Is Clinton Out of Control?

The Wall Street Journal, September 21, 1998

By Sally Satel

If I had a quarter for each person who’s asked me whether President Clinton is a “sex addict,” I’d finally be able to afford that leather-bound set of Freud’s complete works. “The people who are going to help [Mr. Clinton] out of this scandal,” Dick Morris predicts, “are ministers, clergymen, psychiatrists and experts on addiction.” Adds Sen. Orrin Hatch (R., Utah): “He needs help.” The American Psychiatric Association reports being flooded with Clinton-related queries. On “Meet the Press,” host Tim Russert asked Clinton counsel Charles Ruff whether the president should “maybe take six to eight weeks off and get help.”

So is Mr. Clinton sick, or just behaving badly? Is he really a “sex addict”? And if he is, could “six to eight weeks” do the trick? In his much-hyped book, “The Clinton Syndrome: The President and the Self-Destructive Nature of Sexual Addiction,” therapist Jerome David Levin claims it’s a no-brainer to diagnose the president as a sex addict. After all, Mr. Levin notes, Mr. Clinton’s “sex-life [was] out of control” yet he exhibited the telltale “denial that is so characteristic of all addictions.”

Mr. Levin isn’t the president’s analyst, and neither am I. I have no idea what constellation of neuroses are at work. But I do know that people who seem to thrive on reckless sex are not helpless to stop themselves. Some need therapy, others stop on their own, but all have a moral obligation to arrest their behavior.

The current Diagnostic and Statistical Manual (DSM-lV), the psychiatrist’s bible of mental disorders published by the American Psychiatric Association, does not contain the term “sex addiction.” It does, however, recognize an entry for “Sexual Disorder Not Otherwise Specified”; some psychiatrists put self-destructive sexual acting-out under that category. Others, like Jennifer P. Schneider, argue that sexual addiction deserves its rightful place in the DSM. Dr. Schneider proposes several diagnostic criteria for sexual addiction, key among them (1) preoccupation with sex, (2) frequent engagement in sex and (3) continuation of sex despite recurrent problems caused by it.

But whether sex addiction is codified or not, the age-old question remains: how to tell the difference between an impulse not resisted and an irresistible impulse. In order to determine whether a behavior is voluntary, Harvard psychologist Gene M. Heyman applies the following question as a litmus test: Can the activity be modified by its consequences? If the answer is yes — think of the alcoholic who, after losing his wife and job, finally decides to become sober — then it is under voluntary control. Keep in mind, however, that one person’s intolerable consequence may be another’s annoying aftermath — because he knows from previous experience that he can always charm, threaten or bribe his way out of a serious fix.

When dealing with any kind of addiction or compulsive behavior, a good therapist spends a lot of time helping the patient identify specific stimuli that trigger, in Pavlovian fashion, the desires he must forsake. For the cocaine user, a trigger may be ready cash in the pocket; for an alcoholic, loss of control may start the moment he walks by the bar. For the person who repeatedly engages in improper consensual sex, the trigger may be finding himself alone with a pretty, flirtatious woman. Once the patient and therapist have identified the people, places and even moods that make the patient acutely vulnerable, they devise ways to avoid those situations and modulate the emotions. The patient learns how to throw figurative ice water on the source of his desire — a process for which the patient is responsible.

As for those who succumb — snorting the first hit of cocaine, walking into the casino, pouring the first drink, unzipping — there is less chance of turning back. Psychologist Patrick Carnes, who coined the term sexual addiction, told Time magazine that “what we’re talking about is a loss of control {over} a pleasure that gets you so hooked you cannot stop.”

But there’s the rub for Mr. Clinton. For most red-blooded men, let alone Mr. Carnes’s “sex addict,” interruption of the act itself in midstream would be the hardest thing to do. That is surely the least controllable event in the long sequence of preliminary acts and decisions leading to the actual encounter. Yet according to Monica Lewinsky’s testimony, Mr. Clinton often refused to let the intern perform oral sex to completion. That hardly sounds like a man out of control.