Men: Sex Addiction and Depression

My work over the last fifteen years as a psychotherapist treating sexual compulsions has brought me into contact with men – and more men. They come to my consulting room wearing the mask of shame, humiliation, and confusion. Often, after a period of therapy, they come to a common link among them: they are depressed. Empty and suffering from a disorder that, for men, can be as hidden as sexual deviance itself, depression in men is hardly spoken about. It is women who are depressed – it’s a women’s disease — with depression occurring four times more often in the fairer sex.

Yet I believe there’s a deep cultural collusion taking place: Men don’t speak the truth to themselves or others about the dark, jagged, emptiness that consumes them. Talking about the depth of these feelings is so, well, unmanly literotica. The real story about men, sexual acting out and depression is as complex as each of the wounded souls who enter my consulting room. The impact of depression and sexual deviance/addiction on each of them is enormous.

It is here that issues of gender come into play. Girls are socialized to be connected and expressive. But from a very young age, the boy is told by his culture to act upon feelings – to seek relief through action rather than through connection or introspection. Pain is externalized in men, resulting in domestic violence, failures in intimacy, alcoholism, workaholism and, certainly, sexual compulsion.

The theme of the manliness of invulnerability has permeated our culture for generations. Look at the male heroes we choose: The Man of Steel, Robocop, Iron Man, The Incredible Hulk, The Terminator: all creatures literally made not of flesh and blood and certainly not, horror of horrors, feelings. The culture sends the message that the man who is suffering from unwanted and confusing feelings should not expect help. He must resolve his problems on his own. (“suck it up”)

Often he seeks to resolve his emotional problems by turning to a substance, person or activity to regulate his self esteem and to ward off depression. I believe that this is at the heart of the addictive process. When a covertly depressed man’s connection to the object of his addiction is undisturbed, he feels good about himself. But when the supply runs out – the affair is over, he can’t get to the computer to see porn, he is spurned by women he desires, the credit card maxes out – his self-worth plummets and the hidden depression begins to unfold. Such feelings of emptiness and depletion can drive him back to his addiction, contributing to the vicious cycle of addiction.

Invariably, the issue that arises in treatment is depression and the shame that accompanies it. When one reaches so deeply into a man’s inner pain, one can see the hidden fragility lying dormant there. In the terms of traditional psychotherapy, pain that is internal, lucidly experienced, and able to be spoken about is less disturbed than pain that is externalized and unconsciously “acted out.” Therapy relies on the patient’s insight into his problems with feelings as it the chief motivating agent. The difficulty with this methodology is that it is much more in keeping with the traditional emotional skills of women than those of men. Men do not have readily at hand the same level of insight into their emotional lives as women, because our society dislocates them from the emotional aspects of themselves.

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