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Regulated Passions

THE INVENTION OF INHIBITED SEXUAL

DESIRE AND SEX ADDICTION

In recent years, several different headlines bannered the covers of Cos- mopolitan magazine. In November 1988, "When You're Not Interested in Sex, He's Not Interested: How to Reawaken Your Desire." In July 1989, "Girls Who Are Addicted to Sex: Why They Can't Stop." And finally, in November 1989, the plaintive question, "How Much Sex is Enough?" The Cosmo girl was embroiled in the labyrinthine contemporary debate about sexuality and sexual desire. These debates within popular culture over the nature and limits of sexual desire mirror an important profes- sional development: the invention in the 1970s of two diagnostic cate- gories, Inhibited Sexual Desire (ISD) and Sex Addiction.

Both the medical and popular discourses on desire operate as lan- guages of sex. They exist in a discursive field with apparatuses such as religious texts, legal and educational practices, other medical definitions, and other artifacts of popular culture such as pornography, romantic fic- tion, and popular music, all of which socially construct sexuality. For if we accept that there is no natural or instinctive sexuality (about which we can determine what is too much or too little), it is then clear that we invent sex. It is a social product infused with a set of meanings, constituted through a variety of languages. Since sexuality is organized through regu- lation and definition, it is useful to examine the invention of categories, concepts, and languages that tell us how to be sexual; that delineate what is good, bad, evil, or acceptable sexuality.

In the second half of the twentieth century, the invention of new sex- ual diseases has been central in the regulation of sexuality. In our culture, diseases, like sex, are not simple organic entities, but rather serve as expanded paradigms imbued with diverse meanings. Diseases are arti- facts with social history and social practice. In the area of sexuality, the discursive practices of medicine since the nineteenth century have spawned what Foucault terms a "proliferation of sexualities,"1 most of which carry the stamp of perversion reborn as disease. Thus, the inven- tion of sex addiction and inhibited sexual desire can be understood in light of two related historical factors of the late nineteenth century. First, a range of socioeconomic changes prompted a commercialized sexuality in which sex is increasingly privileged as fundamental to individual identity and happiness.2 Second, the medical profession usurped moral and reli- gious authority in the area of sexuality, generated new and highly visible discourses, and promulgated the diversification of new sexual identities.

Janice M. Irvine

As Foucault suggests, "Sex was driven out of hiding and forced to lead a discursive existence."3 Inhibited sexual desire and sex addiction are two of the most recent medical constructions of sexual disease and disorder. The medicalization of these two conditions, with elaborate systems of diag- nostic categories and treatment interventions, fashions a sexual condition or "sick role"4 and, in the case of sex addiction, an entire identity con- structed around a specific sexual pattern.

It would be a mistake, however, to impute sole and uncontested power to the medical profession in the invention of the new disorders. Rather, new diseases emerge within the triangulation of medical imperatives, the demands and experiences of individuals, and cultural traditions and anx- ieties. This article will examine these three axes of influence. First, it will analyze the history of professional intervention in problematic behavior subsequently defined as desire dysfunctions. Second, it will explore the complexities of definition and treatment, and the implications for afflicted individuals. Finally, it will emphasize the ways in which disease reflects the cultural style of a period.5 It will suggest that, in the late twentieth century, these new diseases chart the medically legitimated boundaries of accept- able contemporary sexual experience and serve as signifiers for powerful cultural anxieties about sexuality and desire.

Disease Narratives

The construction of disease categories entails a complex set of negotia- tions among professionals, the general public, and afflicted individuals which is always mediated by broader cultural ideologies. The particular configuration of very different circumstances for the emergence of ideas about inhibited sexual desire and sex addiction in the mid-1970s offers clues about their powerful individual and social valence.

Although modern clinicians have anecdotally noted cases of low sex- ual desire as early as 1972, ISD was first identified in the medical literature in 1977 by two sexologists working independently: Harold Leif and Helen Singer Kaplan.6 Both are well-known sex therapists who reported the increasing prevalence of complaints about low libido in their clinical prac- tices. This was a noteworthy departure from the presenting problems of most patients during this heyday in sex therapy. With the publication of Masters and Johnson's Human Sexual Inadequacy in 1970, sex therapy had grown throughout the decade to become the most visible, lucrative, and widespread enterprise of sexology.7 On the basis of their research and clinical work, Masters and Johnson had identified several major categories of sexual problems which were eventually adopted by the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IIIR). For

Janice M. Irvine 204

men, the basic sexual dysfunctions included premature ejaculation, pri- mary and secondary impotence, and ejaculatory incompetence (a rare condition in which a man cannot ejaculate intravaginally). Female sexual dysfunctions included dyspareunia (painful intercourse), vaginismus (a tightening of the vaginal muscles that prohibits penile penetration), and several types of orgasmic dysfunctions, broken down into primary or sec- ondary and coital or masturbatory categories.8 These dysfunctions encompassed the range of technical difficulties to which a couple might be vulnerable, and undeniably, Masters and Johnson's sex therapy program helped scores of people improve their sex lives. Their brief, symptomatic treatment seemed perfect for those with little experience or information about sex.

The mere discovery of the program's existence was enough to instill hope and confidence in some couples. By the late '70s, sexologists, with their appeal to scientific legitimacy and medical authority, were riding a wave of popularity in a vast market eager for a new approach to sexual problems. Rumors of dramatic, near-miraculous success rates for inter- ventions with sexual problems were so persuasive that clients began reporting cures merely from sitting in the waiting room. By the end of the decade, however, sex therapists voiced a common lament about the dis- appearance of the "easy cases"-specifically those problems which were essentially the result of ignorance or misinformation, and which responded well to the simple behavioral methods of Masters and Johnson. The new difficulties were reported in different ways: sexual boredom, low libido, sexual malaise, and even sexual aversion and sexual phobia. Harold Leif recommended that the diagnosis of inhibited sexual desire be applied to those patients who chronically failed to initiate or respond to sexual stimuli. The dysfunction is now routinely referred to as either inhibited sexual desire or hypoactive sexual desire. The American Psychological Association estimates that 20 percent of the population has low or absent sexual desire. Among sex therapists, ISD is now reported as the most common presenting problem, constituting half of all diagnoses, and it is considered to be the most difficult sexual problem to treat.9 More women than men are diagnosed with inhibited sexual desire, although many ther- apists report that the rate among males is rising.10

The concept of sex addiction had a quite different beginning, spring- ing to life independently in several cities almost simultaneously. Not sur- prisingly, the idea of being addicted to sex emerged in the addiction move- ment among those who were in recovery from substance use. Its first manifestations were in the establishment of Twelve Step groups to contain what their members describe as "sexual unmanageability." Sex and Love Addicts Anonymous was the first such group, started by a musician in Boston in 1977.1 He had been a member of Alcoholics Anonymous for

Regulated Passions 205

Every week close

to two thousand

meetings for sex

addicts are held

across the country,

and the groups

are said to be

growing at an

annual rate of 30

percent.

years, had a wife, a mistress, engaged in other sexual affairs, and mastur- bated several times a day. His perception that his sexuality was out of control led him to find others with a similar problem so that they could "get sober." Initially they met in private homes, but the growth of the group led them to seek a public meeting space. A local pastor was sympa- thetic but skeptical that his parishioners would support a group of sex addicts so he suggested a name change. Sex and Love Addicts Anony- mous is now also known as the Augustine Fellowship, since one of the members had been reading Augustine's Confessions and claimed, "he's obviously one of us." There are now seven different nationwide fellowships for sex addicts and co-addicts, with such names as Sex Addicts Anony- mous, Sexaholics Anonymous, and Sexual Compulsives Anonymous. All were founded under similar circumstances as the Augustine Fellowship.

Every week close to two thousand meetings for sex addicts are held across the country, and the groups are said to be growing at an annual rate of 30 percent.12 Unlike with ISD, a thriving grass-roots movement of individuals who claimed to suffer from the disorder was already in place by the time professionals engaged with the issue. Now, however, experts and clients work in tandem, since sex addiction has spawned a robust treatment industry. The diagnosis has attracted two types of professionals: the dominant group are "addictionologists" (as they now call themselves), who are joined by a smaller cohort of clinicians who treat sex offenders. Professional awareness of sex addiction was fostered by the "opponent- process" theory of addiction introduced in the early '70s, which suggested that a substance was no longer requisite for addiction.'3 This proposal that any behavioral excess could lead to dependence fit nicely with the popular and widespread generalization of ideas about addiction represented by such figures as the workaholic, shopaholic, and compulsive gambler. Pro- ponents of the syndrome view sex addiction within this expanded para- digm of addiction disorders. There are now scores of texts on sex addic- tion, and treatment programs dot the landscape. The first inpatient program for sex addicts was begun in 1985 at Golden Valley Health Cen- ter's Sexual Dependency Unit in Minneapolis. Addictionologists claim that 6 percent of the population are sex addicts, and approximately 30 percent of these are women. Patrick Carnes, one of the foremost popular- izers of the sex addiction concept, claims that one in twelve people in the U.S. is a sex addict.14

The Professional Divide

The construction of new medical definitions does not simply mirror a perception of illness or problematic conditions. Rather, the discursive

Janice M. Irvine 206

elaboration of disease is shaped by complex factors, including the ideo- logical and economic imperatives of the defining professionals. It is note- worthy that the new diseases of ISD and sex addiction have each been fashioned by highly different professional cohorts, so that the medical discourses have progressed on parallel and quite distinct trajectories. There has been little connection or communication between addictionol- ogists and sexologists and little overlap in specialization. There has been some veiled hostility between the groups, however, deriving from the clash of underlying ideologies and overt treatment goals. These conflicts high- light the constructed nature of the new diseases and reveal the nature of the loyalties and interests of each profession.

The field of addictionology has been marked by rapid professional expansion, particularly since Solomon's opponent-process theory of addic- tion provided theoretical legitimacy for the identification of almost any- thing as an addictive agent. Although the subsequent proliferation of addic- tions widened the professional domain of addictionologists into new areas such as gambling and sexuality, their medical gaze remains one of vigi- lance about excess and admonitions for control and management. This sexual ideology of temperance and abstinence directly opposes the vision of sexual expansion and freedom so implicit in sexology. Addictionologists have criticized many of the sex-enhancing technologies, ideologies, and practices that comprise standard sex therapy models. For example, some believe that penile implant surgery, a lucrative procedure that is quite acceptable among sexologists, signifies and reinforces sex addiction.15 And addiction experts challenge sexologists on their unbridled enthusiasm for the unrestricted use of fantasy and pornography, for their encourage- ment of masturbation, and for their celebration of virtually any sexual activity between consenting adults. Sex addicts, it is thought, may need to practice celibacy and eliminate fantasy and sexually explicit material "in order to attain and maintain sobriety," and sex therapists may simply retraumatize them or facilitate a relapse by the espousal of sexual free- dom.16 While addictionologists may accept the dominance of sexologists in many areas of sexuality, they are staking out their turf and becoming more visibly critical of sex therapists for an alleged lack of effectiveness in the treatment of sex addicts.17

Sexologists, on the other hand, have struggled for professional legiti- macy and a viable commercial market for over a century.18 They pride themselves on scientific rigor in their work and on fairly unqualified acceptance and support of all sexual expression. The very concept of sex addiction-that there can be too much sex-threatens the foundations of the profession. Until the early '90s, sexologists have largely responded to the emerging diagnosis of sex addiction with sarcasm, disavowal, or attacks on its scientific credibility. In a 1988 anthology on sexual desire

Regulated Passions 207

disorders, sexologists Sandra Leiblum and Raymond Rosen noted that sex addiction was beginning to receive considerable attention. They described the affected individuals as "sexual enthusiasts," and noted that they "tend to be admired or envied rather than diagnosed."19 Helen Singer Kaplan claimed that sex addiction is exceedingly rare,20 and is "a media term that doesn't have any scientific validity or meaning."21 Possibly because of his work in treating sex offenders with Depo-Provera,22 noted sexologist John Money was initially a supporter of the new diagnosis, telling the New York Times in 1984 that he had seen many patients who were sex addicts. "Their hypersexuality often exceeds normal capacities," he noted.23 By 1989, however, Money vehemently reversed his position, charging that "the pathologizing of sex by inventing a hitherto unknown disease, sexual addiction" constituted a strategy of "the sexual counter- reformation" that has exercised a destructive effect on the advancement of the science of sexology.24

Professional antagonisms have slowly begun to dissipate into mutual ambivalence largely because of the impact of the AIDS epidemic. This is because sexologists, who have been unable to avoid widespread social anxiety about freer sexual mores, have begun fashioning their practices accordingly. Workshops and interventions such as one entitled "Falling in Love Again" abound for the sexually and relationally bored who are ter- rorized into monogamy by fear of HIV infection. It is not uncommon for sexologists to chart their professional course through the changing cur- rents of cultural ideologies about sex and gender. Sexology has never pre- sented an uncomplicated vision of sexual liberation. Rather, the field has historically managed the contradictions of a progressive sexual message and the need for conservatism and scientific credibility in order to achieve cultural legitimacy and economic viability. Despite these antinomic imper- atives, sexologists generally advance a sexual value system of greater free- dom and participation. Yet the cultural sex panic exacerbated by AIDS has foregrounded the addictionologists' message of sexual chaos and terror of sexual excess. The sexologists' exhortations to sexual pleasure and exper- imentation look increasingly unwise and unhealthy, and they have begun integrating some of the ideas, if not the wholesale diagnosis, of the sex addiction field.

The historical narrative, then, of the construction of inhibited sexual desire and sex addiction reveals a clear bifurcation between two profes- sional cohorts, marked by ideological tensions and distinct border anxi- ety. As experts laboring on opposite poles of the same continuum of sex- ual anxiety and control, however, these professionals share a possibly insoluble conundrum: the task of precise clarification and definition of their disease.

Janice M. Irvine 208

Defining and Treating the Disorders of Desire

The assertion of exact definitional and diagnostic criteria poses an enor- mous challenge when "disease" is a generalized set of signifiers of cultural chaos and social control. The fabric of overdetermined diseases such as sex addiction and inhibited sexual desire is woven from the diverse threads of professional expertise and ideologies, cultural beliefs about sex, and the attempts of individuals to make sense out of their own sexual experiences. Nevertheless, the medical legacy of the doctrine of specific etiology25 has inspired each field to generate myriad hypotheses concerning the individ- ual causes of the disorders. These etiological theories of inhibited sexual desire and sex addiction are not totalizing discourses but rather an amal- gam of diverse and sometimes nebulous perspectives. There is conflict within sexology and addictionology over the origins and nature of their respective disorders, and it would be incorrect to imply a simple unity or consensus. Despite few rigorous research studies, there has been much speculation on the basis of clinical samples and case studies. There are debates over the influences of environment, family, individual personality, and biological factors such as neurochemistry.

Since the nineteenth century, however, professionals have assiduously tracked the etiology of sexual conditions within a biomedical tradition that quantifies desire and locates "this search for the primeval urge in the subject itself."26 It is this impulse to map desire and its varied disorders in the body itself that represents historical congruence among sexuality pro- fessionals and establishes a common theoretical terrain for both inhibited sexual desire and sex addiction. A pervasive and largely assumed under- pinning of both sex addiction and ISD is the representation of sexual desire as a biological drive or surging energy that is either flooding uncon- trollably or woefully diminished. There is the intuitive belief that sex, specifically sexual desire, resides in the body. This essentialist assumption is not surprising, since it infuses mainstream cultural norms about sexu- ality as well as the theoretical foundation of sexual science.27 As historian Jeffrey Weeks noted about nineteenth-century sexology's search for the origins of sexual behavior, "biology became the privileged road into the mysteries of nature. ... "28 Over a hundred years later, although few the- orists would unequivocally advance a strict biological determinism in the etiology of ISD or sex addiction, strong essentialist themes resonate throughout the discourses of the desire disorders.

The literature of both professional cohorts reflects a striking empha- sis on the brain as the site of sexual desire and the source of its myriad manifestations. Advances in neurochemistry converged with the techno- logical revolution in computers to produce a cyborgian vision of sexuality

Regulated Passions 209

and desire characterized by images such as "hard-wiring," "circuitry," "programmed into the brain," and "fixed into the system." In this repre- sentation, the bedrock of desire and its concomitant sexual possibilities reside within regulatory mechanisms of the brain that are alternately per- ceived as impervious to change or quite vulnerable to disruption.

The biological basis of sexual desire is most advanced in the work of Helen Singer Kaplan, who pioneered the notion of inhibited sexual desire and who is likely one of the most unreconstructed essentialists within sex- ology. In her 1979 landmark text on ISD called Disorders of Sexual Desire, Kaplan defines sexual desire as an "appetite or drive which is produced by the activation of a specific neural system in the brain."29 In sociobiological terms, Kaplan describes the importance of sexual desire:

Sexual desire is a drive that serves the biologic function of species survival. It instills a strong erotic hunger that prods us to engage in species specific behavior that leads to reproduction. It moves us to find a mate, to court, to seduce, to excite, to impregnate, to be impregnated.30

For Kaplan, desire is experienced when a specific neural system in the brain is activated, prompting genital sensations and an openness to and interest in sex. When this system is inactive or inhibited, the person "loses his appetite" or "the brain has 'decided' that it is too 'dangerous' to have sex."31

Addictionologists tend to discuss sexual desire very little other than to implicitly regard it as an inherent physiological drive that has spiraled out of control. This discourse harkens back to the eighteenth-century per- spective described by Weeks that "desire was a dangerous force which pre-existed the individual, wracking his (usually his) feeble body with fantasies and distractions which threatened his individuality and sanity."32 Significantly, within the sex addiction literature, the moniker "desire" is generally superceded by its moral ancestor "lust."

Even so, brain-centered sexual theories are even more prolific among addictionologists than sexologists. The dominant theme proposes that a finite number of polymorphous sexual possibilities are locked into the brain in early childhood and subsequent behavior is virtually predeter- mined. The lovemap theory of sexologist John Money has been enthusi- astically deployed by addictionologists, who find the notion of behavioral options programmed into the brain in childhood a compelling explanatory concept. Money describes the lovemap as "a developmental representa- tion or template, synchronously functional in the mind and the brain, depicting the idealized lover, the idealized love affair, and the idealized program of sexuoerotic activity with that lover, projected in imagery and ideation, or in actual performance."33 The lovemap allegedly incorporates

Janice M. Irvine

into the brain a range of social inputs transmitted through sensory mech- anisms. In addition, scientific breakthroughs in neurochemistry have informed the development of an essentialist sex addiction model since, as Patrick Carnes notes, "studies generated greater scientific awareness that addiction could exist within the body's own chemistry."34 Sexual desire and addiction are thus viewed as coterminous physiological events inside the body.

These models enable addictionologists to explain the intransigence of repetitive problematic sexual behavior. It has been encoded into the hard- wiring of the brain. It is not uncommon to hear addictionologists suggest, for example, that our brains spontaneously move into preset programs of activities,35 that the linchpin of co-dependency is the inability to change behavior because it has been programmed in during childhood,36 or that male and female brains are crucially different so that the exact same trauma early in childhood can affect a female differently than a male.37 As we will see, these theoretical perspectives on sexual desire disorders are crucial in that they shape treatment strategies.

Although they occupy considerable space, the brain-centered theories of sexuality are not hegemonic. More recently, sexologists are divided on the centrality of a biologically based model of desire. Many still adhere to a solidly essentialist theory, and scores of studies claim the androgens as the "libido" hormone.38 Other sexologists have posited multidimensional models which privilege psychological and cognitive factors in shaping desire.39 The medical literature frequently describes marital difficulties, fear, and anger as underpinnings of inhibited sexual desire. As Helen Singer Kaplan notes about women who experience ISD in the context of ongoing relational discord, "it is not possible for most people to feel sex- ual desire for 'the enemy."'40 And many addictionologists link sex addic- tion and co-dependency to trauma, child sexual abuse, and a breakdown in spirituality.41 On infrequent occasions, clinicians will point to the role of broader cultural messages that result in complex and often contradictory imperatives about sex.

Even when these professionals invoke more expansive hypotheses to explain the desire disorders, however, they are largely theoretically located in what anthropologist Carole Vance terms the "cultural influence model."42 In this view, sexuality, although influenced by culture, is thought to encompass universal forms of expression driven by an inner force or impulse. Vance notes, "Although capable of being shaped, the drive is conceived of as powerful, moving toward expression after its awakening in puberty, sometimes exceeding social regulation, and taking a distinctively different form in men and women."43 While the cultural influence model as it appears in professional theories of desire disorders is a marked improvement over rigidly essentialist frameworks, it retains determinist

Regulated Passions 211

assumptions. And unlike social construction theory, it leaves unexamined the radical mediation of sexuality by history and culture. Only infre- quently, for example, does the literature on sex addiction and ISD acknowledge the role of societal norms about sex in shaping desire.

Aside from theoretical congruence concerning the nature and origins of desire, however, both professional cohorts face the challenge of pre- cisely elucidating the parameters of their new diseases. The experts con- structing sex addiction and inhibited sexual desire share a common con- ceptual and practical problem of definition: the decisive question of how much is too much and how little is too little. This indeterminacy is a familiar dilemma in describing sexual disorders. Kinsey was famous for anecdotally defining the promiscuous individual as "someone who's get- ting more than you are." Similarly, Masters and Johnson struggled for a reasonable definition of premature ejaculation. For example, given the range of partners a man might have, he might be premature with one partner and not with another. For ISD and sex addiction, professionals have given diagnostic weight to outside referents. For sex addicts, repeated criminal offenses can serve as a surrogate marker for the subjec- tive experience of being out of control sexually. An angry and dissatisfied partner is often the impetus for someone to seek professional treatment for ISD. Yet again, the fundamental subjectivity is inescapable, and calls to mind the exchange in Annie Hall between Woody Allen and Diane Keaton when their therapist asks how often they have sex. He says, "Hardly at all. Only three times a week," while she replies, "All the time. At least three times a week." Clinicians admit that, especially with ISD, the concept of de- sire discrepancy is inevitably relational, so that individuals can easily shift diagnoses depending on their partner. Ultimately both ISD and sex addic- tion rely heavily on self-diagnosis and serve as beacons for the individual who feels a sense of inadequacy or incongruence with cultural or inter- personal sexual norms. Yet despite their inevitably subjective character, professionals have tried to establish quantifiable frames for their diseases.

The nomenclature committee of the American Psychiatric Associa- tion recognized inhibited sexual desire as a clinical entity in 1980 and it was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), thus making it an official mental illness. The DSM-IIIR (1987) elaborated this classification further by dividing the disease into two cate- gories: Hypoactive Sexual Desire Disorder and Sexual Aversion Disor- der.44 The definition of HSD is vague but implies that the person must be distressed or that there must be an inherent disadvantage to low sexual interest (anger of a spouse, for example). Helen Singer Kaplan describes HSD as either primary-a rare lifelong history of asexuality-or secondary, in which there is a loss of sex drive after a history of "normal sexual development." Kaplan describes the typically situational HSD woman as the one who

Janice M. Irvine 212

feels very erotic during the many years of her precoital experiences. She felt desire and erotic pleasure during "petting," but she loses sexual interest after she has engaged in coitus, or after marriage, or after childbirth, i.e., in situ- ations which on a symbolic and unconscious level represent danger.45

The diagnosis of ISD remains controversial among sexologists, with little consensus regarding operational criteria. Some sexologists have even sug- gested that the disorder is so vague and diagnostic boundaries so blurred that ISD, as a "catch-all" diagnosis, represents the schizophrenia of sex therapy.46 Many negotiate these difficulties with the strategy summarized by sex therapists Sandra Leiblum and Ray Rosen that "you know it when you see it."47

Proponents of the sex addiction diagnosis suffer similar definitional quandaries, resulting in a myriad of checklists and screening question- naires to determine one's vulnerability. Many subscribe to the AA maxim: If you think you've got a problem, you probably do. The Sexual Depen- dency Unit at Golden Valley defines sex addiction as "engaging in obses- sive/compulsive sexual behavior which causes severe stress to addicted individuals and their families."48 Sex becomes the organizing principle of the addict's life, for which anything will be sacrificed. In addition, sex addiction can include the following behaviors when they have "taken con- trol of addicts' lives and become unmanageable: compulsive masturba- tion, compulsive heterosexual and homosexual relationships, pornogra- phy, prostitution, exhibitionism, voyeurism, indecent phone calls, child molesting, incest, rape and violence."49 Among the several Twelve Step groups, definitions of sex addiction vary, as do the concepts of what con- stitutes "sobriety." Yet among both professionals and recovering sex addicts, two themes are consistent. First, whatever the behavior, it is prac- ticed compulsively. And second, the common enemy is lust, which is thought to drive the sex addiction cycle. In a manner reminiscent of the social purity movements of the late nineteenth and early twentieth cen- turies, lust is thought to lead the victim into uncontrollable and destruc- tive behavior. Lust, therefore, must be eliminated. Sexaholics Anonymous is perhaps the most restrictive in this sense, in that freedom from lust occupies center stage in the definition of sobriety. The literature states that:

Any form of sex with one's self or with partners other than the spouse is pro- gressively addictive and destructive. Thus, for the married sexaholic, sexual sobriety means having sex only with the spouse, including no form of sex with one's self. For the unmarried .. freedom from sex of any kind. For all ... progressive victory over lust.50

Regulated Passions 213

As with the

social purity

movements,

addictionologists

view sex as simply

Again, as in the social purity movements, addictionologists view sex as simply one of the falling dominoes in a downward-spiraling cycle of destruction that may include, among other elements, eating, gambling, drugs, and alcohol. One professional, for example, described as vulnerable "a particular kind of woman very involved with fantasy who is a compul- sive masturbator, compulsive overeater, and reads romance novels."51 Addictions are described as multiple and often interchangeable. Ann is another case described in the treatment literature:

one of the falling

dominoes in a

downward-

spiraling cycle of

Ann spent almost every night in cocktail lounges searching for men. After several years of emotionally empty one night stands, she came to the realiza- tion that she and the men she seduced were simply using each other sexually. In desperation she swore off the bar scene and joined her friend Judy in small stakes bingo and card games. Within one month, Ann had identified several high stakes poker and bingo games and had become totally absorbed in her new-found gambling compulsion.52

destruction that

may include,

among other

elements, eating,

gambling, drugs,

and alcohol.

To discourage such symptom substitution, professionals are warned that treatment must include all the addictions. Self-help groups thus cast an ever-widening net to include such compulsions as excessive masturba- tion, gambling, bingo, and romance novels.

In her landmark, best-selling text, Women, Sex, and Addiction, Char- lotte Kasl expands the system of addiction even further by intertwining sexual co-dependency with sex addiction in women. Co-dependent (or co-addict) was a term originally created to describe the partner of an alcoholic. Kasl has broadened the definition to refer to a "devastating dis- ease" in which a woman has sex anytime she doesn't want to, in order to maintain a relationship or placate a partner. Co-dependency, Kasl notes, is "women's basic programming" and is only a slight exaggeration of the culturally prescribed norm for women.53

Despite internal disagreement and confusion among sexologists and addictionologists over the etiology, definitions, and operational criteria of their diseases, some consistent treatment strategies have evolved. These are shaped by the biomedical infrastructure central to the construction of the desire disorders. For regardless of documented social correlatives such as abuse, power differences in heterosexual relationships, or cultural pres- sures as possible etiological factors, the disease model of sexual desire disorders retains prominence. Sex addiction is considered dangerous, and by some, such as Anne Schaef, "a progressive, fatal disease."54 Likewise, sexologists view inhibited sexual desire as a serious and intractable dis- ease. Unlike the other sexual dysfunctions, it has a poor prognosis with available treatment. Treatment strategies for both sex addiction and inhib- ited sexual desire remain steadfastly fixed on the individual (or often in

Janice M. Irvine 214

the case of ISD, the couple), with the goal of management, adjustment or regulation of sexual desire and sexual behavior. The most common inter- ventions are individual or couples therapy, sometimes supplemented with pharmaceuticals. For sex addiction, Twelve Step groups are an essential complement to either inpatient or outpatient treatment.

The professional reliance on organic, neurochemical explanations for both ISD and sexual addiction has predictably led to the search for a "magic bullet" as experts in both fields look hopefully and confidently to the future of neurochemistry for unlocking the determinants of their dis- eases. Meanwhile, drug treatment is used as an adjunct to treatment for both dysfunctions. The antidepressant drug Wellbrutin was once the great treatment hope for ISD until it was found to trigger seizures. Now, despite lack of evidence of efficacy, testosterone is being prescribed for low sexual desire in premenopausal women.55 Prozac is often prescribed for sex addiction, although there is much controversy and suspicion among sex addicts about using a drug to treat an addiction.

Medicalizing Desire

In our culture, both disease and desire are medical events, individual experiences, and social signifiers. There is no linear relationship between medical ideology and individual behavior. We are not passively shaped by broader medical ideas; yet neither does our medical discourse directly reflect an internal, universal experience of individuals. The content of medical diagnoses is shaped by social, economic, and political factors. And both specifically medical and broader cultural ideologies operate in the construction of individual experiences of sexual desire. Not simply a biological urge, sexual desire is a culturally constructed composite. It is imperative, therefore, to analyze the contemporary medicalization of sex- ual desire along these three dimensions.

The nineteenth century marked a shift in scientific investigation of sexual matters. Hence, sexuality has represented a site of expansion and control by the medical profession, with its interests in delineating the nature of sexual impulses and constructing new psychological categories of behav- ior. The themes in ISD and sex addiction of sexual conflict, chaos, and dis- order are familiar legacies from more than a century of a medical gaze onto sexual expression. The invert, the sexual psychopath, the hypersexual female, and the onanist are but some of the historically demonized charac- ters who step from the text of a medical discourse of definition and regula- tion.56 It is not surprising, then, that professionals in the late twentieth century would conceptualize concerns regarding sexual desire as major

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medical problems, since historically physicians have played a significant role not only in the management of sexual behavior but in defining the exis- tence, appropriateness, and ideal object of sexual desire or passion.

Broader societal constructs of desire have largely been based not on the felt experiences of individuals, but on ideological beliefs about sexu- ality and gender. For example, permission for any individual woman to experience desire, discuss sexuality, initiate a sexual encounter, or present herself as passionate varies historically and culturally. Carl Degler has documented the variability in nineteenth-century medical advice literature regarding desire in middle-class women. One theme speaks to the strength of women's passion; another articulates the stereotypic Victorian view that women approach sex "with shrinking, or even with horror, rather than with desire."57 Further, Nancy Cott has related variations in the dominant ideology about women's passion through the eighteenth and nineteenth centuries not to changes in individual and interpersonal sexual experiences, but to cultural shifts in metaphoric systems about the nature of women. Passionlessness, she argues, transformed women's image in the nineteenth century to one of spirituality, away from the eighteenth- century view of women as lustful creatures prone to sexual excess.58 The most recent medical constructions of desire disorders reinscribe histori- cally familiar themes of morality, regulation, the ambivalence of pleasure, and the ruin of excess and depravity.

The power of medical ideology in the construction of sexual desire derives from its expansion, its authoritative voice. There must be cultural recognition that desire problems are diseases with a subsequent adoption of the language and concepts of dysfunction. This process is facilitated by popular representation, and by the early 1990s, both ISD and sex addic- tion had achieved a certain currency within popular culture. For sufferers of low sexual desire, articles abound on DINS (dual-income, no sex), cast- ing ISD as the latest malady for yuppies too tired from an active day on Wall Street to have sex. And at least one popular self-help manual has appeared, entitled Not Tonight, Dear, in which the author promises that "the mental nature of desire makes it particularly amenable to improve- ment through reading."59 Given that our cultural balance consistently tilts away from pleasure and toward prohibition, the idea of sex addiction has more thoroughly captured the popular imagination. In addition to the thousands of Twelve Step groups, the afflicted may call a National Sexual Addiction Hotline. The National Enquirer reported that Rob Lowe had entered a sexual addiction clinic,60 and Arnie Becker on "L.A. Law" began to describe his sexual exploits as "satyriasis." The shift in the sex- ual spirit of our times is perhaps best captured by Erica Jong's new book, Any Woman's Blues, in which the central female character is a sex addict who in the end joins a Twelve Step group.61 A New York Times ad bla-

Janice M. Irvine

zoned, "In the seventies, Erica Jong taught women how to fly ... now she shows them how to land."62 Through their widespread dissemination of the concepts of inhibited sexual desire and sex addiction, these popular- izations continually reassert and legitimate the idea that cultural ideologies about appropriate sexual expression are valid medical conditions respon- sive to individual intervention and cure.

The existence of inhibited sexual desire and sex addiction as medical diagnoses ensures that proposed solutions will be individual rather than structural/cultural. In part ideological, this therapeutic trajectory is also driven by a financial motor, and clearly economic incentives are central to medical expansion. Treatment for sexual desire problems is a vast and lucrative commercial venture. The revenues of Sex and Love Addicts Anonymous, for example, soared to over $100,000 after Hazelton took over distribution of their central text in 1988.63 Golden Valley Health Center employs an international public relations firm to manage the scores of daily calls received from around the world about the Sexual Depen- dency Unit. And sexologists report that at least half of the clients coming for sex therapy present with claims of low sexual desire.64 The large num- bers of individuals engaged in treatment for desire problems speak to the widespread acceptance of medical constructs and the availability of pro- fessionals who offer medical diagnosis and treatment. But perhaps most importantly, it indicates the pain and confusion experienced by so many people concerning their sexual desire and behavior.

In this respect, then, it is important to evaluate the medicalization of desire by its therapeutic impact. How does the existence of ISD and sex addiction as disease entities shape individual experiences of sexuality? Has the creation of these diseases either limited or expanded other options for thinking about sexual desire? What does it mean to take on the identity of a sex addict? If one feels little sexual desire, is it helpful to define that absence as a disease? Does it matter that it is clinicians who will offer the range of answers to the Cosmo girl who wonders "how much sex is enough?" While there are anecdotal or clinical reports, the desire disor- ders are too new for the emergence of a nuanced ethnographic and phe- nomenological literature on the meanings of these diagnoses for men and women. But speculation about the broader cultural implications and the limits of individual impact is possible given our knowledge about the nature of medicalization and of the particular theoretical contours of both inhibited sexual desire and sex addiction.

The imposition of a biomedical paradigm over social events or prob- lems may suggest potential advantages. These include the increased recog- nition it promotes and the conceptual framework it offers for worried individuals. Further, a medical diagnosis confers legitimacy on a particu- lar set of difficulties. The seemingly neutral and scientific language of

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The ideal model

presented for

sexually addicted

women is a social

purity vision of a

spiritually based,

monogamous

sexuality that is

always relationally

oriented. Any

variation from this

is pathologized,

and within the

sex addiction

field, retro-purity

terms have

reemerged, such

as "promiscuity,"

"nymphomania,"

and "womanizer."

disease may offer palpable relief to those who secretly worry that their sexuality is inadequate or out of control. Especially when the definitional options are those of morality or personal failure, a medical diagnosis may sound more dispassionate and, significantly, admits one to a high-tech arena of research and psychotechnology.65 According to one clinician, "Lack of desire is like a fever. Something is going on."66 As with con- tracting the flu, feeling too much or too little desire is nobody's fault. All that remains is the breakthrough treatment discovery.

Ultimately, however, medical diagnosis offers a false neutrality, for, "as illnesses are social judgments, they are negative judgments."67 Disease designations connote discomfort, deviance, treatment, and cure. Sexolo- gists and addictionologists, for example, have reified the desire disorders into static and simplistic categories. Diagnostic profiles and checklists are purposely vague so as to be inclusive of a wide range of behaviors. One profile for sexually addicted women includes and indicts behavior as diverse as "multiple and serial relationships; affairs; one night stands; cruising bars, health clubs, etc.; personal columns; masturbation; fantasy; preparing and dramatizing; S/M; exposing; dangerous situations; self abuse; suicidal and homocidal; relationships with sexual compulsive men."68 The ideal model presented for sexually addicted women is a social purity vision of a spiritually based, monogamous sexuality that is always relationally oriented.69 Any variation from this is pathologized, and within the sex addiction field, retro-purity terms have reemerged, such as "promiscuity," "nymphomania," and "womanizer." Accepting the disease model of inhibited sexual desire and sex addiction in exchange for a moral framework proves, then, to be a bad bargain. For the taint of stigma and deviance inheres in the expansive diagnostic categories.

Reliance on individual treatment solutions remains a major short- coming of the medical model. In the case of ISD and sex addiction, the obvious limitation is that, in the absence of social and historical insight, the problem is located within the individual chemistry or psyche and is presumed amenable to medical intervention. The inadequacy of a bio- medical approach to treatment is glaring with the desire disorders, even when one looks at etiology as defined by the professionals themselves. Despite the preoccupation with lovemaps and brain circuitry, professional literature suggests a broader range of social correlatives. ISD is frequently related to fear, anger, and marital problems; some studies suggest that power struggles and lack of respect are major dynamics for ISD in women.70 Sex addiction is linked to childhood sexual trauma.71 Given this data, a sociohistorical approach to treatment would suggest the need for a more encompassing strategy for change. Yet clinicians articulate no social vision to end sexual abuse, challenge the primacy of the nuclear family, end the double standard, improve sex education, or expose

Janice M. Irvine 218

destructive and coercive sexual ideologies. Significantly, there are no treat- ment outcome studies for sex addiction, and ISD is widely considered the most difficult sexual problem to treat.

Medicalizing desire, then, cannot really be said to eliminate moral stigma or enhance "cure." Other potential effects are difficult to discern clearly. There is some concern that the message from the proliferation of sexual diseases privileges certain styles of sexual expression and margin- alizes others. At least one sex therapist has been critical of the broader therapeutic milieu of sex therapy, whose emphasis on sexual enhance- ment techniques increases the "pressure we all are under to 'always say yes.'"72 It is widely recognized that the discourse of sickness can readily become coercive, and there is evidence that this is increasingly true for the sexual dysfunctions.73 One client in therapy for ISD voiced precisely this complaint about her husband's appropriation of the disease frame:

But he's got this hang-up about my having to have sex the way he does. "Doesn't it feel good to you?" he asks. So, I rub my earlobe and say, "yeah, and this feels good, too, but I never think about rubbing my earlobe and if I do I don't say, 'Wow, I can't wait to do it again.' I like Chinese food, but if I had to go a year without any, I wouldn't be miserable." He says I'm inhibited and don't know it and that I need therapy. When he gets angry he calls me an uptight, frigid bitch, and says I'm sick.74

Yet individuals internalize disease models in highly variable ways, and it is important to acknowledge that despite coercive potential, scores of people report relief and validation from the desire diagnoses. Individuals also negotiate these diagnostic systems idiosyncratically. With sex addic- tion, for example, there are clearly individuals who instrumentally select from the menu of treatment options, attending recovery groups for the structure, support, and community, but eschewing the adoption of a full- blown identity. Countless others, however, opt for wholesale acceptance of the addiction ideology as an explanatory device for their fears, and they find solace in their "sobriety" from the disease. The AIDS epidemic has been the perfect impetus for many to define behavior as out of control which once would have been perfectly acceptable, and in 1986 the national gay newsmagazine The Advocate reported that thousands of gay men were reporting that they suffered from the disease of sex addiction.75 The out-of-control behavior defined by the men themselves ranged from masturbation once or twice a month by a devout Catholic to relentless cruising of peep shows. All claimed to experience great relief from their "sexual recovery plans."

This underscores the importance of individual needs and cultural anxieties in the construction of disease categories. For inhibited sexual desire and sex addiction serve as contemporary disease categories which

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help people create meaning out of their sexual experiences. The diag- noses offer the hope of achieving "normalcy" to those who experience their sexual desire as either inadequate or out of control. They are bipolar constructs that map the contradictory cultural landscape regarding the negotiation and management of appropriate sexuality. These disorders emerged in the mid-1970s and flourish during an era of distinct and pal- pable tensions regarding sexual norms. They are informed by the dichoto- mous contemporary ideology in which sex is simultaneously heralded as the linchpin of individual fulfillment and denigrated as the source of chaos, exploitation, and death.

Desire, too, is a cultural trope for both pleasurable satisfaction and dangerous, possibly alien, hunger. Historian Joan Jacobs Brumberg and philosopher Susan Bordo speak to this ambivalence and fear in their analyses of anorexia nervosa.76 Women are terrified and repelled by visions of themselves as voracious, needy, yearning, and hungering with- out restraint. "Appetite," Brumberg writes, "is an important voice in female identity."77 Yet appetite, whether for food or for sex, carries with it the hope of satisfaction and the fear of wanting too much or of needing and not getting. Desire is not neutral. Cultural attitudes toward high lev- els of sexual desire reflect this pleasure/danger dichotomy.78 We are assured by experts on ISD that "an increase in sexual desire is invariably beneficial," since high levels of sexual desire inspire people to exercise, watch their weight, dress with flair, groom themselves carefully, and oth- erwise operate as healthy, attractive individuals.79 For sex addicts, how- ever, it is "the athlete's foot of the mind. It never goes away. It always is asking to be scratched, promising relief."80 Desire, then, will either make you a better person or ruin your life.

These bifurcations, so dramatically visible in this era of epidemics such as AIDS, were apparent in the sexual ethos of the 1970s as well. The glut of media information about sex during that decade reflected both a growing openness and increasing sexological expertise. Further, the pub- lic challenges of the feminist and lesbian and gay liberation movements to hetero/sexist imperatives created new sexual space. Many women were empowered not merely to avoid exploitive sex, but to seek out fantasy, orgasms, and thrills. Feminist consciousness-raising groups facilitated both a critique of existing sexual relationships and the exploration of new sexual terrain. A study of married couples in the early '70s revealed greater sexual experimentation among white couples of all classes. Main- stream books like The Joy of Sex, The Sensuous Woman, and My Secret Garden spoke to a new sexual spirit. By the late '70s, women had become increasingly active partners, and couples were enthusiastically proclaiming the importance of sex to a good relationship.81

Janice M. Irvine 220

Yet this sexual enthusiasm was striated with oppositional impulses. The persistence of the double standard thwarted many women's pursuit of sexual freedom. Feminist organizing drew greater public attention to sex- ual violence as a mechanism for the social control of women. And the plethora of sexual options touted by sexologists and the media were expe- rienced by many merely as increased pressure. The glaring disjuncture between expectations of an easy sexual pleasure and the realities of failed sex helped create a cultural basis for the successful development of clinical programs of sex therapy. The growing New Right launched challenges to sex education, legalized abortion, and gay liberation, reinscribing notions of abstinence, morality, and sexual self-control on the collective psyche. The calls for sexual restraint became, of course, even more widespread and entrenched throughout the '80s with the emergence of the AIDS epidemic. On parallel tracks, then, inhibited sexual desire and sex addiction mark these contradictory themes of sexual freedom contrasted with growing sexual fear and prohibition. Together they constitute a set of regulatory discourses and serve as social signifiers that shape individual experience.

However, medical diagnoses function differently for individuals and may operate fluidly and unpredictably in the culture. While constructed diseases like ISD and sex addiction play a central role in the creation and reinforcement of the traditional sociosexual order, the diagnoses might also contain the seeds of disruption and opposition. For example, the diagnostic binarisms of inhibition and excess easily suggest gendered sex- ual norms, and in fact, early on, demographics revealed more women diagnosed with ISD while men largely filled the ranks of sex addicts. The disorders therefore reified a normative system of sex/gender relations. For women, ISD was simply a reformulation of historical diagnoses of frigidity, implying withholding unresponsiveness. Conversely, the male sex addict represents a more extreme version of male sexual energy and aggression.

As the male/female ratios become more equivalent, the definitions are still internally gendered. For example, the profiles of male and female sex addicts are quite different. Men are identified as sex addicts when they exhibit repetitive and extreme forms of behavior. Often they are prone to violence, or are engaging in behavior such as fetishism. This is not the typical standard for female sex addiction. Instead, women sex addicts are described as risking victimization or using sex to feel vicariously powerful. Women sex addicts are said to prepare and dramatize, unlike men. As one therapist said, "We're talking about picking the right music, picking the right clothes, picking the right make-up."82 These rituals may extend for hours or days before being sexual.

Clear ideas about appropriate sexual behavior for women emerge in the definition of sex addiction. Charlotte Kasl, who has been the major

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spokesperson on female sex addiction, links sex addiction in women to a break from having sex in a loving relationship and within a larger spiritual context. In a revealing statement that reflects cultural ideologies about inherent differences between male and female sexuality, she claims, "Sex addiction in women reflects an internalization of male norms of sexuality involving power, aggressiveness, and control."83 In fact, the idea of aggres- sion and extreme sexual behavior among women is so taboo that the con- cept of sex addiction quickly splintered, with women identifying instead as sexual co-dependents, romance addicts, and relationship addicts.

Yet in a cultural moment of instability and ambivalence, the diag- noses of ISD and sex addiction may signify the manner in which sex/gen- der boundaries are also being eroded. ISD, as it is recently constructed, draws on feminist assertions of the importance of pleasure and desire for women. Despite its many shortcomings, the diagnosis of ISD can serve as a cultural protest by women; a demand for satisfaction in sex and a refusal to settle for less. Similarly, the construct of sex addiction is sometimes for- mulated as a complaint against sexual accommodation and exploitation of women. Feminists in the field claim that addiction often represents women's escape from "the powerless feelings of codependency." Co- dependency has been described as a "disease of inequality" in which oppressed people must understand and accommodate those in power.84 For some of these women, then, the struggle against sex addiction may serve as a fundamental challenge to restrictive gender roles. Similarly, some men who identify with either ISD or sex addiction have criticized tra- ditional male sexual expectations. It is too soon to tell whether the male who identifies with ISD will simply be silently ridiculed and despised while the female sex addict will remain an anomaly destined for "Oprah." But the new diagnoses clearly allow for more than the simple recuperation of normative roles.

These deconstructions simply suggest that, like the nineteenth-century proliferation of sexualities, the invention of contemporary medical cate- gories is not one-dimensional in effect. Discourse, as Foucault notes, pro- duces and reinforces power but also exposes and destabilizes it. The cre- ation of new sexual disorders reinscribes traditional sex/gender relations while possibly providing a site for resistance, however minimal. Central to this resistance, however, is a consistent and sharp awareness of how these new diseases, as signifiers of social relations and anxieties, are generally supportive of dominant political interests and social structures. This is especially true in an era when, as medical experts are asserting guidelines about "safer" and hence "appropriate" sex, many individuals feel more vulnerable and therefore susceptible to medical definition, intervention, and control.

Continual challenge of medical definitions is essential, particularly as the new desire disorders become widespread. For despite the potential for

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some regrounding of sex/gender relations, the tendencies of medicaliza- tion are such that ISD and sex addiction can easily become social practices inimical to the goals of feminism and the lesbian/gay movement. We must remember that in the earlier social purity movements, feminist themes resounded through movements that were otherwise conservative and anti- sex.85 The social purity themes of lust, degradation, and loss of control inherent in the sex addiction construct should give us pause, particularly, for example, as the model is being suggested as salient to the area of sex- ual abuse and sex offenders.86 After decades of scholarship suggesting that power inequities and gender oppression underpin most sexual vio- lence, feminists should be wary of models that suggest that rapists and sexual abusers suffer instead from individual dysfunctions. And despite enthusiastic identification by scores of lesbians and gay men, sex addiction has gotten little, and decidedly negative, attention in the gay press. The one major article in The Advocate, entitled "Reinventing the Sex Maniac," rightfully worried that sex addiction was simply a new expression of homophobia and self-hatred.87

Inhibited sexual desire and sex addiction are not demon diagnoses; they have offered validation and community to many. But since the bio- medical model is a severely limited paradigm for understanding sexuality on either a social or personal level, it is clearly time for an alternative popular and accessible frame for people to understand their experiences or engage in collective discussion and support for sexual concerns. Pro- gressive movements currently articulate a public and oppositional dis- course that inserts the elements of history, cultural ideologies, and power relations into any analysis of sexuality. The next challenge is to create the space for individuals to determine how the personal might be political in their sex lives. Otherwise the new desire disorders stand as uncontested models in which sexual anxieties, discomfort, and problems inhere in the individual body or psyche rather than the body politic.

Notes

1. Michel Foucault, The History of Sexuality, Vol. 1: An Introduction (New York: Pantheon, 1978), 48.

2. John D'Emilio and Estelle Freedman, Intimate Matters: A History of Sexu- ality in America (New York: Harper & Row, 1988).

3. Foucault, The History of Sexuality, 33. 4. Talcott Parsons, "The Sick Role and the Role of the Physician Reconsid-

ered," Health Society, no. 53 (1975), 257-78. 5. Elizabeth Fee, "Henry E. Sigerist: From the Social Production of Disease

to Medical Management and Scientific Socialism," Milbank Quarterly 67, sup- plement 1 (1989).

6. See Sandra R. Leiblum and Raymond C. Rosen, "Introduction," in Sex-

Regulated Passions 223

ual Desire Disorders, ed. Leiblum and Rosen (New York: Guilford Press, 1988), vii.

7. See Janice M. Irvine, Disorders of Desire: Sex and Gender in Modern Amer- ican Sexology (Philadelphia: Temple University Press, 1990), for a discussion of sexology's history.

8. William Masters and Virginia Johnson, Human Sexual Inadequacy (New York: Bantam Books, 1970).

9. Leiblum and Rosen, "Introduction," in Sexual Desire Disorders. 10. Anthony Pietropinto and Jacqueline Simenauer, Not Tonight, Dear: How

to Reawaken Your Sexual Desire (New York: Doubleday, 1990). 11. This history is from Richard F Salmon, "A History of the 12-Step Fel-

lowships for Sexual Addicts and Co-Addicts," presented at the National Confer- ence on Sexual Compulsivity/Addiction, Minneapolis, 21 May 1990.

12. Ibid. 13. Richard Solomon, "The Opponent-Process Theory of Acquired Moti-

vation," American Psychologist 35 (1980), 691-712. 14. Daniel Goleman, "Some Sexual Behavior Viewed as an Addiction," New

York Times, 16 October 1984. 15. Audience discussion during Carole G. Anderson, "Assessment and

Treatment of the Sexual Dependency, Eating Disorders, Sexual Trauma Com- plex," presented at the National Conference on Sexual Compulsivity/Addiction, Minneapolis, 20 May 1990.

16. Ginger Manley, "Sexual Health Recovery in Sex Addiction: Implica- tions for Sex Therapists," American Journal of Preventive Psychiatry and Neurology 3, no. 1 (Spring 1991).

17. Mark Schwartz, "Four Paraphilias: Victim to Victimizer Triumph over Tragedy," presented at the National Conference on Sexual Compulsivity/Addic- tion, Minneapolis, 20 May 1991; and Manley, "Sexual Health Recovery in Sex Addiction."

18. See Irvine, Disorders of Desire, for a discussion of sexology's strategies to achieve professional legitimacy.

19. Leiblum and Rosen, "Introduction," in Sexual Desire Disorders. 20. Goleman, "Some Sexual Behavior Viewed as an Addiction." 21. Craig Rowland, "Reinventing the Sex Maniac," The Advocate, 21 January

1986: 45. 22. Judy Foreman, "Drugs May Help Sex Offenders," Boston Globe, 5

March 1984. 23. Goleman, "Some Sexual Behavior Viewed as an Addiction." 24. John Money and Margaret Lamacz, Vandalized Lovemaps: Paraphilic Out-

come of Seven Cases in Pediatric Sexology (New York: Prometheus Books, 1989). 25. Renee Dubos, Mirage of Health (New York: Harper & Row, 1959). 26. Jeffrey Weeks, Against Nature: Essays on History, Sexuality, and Identity

(London: Rivers Oram, 1991), 70. 27. See Jeffrey Weeks, Sex, Politics, Society: The Regulation of Sexuality since

1800 (New York: Longman, 1981); Weeks, Against Nature; Irvine, Disorders of Desire.

28. Weeks, Against Nature, 70. 29. Helen Singer Kaplan, Disorders of Sexual Desire and Other New Concepts

and Techniques in Sex Therapy (New York: Brunner/Mazel, 1979), 9. 30. Ibid., 78.

Janice M. Irvine 224

31. Ibid., 25. 32. Weeks, Against Nature, 70. 33. Money and Lamacz, Vandalized Lovemaps, 43. 34. Patrick J. Carnes, "Sexual Addiction: Progress, Criticism, Challenges,"

American Journal of Preventive Psychiatry and Neurology 2, no. 3 (May 1990), 1. 35. Ian Forster, "Co-Dependency: A New Description and Theory-A Cor-

relation between Co-Dependency and the Development of Addictive Disease," presented at the National Conference on Sexual Compulsivity/Addiction, Min- neapolis, 21 May 1991.

36. Ibid. 37. Schwartz, "Four Paraphilias." 38. Leiblum and Rosen, "Introduction," in Sexual Desire Disorders. 39. See ibid. for the parameters of this debate. 40. Kaplan, Disorders of Sexual Desire, 90. 41. See, for example, Patrick J. Carnes, Out of the Shadows: Understanding

Sexual Addiction (Minneapolis: CompCare Publications, 1983), and Charlotte Kasl, Women, Sex, and Addiction: A Search for Love and Power (New York: Ticknor & Fields, 1989).

42. Carole S. Vance, "Anthropology Rediscovers Sexuality," Social Science and Medicine 33, no. 8 (1991), 875-84.

43. Ibid., 878. 44. Leiblum and Rosen, "Introduction," in Sexual Desire Disorders. 45. Kaplan, Disorders of Sexual Desire, 63-64. 46. Clearing-Sky and Thornton, cited in Leiblum and Rosen, "Introduc-

tion," in Sexual Desire Disorders, vii. 47. Leiblum and Rosen, Sexual Desire Disorders, 8. 48. "Sexual Addiction," brochure of the Golden Valley Health Center. 49. Ibid. 50. Quoted in Richard Salmon, "Twelve Step Resources for Sexual Addicts

and Co-Addicts," presented at the National Association on Sexual Addiction Problems of Colorado, 1989.

51. Keziah Hinchen and Anne McBean, "Sexually Compulsive or Addicted Women," presented at the National Conference on Sexual Compulsivity/Addic- tion, Minneapolis, 21 May 1990.

52. Marvin A. Steinberg, "Sexual Addiction and Compulsive Gambling," American Journal of Preventive Psychiatry and Neurology 2, no. 3 (May 1990), 40.

53. See Kasl, Women, Sex, and Addiction. 54. Anne Schaef, Escape from Intimacy: The Pseudo-Relationship Addictions

(San Francisco: Harper & Row, 1989), 34. 55. See Irvine, Disorders of Desire, for a discussion of ISD and drug treat-

ment. 56. Gayle Rubin, "Thinking Sex: Notes for a Radical Theory of the Politics

of Sexuality," in Pleasure and Danger: Exploring Female Sexuality, ed. Carole S. Vance (Boston: Routledge & Kegan Paul, 1984), 267-318.

57. Carl Degler, "What Ought to Be and What Was: Women's Sexuality in the Nineteenth Century," in Women and Health in America, ed. Judith Walzer Leavitt (Madison: University of Wisconsin Press, 1984), 40-56.

58. Nancy Cott, "Passionlessness: An Interpretation of Victorian Sexual Ide- ology, 1790-1850," in Women and Health in America, ed. Leavitt, 57-69.

59. Pietropinto and Simenauer, Not Tonight, Dear, 6.

Regulated Passions 225

60. "Rob Lowe in Sex Addiction Clinic," National Enquirer, 5 June 1990. 61. Erica Jong, Any Woman's Blues (New York: Harper & Row, 1990). 62. New York Times Book Review, 4 February 1990. 63. Salman, "A History of the 12-Step Fellowships." 64. See Leiblum and Rosen, "Introduction," in Sexual Desire Disorders, and

Pietropinto and Simenauer, Not Tonight, Dear, 4. 65. S. Chorover, "Big Brother and Psychotechnology," Psychology Today

(October 1973), 43-54. 66. Pietropinto and Simenauer, Not Tonight, Dear, 4. 67. Peter Conrad and Joseph Schneider, Deviance and Medicalization: From

Badness to Sickness (St. Louis: C. V. Mosby Company, 1980), 31. 68. Handout from Keziah Hinchen and Anne McBean, "Sexually Compul-

sive or Addicted Women," presented at the National Conference on Sexual Com- pulsivity and Addiction," Minneapolis, 21 May 1990.

69. See Kasl, Women, Sex, and Addiction. 70. See Irvine, Disorders of Desire, for an expansion of this argument. 71. See Kasl, Women, Sex, and Addiction, and press release from Golden

Valley Health Center, 1990. 72. Bernard Apfelbaum, "An Ego-Analytic Perspective on Desire Disor-

ders," in Sexual Desire Disorders, ed. Leiblum and Rosen, 78. 73. See Irvine, Disorders of Desire, for a broader examination of these issues. 74. Pietropinto and Simenauer, Not Tonight, Dear, 20. 75. See Rowland, "Reinventing the Sex Maniac." 76. Joan Jacobs Brumberg, Fasting Girls: The History of Anorexia Nervosa

(New York: Plume, 1988), and Susan Bordo, "Anorexia Nervosa: Psychopathol- ogy as the Crystallization of Culture," in Feminism and Foucault: Reflections on Resistance, ed. Irene Diamond and Lee Quinby (Boston: Northeastern University Press, 1988), 87-118.

77. Brumberg, Fasting Girls, 265. 78. Carole S. Vance, ed., Pleasure and Danger: Exploring Female Sexuality

(Boston: Routledge & Kegan Paul, 1984). 79. Pietropinto and Simenauer, Not Tonight, Dear, 15-16. 80. Carnes, Out of the Shadows, vii. 81. See Irvine, Disorders of Desire, for a discussion of these cultural patterns. 82. Anne McBean, "Assessment and Treatment of Sexually Compulsive

Women: A Guide through the Labyrinth," presented at the National Conference on Sexual Compulsivity/Addiction, Minneapolis, 19 May 1991.

83. Kasl, Women, Sex, and Addiction, 43. 84. Ibid., 31. 85. See Ellen Carol DuBois and Linda Gordon, "Seeking Ecstasy on the Bat-

tlefield: Danger and Pleasure in Nineteenth-Century Feminist Sexual Thought," in Pleasure and Danger, ed. Vance, 31-49, and Margaret Hunt, "The De-Eroti- cization of Women's Liberation: Social Purity Movements and the Revolutionary Feminism of Sheila Jeffries," Feminist Review 34 (Spring 1990), 23-46.

86. Judith Lewis Herman, "Considering Sex Offenders: A Model of Addic- tion," Signs 13, no. 4 (1988), 695-724.

87. Rowland, "Reinventing the Sex Maniac."

Janice M. Irvine 226