Tuesday, March 11, 2014

Men: Sex Addiction and Depression

My work over the last fifteen years as a psychotherapist treating sexual compulsions has brought me into contact with men - and more men. They come to my consulting room wearing the mask of shame, humiliation, and confusion. Often, after a period of therapy, they come to a common link among them: they are depressed. Empty and suffering from a disorder that, for men, can be as hidden as sexual deviance itself, depression in men is hardly spoken about. It is women who are depressed - it's a women's disease -- with depression occurring four times more often in the fairer sex.

Yet I believe there's a deep cultural collusion taking place: Men don't speak the truth to themselves or others about the dark, jagged, emptiness that consumes them. Talking about the depth of these feelings is so, well, unmanly. The real story about men, sexual acting out and depression is as complex as each of the wounded souls who enter my consulting room. The impact of depression and sexual deviance/addiction on each of them is enormous.

It is here that issues of gender come into play. Girls are socialized to be connected and expressive. But from a very young age, the boy is told by his culture to act upon feelings - to seek relief through action rather than through connection or introspection. Pain is externalized in men, resulting in domestic violence, failures in intimacy, alcoholism, workaholism and, certainly, sexual compulsion.

The theme of the manliness of invulnerability has permeated our culture for generations. Look at the male heroes we choose: The Man of Steel, Robocop, Iron Man, The Incredible Hulk, The Terminator: all creatures literally made not of flesh and blood and certainly not, horror of horrors, feelings. The culture sends the message that the man who is suffering from unwanted and confusing feelings should not expect help. He must resolve his problems on his own. ("suck it up")

Often he seeks to resolve his emotional problems by turning to a substance, person or activity to regulate his self esteem and to ward off depression. I believe that this is at the heart of the addictive process. When a covertly depressed man's connection to the object of his addiction is undisturbed, he feels good about himself. But when the supply runs out - the affair is over, he can't get to the computer to see porn, he is spurned by women he desires, the credit card maxes out - his self-worth plummets and the hidden depression begins to unfold. Such feelings of emptiness and depletion can drive him back to his addiction, contributing to the vicious cycle of addiction.

Invariably, the issue that arises in treatment is depression and the shame that accompanies it. When one reaches so deeply into a man's inner pain, one can see the hidden fragility lying dormant there. In the terms of traditional psychotherapy, pain that is internal, lucidly experienced, and able to be spoken about is less disturbed than pain that is externalized and unconsciously "acted out." Therapy relies on the patient's insight into his problems with feelings as it the chief motivating agent. The difficulty with this methodology is that it is much more in keeping with the traditional emotional skills of women than those of men. Men do not have readily at hand the same level of insight into their emotional lives as women, because our society dislocates them from the emotional aspects of themselves.

Overt depression, prevalent in women, can be seen as internalized self-hate. Covert depression, which is prevalent in men, can be viewed as internalized disconnection - the experience of helplessness, hopelessness and despair is warded off by various "acting out" defenses, inclusive of sex addiction.

The hidden depression in such men stems from a lack of internal vitality. The pain they have but refuse to feel stems from a toxic relationship to the self, which is another way of describing depression. Depression is a disorder wherein the self attacks the self. In overt depression, that attack is evident: in covert depression, the man's defenses protect him from awareness of any feelings. Sex addiction is a perfect way to not feel feelings.

This sense of self-attack could also be called shame, an acutely uncomfortable feeling of being worthless, less than others, outside of the human community. Some experience it as the desire to be "invisible". For many men the state of shame is itself shameful, adding to their distress and pushing them to conceal their depression from others. While some men have the classic symptoms of depression -- feelings of hopelessness, helplessness and despair -- many more experience depression as a state of numbness, known in psychiatry as alexithymia. This experience is not about feeling bad so much as about not having the capacity to feel at all. This incapacity to feel is often discussed as a sense of "emptiness" or "boredom" that emerges when the sex addict isn't engaging in his chosen sexual expression.

A common defense against the painful experience of shame is inflated value, or grandiosity which sexual acting out provides. A feeble sense of self wards off negative feelings through the sense of power that men feel when they are in "the erotic haze." But such attempts are never fully successful. The underlying assault on self always threatens to break through. Underneath the high of sexual acting out are deep feelings of inferiority and shame and powerlessness.

Quite a number of theorists have written about the use of grandiosity to ward off shame. This flight from shame into grandiosity lies at the heart of sex addiction. The excitement of sex, the "erotic haze", the orgasm, the identification with "perfect" men in internet pornography -- lifts the man out of depression and the state of shame into a state of powerfulness, eradicating unwanted feelings as surely as a few martinis do for the alcoholic.

One thing that distinguishes the sex addict from the non-addict is the use of sex as a substitute for self-esteem. The difference between normal and addictive use of sex is the difference between an already adequate sense of self-esteem and desperately shoring up an inadequate one. Nondepressed men turn to sex for relaxation, intimate sharing and fun.

Depressed men turn to sex for relief from distress. Sexual acting out is a magic elixir, transforming shame into grandiosity and moving him from a sense of helplessness to a sense of omnipotent control. The feelings associated with depression vanish with the experience of having an inordinate powerful sense of self.

When the awareness of a pattern of sexual addiction and the very painful consequences becomes clear, the addict may begin to seek treatment. Most sex addiction therapists recommend a behavioral way of curtailing the sexual acting out and the acceptance of a recovery program.

In therapy, the addict is likely to experience strong feelings about the consequences of his acting out. The secret life is unveiled revealing affairs, exhibitionism, voyeurism, masochism or other behaviors comprising a particular sex addict's modus operandi of sexual deviance. The real story about men, sexual acting out and depression is as complex as each of the wounded souls who enter treatment (or remain out of it). The impact of depression and sexual deviance on each of them is enormous.

In treatment, the addictive defense must be confronted and stopped. Then, the hidden pain emerges as depression, and underneath the depression lies childhood trauma. It is only when these traumas are worked through that there can be true freedom from addictive slavery. Only after the shame cycle has stopped, after the addictive pattern has been broken and the person has moved into "recovery" can the pain of hidden depression be addressed and resolved.

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