Some addictions are funnier than others. There aren't many good heroin comedies; not even Ben Stiller can wring a laugh out of smoking crack. Alcoholism, on the other hand, has its moments, and by long-standing convention smoking huge quantities of marijuana is truly hilarious. So where in this humor hierarchy shall we put the compulsion to have sex?
It was high comedy as recently as 2007, when Will Ferrell's satyrical lead in Blades of Glory reveled in his sex addiction as "a real disease with doctors and medicine and everything!" Now, with the Friday premiere of the film Choke, a darkly comic sex-rehab drama starring Sam Rockwell, and the Sunday debut of the second season of Showtime's Californication, a half-hour family dramedy with David Duchovny as a recovering sexaholic, the condition seems to have found its place somewhere closer to the middle of the spectrum.
Choke has elements of a classic stoner film—something like Harold and Kumar Can't Stop Masturbating. A couple of slacker dudes create cheerful mayhem as they pursue their fix, clash with co-workers, and evade the law. But there's plenty of emotional pain to go with the sexual hijinks—severed friendships, the death of a parent, the discovery of rock bottom while bent over a public toilet. Californication also teeters between humor and pathos: The season begins with Duchovny's character swearing off sex for the sake of his family, then chronicles his efforts to abstain. In Episode 1, he inadvertently performs cunnilingus on a young woman whom he'd taken to be his girlfriend. * (Oops!) But no matter how wacky the indiscretion, each misstep results in a miserable argument and a tearful near-breakup. (Then there's the added, implied drama of Duchovny's real-life travails with compulsive sex.)
So is Don Juanism funny, or is it sad? The pop-culture ambivalence reflects an uncertainty that extends all the way through the medical establishment—to the sex therapists, psychologists, and psychiatrists who can't agree on how to define sexual addiction, or indeed whether it should be called an "addiction" at all. Partisans for the diagnosis see it as a valuable tool for expanding treatment and gaining acceptance for a long-suffering minority. Opponents view it as a dangerous intrusion of morality into medicine and yet another avenue for the marketing of self-help books and psychopharmaceuticals. But the debate rests on a much bigger question posed by modern brain science: What does it mean to be an addict in the 21st century?
The modern notion that you can be "addicted" to sex, or to any behavior—like eating, shopping, gambling, or texting—has been in ascendance among scientists only for the past quarter-century. An early version of this idea did show up in the writings of Sigmund Freud, who in 1897 described the compulsive use of alcohol, morphine, and tobacco as a substitute for masturbation, the "primary addiction." (His follower, Sandor Rado, an important figure in early-20th-century American psychology, referred to the drug high as a "pharmacogenic orgasm.") But his theory carried little weight with researchers unaffiliated with psychoanalysis.
By the time of World War I, researchers on drug dependence had begun to make regular, clinical use of the word addiction—to suggest a psychological disorder, an affliction of the will rather than the body. A few decades later, the focus had begun to shift to the chemistry of the drugs themselves. These scientists were more interested in the particular effects that a substance has on the body—the biological dependency it creates—than the behavioral patterns of its users, the addiction.
This neurophysiological approach to drug use reached its zenith in the 1970s, when scientists finally worked out the connection between addictive drugs, neurotransmitters, and the neural "pleasure centers" of the mesolimbic reward system. The 1973 discovery of opiate receptors in the brain made it clear that our normal pleasure response is something like a scaled-down version of a drug high: Heroin and morphine work by mimicking our natural brain chemicals, and overstimulating our mesolimbic pathway.
At the same time, a hippie-era boom of recreational drug use forced researchers to broaden their definitions. Opiates weren't the only habit-forming chemicals that triggered the mesolimbic system—so did substances like cocaine, cannabis, and Quaaludes. Drug-rehab programs started to treat patients for broad "substance-abuse" problems rather than dependencies on particular drugs. Since all these drugs shared a common brain pathway, a defect in that pathway could make someone susceptible to all of them at once.
The new science of drug addiction opened the door for behavioral addictions, too. If activities like eating and sex could activate the same pleasure centers as heroin, morphine, and cocaine, it was a small step to assume that repeated behavior might generate its own dependency. You don't need dope to get a dopamine spike, so just about anything could take on the trappings of a chemical high.
Sure enough, psychologists of the era began to construe habit-forming or compulsive behaviors in chemical terms. "Pathological gambling disorder," for one, was introduced into the Diagnostic and Statistical Manual of Mental Disorders in 1980 and was soon defined in parallel with substance-use disorders. Meanwhile, "sex addiction" was laid out for the first time in a medical journal in 1978; five years later, the diagnosis was popularized by addiction therapist and rehab entrepreneur Patrick Carnes in his book Out of the Shadows.
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.