A CASE OF SEXUAL ADDICTION AND DEPRESSION

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A CASE OF SEXUAL ADDICTION AND DEPRESSION

Introduction

The central issue of this case is sexual addiction, or compulsion. The theory of sexual addiction is a controversial one. The controversy is not whether there is such a thing as sexual disorder or dysfunction, but whether a person can actually be addicted to sex. Psychologist Eli Coleman, PhD, maintains that one can't be addicted to sex because sex is not a substance. Another expert in the field, Patrick Carnes, PhD, has developed a detailed theory of sexual addiction and directs and consults with treatment programs for the "sex addicts" throughout the country.

Whatever the psychologists finally decide, a great deal of attention is being paid to the issue of sexual compulsion. Activities defined as sexually compulsive include excessive masturbation, use of pornography, prostitution, voyeurism, incest, and rape. Starting in the 1980s, the focus on AIDS has brought attention to promiscuity as a sexual addiction or compulsion, and more and more people are seeking psychotherapy to stop this kind of behavior. Treatment approaches include individual therapy, group treatment, and work with spouses and families of origin. A goal of therapy, according to Carnes, is to break the addiction cycle, described as a four-step routine that intensifies with each repetition. The steps in this addiction cycle are as follows:

Preoccupation: The state of mind where the person is completely engrossed with thoughts of sex.
Ritualization: The person's own routines that lead to sexual behavior.
Compulsive sexual behavior: The sex act, which is the end goal of the person's preoccupation and ritualization.
Despair: The feeling of utter hopelessness after the sex act.
The despair comes, in part, because these people don't feel they can control their behavior and because the behavior keeps them from developing the rich, intimate relationships that help lead to self-realization (Jane Simon, American Journal of Psychoanalysis, Fall 1982).

The woman we're going to be talking about today had these four behaviors. She also had the isolation from others that goes along with this particular compulsion. It wasn't initially apparent to me how deep her limitations were in this area. As the case unfolded, however, and we were able to explore this pathology from a number of angles, the remedy picture became clear. She experienced a significant healing in a matter of months from the appropriate remedy, in sharp contrast to the failure of her years of psychotherapy for depression and sexual compulsion.

Let me describe my patient. She was a 44-year-old woman, with dark hair, an olive complexion, and a worried expression. Whenever I came out to the waiting room to get her, I had the sense that she was afraid I was going to be really angry with her. It was a kind of cringing, worried look.

Case Presentation: Fears Men, While Addicted to Sex With Them

W.M.

Female

Age 44

Chief Complaint: She vacillates between being spacy (3) and depressed (2), with overpowering sleepiness (3). She takes Caprestatin and other supplements that mildly help.

Previous Remedies: She has been given a number of homeopathic remedies by well-trained classical prescribers. Sepia was helpful for environmental sensitivities. Natrum muriaticum partially helped the depression. She had five doses over a two-year period. Phosphorus helped both the depression and the sensitivities for two years, and then stopped helping. She experienced no change from Lycopodium, Platina, Phosphoric acid, Aurum metallicum, and Medorrhinum.

She has had depression (2) since childhood. It has increased since she had a child six years ago. She never feels happy and is always somewhat depressed. The depression is worse if she goes without sex for a while.

She has difficulty relating to people, particularly to men and groups. "I'll walk into a room and not know what to do."

She tends to be spacy and has trouble staying awake during the day (3). She falls asleep in meetings (3) and feels like "I'm not in my body. I'm up in space somewhere." These symptoms are worse from exposure to fluorescent light (2), gas furnaces or stoves (2), and car exhaust.

She complains of being addicted to sexual relationships with men (3). "I always end relationships because I'm bored. I just want the sex. I'm either bored or feel trapped, so I leave." She gets high from sex and feels deprived when she doesn't have it, so she seeks out new partners. She enjoys sex but doesn't know what to say to her partners afterwards. She feels she can't talk to men. She has four or five sexual encounters each week, with different men.

She is an artistic person and would like to paint, "...but I stop my creativity."

She moved to Minnesota to get away from her mother. "She is so powerful and critical of me. She is always talking. I can't get a word in." She is angry (3) at her mother.

Her energy is okay, but she has trouble falling asleep at night (2). It is impossible for her to sleep on the right side (3). She often wakes too early in the morning (1).

Her hips ache in bed in the winter.

She is angry often (3), and is always angry at her mother. She gets hysterically angry (3) when dealing with her son's father, because "He's not interested in him."

She had an abortion eight years ago and was devastated by it, so she decided to get pregnant again and have a child. She had a short affair with a man she knew in order to conceive her son. She loves her son but dislikes children (2) in general. "It's an effort to spend time with them."

She used to be a nurse but hated working with people physically. "I was disgusted by it all" (2).

Fears talking in a group (3).

Fears men (3). "I don't know what they'll do to me."

Fears crowded spaces (2).

Her eyes are dry (3) constantly; nothing helps.

Her mouth is dry (2); drinking doesn't help.

She faints a couple of times a year, in crowded, warm rooms.

She was anorexic until a few years ago when she started getting hypoglycemic. Now she has to eat frequently, but eats as little as possible.

Gets autumn hay fever (2), with sneezing (1), itchy, dry eyes (2), and fatigue (3).

She is thirstless, except premenstrually (2). Also is tired (2) premenstrually. She has a three-day flow with no cramps.

Desires salt (2).

Feels warm.

Assessment: Depressed woman with sexual compulsiveness, sleepiness, spaciness, and hay fever.

Ken Luby: She tends to be spacy, and she has trouble staying awake during the day, falls asleep in meetings, and feels "...like I'm not in my body. I'm up in space somewhere." When I read that in light of the general sexual addiction, the first remedy that came to mind for me was Lac caninum. Looking in Boericke, I found the remedy listed for attacks of rage, sexual organs easily excited, and right-sided sciatica. The sciatica may relate to her not being able to sleep on the right side. Boericke also describes great lassitude and a sensation as if walking or floating on air.

Ohanian: Good idea.

Judyth Reichenberg-Ullman: I looked at all the remedies I usually think of for high sexual desire, and they didn't seem to fit. So, I thought of Opium, because of the strong sleepiness, the dryness of the eyes underlined three times, and increased sexual desire for women (listed in italics under Opium).

Eric Sommermann: How about Raphanus? It has nymphomania, sexual insomnia. Boericke says, "...with aversion to her own sex and children, and sadness."

Ohanian: Yes, that fits a lot of this case.

Sheryl Kipnis: I looked at the overwhelming sleepiness and the dryness of the mucous membranes and started thinking about Nux moschata, which is not a remedy I would think about for such strong sexual interest. So, I went over to the Kent Homeopathic Associates' booth and asked David Warkentin to look up the remedy in Reference Works, his new materia medica program. What we found were a couple of rubrics in Kent and Boenninghausen: Sexual passion increased and Heightened sexual desire.

Peggy Chipkin: I was thinking exactly the same thing, Nux moschata. In addition to what Sheryl mentioned, Nux moschata is supported by the fainting, the hysteria, the sense of floating, and the peculiarity of the dryness with the thirstlessness.

Ohanian: Those are all good ideas.

First Prescription: Analysis and Follow-Up

There is a great deal going on in this case. Here is a woman who had been treated with some success. Yet she still has some major problems, including overpowering sleepiness and spaciness that were often triggered by environmental reactions, lifelong depression, compulsive sexual behavior, inability to commit to a relationship with one man, fear of and difficulty with interacting with people, and hay fever. I chose to focus on what I believed to be the most reliable symptoms of the case, covered by these rubrics:

- EYE, Dryness.

- MOUTH, Dry, thirstless.

- SLEEP, Sleepiness, overpowering.

- GENERALITIES, Faints, crowded room, in.

I suspected that a small remedy would be most useful, given the lack of a clear essence and the mixed results of past polycrest prescriptions. Repertorization pointed to Nux moschata as the likely remedy, being in bold type in the first three rubrics and regular type in the fourth.

Kent says the following in his materia medica:

The Nux moschata patient is always ready to go to sleep. It is with great difficulty that she can keep awake. She falls asleep on all occasions, in season and out of season. The patient appears dazed....The sleepiness and dazed state are two things combined and when combined are difficult to cover by a remedy.

Clarke, in his Dictionary of Practical Materia Medica, states:

When any complaint causes drowsiness or is accompanied by drowsiness Nux moschata must be considered and if in addition there is chilliness and thirstlessness Nux moschata must be given....Chilliness may be considered the second keynote. But quite as important is the third. Dryness. The dryness may be only a sensation but may be actual as well.

This patient was not chilly. But she was not aggravated by heat and was at times better from it. So, her lack of chilliness didn't rule out the remedy. The combination of sleepiness, spaciness, dryness of mouth without thirst, dryness of eyes, and tendency to faint painted a convincing enough picture of Nux moschata.

Plan: Nux moschata 200c, single dose.

First Follow-Up: Two Months After Nux Moschata

She is severely depressed (3).

Her heart is pounding.

She has trouble sleeping (2).

One week after she took the remedy her spaciness disappeared.

It is 70 percent easier for her to stay awake in meetings; less sleepiness in general.

She has a vaginal yeast infection, with a yellow discharge and itching (2).

Her physical energy is much better.

The dryness in her eyes is better.

Her depression is no better. "There is no point to anything. I can't smile."

She still isn't talking to people. They comment about it at lunch.

She gets sullen and wants to get up and walk away from co-workers.

Is averse to meat (2), although at one time she craved it.

Desires muffins (2) and chocolate chip cookies (2).

She is eating poorly.

Assessment: Improvement in her spaciness and sleepiness, but not in her depression.

Plan: Wait one month.

Second Follow-Up: Three Months After Nux Moschata

She hasn't been depressed.

She painted a beautiful picture for the first time in a long time.

Her energy is still pretty good.

Some spaciness is returning, but she is not falling asleep in meetings.

Is feeling more down to earth.

Her sleep at night has improved.

Feels hot (3) and dry (3) all over, when she wakes in the middle of the night.

The dryness in her eyes is returning.

Her digestion has improved.

She is very forgetful (2). She forgot to pick up a woman for an appointment.

The vaginitis continues.

She isn't eating meals.

Desires cookies (2) and muffins (2).

Her intense sexual energy has eased up. "I'm not focused on it. It's not a driving force anymore."

She is developing a friendship with a man. It's hard to talk to him, but she is "hopeful." It's a non-sexual relationship.

"I can see my body but don't relate to it. I feel that someone could blow me over pretty easily. I'm not very solid."

She had used marijuana daily for five years, and then stopped this 12 years ago.

Assessment: Improvement.

Plan: Wait.

Third Follow-Up: Eight Months After Nux Moschata

"A lot has gone on."

Her spaciness and sleepiness are still better.

She is depressed (3) over a relationship she started and then ended. She felt anxious (3) around her boyfriend, and couldn't talk to him. She felt threatened to hear him talk about his activities, was worried that he was more accomplished than she. She felt good with him only during sex.

She has never been able to make a commitment in a relationship. She couldn't give, couldn't stand it, and felt trapped (3).

She is very judgmental about men -- their looks, education, how they talk.

She is feeling lonely a lot now. She sits and reads, and is spending too much time alone. Gets panicky (3) when alone more than a couple of hours.

Feels drained (2) around people. Entertaining her son drains her. She won't spend the whole day with him. She dreads the idea of a vacation -- having to spend time with him or someone else. She is less drained with women than with men. She is thinking that maybe she is a lesbian, but she doesn't like the idea of sex with a woman.

Feels negative and hopeless (3) about men. She can't be in a relationship, yet can't stand being without sex (3). "Without sex there is nothing for me. What is the point of going on without sex? Sex is the only thing to get me out of a depression."

S & M sex is the most exciting.

After sex she wants the man to leave right away. She wants to be alone.

She was always withdrawn as a child. "I've always been scared of being swallowed up" (3).

Her mother is "invasive." "She never stops talking, never lets me finish a sentence. I always thought it was her survival or mine. I can't stand being around her."

She is panicky (3) around men. "I get this panicky feeling and just stop seeing them. I spent two days with this guy and couldn't wait to get away from him." She is relieved after leaving them.

When she was a child her father held her tight to his chest, and wouldn't let her go. She panicked (3) at this, fearing she would suffocate.

Her heart pounds (2) when she feels trapped and panicked with a man or a group of people, and she feels hot (2).

Her heart pounds(2) sitting at her desk after interacting with colleagues.

She is fearful (2) in crowded places, at parties, or with more than one or two people at lunch.

Assessment: Sexual compulsiveness with depression and anxiety.

Bob Ullman: I have an idea about a small remedy, which comes from looking at two rubrics. The central issue in her case seems to be a fear of suffocation, which has come from that experience with her father. If you look under Fear of suffocation in the repertory, there is Robinia. Robinia also has nymphomania, and so the combination of nymphomania and fear of suffocation yields Robinia. She doesn't seem to have the hyperacidity that is usually associated with this remedy.

Julek Meissner: I cross-referenced aversion to company, yet dreads being alone, with dread of men and indifference in relations, close relationships, especially to her children, and I chose Sepia. Then I went back to the Kent Homeopathic Associates' booth and asked them to check Sepia in Reference Works. Sepia is indeed listed in Allen, Boenninghausen, Farrington, and Kent's materia medica for increased sexual desire.

Lianne South: I looked at the whole concept of suffocation. There is suffocation at a physical level but much more on the emotional level, a problem with intimacy. I looked at Stramonium, because it has the increased desire and the fears.

Andrea Sullivan: For all the reasons mentioned by Julek, I chose Lycopodium: dread of being alone, aversion to company, hatred of men, fear of men, and indifference to relations and children.

Randall Bradley: I would probably first give Nux moschata again, because she was starting to relapse a number of months ago. The sleepiness was the deepest symptom in the initial case; that's why the depression didn't ameliorate immediately. If you look at it in a "linear" way, the case was moving in a healing direction, out of the deeper parts of the organism. She's relapsed but not all the way back into that deepest state, and I would be inclined to try the remedy one more time before moving on.

But I am assuming that this isn't right, because we wouldn't be talking about the case at this point. I decided to look at her fear of intimacy, thinking about her desire to be with people but not being able to handle being with them. This leads me to Ambra grisea.

Ohanian: That's a good idea.

Peggy Chipkin: I felt that too much had fallen away to stay with Nux moschata. We were left with a trapped feeling, a need for sex, a need for company, yet a need to be alone, and the whole idea of being trapped with a sense of suffocation relating to the trapped feeling. Commitment is also a difficult problem. Then I looked at what follows Nux moschata and I found Lycopodium is there. So, I would like to suggest Lycopodium.

Laurie Dack: I looked at the fear of suffocation, the fear of crowds, and the fear of being alone, with heart palpitation and tremendous terror, and I thought of Aconite.

Second Prescription: Analysis and Follow-Up

This was a tough point in the case for me. The remedy had made her painfully aware of her inability to be in a relationship. She really had tried. She found somebody, but she just couldn't have a relationship with him.

The most limiting symptoms at this time appeared to be her compulsive sexual behavior and inability to have relationships -- both romantic and platonic. She had already taken remedies we often think about for these symptoms -- Lycopodium, Medorrhinum, Platina -- without effect. So, I believed I had to look at the case from a different angle.

What seemed peculiar was that she felt very trapped and panicked with men after having sex with them. She had to have sex frequently. It was the only thing that made her feel good, yet she couldn't stand to have the same partner over time because she would feel suffocated by his very presence.

The issue wasn't that men were demanding of her or that she didn't want to take responsibility in a relationship. Instead, she panicked at the physical closeness. In this panicked state, she wouldn't know what to say or how to converse with her partner. So, she would get even more uncomfortable and decide not to see him again.

In probing into possible reasons for her panic, I learned that as a child she felt her survival was in question. She felt she was in a life-threatening situation because her mother psychologically swallowed her up and, more precisely, because her father held her so tightly she had trouble breathing. Her fear was so intense in this situation, she thought she would die. This particular fear stayed with her all her life.

I considered Aconite because of this fear. George Vithoulkas, in describing the chronic state of Aconite, says that it mainly starts after an almost fatal shock or fright, and that afterwards the fear and terror are retained inside. The fear would come up so suddenly and strongly for this woman that she would have to leave whatever situation she was in to cope with it.

In studying the case, I considered the following rubrics:

- MIND, Fear, suffocating of.

- MIND, Fear, in a crowd.

- CHEST, Palpitation, heart, after a fright.

Aconite is the only remedy listed in bold type in these rubrics, which represented the strongest symptoms in the case. Yet, I was reluctant to give it because I could find nothing about increased sexuality for Aconite.

Plan: Aconite 1M, single dose.

Fourth Follow-Up: Four Months After Aconite

After taking Aconite, her fear greatly diminished.

She started a relationship three months ago, and now is "nicer to men in general. I am more open to talking and being friendly."

She has not felt depressed.

Is anxious (2) about wanting her boyfriend and her son to like each other.

She has good energy but sometimes feels sad and wants to sit and stare out the window.

She is starting to paint again and feels more creative energy.

She is less drained by her son.

Desires fruit (2).

Her breasts were swollen and she had a right temporal headache before menses, for the last two cycles.

Her digestion is fine.

Assessment: Improvement.

Plan: Wait.

Fifth Follow-Up: Nine Months After Aconite

She has been in her relationship now for eight months. "I really got through the panic. I actually like him and like being with him."

She struggles and feels somewhat ashamed to be involved with him because he isn't refined, but she is basically happy.

There is no problem with spaciness or tiredness. This is "the best it's ever been."

She completed some paintings and has a show at a local gallery.

She has a friend now at work, but she is still retiring and it's still hard to "be out there."

It's difficult to compete for others' attention -- she holds back. "It pains me to be out of it, but if I start talking no one will listen. People will ignore me."

She saw her mother three weeks ago. "She doesn't listen. She literally talks while I'm talking. It's too hard to go against this energy of hers. I'd rather give up."

She is no longer sitting and staring out the window.

Her headaches stopped three months ago.

Her premenstrual symptoms have improved.

Desires chocolate (2), cheese (2), and ice cream (2).

Her appetite is improving, and she is cooking more.

Assessment: Improved.

Plan: Wait.

Sixth Follow-Up: Fifteen Months After Aconite

She has been in the same relationship for over one year. It isn't easy, but she loves him and wants to be there.

Only occasional depression, spaciness, or sleepiness.

No headaches.

She has good energy, but feels drained after talking in front of a group or after a social event.

She has joined a women's therapy group to talk about her mother, and is able to talk there easily. She trusts she'll have the attention of group members, and she doesn't panic.

She is looking at a career change. She wants something more challenging than social work

She is continuing to paint.

Has slight hay fever symptoms, itching (1) and dry eyes (1) when tired.

Assessment: Improvement. This woman's creative energy is better. She is more easily able to talk with people; she feels she can do more challenging work; and her spaciness, sleepiness, and depression are better. Most significantly, she has been able to maintain an intimate, romantic relationship for the first time in her life, and has stopped her compulsive promiscuous sexual behavior. This is a deep change in a case of a serious psychological disorder.

Plan: Wait. Follow-up in six months or as needed.

Steve Subotnick: I've been treating a case for two or three years, where the patient has a similar kind of overwhelming anxiety and fear of suffocation. The patient is a 60-year-old white woman who always had to be in relationships with black men only because they were the only ones who could satisfy her sexually. She would go through about three relationships a month. I treated her with ascending potencies of Aconite, finishing with 50M, and this remedy resolved her incredible fear and anxiety. It was interesting that Aconite was her remedy for about two years, and then she finally moved on to Lachesis.

Ohanian: That is interesting.

Steve Subotnick: Yes. And my patient did have a very high sex drive, so I think that this is probably an element of the Aconite picture. What I focused on in my prescription was the incredible fear that was underlying everything else. She had been involved with the Rajneesh movement. And she had a very bad experience, which frightened her.

Judyth Reichenberg-Ullman: I'm wondering why Nux moschata was the top layer in this case, because what's really interesting is the way that sex was a drug for her. It would temporarily relieve her terror, and this appeared to be the root of the nymphomania. Perhaps the sex was like a numbing agent for her, hence the need for Nux moschata.

Ohanian: Yes. That was one of the trickier aspects of the case. The Nux moschata covered the case so clearly initially, and then the Aconite was needed. Sex was like a drug for her; she was addicted to the act of sex in the way that the experts describe addiction to a substance. I don't have a real clear answer for you. Both remedies were needed. It was almost like she was two very different people when each prescription was made. I also don't think this case is finished. This woman has some serious issues, and she may require other prescriptions in the future.

Laurie Dack: Well, I'm not sure that the sex was a numbing agent for her, because she was involved in S & M sex. It seems to me that it is a part of the panic too.

Ohanian: Kind of an extension of the sex?

Laurie Dack: That's the kind of sex that she seems to be attracted to. It's not the quiet or comforting kind of sex at all. She is more attracted to this intensity and maybe even a kind of fear or terror associated with this kind of sex.

Ohanian: That's a good point. That was something she was very reluctant to talk about. She would say that she wanted S & M sex, but would not go any further. Going back to what Lou Klein was saying yesterday (concerning sex in the consulting room), sex was a big part of this case. But it took months and months to get all the information that I could get from her in order to understand her better.

Bob Ullman: One way to manage anxiety or fear is to dissociate, which is, in a sense, to leave your body. And that's exactly what she did. I think that was just her way of managing the underlying anxiety, by dissociating, and Nux moschata brought her back into her body. She then had to feel her feelings of anxiety and fear, and that's when Aconite was the appropriate prescription.

Randall Bradley: Also, the S & M type of sex would be something that would push her out and away from the people she was having sex with. It is perhaps logical that this would be the kind of sex that she would be attracted to. This kind of sex would push her as far away from her partner as she could get and still be involved sexually.

Ohanian: Good point. And that was her goal, to not be connected with her partners.

Marcia Neiswander: On the same idea, the dissociation would lessen her anxiety, which is why it's such an addictive process for this woman. Anything that would reduce the anxiety would possess a tremendously addictive property for her.

Ohanian: And so it did. One of the challenges of this case, because the sexual issues were so compelling, was to try to see the underlying thread of the case. This thread was the fear of death, which we associate so closely with Aconite.

International Foundation For Homeopathy.

~~~~~~~~

By Valerie Ohanian

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