchers understand to be addiction.

Here’s why: addicts withdraw. When you lock a dope fiend in a room without any dope, the lack of drugs will cause an immediate physiological response — some of which is visible, some of which we can only track from within the body. During withdrawal, the brains of addicts create junctions between nerve cells containing the neurotransmitter GABA. This process more or less inhibits the brain systems usually excited by drug-related cues — something we never see in the brains of so-called sex and porn addicts.

A sex addict without sex is much more like a teenager without their smartphone. Imagine a kid playing Angry Birds. He seems obsessed, but once the game is off and it’s time for dinner, he unplugs. He might wish he was still playing, but he doesn’t get the shakes at the dinner table. There’s nothing going on in his brain that creates an uncontrollable imbalance.

The same goes for a guy obsessed with watching porn. He might prefer to endlessly watch porn, but when he’s unable to, no withdrawal indicative of addiction occurs. He’ll never be physically addicted. He’ll just be horny, which for many of us, is merely a sign we’re alive.

There haven’t been any studies that speak to this directly. As such, the anti-fapper narrative is usually the only point discussed: Guys stop masturbating after they stop downloading porn, and after a few days, they say they’re able to get normal erections again. This coincides with the somewhat popular idea that watching porn leads to erectile dysfunction, a position that porn-addiction advocates such as Marnia Robinson and Gary Wilson state emphatically. (Robinson wrote a book on the subject, though her degree is in law, not science, and Wilson, a retired physiology teacher, presented a TED Talk about hyperstimulation in Glasgow.) These types of advocates are wedded to the idea that porn is an uncontrolled stimulus the brain gets addicted to because of the dopamine release it causes. According to their thinking, anything that causes dopamine release is addictive.

But there’s a difference between compulsion and addiction. Addiction can’t be stopped without major consequence, including new brain activity. Compulsive behavior can be stopped; it’s just difficult to do so. In other words, being “out of control” isn’t a universal symptom of addiction.

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Then what, exactly, does it mean when Tiger Woods and Josh Duggar go to rehab for sex addiction? Or when Dr. Drew offers it up on TV for washed-up celebrities? The answer is simple: They’re giving free marketing to the new American industry of sex addiction therapy. Reformers Unanimous, the faith-based treatment program chosen by Duggar, is likely to gain a number of new patients thanks to the media frenzy surrounding his admission to their facilities after the Ashley Madison hack exposed the affairs Duggar blamed on porn addiction.

These programs are similar to traditional 12-step models, except even more informed by faith. By misdiagnosing patients from the start, they gloss over the underlying issues that might make someone more prone to compulsive sexual behaviors, including Obsessive Compulsive Disorder and depression. Plenty of compulsive and ritualistic sexual behaviors aren’t addictions; they’re symptomatic of other issues.

Unfortunately, that’s just scratching the surface of the faulty science practiced by these recovery centers. For instance, according to proponents of the sex addiction industry, the more porn someone watches, the more they’ll experience erectile dysfunction. However, my recent study with Nicole Prause, a psychophysiologist and neuroscientist at UCLA, showed that’s absurd. While advocates of sex and porn addiction are quick to correlate the amount of porn a guy looks at to how desensitized his penis is, our study showed that watching immense amounts of porn made men more sensitive to less explicit stimuli. Simply put, men who regularly watched porn at home were more aroused while watching porn in the lab than the men in the control group. They were able to get erections quicker and had no trouble maintaining them, even when the porn being watched was “vanilla” (i.e., free of hardcore sex acts like bondage).

There is, of course, other evidence that porn isn’t a slippery slope to physical or mental dysfunction. A paper just came out in the Journal of Sex & Marital Therapy from German researchers that looked at both the amount of porn consumed by German and Polish men and women and their sexual attitudes and behaviors. It found that more porn watched meant more variety of sexual activity — for both sexes.

Despite these results, there’s still an entire publication, Sex Addiction & Compulsivity, committed to demonstrating that porn creates erectile dysfunction. Its very existence suggests sex addiction and its treatments are real, yet the journal doesn’t take a stance on any particular treatments. And while its resolutions come from peer-reviewed articles, these articles only get reviewed by people who already believe in the notion of sex addiction.

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Which is why the journal has zero impact. The number of times a scientific journal gets used in other scholarly work is measured by something called the Journal Citation Reports (JCR). That number determines a journal’s official impact factor. So far, Sex Addiction & Compulsivity has a JCR impact factor of 0.00. Nobody cites anything from it, except maybe their own cult of followers who publish on blogs and personal websites.

The journal benefits from a very 21st century way of creating a veneer of objectivity. As long as there are papers in it, people can cite them as “scientific.” Even if the work — and the people who oversee it — are anything but. An influential associate editor there is David Delmonico, a professor who runs an “internet behavior consulting company” that offers “intervention for problematic Internet behaviors.” He believes sex addiction is real because he’s wary of the supposedly horrible effects the internet (and all the porn there) can have on human behavior.

Such porn-shaming isn’t all that different from the guilt conservatives attach to sex, even though conditioning men to feel bad about their sexual behaviors only leads to the kind of secretive, damaging behaviors evidenced in the Duggar story. What’s worse: when sexuality is labeled a “disease” like addiction, guys no longer have to own their sexuality — or their actions. It’s unnecessary to explain why they cheated because it’s beyond their control. And so, the “addict” stigma is preferable because it’s one they can check into rehab and recover from. Being considered an “adulterer,” on the other hand, is harder to shake.

Complete Article HERE!

Family History and Addiction Risk: What You Need to Know to Beat the Odds

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You grew up in a family of substance users. You know that your risk for developing an addiction to drugs or alcohol is greater because of this hereditary factor. But what exactly are your risks? And is there anything you can do to reduce your risk?

According to the National Council on Alcoholism and Drug Dependence (NCADD), the single most reliable indicator for risk of future alcohol or drug dependence is family history. In an article written for NCADD, Robert Morse, MD, former Director of Addictive Disorders Services at the Mayo Clinic and member of NCADD’s Medical/Scientific Committee, says, “Research has shown conclusively that family history of alcoholism or drug addiction is in part genetic and not just the result of the family environment…millions of Americans are living proof. Plain and simple, alcoholism and drug dependence run in families.”

How Family History Affects your Chances for Addiction

Family history affects your chances of addiction in many ways. Genes are one important factor. But alcoholism and drug addiction are “genetically complex.”

Recent research has identified numerous genes, and variations within these genes, that are 005associated with the addictive process. One way genes affect a person’s risk for addiction involves how genes metabolize alcohol. Another is how nerve cells signal one another and regulate their activity. Such changes in genes can be passed down from one generation to another.

Perhaps the strongest evidence for heredity’s role in addiction comes from twin studies and adoption studies. Studies of twins found a 60% rate of similarity regarding addiction in identical twins vs. a 39% rate of similarity in fraternal twins. Studies of children adopted in infancy and studied for addiction risk in adulthood found that biological sons of alcoholics were four times more likely to become alcoholics, even when the adoptive parent had no issues with addiction, so the l factor of family environment was minimal.

But genetic predispositions are not the only factor in predicting the role of family history in addiction risk. Environmental aspects also play a role, even though they may be less significant in some cases.

Researchers have identified several family-related risks for increased vulnerability:

  • Family dysfunction (conflicts or aggression)
  • A parent who is depressed or has other psychological issues
  • One or more parents who abuses or is addicted to drugs or alcohol

Additional social and personal issues that contribute to risk include:

  • Limited social skills
  • Fragile self-esteem
  • Minimal or no support system
  • Personal history of impulsivity, aggression or difficulty managing emotions
  • A history of trauma or abuse (high risk for post traumatic stress)
  • Other psychiatric disorders such as depression, anxiety or bi-polar disorder
  • Friends or acquaintances who are regular users and who provide easy access to drugs or alcohol

Addressing and Reducing Risks

An alternative viewpoint regarding a family history link for addiction comes from a National Institute of Health (NIH) meta-study of 65 published papers documenting 766 study participants who were college or university students. Controlling for alcohol consumption and use disorders, family history was reviewed as the variable. The meta-study found that students who had family histories of alcohol or drug problems did not drink more but they were likely to be more at risk for problems that are associated with drug or alcohol use (ex: causing shame or embarrassment to someone; passing out or fainting; or having problems with school).

The bottom line is that there are still a lot of uncertainties when it comes to assessing drug and alcohol risks as they relate to family history. The good news is that even if you come from a family with a troubled history, or a history of addictions, that does not mean you will automatically become an addict. The risk is higher, but there are ways to prevent that from happening. You can choose to be proactive and greatly reduce your addiction risk.

Here are a few suggestions to reduce your addiction risk:

  • Avoid under-age drinking or substance use; early-onset of use increases risk
  • Choose abstinence or carefully monitor your consumption
  • Avoid associating with heavy drinkers or substance users
  • Manage your psychological health; seek assistance from a mental health provider if you are highly stressed, anxious or depressed
  • Participate in workplace or school prevention programs

Intervention Strategies

Should you already find yourself dealing with an alcohol or drug issue, here are some intervention strategies provided by the National Institute of Health, in their publication, Alcohol Alert:

  • Motivational Interview: This strategy focuses on enhancing your motivation and commitment to changing your behavior, if you are currently abusing drugs or alcohol. Typically you would work with an addictions counselor or mental health professional and discuss your beliefs, choices and behaviors associated with substance use. The purpose of the interview is to help you develop a realistic view of your use, problems associated with it and your treatment goals and expectations.
  • Cognitive–Behavioral Interventions: These strategies are taught by a counselor or therapist, or they can sometimes can be accessed via an online self-help program. They help you change your behavior by helping you recognize when and why you drink excessively or use illegal substances. Cognitive-behavioral approaches challenge irrational expectations about substance use and raise your awareness of how drugs or alcohol affect your health and well-being. They provide tools for mentally and emotionally addressing denial, resistance, self-criticism and shame.
  • Drug-Free Workplace programs: Many workplaces now help their employees who are abusing alcohol or drugs. Lifestyle campaigns encourage workers to ease stress, improve nutrition and exercise, and reduce risky behaviors such as drinking, smoking, or drug use. Other programs promote social support and volunteerism. Many Employee Assistance Programs offer employees referrals to substance abuse or other treatment programs, and may help pay for treatment.

Remember, the risk for alcohol and drug addiction does run in families. But you can manage the risk and avoid an addiction problem in your own life. Be proactive in monitoring your substance use, manage your mental and emotional health and seek support if you need it. The final outcome will depend on you and the choices you make today, not on your history.
Complete Article HERE!

“Porn” problems unlike any known addiction in largest neuroscience study

Like I’ve said all along…

When studying addictions, there are known relationships between certain stimuli and reactions in the brain. These reactions have, in some instances, become the benchmark for what constitutes an addiction and addiction-based behaviors.  There has been heated debate over the very existence of porn “addiction” and what that addiction would look like when studied.

porn addiction, no such thing

In the largest neuroscience study of porn addiction to date, research conducted at UCLA found a clear reversal of the brain’s typical addiction response in study participants when they were shown sexual images. With the use of brain wave monitoring, participants who reported major problems controlling their viewing of sex films showed decreased brain reactions when shown the sexual images, rather than heightened activity as having a “porn addiction” would suggest.

The study shows that the brain does not react the way an addict’s brain would react to cues for their drug of choice. In fact, the study shows that the hypothetical “sex addict” brain reacts in the opposite way that a drug addict’s brain reacts, questioning whether sex addiction actually exists.

“This finding is important, because it shows a reversal of a part of the brain response that has been consistently documented in other substance addictions and gambling disorder,” Prause said. She also noted that this was consistent with their previous study, in which participants served as their own control and no relationship existed between the severity of their sex film problems and their brain response.

Many self-identified “hypersexual” people say they have an uncontrollable urge for sexual stimuli, and that it has resulted in negative life consequences such as loss of jobs or loss of relationships. For this reason, many clinicians have suggested that “sex addiction” be diagnosed much like drug addiction.

“While we do not doubt that some people struggle with their sexual behaviors, these data show that the nature of the problem is unlikely to be addictive,” said Prause.

The study involved 122 volunteers, both men and women. Some had problems controlling their viewing of sex films and met suggested criteria for problem use of pornography by three different questionnaire measures. Others denied any problems with their viewing of sex films. The 122 participants viewed images and were monitored using electroencephalography (EEG) that measures brain waves. The images were of sexual and non-sexual scenes. They included photos of people skydiving and of a man and woman engaging in intercourse, among others.

The study measured the late positive potential (LPP). Co-author Greg Hajcak described, “The LPP reflects electrical activity of the brain that is recorded at the scalp and time-locked to the presentation of pictures.” The LPP is a very common measure in studies of emotion. “The size of the LPP reflects the intensity of an emotional response, and reflects brain activity occurring in the visual system and ancient subcortical structures,” explained co-author Dean Sabatinelli.sex-addiction

“Hundreds of studies have found that the LPP is larger for emotional compared to neutral pictures,” described Hajcak, “and previous work from myself and my colleagues have shown that cocaine addicts have an increased LPP to cocaine-related pictures.” To test for correlation with hypersexuality, one would expect the brain to show high rates of activity when shown sexual images. In this study, a reverse effect was shown.

“The extent that individuals struggle with attempts to control urges or other internal states such as thoughts or emotions may change how problematic pornography viewing becomes,” co-author and psychologist Cameron Staley added. “Labeling a person’s attempt to control urges a ‘sexual addiction’ may interfere with therapy approaches such as Acceptance and Commitment Therapy (ACT) that can reduce distressing sexual behaviors.”

The study appears in the current online edition of the scientific journal Biological Psychology (http://www.sciencedirect.com/science/article/pii/S0301051…).

Authors on the study are Dr. Nicole Prause, Liberos LLC (http://www.liberoscenter.com); Dr. Vaughn R. Steele, The Mind Research Network, UNM-Albuquerque; Dr. Cameron Staley, Idaho State University, Pocatello, ID; Dr. Dean Sabatinelli, University of Georgia, Athens, GA; Dr. Greg Hajcak, Stony Brook University, Stony Brook, NY.

This research was conducted in the UCLA Department of Psychiatry and Biobehavioral Sciences (http://www.psychiatry.ucla.edu/), which is the within the David Geffen School of Medicine at UCLA for faculty who are experts in the origins and treatment of disorders of complex human behavior. The lead author is the founder at Liberos LLC, a company in the UCLA startup program devoted to neuroscience research and the treatment of human sexual problems.
Complete Article HERE!

Sex Addiction, or Too Much of a Good Thing?

This last post of 2010 will start with a declaration. One of my famous “Thus Sayeth Dr. Dick” sorta things, if you please.

Ready?

I categorically reject the concept of sexual addiction that has been floating around in the popular culture for the last 20 years or so.

And yes, I know this will rankle a bunch of you, but you’ll just have to get over it. You see, there is no such thing as a sexual addiction. Period!

Nowadays people bandy about the term addiction as if it can be applied to any and all obsessive behaviors. I have an addiction to chocolate; I’m addicted to shopping; I’m addicted to video games; I’m addicted to porn—or, I’m a sex addict. NONSENSE!

That being said, I hasten to add that I do believe there are sexual obsessions and compulsive sexual behaviors, plenty of ’em in fact. However, obsessions and compulsions are not addictions, and addictions, while they may involve irresistible impulses, are not the same thing as compulsions. Get it? Got it? Good!

I want to be absolutely clear about this. An addiction is a very specific condition. It denotes a dual dependency, physical as well as a psychological.

  • A physical dependency occurs when a substance is habitually used to a point where the body becomes reliant on its effects. The substance must be used constantly, because if it is withheld, it will trigger symptoms of withdrawal.
  • Psychological dependency occurs when the substance habitually used creates an emotional reliance on its effects. There is no functioning without it. Its absence produces intense cravings, which if not fed will trigger symptoms of withdrawal.

Check it out. With the help of my handy-dandy dictionary, a good place to start in discussions of this sort, I discovered these three very distinct definitions:

Addiction: The need for and use of a habit-forming substance (as heroin, nicotine, or alcohol) characterized by well-defined physiological symptoms upon withdrawal. Broadly: persistent use of a substance known by the user to be harmful. A state of physiological and psychological dependence on a drug.

Compulsive: Driven by an irresistible inner force to do something; i.e., a compulsive liar.

Obsession: A persistent disturbing preoccupation with an often unreasonable idea or feeling.

See? Different words. Different meanings. Not a particularly complex notion to grasp, right?

And listen, just because a bunch of yahoo afternoon talks show hosts and even a load of my esteemed professional colleagues banter these words about like they were interchangeable doesn’t make it so. In fact, we do ourselves a huge disservice by muddling these very specific concepts into a jumble. My fellow therapists should be the first to recognize this because finding help for an addiction or an intervention for an obsessive/compulsive disorder will be as specific as the problem itself.

One thing is for certain: identifying one of the things, as the other will complicate the problem solving. It’s like going to the doctor with a headache, and when the doc asks where does it hurt, you point to your stomach. It just won’t do.

Hi Dr. Dick,
I recently found out my boyfriend has been cheating on me. He wants me to forgive him, but he keeps on doing the same thing over and over again. He’s like addicted to sex or something. I love him very much, but I feel dirty just by being around him and knowing what he’s doing. It also makes me feel stupid putting up with all of this and at the same time I still love him, please give me some advice. Thank You.
— Darlene

Before we turn our attention to your boyfriend’s behavior, let me make a quick observation about you. You’re a big fat ball of contradictions, huh? How can you say that you love the person that makes you feel dirty and stupid? You’re deceiving yourself about at least one of those feelings. And if I had to guess, I’d say what you’ve got with your man ain’t love—it’s an obsession.

Your boyfriend probably has you figured out by now, and he knows that you will tolerate his misbehavior, which gives him tacit permission to do whatever he feels like doing. From where I sit, you’re the real sap. If you’re really serious about reining in your wayward BF, you’d better come up with a clear, unambiguous message about what you will and will not tolerate. Until you do precisely that, he’ll just think that he can roam wherever he wants and whenever he wants.

If the two of you are supposed to be living in a sexually exclusive relationship, and he’s taking his business elsewhere, then he’s got a problem, too. However, I caution you against thinking that his sexual behaviors are an addiction. Because they’re not.  And thinking they are will not help you find the solution to the problems you folks are having.

There are root causes for his behavior, just like there are root causes for your behavior. To get to the bottom of all of this, each of you will need to invest a good deal of time and energy with a qualified therapist. One can only hope that there’s a big enough bank of goodwill between the two of you to carry the day because overcoming your obsession and his compulsions will demand all of your emotional resources.

Dear Dr. Dick,
I have been in a relationship for five years now and truly love my partner, however I can never seem to get enough sex. I am 30 and he is 29, but I constantly find myself in the chat rooms lookin’ for younger guys to have sex with. It’s more than just a hobby—it’s a habit! I’ve actually lost jobs because he’d be out of town and I’d spend almost every waking hour on the PC with a cocktail looking for sex, not caring about anything else. It’s like I’m addicted to sex. He knows I have played around (I actually have talked him into three-ways a few times), but he has no idea how extreme it’s become. I don’t know what’s wrong with me. I’m not unhappy with him. I just can’t seem to stop wanting sex with younger guys. Any suggestions?
— Brian

It’s interesting that you should tell me about your compulsive sexual behavior in the same breath that you tell me of your love for your partner. As you’ve probably guessed already, there isn’t really much of a connection between the two. Love and sex are two very different things. Sometimes they go together, but not always or even often for that matter.

It appears to me that you’ve really got two problems happening simultaneously: First, your compulsive prowling of the internet for sex (complicated, I might add, by your alcohol consumption). Second, the deception you’re practicing on your partner. Let’s deal with each of these in turn.

Your particular sexual activity, like any compulsive behavior (overeating, excessive shopping, etc.), is more than just a bad habit. It’s a serious psychological dysfunction. Take it from me: breaking this behavior pattern will be nearly impossible without some professional help. If the problem is as serious as you say, then you’d better seek help right away. This sort of thing, if left untreated, will not only destroy your relationship, it will ruin your life. When you seek that professional help, I encourage you to include information about your alcohol consumption. If there is an addiction in all of this, it’s the alcohol, not the sex. And in your case, the addiction may be fueling the compulsion.

Now, regarding your relationship. It’s imperative that you come clean with your partner about your sexual obsessions and compulsions, as well as your probable alcohol addiction. Not only will you feel better about not lying to him anymore, you’re going to need his support in overcoming the difficult obstacles you face. I suggest that you attend to this right away. There’s not a moment to lose.

Good Luck

A handy history

Condemned, celebrated, shunned: masturbation has long been an uncomfortable fact of life. Why?

by Barry Reay

A handy history

The anonymous author of the pamphlet Onania (1716) was very worried about masturbation. The ‘shameful vice’, the ‘solitary act of pleasure’, was something too terrible to even be described. The writer agreed with those ‘who are of the opinion, that… it never ought to be spoken of, or hinted at, because the bare mentioning of it may be dangerous to some’. There was, however, little reticence in cataloguing ‘the frightful consequences of self-pollution’. Gonorrhoea, fits, epilepsy, consumption, impotence, headaches, weakness of intellect, backache, pimples, blisters, glandular swelling, trembling, dizziness, heart palpitations, urinary discharge, ‘wandering pains’, and incontinence – were all attributed to the scourge of onanism.

The fear was not confined to men. The full title of the pamphlet was Onania: Or the Heinous Sin of Self-Pollution, and all its Frightful Consequences (in Both Sexes). Its author was aware that the sin of Onan referred to the spilling of male seed (and divine retribution for the act) but reiterated that he treated ‘of this crime in relation to women as well as men’. ‘[W]hilst the offence is Self-Pollution in both, I could not think of any other word which would so well put the reader in mind both of the sin and its punishment’. Women who indulged could expect disease of the womb, hysteria, infertility and deflowering (the loss of ‘that valuable badge of their chastity and innocence’).

Another bestselling pamphlet was published later in the century: L’onanisme (1760) by Samuel Auguste Tissot. He was critical of Onania, ‘a real chaos … all the author’s reflections are nothing but theological and moral puerilities’, but nevertheless listed ‘the ills of which the English patients complain’. Tissot was likewise fixated on ‘the physical disorders produced by masturbation’, and provided his own case study, a watchmaker who had self-pleasured himself into ‘insensibility’ on a daily basis, sometimes three times a day; ‘I found a being that less resembled a living creature than a corpse, lying upon straw, meagre, pale, and filthy, casting forth an infectious stench; almost incapable of motion.’ The fear these pamphlets promoted soon spread.

The strange thing is that masturbation was never before the object of such horror. In ancient times, masturbation was either not much mentioned or treated as something a little vulgar, not in good taste, a bad joke. In the Middle Ages and for much of the early modern period too, masturbation, while sinful and unnatural, was not invested with such significance. What changed?

Religion and medicine combined powerfully to create a new and hostile discourse. The idea that the soul was present in semen led to thinking that it was very important to retain the vital fluid. Its spilling became, then, both immoral and dangerous (medicine believed in female semen at the time). ‘Sin, vice, and self-destruction’ were the ‘trinity of ideas’ that would dominate from the 18th into the 19th century, as the historians Jean Stengers and Anne Van Neck put it in Masturbation: The Great Terror (2001).

There were exceptions. Sometimes masturbation was opposed for more ‘enlightened’ reasons. In the 1830s and 1840s, for instance, female moral campaign societies in the United States condemned masturbation, not out of hostility to sex, but as a means to self-control. What would now be termed ‘greater sexual agency’ – the historian April Haynes refers to ‘sexual virtue’ and ‘virtuous restraint’ – was central to their message.

Yet it is difficult to escape the intensity of the fear. J H Kellogg’s Plain Facts for Old and Young (1877) contained both exaggerated horror stories and grand claims: ‘neither the plague, nor war, nor smallpox, nor similar diseases, have produced results so disastrous to humanity as the pernicious habit of Onanism; it is the destroying element of civilised societies’. Kellogg suggested remedies for the scourge, such as exercise, strict bathing and sleeping regimes, compresses, douching, enemas and electrical treatment. Diet was vital: this rabid anti-masturbator was co-inventor of the breakfast cereal that still bears his name. ‘Few of today’s eaters of Kellogg’s Corn Flakes know that he invented them, almost literally, as anti-masturbation food,’ as the psychologist John Money once pointed out.

The traces are still with us in other ways. Male circumcision, for instance, originated in part with the 19th-century obsession with the role of the foreskin in encouraging masturbatory practices. Consciously or not, many US males are faced with this bodily reminder every time they masturbate. And the general disquiet unleashed in the 18th century similarly lingers on today. We seem to have a confusing and conflicting relationship with masturbation. On one hand it is accepted, even celebrated – on the other, there remains an unmistakable element of taboo.

When the sociologist Anthony Giddens in The Transformation of Intimacy (1992) attempted to identify what made modern sex modern, one of the characteristics he identified was the acceptance of masturbation. It was, as he said, masturbation’s ‘coming out’. Now it was ‘widely recommended as a major source of sexual pleasure, and actively encouraged as a mode of improving sexual responsiveness on the part of both sexes’. It had indeed come to signify female sexual freedom with Betty Dodson’s Liberating Masturbation (1974) (renamed and republished as Sex for One in 1996), which has sold more than a million copies, and her Bodysex Workshops in Manhattan with their ‘all-women masturbation circles’. The Boston Women’s Health Collective’s classic feminist text Our Bodies, Ourselves (1973) included a section called ‘Learning to Masturbate’.

Alfred Kinsey and his team are mainly remembered for the sex surveys that publicised the pervasiveness of same-sex desires and experiences in the US, but they also recognised the prevalence of masturbation. It was, for both men and women, one of the nation’s principal sexual outlets. In the US National Survey (2009–10), 94 per cent of men aged 25-29 and 85 per cent of women in the same age group said that they had masturbated alone in the course of their lifetime. (All surveys indicate lower reported rates for women.) In the just-published results of the 2012 US National Survey of Sexual Health and Behavior, 92 per cent of straight men and a full 100 per cent of gay men recorded lifetime masturbation.

There has certainly been little silence about the activity. Several generations of German university students were questioned by a Hamburg research team about their masturbatory habits to chart changing attitudes and practices from 1966 to 1996; their results were published in 2003. Did they reach orgasm? Were they sexually satisfied? Was it fun? In another study, US women were contacted on Craigslist and asked about their masturbatory experiences, including clitoral stimulation and vaginal penetration. An older, somewhat self-referential study from 1977 of sexual arousal to films of masturbation asked psychology students at the University of Connecticut to report their ‘genital sensations’ while watching those films. Erection? Ejaculation? Breast sensations? Vaginal lubrication? Orgasm? And doctors have written up studies of the failed experiments of unfortunate patients: ‘Masturbation Injury Resulting from Intraurethral Introduction of Spaghetti’ (1986); ‘Penile Incarceration Secondary to Masturbation with A Steel Pipe’ (2013), with illustrations.

‘We are a profoundly self-pleasuring society at both a metaphorical and material level’

Self-stimulation has been employed in sexual research, though not always to great import. Kinsey and his team wanted to measure how far, if at all, semen was projected during ejaculation: Jonathan Gathorne-Hardy, Kinsey’s biographer, refers to queues of men in Greenwich Village waiting to be filmed at $3 an ejaculation. William Masters and Virginia Johnson recorded and measured the physiological response during sexual arousal, using new technology, including a miniature camera inside a plastic phallus. Their book Human Sexual Response (1966) was based on data from more than 10,000 orgasms from nearly 700 volunteers: laboratory research involving sexual intercourse, stimulation, and masturbation by hand and with that transparent phallus. Learned journals have produced findings such as ‘Orgasm in Women in the Laboratory – Quantitative Studies on Duration, Intensity, Latency, and Vaginal Blood Flow’ (1985).

In therapy, too, masturbation has found its place ‘as a means of achieving sexual health’, as an article by Eli Coleman, the director of the programme in human sexuality at the University of Minnesota Medical School, once put it. A published study in the Journal of Consulting and Clinical Psychology in 1977 outlined therapist-supervised female masturbation (with dildo, vibrator and ‘organic vegetables’) as a way of encouraging vaginal orgasm. Then there is The Big Book of Masturbation (2003) and the hundreds of (pun intended) self-help books, Masturbation for Weight Loss, a Womans Guide only among the latest (and more opportunistic).

Self-pleasure has featured in literature, most famously in Philip Roth’s novel Portnoys Complaint (1969). But it is there in more recent writing too, including Chuck Palahniuk’s disturbing short story ‘Guts’ (2004). Autoeroticism (and its traces) have been showcased in artistic expression: in Jordan MacKenzie’s sperm and charcoal canvases (2007), for example, or in Marina Abramović’s reprise of Vito Acconci’s Seedbed at the Guggenheim in 2005, or her video art Balkan Erotic Epic of the same year.

On film and television, masturbation is similarly pervasive: Lauren Rosewarne’s Masturbation in Pop Culture (2014) was able to draw on more than 600 such scenes. My favourites are in the film Spanking the Monkey (1994), in which the main character is trying to masturbate in the bathroom, while the family dog, seemingly alert to such behaviour, pants and whines at the door; and in the Seinfeld episode ‘The Contest’ (1992), in which the ‘m’ word is never uttered, and where George’s mother tells her adult son that he is ‘treating his body like it was an amusement park’.

There is much evidence, then, for what the film scholar Greg Tuck in 2009 called the ‘mainstreaming of masturbation’: ‘We are a profoundly self-pleasuring society at both a metaphorical and material level.’ There are politically-conscious masturbation websites. There is the online ‘Masturbation Hall of Fame’ (sponsored by the sex-toys franchise Good Vibrations). There are masturbationathons, and jack-off-clubs, and masturbation parties.

It would be a mistake, however, to present a rigid contrast between past condemnation and present acceptance. There are continuities. Autoeroticism might be mainstreamed but that does not mean it is totally accepted. In Sexual Investigations (1996), the philosopher Alan Soble observed that people brag about casual sex and infidelities but remain silent about solitary sex. Anne-Francis Watson and Alan McKee’s 2013 study of 14- to 16-year-old Australians found that not only the participants but also their families and teachers were more comfortable talking about almost any other sexual matter than about self-pleasuring. It ‘remains an activity that is viewed as shameful and problematic’, warns the entry on masturbation in the Encyclopedia of Adolescence (2011). In a study of the sexuality of students in a western US university, where they were asked about sexual orientation, anal and vaginal sex, condom use, and masturbation, it was the last topic that occasioned reservation: 28 per cent of the participants ‘declined to answer the masturbation questions’. Masturbation remains, to some extent, taboo.

When the subject is mentioned, it is often as an object of laughter or ridicule. Rosewarne, the dogged viewer of the 600 masturbation scenes in film and TV, concluded that male masturbation was almost invariably portrayed negatively (female masturbation was mostly erotic). Watson and McKee’s study revealed that their young Australians knew that masturbation was normal yet still made ‘negative or ambivalent statements’ about it.

Belief in the evils of masturbation has resurfaced in the figure of the sex addict and in the obsession with the impact of internet pornography. Throughout their relatively short histories, sexual addiction and hypersexual disorder have included masturbation as one of the primary symptoms of their purported maladies. What, in a sex-positive environment, would be considered normal sexual behaviour has been pathologised in another. Of the 152 patients in treatment for hypersexual disorder in clinics in California, New Mexico, Pennsylvania, Texas and Utah, a 2012 study showed that most characterised their sexual disorder in terms of pornography consumption (81 per cent) and masturbation (78 per cent). The New Catholic Encyclopedia’s supplement on masturbation (2012-13), too, slips into a lengthy disquisition on sex addiction and the evils of internet pornography: ‘The availability of internet pornography has markedly increased the practice of masturbation to the degree that it can be appropriately referred to as an epidemic.’

Critics think that therapeutic masturbation might reinforce sexual selfishness rather than sexual empathy and sharing

The masturbator is often seen as the pornography-consumer and sex addict enslaved by masturbation. The sociologist Steve Garlick has suggested that negative attitudes to masturbation have been reconstituted to ‘surreptitiously infect ideas about pornography’. Pornography has become masturbation’s metonym. Significantly, when the New Zealand politician Shane Jones was exposed for using his taxpayer-funded credit card to view pornographic movies, the unnamed shame was that his self-pleasuring activities were proclaimed on the front pages of the nation’s newspapers – thus the jokes about ‘the matter in hand’ and not shaking hands with him at early morning meetings. It would have been less humiliating, one assumes, if he had used the public purse to finance the services of sex workers.

Nor is there consensus on the benefits of masturbation. Despite its continued use in therapy, some therapists question its usefulness and propriety. ‘It is a mystery to me how conversational psychotherapy has made the sudden transition to massage parlour technology involving vibrators, mirrors, surrogates, and now even carrots and cucumbers!’ one psychologist protested in the late 1970s. He was concerned about issues of client-patient power and a blinkered pursuit of the sexual climax ‘ignoring … the more profound psychological implications of the procedure’. In terms of effectiveness, critics think that therapeutic masturbation might reinforce individual pleasure and sexual selfishness rather than creating sexual empathy and sharing. As one observed in the pages of the Journal of Sex and Marital Therapy in 1995: ‘Ironically, the argument against masturbation in American society was originally religiously founded, but may re-emerge as a humanist argument.’ Oversimplified, but in essence right: people remain disturbed by the solitariness of solitary sex.

Why has what the Japanese charmingly call ‘self-play’ become such a forcing ground for sexual attitudes? Perhaps there is something about masturbation’s uncontrollability that continues to make people anxious. It is perversely non-procreative, incestuous, adulterous, homosexual, ‘often pederastic’ and, in imagination at least, sex with ‘every man, woman, or beast to whom I take a fancy’, to quote Soble. For the ever-astute historian Thomas Laqueur, author of Solitary Sex (2003), masturbation is ‘that part of human sexual life where potentially unlimited pleasure meets social restraint’.

Why did masturbation become such a problem? For Laqueur, it began with developments in 18th-century Europe, with the cultural rise of the imagination in the arts, the seemingly unbounded future of commerce, the role of print culture, the rise of private, silent reading, especially novels, and the democratic ingredients of this transformation. Masturbation’s condemned tendencies – solitariness, excessive desire, limitless imagination, and equal-opportunity pleasure – were an outer limit or testing of these valued attributes, ‘a kind of Satan to the glories of bourgeois civilisation’.

In more pleasure-conscious modern times, the balance has tipped towards personal gratification. The acceptance of personal autonomy, sexual liberation and sexual consumerism, together with a widespread focus on addiction, and the ubiquity of the internet, now seem to demand their own demon. Fears of unrestrained fantasy and endless indulging of the self remain. Onania’s 18th-century complaints about the lack of restraint of solitary sex are not, in the end, all that far away from today’s fear of boundless, ungovernable, unquenchable pleasure in the self.

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