Charlie was a man in his early fifties who entered treatment after breaking up with a woman for whom he cared deeply. He had been married twice previously and had a daughter on welfare with five children who he was trying to help. Charlie also had a chronic inherited medical condition that required careful and frequent monitoring. Though he followed protocol he was in denial about the serious nature of his illness and pushed himself physically beyond realistic limits.
We began by addressing both the need for Charlie to take better care of himself physically and, though he was desperately lonely, his habit of running from commitment in long-term relationships. We were able to tie these behavior patterns to childhood issues including his relationship with his mother which he described as being overly invested in him. It was not overtly sexual but too close for his comfort. Both parents abused alcohol and held wild parties in which numerous relatives came to drink. The men in the family, his father’s brothers, were much worse than his father—drinking and hitting their wives. They were known to be cheating on them as well. The patient witnessed all of this even as he attended a private school where he was admonished to avoid any impropriety, sexual or otherwise. Given that Charlie was very motivated to understand himself and the effects of the chaotic working class background in which he had been raised, we were able to make good progress on a number of issues.
Yet a persistent problem that he had mentioned from the beginning proved particularly resistant to treatment. Charlie continued to search out prostitutes and spent inordinate amounts of time and money on porn sites. He kept this activity secret from everyone including the woman who was his romantic partner and is now his housemate. He was however aware of the problems that these activities pose, both in terms of safety and his lack of integrity in regard to any potential romantic partner. We have explored the roots of this behavior in relation to his upbringing and the activities that he witnessed as well as the hypocrisy that so angered him in the form of teachings at his religious school. Yet the problem—Charlie’s sexual addiction—remains.
Why is this problem so resistant to treatment? Does it meet the definition of an addiction as specified in The Diagnostic and Statistical Manual of Psychiatric Disorders, Volume Four: “distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used?” Does it involve “compulsive searching for multiple partners, compulsive fixation on an unattainable partner, compulsive masturbation, compulsive love relationships and compulsive sexuality in a relationship?”
Though Charlie is in many ways a good, caring, and generous person, there is a part of him that views women as sexual objects, lacking in humanity or subjective presence. When he seeks out prostitutes he loses contact with his humanity. He is meeting a need and the woman becomes a thing, an object whose function is to satisfy his need. Charlie is able to encapsulate his feelings so that he doesn’t have to imagine what it is like for the women he sees. The treatment for what he himself recognizes as an addiction has proved long and difficult. Next week I will talk about the reasonably successful progress that we have made.
Ellen Toronto is a clinical psychologist in private practice in Spring, Texas and has been practicing since 1980. In 2017, she was elected a Fellow in Psychoanalysis by the American Psychological Association. In 2016, Dr. Toronto's practice was recognized as one of the top Ann Arbor Psychology practices. She received her Ph.D. in Psychology from the University of Michigan. Dr. Toronto is married to Robert Toronto, Ph.D., and together they have four sons and eleven grandchildren.