“ … as the tip of the little finger caught in a mill crank will draw in the hand, and the arm, and the whole body, so the miserable mortal who has been caught firmly by the end of the finest of his nerve is drawn in and in, by the enormous machinery of hell, until he is as I am. Yes Doctor, as I am, for while I talk to you, and implore relief, I feel that my prayer is for the impossible, and my pleading with the inexorable.”
– Joseph Sheridan Le Fanu, “Green Tea”
“Reefer Madness” in the U.S. Senate …
In November 2004, a panel of anti-pornography advocates, addiction treatment professionals, and other experts testified before the U. S. Senate’s Commerce Subcommittee on Science that a product which millions of Americans consume is dangerously addictive. They were talking about pornography.
The panel, convened by then Sen. Sam Brownback, an outspoken Christian conservative and chairman of the Subcommittee, provided testimony on Internet pornography’s addictive effects and its potential health hazard to the American public.
Internet pornography was said to be corrupting children and hooking adults into an addiction that threatens jobs and families. The effects of porn on the brain were called “toxic” and compared to heroin. One psychologist claimed “prolonged exposure to pornography stimulates a preference for depictions of group sex, sadomasochistic practices, and sexual contact with animals.”
The panel concluded it’s testimony by noting that scientific research “directly assessing the impact of pornography addiction on families and communities is rather limited” and called for Congress to both finance scientific studies and launch a public health campaign warning people about the dangers of “porn addiction.”
Since that hearing, much has been learned about behavioral addiction. So much so, that reading the panel’s testimony is akin to watching 1936’s campy film classic, “Reefer Madness.” And while a limited measure of the panel’s testimony has been reinforced by subsequent neurophysiological studies, it’s interesting to see just how far some people will go to convince us that ready access to pornography is one of the worst things in the world.
Pornography is a Loaded Subject …
Opponents argue that pornography can ruin marriages, lead to sexual addiction or other unhealthy behaviors, and encourage sexual aggression. Proponents claim that erotica can enhance sex lives, provide a safe recreational outlet and perhaps even reduce the incidence of sexual assault. (After pornography was legalized in Denmark in 1969, for instance, researchers reported a corresponding decline in sexual aggression.) But in some ways, both arguments are moot: People like porn. Various international studies have put porn consumption rates at 50 percent to 99 percent among men, and 30 percent to 86 percent among women. A 2008 study on university campuses found that a whopping 87 percent of “emerging” adult men (aged 18-26), and 31 percent of emerging adult women report using porn at some level. Twenty percent of young men report using pornography daily or every other day, and almost half use it at least weekly.
Porn is practically ubiquitous, and the Internet has made it easier than ever to get an erotic fix. The accessibility, affordability and anonymity provided by the Web have put adult content right at our fingertips. The fact is there are a lot of people out there using a lot of porn who have no problems with it whatsoever. So when does compulsive viewing of pornography become a problem?
The Internet and Addictive Behavior …
We all have the brain reward circuitry that makes sex rewarding. In fact, this is a survival mechanism. In a healthy brain, these rewards have feedback mechanisms for satiety or ‘enough.’ But hypersexual disorder (a broad category which includes sex addiction, chronic masturbation, etc.) and internet pornography addiction is far more than just an overabundance of libido. With addiction, the circuitry becomes dysfunctional such that the message to the individual becomes ‘more’, which leads to the pathological pursuit of rewards.
Interestingly, the very nature of the internet lends itself to addictive behavior. There is a key element found throughout all internet-related experiences: The ability to maintain or heighten arousal with the click of a mouse or swipe of a finger. Attention to new and different things (scanning for salient cues in the environment) furthers survival, and research shows that it activates the brain’s reward system. Thus, the act of seeking (which would include surfing) triggers the reward system. So do stimuli that violate expectations (positive or negative), which is often found in today’s video games and internet pornography. Some internet activities, because of their power to deliver unending stimulation and activation of the reward system, are thought to constitute supernormal stimuli1, which helps to explain why users whose brains manifest addiction-related changes get caught in their pathological pursuit.
In short, generalized internet chronic overuse is highly stimulating. It recruits our natural reward system, but potentially activates it at higher levels than the levels of activation our ancestors typically encountered as our brains evolved, making it liable to switch into an addictive mode.
Defining An Addiction is not the Same as Diagnosing It …
Pornography addiction has been defined as compulsive sexual activity with concurrent use of pornographic material, despite negative consequences to one’s physical, mental, social, or financial well-being.2
Determining whether pornography is a diagnosticable addiction is no scientific slam dunk. Two questions have to be answered first, and the answer to each has some elements of uncertainty.
First, can pornography become addictive? Addiction, almost by definition, involves significant dysfunction in a person. Their functional level at their job, in their family, in school, or in society in general, is altered. Human beings can do all sorts of dysfunctional things when they have addiction. The response of society has often been to punish those antisocial and dysfunctional behaviors, and to believe that the person with addiction is, at their core, “a bad person.” When you understand what’s really happening with addiction, you realize that good people can do very bad things, and the behaviors of addiction are understandable in the context of the alterations in brain function. Addiction is not, at its core, a social problem or a problem of morals. Addiction is about brains, not just about behaviors.
The American Society of Addiction Medicine (ASAM), founded in 1954 and representing over 4200 physicians, clinicians, and associated professionals, is the most regarded professional organization in the field of addiction medicine. In 2011, as a result of growing neuroscientific evidence, ASAM formally expanded their definition of addiction to include both behaviors and substances:
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
This ASAM definition makes clear that addiction is not about the substances or behavior; it is not even the quantity or frequency of use. Addiction is about what happens in a person’s brain when they are exposed to rewarding substances or rewarding behaviors. It’s more about reward circuitry in the brain and related brain structures than it is about the external chemicals or behavior that “turn on” that reward circuitry. Food, sex ,gambling, internet gaming, and even shopping behaviors can be associated with the “pathological pursuit of rewards” described in this definition of addiction.
Second, Can pornography addiction be diagnosed? The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) has been the standard diagnostic system for mental disorders since the early 1950’s. It serves as a universal authority for psychiatric diagnosis. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications.
The DSM lists hundreds of diagnoses of different conditions, and the criteria by which one makes a diagnosis. The method that psychiatry has relied upon has been the patient interview and outwardly observable behaviors; i.e., the DSM focuses on outward manifestations that can be observed and the presence of which can be confirmed via a clinical interview or standardized questionnaires about a person’s history and their symptoms. A diagnosis does not depend on a particular theory of psychology or a theory of etiology (where a disease comes from); rather the DSM just looks at behaviors you can see or symptoms or experiences that a patient reports.
When the fifth edition (DSM-5) was being drafted, experts considered a proposed diagnostic addiction called hypersexual disorder, which included subcategories for pornography, sex addiction, and chronic masturbation. In the end, however, because of lack of research and lack of an agreed upon list of symptomatic behaviors, reviewers determined that there wasn’t enough evidence to include hypersexual disorder and its sub-categories in the 2013 edition.
That said, not being included in the DSM-5 does not mean hypersexual disorder and pornography addiction don’t exist. Already the new DSM accepts gambling (a behavioral addiction) and lists internet videogaming addiction for possible inclusion. And since DSM-5 came out in 2013, more than 80 brain studies of various forms have revealed that addiction to and on the internet (to include internet pornography addiction) entails the same fundamental kinds of neural changes seen in the brains of substance addicts.
About Those Studies3 ….
Most of the studies used neuroimaging measures, EEGs, or physiological measurements, although some studies used neuropsychological measures. The common thread was that they all used neural data to tie Internet-related behavioral addictions (and their subtypes, like pornography addiction) to the well-established neuroscience on “substance abuse.” The net result was a very large number of neuroscience based studies that support the application of the drug addiction model4 to addictive Internet-related behaviors. These studies collectively constitute strong evidence for considering addictive Internet behaviors as behavioral addiction.
Maybe It’s Not a Large Public Health Issue …
For some people, internet pornography is a real problem. They spend excessive time viewing pornography instead of interacting with others. These individuals report depression, social isolation, career loss, decreased productivity, and adverse financial consequences. Internet pornography addicts tend to show symptoms like compulsive novelty seeking and shifting sexual tastes. These symptoms can further exacerbate stress, confusion, fear and despair if users’ porn-based sexual fantasies morph to the point where they clash with their self-identified sexual desires or orientation.
Fortunately, it appears only a small percentage of people are susceptible. Despite the lack of diagnoses guidance in DSM-5, several studies have attempted to determine the extent to which internet pornography addiction may be prevalent. One study of a sample of 9,265 people found that 1% of Internet users are clearly addicted to cybersex (though 17% of users met criteria for problematic sexual compulsively.) In short, even though pornography is addictive, it doesn’t appear to be anywhere in the same class as highly addictive substances like opiates.
Still, without the clinical diagnostic tools provided by DSM-5, it’s hard to substantiate how many of the self-identified pornography “addicts” are truly addicted. Self-perceptions, biases, and responsibility avoidance may play a large role in inflate the self-reported numbers. For example, another 2014 study identified a connection between a subjects religious beliefs and their self perception of pornography addiction. One of the findings of the study is that there appeared to be a predilection in religious people to believe they are addicted to pornography regardless of how much they watch or whether it negatively impacts their lives (roughly 50% of Christian men and 20% of Christian women self-report being addicted to porn.)
And the Moral Implications for the Porn Industry Are …
Assuming that pornography addiction is a real disease of the brain, and that for a small percentage of people it is a very real problem, what then are the moral implications for the pornography industry?
Over two thirds of young men (18-26 years of age), and nearly half of young women believe that porn consumption is morally acceptable.5 This statistic of acceptance is particularly interesting because it is pulled from a generation which often defines right and wrong in terms of consequences. Consequence-based morality maintains that if something doesn’t hurt yourself or others, it’s not wrong. But even that moral code is not absolute and, as with any other moral code, risk-reward trade offs are implied when making a morality-based decision. And so, for the majority of people, the very real consequences of porn addiction, either intentionally or through ignorance, take a back seat to the entertainment value pornography provides. And it’s within this moral context that today’s pornography industry operates.
Make no mistake. Pornography is a business. A legal business born out of demand. And it’s good business practice to encourage people to use your product. So, as long as the industry follows those limited government regulations put in place to protect the most at-risk persons, it’s hard to see how they bear the preponderance of moral culpability for the suffering of people that have become addicted to their product.
As the American Society of Addiction Medicine (ASAM) points out, personal responsibility is important in all aspects of life, including how a person maintains their own health. It is often said in the addiction world that, “You are not responsible for your disease, but you are responsible for your recovery.” People with addiction need to understand their illness and then, when they have entered recovery, to take necessary steps to minimize the chance of relapse to an active disease state. Persons with diabetes and heart disease need to take personal responsibility for how they manage their illness–the same is true for persons with addiction.
Still, the pornography industry might do well to look to online gambling sites that allow options which assist addicts manage their disease. For example, A large number of reputable online casinos offer players the option to select daily or weekly online gambling limits. In fact, the majority of online gambling jurisdictions have made it compulsory for online casinos to offer this type of service. And for problem gambling addiction, players can also request that the casino block their account under the self-exclusion policy. This can be either a permanent or temporary block and during the specified period the player will not be able to access the account and the casino will stop sending that player promotional offers.
Providing similar options could go a long way towards alleviating whatever limited culpability society may end up perceiving that pornographic websites have regarding pornography addiction and it’s consequences.
And the Moral Implications for Ceara Lynch Are …
The discussion above applies equally to the online female domination/financial domination genre of pornography. With one notable distinction. Many online female dommes actually encourage and promote addiction within their clips. Not addiction to pornography, per se; rather they promote a particular form of online pornography addiction – addiction to their own specific name brand of pornographic material and related behavior.
Following last month’s blog on Morality, Politics and Sin, Ceara Lynch wrote to me, “I don’t think of morality as ‘what is proper’ (as you wrote) rather, to act morally is to act in a way that inflicts the least amount of suffering. I don’t think offense is suffering (a la racial humiliation).” Hers is a consequence-based approach to morality. So what is the consequence of encouraging addiction? By definition, addiction entails harmful actions. It’s hard to rationalize the explicit promotion of pornography addiction with a moral standard of “inflict the least amount of suffering.”
But things are more ambiguous and nuanced than that. Ceara Lynch sells fantasy. Some guys want her to make them mentally “suffer”. At least within the context of the fantasy they envision when they commission or buy a video clip from her.
I’ve written elsewhere in this blog (Dignity and Humiliation, Playing with Men) that I think Ceara’s talent is her ability to play on the edge – to push the envelope of femdom fantasy without compromising the freedom of choice, and real world dignity, enjoyed by her customers. Ceara has no intention of hurting her customers or causing them harm and suffering. And intent, like consequences, matters. In a consequence-based moral framework, good intentions mitigate to a certain extent bad consequences.
Statistically, Ceara Lynch customers probably include a small percentage of genuine pornography addicts. For those few unidentifiable cases, any video clip or marketing effort that explicitly promotes or encourages their addiction could be viewed as morally irresponsible. Whether Ceara sees the same moral dilemma is unclear. As I said, the moral dimensions of online femdom/findom are nuanced and often ambiguous.
With Ceara Lynch’s increasing celebrity, and her forthcoming movie, it’s probably safe to assume that some increased backlash against her particular brand of pornography will ensue. Given the increasingly accepted reality of pornography addiction, it might be good business for Ceara to acknowledge, within any future addiction-promoting video products, the real world harm caused by pornography addiction. The gambling and alcohol industries use a disclaimer (“drink responsibly’) which, though almost absurd in their ineffectiveness, at least provide an appearance of accepting some modicum of responsibility for addressing the problem. And, as the saying goes, for most people, their perception is their reality.
1 Supernormal stimuli are artificial stimuli that overrride an evolutionarily developed genetic response. Junk food is supernormal stimuli in that they provide an exaggerated stimulus to craving for salt, sugar, and fats. Television is often considered a supernormal stimuli as an exaggeration of social cues for laughter, smiling faces and attention-grabbing action. Surgically altered breasts are supernormal stimuli.
2 Regarding the definition “… compulsive sexual activity with concurrent use of pornographic material, …” A leading researcher claims that Internet porn can lead to chronic masturbation, and that the masturbation itself is the primary issue. With each ejaculation, as with orgasm, you are turning on refractoriness. With each successive ejaculation, for chronic masturbators, the inhibition gets stronger — because of the increased serotonin — making it less likely for these men to achieve another erection, much less another ejaculation … it’s not the porn per se but its use in chronic and obsessive masturbation. The addiction is not actually to the porn but to the orgasm and the predictability of reward.
4 For a detailed explanation of the drug addiction model, refer to the Addendum at the end of this blog entry.
6 “Always better” expectation may help to explain why 60% of men reporting compulsive sexual behavior (average age: 25 years) had difficulty achieving erections/arousal with real partners, yet could achieve erections with internet.
Addendum: The Neuroscience of Drug Addiction
Addiction is, at its root, a faulty and inadequate form of learning. And like learning to ride a bike, addiction is not quickly unlearned.
There are things you don’t forget, and there are things you can’t. For people who become drug addicts, the drug experience is not only unforgettable but indelibly etched into that person’s physiological brain circuitry.
And much of that memory is false. Because all addictive drugs appear to share a rather mysterious property: They’re “better than the real thing.” Better, that is, than the real things our reward circuitry was designed by evolution to reward: food, sleep, sex, friendship, novelty, etc. And better, even, than they were the last time around. At least, it sure seems that way to the addict.
Addictive drugs mimic natural rewards such as food and sex by kindling a network of brain areas collectively called the reward circuitry, which is responsible for enjoyment — which if you think about it, is an important survival response. It gets us to do more of the kinds of things that keep us alive and lead to our having more offspring: food-seeking and ingestion, hunting and hoarding, selecting a mate and actually mating.
Moreover, addictive drugs fire up the reward circuitry in a way that natural rewards can’t — by, in a sense, pressing a heavy thumb down on the scale of pleasure. Over time, the desire for the drug becomes more important than the pleasure the addict gets from it. By the time the thrill is gone, long-lasting changes may have occurred within key regions of the brain.
The brain is a little bit like the big snarl of tangled wires snaking their way out of that six-outlet surge protector behind your bed. They know where they’re going, even if you don’t. Nerve cells (or neurons, as scientists call them) can be seen as hollow wires transmitting electrical currents down long cables called axons to other neurons.
Addiction was once defined in terms of physical symptoms of withdrawal, such as nausea and cramps in the case of heroin or delirium tremens in the case of alcohol, which reflect physiological changes within cells of an addict’s body. It’s now seen as changes in brain circuits, or combinations of neurons; in other words, the very neurophysiological changes that result from learning and experience. You crave and use a pernicious drug again and again because you have a memory of it being more wonderful than anything else, and because your brain has been rewired so that, when exposed to anything that reminds you of the drug, you will feel rotten if you don’t get some.
These are symptoms of a brain disease, not a mere weakness of will. Over time, these subcellular changes alter the strength of connections in the circuit, essentially hardwiring the yen for drugs into an habitual craving that is easily reignited not only by the drugs but also by the environment – people, places, things and situations associated with past drug use – even when the addict hasn’t been anywhere near the drug or the drug scene for months or years.
But what flips on the reward circuit in regular life, when electrical zaps to the brain are blessedly few and far between? The same chemical that triggered by dope. It’s called dopamine.
Dopamine is one of a growing number of known neurotransmitters, substances neurons produce for the purpose of relaying information from one neuron to the next. Different groups of neurons manufacture different neurotransmitters, which all work pretty much the same way but in different nerve bundles and with a spectrum of different results. These substances are stored inside numerous tiny bulbs budding from points along a neuron’s long, electricity-conducting axon at key contact points the neuron shares with other neurons.
When an electrical signal roaring down the axon’s surface rumbles past one of these little bulbs, myriad molecules of neurotransmitters get squirted into the surrounding space. They diffuse across that space (called a synapse) to specialized receptors on the abutting neuron, where the interaction can either set off (enhance) or shut down (impede) a new electrical current in the downstream neuron.
These dopamine-squirting neurons constitute a tiny fraction of all neurons. But each of them can network with up to 10,000 or more other neurons stretching to the far corners of the brain. A dollop of dopamine in your tank can really boost your reward mileage, so to speak.
Once dopamine’s centrality to the neurons constituting the reward circuit was worked out, people started wondering whether drugs might activate the reward circuits. It turned out they do.
One reason that the advances in our study of the neurophysiology of addiction so far exceed our understanding of other psychiatric disorders is because the animal models for addiction are extremely good. Teach a rat to press a lever for an infusion of a drug of abuse, and you will see the same compulsive behavior in the rat that you would in a person. A rat will work very hard to get drugs. It will press that lever hundreds, even thousands, of times and endure pain and suffering to get drugs.
As these animal studies have shown, virtually all abused drugs — for instance, heroin and other opiates; cocaine, amphetamines and other psychostimulants; nicotine; and alcohol — operate by interfering with the reward circuitry. They cause the release of dopamine in target structures such as the nucleus accumbens, that key structure in the experience of pleasure.
Different drugs do this in different ways. Cocaine and amphetamines prolong the effect of dopamine on its target neurons. Heroin inhibits other neurons that inhibit these dopamine neurons. (In the logic circuitry that is the brain, a double negative roughly equals a positive.)
You might think that the more you eat, or the more sex you have, or the more good vibrations you get, the more dopamine your reward-circuit neurons will squirt at their target structures in the brain. But it’s not so simple.
It turns out that what really gets the reward circuitry jazzed up isn’t so much the good vibes as it is the extent to which the goodness of the vibes exceed expectations.
Consider the following animal study. The test animal learns that if it presses a lever after it receives an environmental cue — to wit, a light goes on — it will get a reward: say, a nice slice of apple or a drop of juice. Of course, the animal soon learns to reach for the lever the instant the light goes on. With repeated exposure, the animal gets the hang of it, and a few interesting things happen inside its brain. The reward itself (the food) no longer produces the dopamine surge associated with reward-circuit activation – it is now the light, not the food, that triggers the activity in the reward circuit. The timing of the reward-circuitry’s dopamine squirts has shifted from the time of reward delivery to the time of the cue (the essence of the so-called “conditioned response.”) It’s not that the juice or apple slice no longer tastes good. It’s that the reward circuitry is responding to the difference between what we expect and what we get. How much dopamine gets secreted depends not on how great the reward is, but on the degree to which it meets expectations. The juice still tastes great, but it’s no longer a surprise; it’s predictable. However, the light’s timing can’t be predicted. It’s always a surprise, and (as the animal now knows) it’s always a prelude to something good.
The reward circuitry is always secreting dribs and drabs of dopamine. If an experimental animal gets a bigger-than-expected reward, the frequency and amount of dopamine secretion increases; if it’s smaller than anticipated (or if the light goes on but the animal’s frantic lever-pressing brings no juice at all), dopamine secretion drops below baseline levels. Moreover, this depression in firing rates of dopamine-secreting neurons occurs precisely when the anticipated reward should have come, but didn’t. Thus, the brain seems to interpret the absence of the expected reward not merely as a lack of enjoyment but as a punishment (“negative reinforcement.”)
Variations in dopamine levels tell all kinds of structures in your brain when something you want is within reach, getting closer, slipping away or not working for you anymore. At least that’s the way it’s supposed to work. Cocaine, heroin and other abused substances usurp this system. And they do it in a really creepy, pernicious way: by short-circuiting it.
With normally rewarding things like food and sex, we usually have a pretty good idea of how good it will be. It’s when the reward exceeds our expectations that the dopamine circuitry really lights up big time. Conversely, if our expectations aren’t met, dopamine activity drops off.
But cocaine, heroin, alcohol and nicotine directly activate the circuit — they goose dopamine secretion — regardless of how high the expectation was. And every time you activate that dopamine activity, you getting a readout that says, ‘Wow, this was even better than I thought it would be.” It’s always better than you expected. Every single time. The experience is remembered as always getting better — even if, paradoxically because of tolerance mechanisms in the brain, it’s actually not so great anymore.6
In susceptible individuals, repeated drug use creates the same kind of lasting changes in the connections among neurons that we get from learning to ride a bike. One important way our brains snap an experience into long-term memory is by strengthening the synaptic contacts between neurons in the network that encodes this experience. This involves a number of biochemical changes in both the bulb protruding from a neuron’s axon and the brush-like extension of a nearby neuron. The long-term strengthening of drug-associated memory circuits, combined with that “even better than expected” illusion addictive drugs foist on users, goes a long way toward explaining what is probably the biggest problem addicts and those who treat them face: a pronounced tendency to slide back into the habit.