What can Choke and Californication teach us about sex addiction?

Through the 1990s and until today, the rhetoric of behavioral addiction became even more reliant on neurochemistry. Pornography is now described by some psychologists as an "erototoxin" that triggers the release of an addictive cocktail of neurotransmitters and hormones. A few weeks ago, Carnes explained to the New York Times that an orgasm releases as much dopamine as an alcoholic beverage.

It's a reversal of Freud's formulation from more than a century ago. We used to see drug abuse as a psychological problem—like compulsive masturbation. Now, with our advanced knowledge of the brain, we're starting to see compulsive masturbators as victims of a disease, like drug addicts.

For all that, we're no closer to accepting the uneasy truth that addiction is something in between—a neurological disorder of free will, as National Institute on Drug Abuse Director Nora Volkow would have it. She argues that a healthy brain can fend off unhealthy impulses and desires. When the brain malfunctions, we lose the ability to inhibit compulsive behavior, a situation she likens to driving a car with no brakes.

In popular culture, the tension between behavior and disease translates into a confusion between comedy and tragedy. Is a sex addict like Will Ferrell's character in Blades of Glory—who even trolls for partners at his 12-step program—just a self-indulgent horn-dog? (The joke about sex addicts hooking up at group meetings also turns up in Choke, an episode of Cheers, and an episode of Nip/Tuck.) Or is he more like a cancer patient, with no control over how or why he is afflicted?

When it comes to compulsive sexual behavior, the professionals have their own ambivalence, which plays out as a question of semantics rather than aesthetics: The community argues over the inclusion of behavioral addictions—or even the word addiction itself—in the next version of the DSM. Some argue that the euphemistic use of dependence has done little to eliminate the stigma associated with the condition. Others see the medicalization of behavior—sexual or otherwise—as a form of social control.

In a certain sense, they're just as confused as we are.

Correction, Sept. 30, 2008: The original version of this article described Duchovny's character as performing cunnilingus on an underage girl whom he'd taken to be his wife. Her age was never confirmed, and he mistook her for his girlfriend. (Return to the corrected sentence.)