Articles by David H Jacobs Ph.D

Is Sex Addiction a Disease?

I have a friend who has diabetes. His pancreas does not produce enough insulin to keep him healthy or even alive. He would die without injections of insulin. He lives in and is dependent on his body as automatic, self-regulating, cause-effect machine, just as we all do. He is no more responsible for the workings of his pancreas than for a solar flare, the weather, the temperature at which water boils, the atomic weight of hydrogen, etc. The reason why his pancreas behaves as it does and the consequences of how his pancreas behaves for his biological health have nothing to do with him as a person (a complex psychosocial language using acculturated self-reflective being). He is a victim of organic structures and processes. He has what is conventionally known as a disease.

Is sex addiction a disease or is disease in this case being used as a metaphor or analogy. What must be acknowledged at the outset when talking about sex addiction is this: no organic/biological abnormality or pathology can be pointed to in the case of sex addiction. This seems to rule out disease in the conventional medical sense. But from a cultural standpoint the terms disease, illness, and disorder are not limited to cases in which organic pathology can be demonstrated.

For example, just this month, the National Institute of Mental Health issued a statement in which mental disorders were referred to as medical disorders. At the same time, it was admitted that mental disorders cannot be identified through organic/biological evidence. From the perspective of medicine and culture the idea of disease is invoked to refer to very objectionable behaviors even if no tangible evidence of relevant organic/biological pathology can be found.

As a historical note it could be observed that beginning in the 19th century psychiatry began calling objectionable behaviors diseases (homosexuality being the classic case) even though it was clear that evidence of morbid anatomy or physiology was absent. Today both psychiatry and popular culture refer to many behaviors in terms of disease in the absence of evidence of morbid anatomy or physiology. To many professional and lay people it seems self-evident that extreme or unreasonable behavior should be called a disease.

Disease has become a contested, slippery term. The new Diagnostic and Statistical Manual of the American Psychiatric Association defines bereavement as a mental illness if bereavement persists more than two weeks after the death of a loved one. In the current professional and cultural climate, the question of whether sex addiction is a disease does not have a straightforward answer. A person is usually not held to be responsible for diseases (like child onset diabetes, measles, defective heart valve, leukemia, etc) that arise without any contribution from a person’s own behavior or habits.

How then to think of sex addiction? No one is responsible for the family they were born in to and how they were treated in their family by parents and other care takers. Clinically, it can be observed that sex addicts report serious departures from appropriate nurturing care during the course of growing up in their families.

There is no clear cultural view concerning how much psychosocial conditions of early life influence adult behavior. It could be acknowledged that a person had a very bad time growing up, but should his or her offensive behavior as an adult be excused by regarding offensive behavior as something like a disease? My diabetic friend will die without insulin no matter how conscientious he is about diet. He cannot do better because he is in the grip of biological processes beyond his control. What of a married man who continuously seeks sex outside the marriage in numerous forms (strip clubs, massage parlors, escorts, prostitutes, affairs, etc.)? Clinically we find that this sort of behavior is associated with serious maltreatment in the course of growing up, but answering the question of whether a sex addict has a disease is such a contested cultural-moral-ideological matter that it evades a straightforward answer.

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