Well today was just another semi-unproductive day with the same frustrations and anxieties as pretty like every other day.
I may appt. with my Dr. The session was a bit more lively than most as I wasn't holding too much back. As some of you may know through other blogs I've written, I ceased homeschooling my son due to his being defiant, adhd, odd and probably other things and really not getting any support from home. Home is a long story in itself and that is dying a slow death. Bottom line before I drone on.... she had seen him and she brought up having me declared disabled. Of course I did not know the pros and cons of this, but even if, that's if that did happen, I would continue to be "interviewed" to see if I was able to work as some job. (Yeah.. right) Thanks to all of the "true" support at home, I'm rather a wreck in motion. Add to that lack of any real marriage, and the kids being turned against me (oh yeah.. my paranoia). Looks like the wife is meeting with another doctor about seeing my son about his problems..... but of course i am blamed for alot of this. I call this the boomerang effect.... where no matter what happens or happens to... some how it comes back to me in some form or fashion. Me... when I told my dr. and gave him permission to talk to her to set up some sort of meeting w/ him or counselor so that the air, at least on my part can finally be told. What I get at home is "I am not going to engage you" and then she walks away. She and my son are still under the impression that I am homeschooling, but there would have to be major, major changes for that to happen. Leaving w/ half of nothing (of which I have) is workable or will just have to work out. I am too old to drag this process out for 4 - 6 years. I am 50 and still have some good years remaining and I am not going to continue to live the way things have been over the past 4 years.
That's it for now..... off to post to other blogs. Have a great evening and enjoy your Friday.
Thursday, September 6, 2007
Monday, September 3, 2007
Lack of sex with my husband is driving me to infidelity
Lack of sex with my husband is driving me to infidelity
Bel Mooney
Dear Bel,
On March 21, replying to Rob about his sexless relationship, you wrote that women longing for more physical intimacy are “in a minority”. I am one of those women. Surely the problem is far worse this way round? You asked of a man visiting a prostitute to compensate for a frigid marriage, “who will judge him for that honest transaction?” I doubt you would think a prostitute an appropriate solution for a woman in the same position.
I am 38 and have been faithfully married for 15 years. My husband is 41. We were childhood pals, and are still the best of friends. In the early stages of our relationship the sex was fantastic. But I hate him for inflicting a marital situation on me in which we live as little more than brother and sister. For the past seven years he has virtually never initiated sex, saying he’s too tired (I work full-time, too) or needs to feel good to feel sexual, so it is never on the agenda. When relaxed (eg, weekends, or on holiday) he chooses TV or reading rather than making love. Physical affection between us is minimal.
I’ve tried everything to kick-start our sex life. I make an effort with my appearance — to no avail. I tried waiting for him to take the initiative. The longest wait was eight months, without the slightest indication that he’d even noticed. I have eliminated the possibilities that he’s having an affair or homosexual; he’s just not that interested in sex. He knows how important our sexual relationship is to me and how unhappy I am. But he does nothing to change and I cry myself to sleep most nights.
Now I have met someone else, a colleague from my previous job. In his early sixties, he’s also married with three children, though his are grown-up (mine are 10, 9 and 5). We very much enjoy each other’s company. I find him very attractive because of his age and experience. He asked if I want to go to bed but seems equally happy just to be friends. The promise of a loving, discreet affair with a trusted friend is tempting. Neither of us would have the slightest interest in leaving our spouses but I very much want the comfort of physical intimacy with someone I care about who’s tender with me. I’ve been considering this for three years now, so I’m not the sort of person to rush into an extramarital relationship. I think about sex with my friend every day.
I hate the idea of betraying my husband but how can I reconcile myself to a celibate life in my sexual prime? I’ve considered leaving because I can’t cope with the torture of feeling ignored. Even if my husband, by some miracle, were to change his behaviour now, I wonder whether I could forgive him for so many years of insensitivity to my unhappiness. Could an affair be making the best of a bad situation and save my marriage?
Annabel
You write with one problem, but there are two within your letter, albeit connected. There is the issue of a marriage devoid of physical expression of love, and then there is your question about whether to embark on an affair. I suspect that the unexpected opportunity for the latter has served to intensify your frustration with the former, so let us take each issue in turn.
It was inevitable, after my reply to Rob, that many men would write emotionally to say they felt less isolated to read of another in their situation. The subject lifts the lid on much misery within marriage — suffered by both genders. But proportionately it seems I was right: many, many more letters from men than from women. Still, both the following readers were keen that Rob should understand how some women sympathise with his plight. T, aged 37 and married for 13 years with two children, wrote: “My husband has not wanted sex with me for three years. It was a problem from the start and despite sessions at Relate and private counselling, we seem no further on. I am desperate for some affection and some passion.”
Similarly, M, who is 43, is eloquent about her “virtually sexless and intermittently affectionate marriage” to a “great dad” of their three children. “Periodically I ask why we are living like this; he says he doesn’t know and we must do something about it, but talking is as far as it goes. I’ve had my advances rejected so often that it makes my soul shrivel. It doesn’t seem to bother him that we never make love. He loves me — but I need more. I’ve never felt so lonely as now. I can’t look elsewhere as I don’t want to break up our family unit.” Three others took up the theme.
Writing as long ago as 1949, the great American psychiatrist Edmund Bergler pointed out (in Conflict in Marriage ): “The statistical impressions gained from unprejudiced observers are tragically high: they estimate that 89 per cent of women are frigid, and 34 per cent of men suffer from various forms of impotence”. That acts as a healthy counterbalance to the notion that our society is so sexually obsessed that it makes people feel inadequate; in truth, sexual problems are probably at the root of Tolstoy’s dictum about unhappy families. Few couples can sustain early passion, but if the “falling off” is equal they can settle to a cosy once-a-month sleepy lovemaking and adore their daily cuddles.
But, as shown by all my letters, an imbalance can form a fissure in a relationship which widens into a chasm. If it cannot be crossed it will have to be borne, or else the marriage will (in time) surely come to an end, even if no divorce takes place. It’s a melancholy prospect — and I’d be lying if I offered glib answers.
The advice columnist might recommend counselling, or dressing up to look sexy, or fantasy, or even the solace of masturbation — but what if some or all of those have been tried, to no avail? Any psychotherapist will tell you that problems in the bedroom have their origins years before, before the couple met, so tightly is our sexuality woven with infantile sensations and relationships. Perhaps that’s why Susie Orbach called her 1999 book The Impossibility of Sex .
What seems to wound as much as the physical rejection is the unwillingness to engage with the hurt that’s being inflicted: the turning away of the mind as well as the body. That’s why you imply that it might even be impossible to forgive your husband now, for “so many years of insensitivity”. That there could be deep reasons, that he could (for example) be one of those men for whom the naughty act of sex is split off from marital affection/friendship or that in fact his most secret fantasies do involve his own sex (how would you know?) . . . Such issues may no longer interest you. Certainly the one — male or female — who bewails a sexless relationship seems to reach a point when all that matters is the lack, not the cause.
Which is where a possible lover comes in. M is wise; she equates “looking elsewhere” with real danger. You, on the other hand, show your innocence in the assumption that if you started a sexual relationship with this old colleague both of you could keep it under control. You can’t know that. My instinct tells me you’d be the one to fall madly in love/sex (you’re almost there already) with him, and that the turmoil of emotions would make you unhappier than the lack of sex makes you at the moment.
Now I will shock some people here by saying frankly that were you to go off and have a night of fantastic sex with him — and if you were capable of keeping that in its compartment — it wouldn’t bother me at all, since a part of me would wish that fulfilment for you. If “ships that pass in the night” could remain just that, I don’t see the harm; why, the memory of how he rocked your boat could still make you smile when you’re 85. And — Lord knows — wonderful lovemaking (as contrasted with loveless coupling) is one of the joys of the universe.
BUT I think you have to be aware of just how complicated it can be, just how guilty you would feel, just how frustrating great sex can be, in that you’d want more.
Can an affair “save” a marriage? Sometimes, yes. Do I think it would save yours? No.
Bel Mooney
Dear Bel,
On March 21, replying to Rob about his sexless relationship, you wrote that women longing for more physical intimacy are “in a minority”. I am one of those women. Surely the problem is far worse this way round? You asked of a man visiting a prostitute to compensate for a frigid marriage, “who will judge him for that honest transaction?” I doubt you would think a prostitute an appropriate solution for a woman in the same position.
I am 38 and have been faithfully married for 15 years. My husband is 41. We were childhood pals, and are still the best of friends. In the early stages of our relationship the sex was fantastic. But I hate him for inflicting a marital situation on me in which we live as little more than brother and sister. For the past seven years he has virtually never initiated sex, saying he’s too tired (I work full-time, too) or needs to feel good to feel sexual, so it is never on the agenda. When relaxed (eg, weekends, or on holiday) he chooses TV or reading rather than making love. Physical affection between us is minimal.
I’ve tried everything to kick-start our sex life. I make an effort with my appearance — to no avail. I tried waiting for him to take the initiative. The longest wait was eight months, without the slightest indication that he’d even noticed. I have eliminated the possibilities that he’s having an affair or homosexual; he’s just not that interested in sex. He knows how important our sexual relationship is to me and how unhappy I am. But he does nothing to change and I cry myself to sleep most nights.
Now I have met someone else, a colleague from my previous job. In his early sixties, he’s also married with three children, though his are grown-up (mine are 10, 9 and 5). We very much enjoy each other’s company. I find him very attractive because of his age and experience. He asked if I want to go to bed but seems equally happy just to be friends. The promise of a loving, discreet affair with a trusted friend is tempting. Neither of us would have the slightest interest in leaving our spouses but I very much want the comfort of physical intimacy with someone I care about who’s tender with me. I’ve been considering this for three years now, so I’m not the sort of person to rush into an extramarital relationship. I think about sex with my friend every day.
I hate the idea of betraying my husband but how can I reconcile myself to a celibate life in my sexual prime? I’ve considered leaving because I can’t cope with the torture of feeling ignored. Even if my husband, by some miracle, were to change his behaviour now, I wonder whether I could forgive him for so many years of insensitivity to my unhappiness. Could an affair be making the best of a bad situation and save my marriage?
Annabel
You write with one problem, but there are two within your letter, albeit connected. There is the issue of a marriage devoid of physical expression of love, and then there is your question about whether to embark on an affair. I suspect that the unexpected opportunity for the latter has served to intensify your frustration with the former, so let us take each issue in turn.
It was inevitable, after my reply to Rob, that many men would write emotionally to say they felt less isolated to read of another in their situation. The subject lifts the lid on much misery within marriage — suffered by both genders. But proportionately it seems I was right: many, many more letters from men than from women. Still, both the following readers were keen that Rob should understand how some women sympathise with his plight. T, aged 37 and married for 13 years with two children, wrote: “My husband has not wanted sex with me for three years. It was a problem from the start and despite sessions at Relate and private counselling, we seem no further on. I am desperate for some affection and some passion.”
Similarly, M, who is 43, is eloquent about her “virtually sexless and intermittently affectionate marriage” to a “great dad” of their three children. “Periodically I ask why we are living like this; he says he doesn’t know and we must do something about it, but talking is as far as it goes. I’ve had my advances rejected so often that it makes my soul shrivel. It doesn’t seem to bother him that we never make love. He loves me — but I need more. I’ve never felt so lonely as now. I can’t look elsewhere as I don’t want to break up our family unit.” Three others took up the theme.
Writing as long ago as 1949, the great American psychiatrist Edmund Bergler pointed out (in Conflict in Marriage ): “The statistical impressions gained from unprejudiced observers are tragically high: they estimate that 89 per cent of women are frigid, and 34 per cent of men suffer from various forms of impotence”. That acts as a healthy counterbalance to the notion that our society is so sexually obsessed that it makes people feel inadequate; in truth, sexual problems are probably at the root of Tolstoy’s dictum about unhappy families. Few couples can sustain early passion, but if the “falling off” is equal they can settle to a cosy once-a-month sleepy lovemaking and adore their daily cuddles.
But, as shown by all my letters, an imbalance can form a fissure in a relationship which widens into a chasm. If it cannot be crossed it will have to be borne, or else the marriage will (in time) surely come to an end, even if no divorce takes place. It’s a melancholy prospect — and I’d be lying if I offered glib answers.
The advice columnist might recommend counselling, or dressing up to look sexy, or fantasy, or even the solace of masturbation — but what if some or all of those have been tried, to no avail? Any psychotherapist will tell you that problems in the bedroom have their origins years before, before the couple met, so tightly is our sexuality woven with infantile sensations and relationships. Perhaps that’s why Susie Orbach called her 1999 book The Impossibility of Sex .
What seems to wound as much as the physical rejection is the unwillingness to engage with the hurt that’s being inflicted: the turning away of the mind as well as the body. That’s why you imply that it might even be impossible to forgive your husband now, for “so many years of insensitivity”. That there could be deep reasons, that he could (for example) be one of those men for whom the naughty act of sex is split off from marital affection/friendship or that in fact his most secret fantasies do involve his own sex (how would you know?) . . . Such issues may no longer interest you. Certainly the one — male or female — who bewails a sexless relationship seems to reach a point when all that matters is the lack, not the cause.
Which is where a possible lover comes in. M is wise; she equates “looking elsewhere” with real danger. You, on the other hand, show your innocence in the assumption that if you started a sexual relationship with this old colleague both of you could keep it under control. You can’t know that. My instinct tells me you’d be the one to fall madly in love/sex (you’re almost there already) with him, and that the turmoil of emotions would make you unhappier than the lack of sex makes you at the moment.
Now I will shock some people here by saying frankly that were you to go off and have a night of fantastic sex with him — and if you were capable of keeping that in its compartment — it wouldn’t bother me at all, since a part of me would wish that fulfilment for you. If “ships that pass in the night” could remain just that, I don’t see the harm; why, the memory of how he rocked your boat could still make you smile when you’re 85. And — Lord knows — wonderful lovemaking (as contrasted with loveless coupling) is one of the joys of the universe.
BUT I think you have to be aware of just how complicated it can be, just how guilty you would feel, just how frustrating great sex can be, in that you’d want more.
Can an affair “save” a marriage? Sometimes, yes. Do I think it would save yours? No.
Great question!
Dear Sexperts,
Is it normal to feel depressed or very moody if you don’t have sex for two days? Is there an effect on the brain?
Answer:
Depression as a result of not having sex can be attributed to several causes. Sometimes, in a relationship, a lack of sex can be a sign of a much larger problem that is causing you to be unhappy with or about your partner. If you are not engaging in sexual activity because of a fight or problem, it may be that your depression is a result of that troubling incident, and not specifically the lack of sex. There is also research that suggests that orgasms can increase the amounts of serotonin in your body, which would lead to a feeling of euphoria or total happiness. Less sex can lead to less happiness. It is important that sex makes you happy; however, you do not want to be dependent on sex as the only thing that makes you feel good. The hormones that are released in your brain as a result of orgasm are only a temporary solution if you are experiencing severe depression. If you feel that the only time you are not depressed is when you are sexually engaged, it may be helpful for you to confront your depression rather than increase the amount of sex that you are having. After prolonged depression, many people consult with a physician.
Sincerely,
The Sexperts
Depression and sex addiction
Depression and sex addiction:
The moment between the trapezes
By Stephen S, Brockway, M.D
“I choose my behavior; the world chooses my consequences” is a phrase that any recovering sex addict would do well to hold in vivid consciousness. When the awareness of a pattern of sexual addiction starts to become clear, a trail of consequences is likely to follow close behind. Rather than attempt to manage or minimize the consequences, the sex addict is advised to curtail sexual acting out and embrace a quality recovery program taught and modeled by other recovering addicts.
Despite the conviction to move toward the rigorous honesty of recovery, the addict is likely to experience the cold sweat of repercussions of previous behavior. The secret life is unveiled revealing affairs, exhibitionism, voyeurism, or other behaviors comprising a particular sex addict’s modus operandi of acting out. Like the trapeze artist in the circus, the addict encounters the moment between letting go of one trapeze and catching the other. Such a crisis will make one exquisitely aware of hopelessness and depression. Hopefully, it will also dawn on the addict that he/she is powerless and that a Higher Power alone can and will be there in that moment.
Six classes of depressive types expressed in sex addicts
The mental health practitioner who treats sex addiction is called upon to diagnoses and treat the depression that is likely to be present before, during, and after the between-trapeze experience. This depression may present in several different forms, which can be summarized in the following classes:
1. Most commonly, a chronic, low grade depression or dysthymia in a shame-based person who has low self esteem and relatively undeveloped social skills. This dysthymic disorder may be punctuated with major depression especially likely at the time of significant relationship losses or at the time of exposure of the pattern of sex addiction. Shame, loneliness, and awareness of lost time spent in active addiction may haunt the addict. When shame rolls in, depression follows the flood. This type tends to have a strong superego and be at risk for self-punitive suicidal thoughts and behavior.
2. A seeming lack of depression in a perfectionistic, shameless-acting high achiever. Despite not having a history of previous clinical depression, this person may experience an overwhelming major depression as perfectionism and narcissism no longer stem the tide of mounting negative consequences of sexual behavior. Since this person may have a lofty professional and occupational position, the sexual acting out may involve level III abuse of a power position with employees, clients, or patients. If professional consequences (e.g. loss of license, termination of employment) lead to a further and more devastating breakdown in personal relationships (e.g. divorce, marital separation), the person’s shame can be catastrophic and overwhelming, making suicide a real and pressing danger. This person may even need to be hospitalized against his or her will until adequate defenses can be reestablished and a recovery process begun.
3. The depleted workaholic whose life is without joy, and who has no balance in social or recreational spheres. This sex addict is likely to find someone or a series of subjects at work to groom as he/she presents as a martyr-like victim slaving to support a family yet deserving of a sexual release. When depression finally breaks through clinically, after the pattern of sexual behavior is exposed, it is likely to be massive because this addict has little to fall back on when the merry-go-round of work stops. The workaholic pattern becomes a central treatment issue with both sex addiction and depression seen as outgrowths of the long term lack of self care. If a workaholic pattern recurs after treatment, relapse into sex addiction is almost certain, whether it be in the behavior or thoughts of the addict. Therefore, a goal in treatment and after for this person is to halt the pattern of self abandonment expressed previously through workaholism, sex addiction, and martyrdom.
4. Psychotic depression in a person who may be older (45-60 or above) and who has a pre-morbid obsessive-compulsive style and a suspicious temperament. This person may have practiced a type of sex addiction that included perpetrating children or teenagers, but kept it concealed for years. When the addiction progresses and the behavior is discovered, the public outcry and shame may be processed by the addict via psychotic defenses of massive denial and projection. The addict may sink into a stuperous depression with psychotic features including frank paranoid thoughts of feeling acted upon by outside forces and profound social withdrawal. The reality of the perpetrating behavior is alien to the denying lifestyle the person has practiced for years. The recovery from psychosis is gradual and in-depth work on recovery from the addictive sexual cycle must be put off until aggressive pharmacological treatment takes effect.
5. Bipolar depression in a person who may or may not be a true sex addict. Since the manic phase and mixed manic/depressive phases of bipolar disorder are often accompanied by hyper-sexuality with heightened sex drive and increased sexual behaviors of boundary-less type, the clinician, in attempting to make an accurate diagnosis, should be mindful to search for a true pattern of sex addiction behavior which transcends the mood swings of bipolar disorder. A bipolar patient may also be a sex addict, but a significant subset of bipolars show hyper-sexuality during mania that is not part of a pattern of sex addiction. The bipolar group as a whole is at significant risk for suicide (the lifetime suicide rate for untreated bipolars is 15%) and risk can do nothing but rise for the portion who are both bipolar and sex addicts. The dual bipolar/sex addict patient may actually complain of two types of depression; one that is without a particular stimulus (the bipolar depression that comes on suddenly like a black cloud overhead), and another depression which mounts slowly and is accompanied by shame and the emptiness of active addiction much like the dysthymia of Class #1.
6. A sociopath who may feel pain from consequences of addiction or perpetration, but lacks true remorse and may feign a victim stance for secondary gain from significant others and legal authorities. The dramatic victim behavior may mimic depression, but usually lacks the classic vegetative signs (sleep, appetite, energy, and interest disorders) of true major depression. If a person with antisocial personality disorder threatens suicide or acts on suicidal thoughts, it is usually in retaliation toward authority figures, related to substance abuse, or associated with additional accompanying character pathology (e.g. borderline personality).The sociopathic pattern should eventually be evident by the triad of lack of remorse for perpetrator behavior, failure to learn from past mistakes, and projection onto others of blame (lack of accountability). Such a person may have been through multiple previous treatments accompanied by a professed wish to work a strong recovery program yet, in reality, followed by failure to “walk the talk.”
The six classes of depressive types show that the entire array of depressive disorders is expressed in sex addicts. As a practical help to the mental health therapist, it might be useful to codify some of the clinical tools to employ in assessing and treating the depressed, suicidal sex addict. First, the practitioner will want to be able to distinguish the type, depth, and severity of the depression. Second, the therapist should as accurately as possible know what to consider in terms of risk of suicide.
Steps for Determining Severity of Depression
Determining the severity of depression combines a play-it-by-the-book (DSM IV) approach to asking about each possible depressive symptom with an intuitive awareness of what could happen (call it clinical “thinking dirty”) as the sex addict in treatment relates to mounting consequences. These steps are suggested:
1. Take no shortcuts in the intake process. Get a broad anthropological/cultural view of the person while conducting a careful search for symptoms and signs of depression and/or suicidal ideation and plans. The cultural context and support system have a telling influence on suicidal potential.
2. Withhold too early conclusions about character pathology. “Hip-shooting” labeling (e.g. borderline, narcissistic, antisocial) only closes off possibilities in the clinician’s mind and prevents the therapist from seeing the patient in all his/her potential for resilient recovery or calamities such as suicide.
3. Request psychological testing to back up interview data and clinical observations. Something may surface that was not considered earlier (e.g. schizotypal thinking or a low-grade thought disorder.
4. Search out nooks and crannies in relation to suicidaland homicidal thoughts. For example, if a person denies active suicidal thoughts, he/she may still wish that a semi-truck would meet them head on. Likewise, even though a patient is a mother of children and says she would never kill herself because her children need her, has she recently bought life insurance or given away belongings?
5. Review any past history of suicidal ideation or attempts. What are the similarities and differences (e.g. strength or lack of strength of support network) to the present situation? Has the person ever faced anything as humiliating as the exposure of sex addict behavior?
6. Consider, “How deep is this person’s shame?” Will the person consider suicide to be the only “viable” way out of a lifelong shame-existence bind?
7. Inquire about how the person has taken out anger in the past. Toward self? Toward others? He/she is likely to follow the same pattern again.
8. Determine the dynamic significance of the type of sexual acting out practiced by the patient (e.g. the exhibitionist who could never get his mother’s attention). Has that meaning been processed with the patient and the power taken out of the pattern, or does shame still envelop the patient and fuel suicidal/homicidal thoughts?
9. Measure whether the patient’s medication for severe depression is at a therapeutic level. Smoldering along with depression that is only partially treated can heighten the patient’s hopelessness and could lead to suicide (e.g. Is this as good as it gets?).
10. Assess medication compliance. What has been the response of the depression to medication? Does the patient understand the importance of taking medication as prescribed, and for as long as prescribed? Are any side effects intolerable to the patient (e.g. decreased sex drive, anorgasmia, or impotence)?
11. Examine any progress made in treatment in processing anger, shame, and other overwhelming emotions. Have the circumstances of the person’s life changed for the better? For the worse? Remember, if nothing changes, nothing changes.
12. Gauge employment and economic prospects. Has sex-addict behavior led to consequences at work? Will there be further repercussions and consequences?
13. Ask the patient what he or she sees for the future. Hope or hopelessness?
14. Practice appropriate boundary setting with the patient as he/she relates to co-workers and people outside the circle of recovering sex addicts. To whom will the person claim sex addiction, and with whom will anonymity and strict boundaries be maintained? Role play some of these scenarios. Would the person rather die than face so-and-so?
15. Concretize after care plans. Who will see the patient for out-patient treatment? Is that therapist knowledgeable about sex addiction treatment and recovery? Will the therapist refer the patient if suicidality becomes prominent again? Is extended care needed? How many and what type of Twelve Step meetings will the person attend? Will the person get a sponsor and work Steps, or will he/she remain a “movie critic” at meetings as in the past? Will the person “put your whole self in” to recovery, like the song says?
16. Bring to light the person’s growth or lack thereof of a concept of a Higher Power. Does the person think his/her preciousness is a reality? Would a Higher Power really care? Is there still a false Higher Power operating (e.g. money, power, self, another addiction, or a partner)?
In summary . . .
The sex addict is really hurting. It is the clinician’s task to assess where the pain could lead while providing a safe, healing, holding environment.
Depression present at the start of treatment often deepens as shame crashes down upon the addict whose acting out pattern is revealed. Suicidal ideation at the “between trapeze” moment is a likely probability. The educated clinician’s index of suspicion will help to anticipate the presence and depth of depression, and the existence of self-destructive thoughts or plans. Caring and professional assessment and treatment will allow the sex addict to survive the shock of discovery and move toward the daily rewards of a healthy and spiritual recovery.
The moment between the trapezes
By Stephen S, Brockway, M.D
“I choose my behavior; the world chooses my consequences” is a phrase that any recovering sex addict would do well to hold in vivid consciousness. When the awareness of a pattern of sexual addiction starts to become clear, a trail of consequences is likely to follow close behind. Rather than attempt to manage or minimize the consequences, the sex addict is advised to curtail sexual acting out and embrace a quality recovery program taught and modeled by other recovering addicts.
Despite the conviction to move toward the rigorous honesty of recovery, the addict is likely to experience the cold sweat of repercussions of previous behavior. The secret life is unveiled revealing affairs, exhibitionism, voyeurism, or other behaviors comprising a particular sex addict’s modus operandi of acting out. Like the trapeze artist in the circus, the addict encounters the moment between letting go of one trapeze and catching the other. Such a crisis will make one exquisitely aware of hopelessness and depression. Hopefully, it will also dawn on the addict that he/she is powerless and that a Higher Power alone can and will be there in that moment.
Six classes of depressive types expressed in sex addicts
The mental health practitioner who treats sex addiction is called upon to diagnoses and treat the depression that is likely to be present before, during, and after the between-trapeze experience. This depression may present in several different forms, which can be summarized in the following classes:
1. Most commonly, a chronic, low grade depression or dysthymia in a shame-based person who has low self esteem and relatively undeveloped social skills. This dysthymic disorder may be punctuated with major depression especially likely at the time of significant relationship losses or at the time of exposure of the pattern of sex addiction. Shame, loneliness, and awareness of lost time spent in active addiction may haunt the addict. When shame rolls in, depression follows the flood. This type tends to have a strong superego and be at risk for self-punitive suicidal thoughts and behavior.
2. A seeming lack of depression in a perfectionistic, shameless-acting high achiever. Despite not having a history of previous clinical depression, this person may experience an overwhelming major depression as perfectionism and narcissism no longer stem the tide of mounting negative consequences of sexual behavior. Since this person may have a lofty professional and occupational position, the sexual acting out may involve level III abuse of a power position with employees, clients, or patients. If professional consequences (e.g. loss of license, termination of employment) lead to a further and more devastating breakdown in personal relationships (e.g. divorce, marital separation), the person’s shame can be catastrophic and overwhelming, making suicide a real and pressing danger. This person may even need to be hospitalized against his or her will until adequate defenses can be reestablished and a recovery process begun.
3. The depleted workaholic whose life is without joy, and who has no balance in social or recreational spheres. This sex addict is likely to find someone or a series of subjects at work to groom as he/she presents as a martyr-like victim slaving to support a family yet deserving of a sexual release. When depression finally breaks through clinically, after the pattern of sexual behavior is exposed, it is likely to be massive because this addict has little to fall back on when the merry-go-round of work stops. The workaholic pattern becomes a central treatment issue with both sex addiction and depression seen as outgrowths of the long term lack of self care. If a workaholic pattern recurs after treatment, relapse into sex addiction is almost certain, whether it be in the behavior or thoughts of the addict. Therefore, a goal in treatment and after for this person is to halt the pattern of self abandonment expressed previously through workaholism, sex addiction, and martyrdom.
4. Psychotic depression in a person who may be older (45-60 or above) and who has a pre-morbid obsessive-compulsive style and a suspicious temperament. This person may have practiced a type of sex addiction that included perpetrating children or teenagers, but kept it concealed for years. When the addiction progresses and the behavior is discovered, the public outcry and shame may be processed by the addict via psychotic defenses of massive denial and projection. The addict may sink into a stuperous depression with psychotic features including frank paranoid thoughts of feeling acted upon by outside forces and profound social withdrawal. The reality of the perpetrating behavior is alien to the denying lifestyle the person has practiced for years. The recovery from psychosis is gradual and in-depth work on recovery from the addictive sexual cycle must be put off until aggressive pharmacological treatment takes effect.
5. Bipolar depression in a person who may or may not be a true sex addict. Since the manic phase and mixed manic/depressive phases of bipolar disorder are often accompanied by hyper-sexuality with heightened sex drive and increased sexual behaviors of boundary-less type, the clinician, in attempting to make an accurate diagnosis, should be mindful to search for a true pattern of sex addiction behavior which transcends the mood swings of bipolar disorder. A bipolar patient may also be a sex addict, but a significant subset of bipolars show hyper-sexuality during mania that is not part of a pattern of sex addiction. The bipolar group as a whole is at significant risk for suicide (the lifetime suicide rate for untreated bipolars is 15%) and risk can do nothing but rise for the portion who are both bipolar and sex addicts. The dual bipolar/sex addict patient may actually complain of two types of depression; one that is without a particular stimulus (the bipolar depression that comes on suddenly like a black cloud overhead), and another depression which mounts slowly and is accompanied by shame and the emptiness of active addiction much like the dysthymia of Class #1.
6. A sociopath who may feel pain from consequences of addiction or perpetration, but lacks true remorse and may feign a victim stance for secondary gain from significant others and legal authorities. The dramatic victim behavior may mimic depression, but usually lacks the classic vegetative signs (sleep, appetite, energy, and interest disorders) of true major depression. If a person with antisocial personality disorder threatens suicide or acts on suicidal thoughts, it is usually in retaliation toward authority figures, related to substance abuse, or associated with additional accompanying character pathology (e.g. borderline personality).The sociopathic pattern should eventually be evident by the triad of lack of remorse for perpetrator behavior, failure to learn from past mistakes, and projection onto others of blame (lack of accountability). Such a person may have been through multiple previous treatments accompanied by a professed wish to work a strong recovery program yet, in reality, followed by failure to “walk the talk.”
The six classes of depressive types show that the entire array of depressive disorders is expressed in sex addicts. As a practical help to the mental health therapist, it might be useful to codify some of the clinical tools to employ in assessing and treating the depressed, suicidal sex addict. First, the practitioner will want to be able to distinguish the type, depth, and severity of the depression. Second, the therapist should as accurately as possible know what to consider in terms of risk of suicide.
Steps for Determining Severity of Depression
Determining the severity of depression combines a play-it-by-the-book (DSM IV) approach to asking about each possible depressive symptom with an intuitive awareness of what could happen (call it clinical “thinking dirty”) as the sex addict in treatment relates to mounting consequences. These steps are suggested:
1. Take no shortcuts in the intake process. Get a broad anthropological/cultural view of the person while conducting a careful search for symptoms and signs of depression and/or suicidal ideation and plans. The cultural context and support system have a telling influence on suicidal potential.
2. Withhold too early conclusions about character pathology. “Hip-shooting” labeling (e.g. borderline, narcissistic, antisocial) only closes off possibilities in the clinician’s mind and prevents the therapist from seeing the patient in all his/her potential for resilient recovery or calamities such as suicide.
3. Request psychological testing to back up interview data and clinical observations. Something may surface that was not considered earlier (e.g. schizotypal thinking or a low-grade thought disorder.
4. Search out nooks and crannies in relation to suicidaland homicidal thoughts. For example, if a person denies active suicidal thoughts, he/she may still wish that a semi-truck would meet them head on. Likewise, even though a patient is a mother of children and says she would never kill herself because her children need her, has she recently bought life insurance or given away belongings?
5. Review any past history of suicidal ideation or attempts. What are the similarities and differences (e.g. strength or lack of strength of support network) to the present situation? Has the person ever faced anything as humiliating as the exposure of sex addict behavior?
6. Consider, “How deep is this person’s shame?” Will the person consider suicide to be the only “viable” way out of a lifelong shame-existence bind?
7. Inquire about how the person has taken out anger in the past. Toward self? Toward others? He/she is likely to follow the same pattern again.
8. Determine the dynamic significance of the type of sexual acting out practiced by the patient (e.g. the exhibitionist who could never get his mother’s attention). Has that meaning been processed with the patient and the power taken out of the pattern, or does shame still envelop the patient and fuel suicidal/homicidal thoughts?
9. Measure whether the patient’s medication for severe depression is at a therapeutic level. Smoldering along with depression that is only partially treated can heighten the patient’s hopelessness and could lead to suicide (e.g. Is this as good as it gets?).
10. Assess medication compliance. What has been the response of the depression to medication? Does the patient understand the importance of taking medication as prescribed, and for as long as prescribed? Are any side effects intolerable to the patient (e.g. decreased sex drive, anorgasmia, or impotence)?
11. Examine any progress made in treatment in processing anger, shame, and other overwhelming emotions. Have the circumstances of the person’s life changed for the better? For the worse? Remember, if nothing changes, nothing changes.
12. Gauge employment and economic prospects. Has sex-addict behavior led to consequences at work? Will there be further repercussions and consequences?
13. Ask the patient what he or she sees for the future. Hope or hopelessness?
14. Practice appropriate boundary setting with the patient as he/she relates to co-workers and people outside the circle of recovering sex addicts. To whom will the person claim sex addiction, and with whom will anonymity and strict boundaries be maintained? Role play some of these scenarios. Would the person rather die than face so-and-so?
15. Concretize after care plans. Who will see the patient for out-patient treatment? Is that therapist knowledgeable about sex addiction treatment and recovery? Will the therapist refer the patient if suicidality becomes prominent again? Is extended care needed? How many and what type of Twelve Step meetings will the person attend? Will the person get a sponsor and work Steps, or will he/she remain a “movie critic” at meetings as in the past? Will the person “put your whole self in” to recovery, like the song says?
16. Bring to light the person’s growth or lack thereof of a concept of a Higher Power. Does the person think his/her preciousness is a reality? Would a Higher Power really care? Is there still a false Higher Power operating (e.g. money, power, self, another addiction, or a partner)?
In summary . . .
The sex addict is really hurting. It is the clinician’s task to assess where the pain could lead while providing a safe, healing, holding environment.
Depression present at the start of treatment often deepens as shame crashes down upon the addict whose acting out pattern is revealed. Suicidal ideation at the “between trapeze” moment is a likely probability. The educated clinician’s index of suspicion will help to anticipate the presence and depth of depression, and the existence of self-destructive thoughts or plans. Caring and professional assessment and treatment will allow the sex addict to survive the shock of discovery and move toward the daily rewards of a healthy and spiritual recovery.
What is Biopolar Disorder?
What Is Bipolar Disorder?
Bipolar disorder, which used to be called manic depressive illness or manic depression, is a mental disorder characterized by wide mood swings from high (manic) to low (depressed). Periods of high or irritable moods are called "manic" episodes. The person becomes very active, but in a scattered and unproductive way, sometimes with painful or embarrassing consequences.
Examples are spending more money than is wise or getting involved in sexual adventures that are regretted later. A person in a manic state is full of energy or very irritable, may sleep far less than normal, and may dream up grand plans that could never be carried out.
The person may develop thinking that is out of step with reality psychotic symptoms such as false beliefs (delusions) or false perceptions (hallucinations). During manic periods, a person may run into trouble with the law.
If a person has milder symptoms of mania and does not have psychotic symptoms, it is called a "hypomanic" episode. The vast majority of people who have manic episodes also experience periods of severe depression. If manic and depressive symptoms overlap for a period of time, it is called a "mixed" episode. In some people, moods alternate rapidly or it is difficult to tell which mood depression or mania is more prominent.
People who have one manic episode most likely will have others if they do not seek treatment. The illness tends to run in families. Unlike depression, in which women are more frequently diagnosed, bipolar disorder happens nearly equally in men and women. The disorder occurs in approximately 1 percent of the population.
The most important risk of this illness is the risk of suicide. People who have bipolar disorder are also more likely to abuse alcohol or other substances.
Bipolar disorder, which used to be called manic depressive illness or manic depression, is a mental disorder characterized by wide mood swings from high (manic) to low (depressed). Periods of high or irritable moods are called "manic" episodes. The person becomes very active, but in a scattered and unproductive way, sometimes with painful or embarrassing consequences.
Examples are spending more money than is wise or getting involved in sexual adventures that are regretted later. A person in a manic state is full of energy or very irritable, may sleep far less than normal, and may dream up grand plans that could never be carried out.
The person may develop thinking that is out of step with reality psychotic symptoms such as false beliefs (delusions) or false perceptions (hallucinations). During manic periods, a person may run into trouble with the law.
If a person has milder symptoms of mania and does not have psychotic symptoms, it is called a "hypomanic" episode. The vast majority of people who have manic episodes also experience periods of severe depression. If manic and depressive symptoms overlap for a period of time, it is called a "mixed" episode. In some people, moods alternate rapidly or it is difficult to tell which mood depression or mania is more prominent.
People who have one manic episode most likely will have others if they do not seek treatment. The illness tends to run in families. Unlike depression, in which women are more frequently diagnosed, bipolar disorder happens nearly equally in men and women. The disorder occurs in approximately 1 percent of the population.
The most important risk of this illness is the risk of suicide. People who have bipolar disorder are also more likely to abuse alcohol or other substances.
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