I have seen them.

Men, who sit in my office and tell me they are addicts to internet pornography.

They describe symptoms that have long been regarded as markers of addiction.

Dependence — They start feeling poorly, maybe even depressed, if they don’t get their regular quota of exposure.

This is easy enough to get on the internet, so everybody who feels they want this (or “need” this) is able to get it.

Tolerance — People who tell me about using internet porn seem to increase their use of it, to get the same “effect” or “satisfaction.”

There is a corollary to this.

Their lives and interests become narrowed. This includes their interest in real live female sex partners. Their prowess, or ability to satisfy same, seems to decrease.

What’s a psychiatrist to do???

For a couple of years I sent them to Sexaholics Anonymous (S.A.). I don’t say there aren’t other alternatives.

I don’t even say that these folks are the best, for there are many who seem to treat what these folks conceptualize as “lust,” having become an addiction.

I have had patients who have told me they found some real relief from their troubles by going to these groups, and that is the only real measure I have had.

I know that these folks are pretty close to the Alcoholics Anonymous (AA) model, which seems to work through a logic akin to some religions — perhaps closest to Buddhism — or one of the far Eastern religions in particular.

Control of self through negation of self.

Talk about God that sounds enough like religion to send some folks looking for alternative ways of seeing this. Several people have proposed alternative steps.

There has been a study that shows a change in the function (diminished) in certain parts of the brain of internet pornography users.

This seems to be significant, although we absolutely cannot tell from this study about what causes what. So although a couple of media outlets have gone crazy on this one, we cannot tell if people with less function in this part of the brain tend to locate and enjoy internet porn, or if watching internet porn actually shrinks this part of the brain.

The authors have suggested that the parts of the brain identified with this study seem to be associated with reward and motivation.

They are certainly parts of the brain about which we know very little indeed.

Still, I do not seem to be the only person who has recognized that there is at least a possible correspondence to a real clinical syndrome. Those nice U.K. folks at the Telegraph cite a recent movie about this phenomenon, even though they jump to the conclusion that pornography really does affect the brain.

They do, to their credit, link to an excellent author whose work I have always enjoyed, the Canadian born psychoanalyst and excellent clinician Norman Doidge.

Dr. Doidge is a great champion of neuroplasticity. There is lots of evidence from various spheres of neuroscience to heartily endorse the concept of “neuroplasticity.”

The first such sphere that comes to mind is stroke recovery.

When a brain function seems to be lost, that generally means that the cells that fulfill that function have been lost. We know now that contiguous cells can and do work toward replacing that function. A single brain cell — which older conventional medicine was given to believe was “specialized” and “differentiated” and thus could not change its function — actually can.

So it is not impossible to believe that engagement with internet pornography could have an effect upon functionality in the brain.

If you are interested in a highly relevant chapter of Doidge’s work, this link will take your browser to (or open in a new window) a PDF file to read. I believe you could also download it to your hard drive for later reading. Anyway, you will need the free Adobe Acrobat reader to access this (it usually comes with all computer operating systems).

For me, the logical next step is to look for other clinical syndromes with which the structures cited in the internet pornography article might be associated.

The ones I find seem disarmingly relevant:

** Here diminished conductivity of these same structures seems related to severity of alcohol dependence.

A well-established addiction paradigm. What could be clearer?

** A similar reduced activity in cognitive (intellectual — demanding some attention) tasks in adults with residual attention deficit disorder.

Clearly doing things like this could be interpreted as “changing a habit.” At the very least, being induced to deal with things in a different way than habitually.

Whatever. I am no great devotee of concepts such as classification and nomenclature, much preferring phenomenology — hoping for the day when all classification of brain-related illness will have precise neuroanatomical and neurophysiological correlates.

… and we are getting there, for sure.

All right, so it is plausible at least, with our current level of knowledge, that internet pornography is highly addictive, and can significantly limit ability to relate sexually to flesh-and-blood humans, perhaps even to focus attention on other matters.

So what do we do?

First of all, in my professional practice of psychiatry at least, Sexaholics Anonymous stays. Even with increasing validation of psychiatry as “brain disease,” the interpersonal component of such disease remains as strong as ever.

The component of shame is undeniable and potentially overwhelming. Even if there were nothing more than knowing one is not the first nor the only person to have lived this set of symptoms, there would be a good reason.

But wait, there is more.

In other spheres of psychiatric illness, I have actually seen some psychotherapy cures. I am dead-set-convinced that the intelligent and codified speaking to a responsive human being can and does change brain chemistry.
I will freely admit that I have not yet seen the definitive study of brain function to prove this. But I do know why.

Most of the aspects of brain science (and maybe, those aspects of life) that most intrigue me are those that fall “between the cracks.” Those “cracks” have been artificially determined by those who determine the fields and specialties of those who perform scholarly studies.

Those who do the psychotherapy talking are simply not the same people who do the brain studies.

The pure anatomy of these regions have only been recently elucidated in the human.

This means that as much as I would love to run in with a symptom-specific medication treatment for this symptom, I can’t just yet.

I can say that virtually every time I have seen this set of symptoms, they have not been isolated.

I can say, although the overwhelming numbers of cases I have seen have been in men, these symptoms occur in women as well.

I can say they frequently co-occur with depression — a fact that might color my choice of antidepressant. I have seen patients get at least somewhat better with such intervention alone.

But someone who has this problem needs to try to use anything and everything that might help. Be it helping to redirect a brain or talking to someone.

In general, I really like the approach of this website – which really gets into the whole “Your Brain On Porn” concept.

We seem, as a species, to develop problems faster than we can treatments. I believe at this stage in our development, all treatment for psychiatric problems is best viewed as “integrative,” which means including all disciplines that present treatments that might possibly work, if they are “mostly harmless,” even if we can’t quite understand how.

I would be wary of any treatment that purports to have a single answer. The most powerful proponent of that way of thinking is religious zealotry, which builds lots of guilt for patients known to me, but has not, to my knowledge, actually eradicated either symptoms or the problem.

Law seems to work similarly. Its very specter seems to me to raise guilt more than eradicate problems.

Author's Bio: 

Works at Ridgecrest Rural Health Center and Estelle Toby Goldstein, MD (The Renegade Doctor)

Studied BA Biology cum laude at Boston University
Past: Beaver Country Day School

Lives in Ridgecrest, California
From Chelsea, Massachusetts · Moved to Ridgecrest, California