On Saturday September 28th, the Daily Mail Newspaper published an article by Dr Max Pemberton, the newspaper's mental health columnist and NHS psychiatrist. In the article titled 'Sex addiction a real disease? More likely an excuse to behave badly', Dr Pemberton made the claim that the classification of sex addiction as a disease was 'tosh' and that it was a way of famous men justifying their own promiscuity. This open letter to Dr Pemberton takes issue with many of the points that he has raised and the Living Room Cardiff would invite both Dr Pemberton and the Daily Mail to engage with us in a constructive dialogue.
Dear Dr Pemberton,
In your recent article for the Daily Mail 'Sex addiction a real disease? More likely an excuse to behave badly', you make a number of contentious claims about the condition, which are not supported by the available evidence or by our own work with sex and love addicted clients. To begin with, the headline to the article uses the highly subjective phrase 'behave badly', which as a practicing psychiatrist working with vulnerable patients it is hard to imagine you would actually use. It is not appropriate for any practitioner in any psycho-therapeutic role to make such simplistic and crude value judgements about their clients and it is unbecoming of your position as a psychiatrist to publicly make those judgements of others in general. Perhaps you were fulfilling your role here as a Daily Mail columnist and using language that the readers were familiar with? If so, there would appear to be a conflict of interest between your additional paid work as a professional contrarian and your role as a skilled medical practitioner. Your private views are of course your own business, but to present an argument with no scientific basis and to use your credentials as a means of conferring on to these views legitimacy is irresponsible, as the condition you refer to causes acute harm to its sufferers.
Your first claim, that 'increasingly-and cynically-some people now use their 'mental health issues as an excuse for bad behaviour' has no basis in fact or evidence and if there was any research to support this claim you would have published it. Are you referring to all mental health issues here or simply sex addiction? Your first hypothetical case study is a wealthy businessman or celebrity caught out in a sex scandal who attempts to evade trouble by checking into an expensive rehab clinic.
Is this representative of patients that you have personally treated or (as the juxtaposed picture of Michael Douglas suggests), a composite of tabloid stories? If it is the latter, do you consider it fitting that an NHS psychiatrist of your standing and ability should present to the wider public such a narrative? The reason we pose this particular question is that in nearly a decade of working with sex addicts we have seen a diverse range of clients, but in nearly every case they are highly vulnerable. Not only do they normally lack the resources, wealth and influence to evade their problems in the manner you suggest, but the deep rooted emotional causes of their dysfunctional sexual behaviour are rooted in childhood trauma.
Some have been the victims of childhood sexual abuse, others have been victims of emotional neglect or abandonment. All of them have grown up without the love, stability or nurture that children need to have happy and empowered lives as adults. Often, they have problems with other substances or behaviours such as alcohol or street drugs and most find that they lose countless hours of their lives to internet pornography; they become lonely, isolated and lost.
The simple and judgemental picture that you have created here does not actually exist in the lives of most sex addicts. Even the wealthy and the famous who do find that their sexual behaviour is so problematic that they have to find residential treatment for it are worthy of understanding and empathy because irrespective of their wealth or status they are human beings and are capable of sadness and suffering like anyone else.
You state that sex addiction has no neurobiological basis at all? Are you sure? Do you have peer reviewed evidence that shows that there is no connection between this compulsive behaviour and the nervous system? It's quite a claim after all. Perhaps in the interests of scientific objectivity and veracity you might present the research that has brought you to this point of view. It is not sufficient when making contentious scientific claims to simply dismiss something as 'tosh'.
You refer to the recent focus on the importance of the hormone oxytocin as 'fashionable', which implies that its appearance in discourses and debates surrounding mental health is fleeting. It insinuates that as a 'fashionable hormone to study' that is has somehow been put to unscientific purposes. You state that there is 'concern in the scientific community that its impact on our actions has been overblown.' Can you cite one study that says this? Can you quote one respected figure in the field who has gone on record to articulate these concerns?
If not, we at the Living Room Cardiff would invite you to withdraw this statement until there is evidence to support it. You then use a strange logic to justify the weakness of the oxytocin thesis. If oxytocin, the so called 'cuddle hormone' that makes us want to touch each other, is responsible for higher levels of promiscuity, then why aren't new mothers in maternity wards engaged in passionate love affairs, as they all have higher levels of oxytocin after giving birth. Well, the truth of the matter is that new mothers are engaged in the deepest and most tactile love experience of their lives shortly after giving birth, with their baby.
You then make the claim that sex addiction is an entirely made up condition. You are of course entitled to take this position, all addictions and mental health conditions have to be classified and integrated into the language of medicine and psychotherapy, so are to some extent created; however sex addiction and all other addictions involve real world harms and the suggestion that the condition is without real harm is false.
You claim that there are psychiatrists who are happy to see clients privately for sex addiction therapy but who scoff at the diagnosis and the idea that sex addiction is an illness. It is impossible to verify this claim, but assuming it is correct, does it not strike you as odd that men and women seek help from psychiatrists because of their compulsive sexual behaviour if no such condition actually exists? If you are trying to suggest that all that is occurring is a lack of self control, then can you and your colleagues realistically be providing patients with compassionate, judgement free and client centred therapy?
The sex addiction lobby, you claim, has forced the World Health Organisation to relent and classify sex addiction as a disease, but is this what has actually happened? Has a cabal of vested interests forced their own agenda upon the WHO in a bid to enrich themselves or has the organisation expanded its list of diseases to include sex addiction based on research and evidence? Perhaps you might so kind as to clarify. A disease, after all, is simply a condition that affects the normal functioning of the body and mind and compulsive sexual behaviour falls into that category.
The language you use to describe people with complex problems is appalling and one wonders how your own patients might feel about their therapeutic relationship with a clinician so judgemental and unforgiving. Sex addicts are 'lecherous' and their behaviour a 'weakness'. You continually use the language of choice while missing (or deliberately ignoring) the fact that addicts suffer from compulsive behaviour that they have no power or choice over until they are able to find recovery in a non judgemental space. This is the opposite of the incendiary and harmful rhetoric you have employed in your article.
Yours Sincerely,
The staff at the Living Room Cardiff