Understanding And Treating Male Sexual Addiction Through Traditional Chinese Medicine - David Mitchell Bridgman - Thesis for graduation and diploma ‘Classic Chinese Acupuncture,’ Academie voor Chinese Geneeswijze Qing-Bai, The Netherlands Supervision and evaluation by Dianne Sommers 16 October 2006 TABLE OF CONTENTS Acknowledgments page 5 Introduction page 5 Chapter 1 Western Concept of Sexual Addiction page 7 1.1 Definition, History, and Data page 7 Definitions: - desire - addiction - sexual addiction - compulsion - obsession - sexual health - paraphilia Terms equivalent to ‘sexual addiction’: -paraphilia-related disturbance -sexual (obsessive) compulsive behavior -sexual stimulus disturbance -excessive sexual urge -excessive sexual desire 1.2 Characteristics page 9 - Definitive characteristics - Behavioral pattern 1.3 Different Forms page 10 1.4 Consequences page 10 1.5 Etiology page 11 - Primary question - Theories concerning etiology of paraphilia: - Normality theories - Pathological theories - Additional causes of hypersexuality 2 1.6 Diagnosis page 13 1.7 Treatment page 14 - Treatment of the paraphilias - Socio-cognitive behavioral therapy - Psychoanalytical treatment - Hormonal and psychopharmacological intervention - Treatment of hypersexuality 1.8 Notes page 16 Chapter 2 Relevant TCM Concepts page 17 2.1 Sex, TCM, and Ancient China page 17 2.2 San Bao page 19 - Jing - Qi - Shen - Couples within San Bao 2.3 The Heart and the Brain page 23 - The Heart - The Brain 2.4 The Mental-Spiritual Entities page 24 - Shen - Hun - Po - Yi - Zhi 2.5 The Emotions page 27 - Anger - Pensiveness and Obsession - Guilt and Obsession - Joy and Craving 2.6 Desire and Obsession page 28 2.7 Human Nature, Destiny, and Habituation page 30 3 2.8 Possession page 31 2.9 Summary of the Functional Mechanism of the Heart and Mind (Shen), the Mental- Spiritual Entities, the Emotions, Human Nature, and Destiny When in a State of Balance page 31 2.10 Notes page 32 Chapter 3 A TCM Interpretation of Sexual Addiction page 36 3.1 Introduction page 36 3.2 Definitive Characteristics page 37 - Uncontrollable desire - Behavioral pattern -stage 1: continual and progressive thoughts of sex -stage 2: uncontrollable desire -stage 3: sexual act -stage 4: guilt -stage 5: abstinence 3.3 Core Pathology of Sexual Addiction page 41 3 .4 Consequences page 42 3.5 Etiology page 43 3.6 Diagnosis and Treatment page 45 3.7 Notes page 47 Chapter 4 Conclusion page 49 Bibliography page 50 Acknowledgments 4 As I close a chapter of my TCM education with this thesis, I would like to acknowledge those who have helped make it possible. From the heart, I wish to thank: - All my teachers, too many to name, for sharing their knowledge and inspiration. - My partner in TCM, Dewi van der Roest, for all her hard work and continual support. - And my comrade, Marcel de Bruijne, for always being here, keeping me grounded. Introduction Male sexual addiction dates as far back as recorded history but only began to be explored by Western medicine in the late 1970’s. Ancient China placed the utmost importance on moderation for health and longevity. Though sexual temperance was viewed as possibly the most important moderation of all, Classic Chinese medical texts do not mention the concept of sexual addiction, nor the concept of addiction in general, for that matter. In this thesis, I aim to answer the questions: How can one use what is known today from Western medicine and from Traditional Chinese Medicine (TCM) to arrive at a truly TCM understanding of male sexual addiction, its causes and manifestations, which is applicable to the modern-day affliction? How can one then use this understanding to treat those who suffer from this problem? In Chapter One of this thesis, I have made use of current Western medical theories concerning the biochemistry and psychology of sexual addiction, its definition, definitive characteristics, etiology, diagnosis, and treatment. In Chapter Two, I have utilized modern interpretations of TCM and of Classic Chinese texts in order to understand the ancient Chinese view of sex and of addiction-related concepts, including desire, obsession, habituation, and possession. The functional mechanisms of the Heart and the Brain, the mental-spiritual entities, and the emotions are also discussed. Furthermore, the relevant TCM concept of San Bao is explored as I search to understand the level (Jing-Qi-Shen) at which sexual addiction originates and manifests and at which level it can be treated. Finally, in Chapter Three, I utilize the first two chapters to arrive at a TCM interpretation of sexual addiction, its Vital Substance/ ZangFu patterns of disharmony and disturbances of the mental-spiritual entities, and its etiology. I also present a general theoretical model for its treatment on all levels of San Bao. I have tried to limit repetition of explanations of the relevant concepts to what is necessary for a thorough understanding within their contexts. However, in such a nonlinear, holistic system as TCM, I have found a certain amount of repetition to be unavoidable. 5 Although my use of quotations in Chapter Two is quite extensive, I have also limited this to what I feel necessary. In certain instances, the vivid and accurate terminology of Elisabeth Rochat de la Vallee, Claude Larre, and Lonny Jarrett are fundamental to an understanding of the relevant concepts. Furthermore, I have strived for consistency in terminology but have sometimes opted for terms used by the cited authors which deviate from the standard of the thesis, when they emphasize a certain aspect of the concept. All Chinese concepts are capitalized to set them apart from the Western, English concepts. Likewise, all Pinyin terms are capitalized and appear initially in ( )’s after the English translation. The terms Earth, Human, and Heaven also appear in capital letters in order to emphasize the Chinese concept of this triad. My reasons for choosing this topic are several: Firstly, in my adult life, I have encountered many males who truly suffer, both physically and emotionally, from sexual addiction. Whether or not future clients come to my practice asking for help with this specific problem, I find it equally important to understand the affliction when it is a backdrop for other illnesses or a partner to other problems. I have always considered San Bao to be one of the most interesting and important aspects of TCM, and the topic of sexual addiction lends itself well to exploring this uniquely TCM concept. It also lends itself well to exploring various diagnostic and therapeutic visions and approaches, and I feel that viewing a subject from many angles is essential to understanding its essence. Finally, I find sexual addiction to be a prime example of an affliction which embodies man’s innate habitual condition on his personal path in life. I feel that researching this topic will bring me a deeper understanding of what it means to be a practitioner of TCM. Chapter 1 Western Concept of Sexual Addiction 6 1.1 Definition, History, and Data Since recorded history, man has concerned himself with controlling his desires, and regulating one’s sexual desires lies close to the core of all the world’s philosophies and religions.(1) According to The Meriam-Webster Dictionary, ‘desire’ is defined as “a strong wish, longing, craving.” With the step from ‘desire’ to ‘succumbing to desire’ one comes closer to the concept of ‘addiction,’ defined as “the quality or state of devoting or surrendering [oneself] to something habitually or excessively.”(2) Concise Dictionary of Modern Medicine defines ‘addiction’ as “a preoccupation with the compulsive use of a substance despite recurrent adverse consequences.” This is a quite strict definition, and with the words “use of a substance,” reflects the origins of the concept of addiction in connection with alcohol abuse, and later with drug abuse.(3) Arguably, a distinction may need to be made between addiction to external chemical substances and a more liberal use of the term. This being said, the modern day concept of addiction is not as an exclusive term for inhaling or ingesting chemicals with psychoactive effects. It includes many forms, if not any form, of sensory stimulation and behavior with obsessive tendencies, (4) including work, excercise, eating, and gambling.(5) The possibilities for addiction are, in fact, endless. The concept of sexual addiction, together with the aforementioned addictions, evolved from the earlier concept of alcohol and drug addiction.(6) Concise Dictionary of Modern Medicine defines ‘sexual addiction’ as equivalent to ‘sex compulsion,’ i.e. “compulsive and ritualized sexuoerotic hyperactivity, generally under specific sexuoerotic conditions and stimuli.” The word ‘stimuli’ here suggests a neurochemical element, but the core of the definition lies in the subject’s actions and not in his biochemistry. ‘Compulsion’ is defined as “a behavior ... which is repetetive ..., which a person feels compelled to perform in response to an obsession ... or behaviors ... aimed at preventing or reducing distress ... or behaviors that are clearly excessive.” ‘Obsession’ is defined as “recurrent and persistent thoughts, impulses, or images that are perceived as intrusive and inappropriate and cause marked anxiety or distress.” The most accessible discussion I have found regarding the correct terminology for the affliction I have thusfar termed ‘sexual addiction’ comes from sexologist and sex therapist Hannie van Rijsingen: The World Health Organization defines ‘sexual health’ as “a condition of physical, emotional, mental, and social well-being, related to sex; It is not only the absence of sickness, dysfunction, or weakness. Sexual health requires a positive and respectful approach to sexuality and sexual relations. Sexual health requires the ability to engage in pleasurable and safe sexual experiences, without compulsion, discrimination, or aggression. To achieve and sustain sexual health, the sexual rights of all persons must be respected, protected, and realized.”(Schaalma, Kok, 2004)(7) In the case of sexual addiction, whereby sexual desires and behavior are no longer under control, the “mental well-being, related to sex” is certainly questionable.