Sexuality & Culture
An Interdisciplinary Quarterly
Sexuality & Culture (2013) 17:1-19
Inventing Sex: The Short History of Sex
Barry Reay, Nina Attwood & Claire
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Inventing Sex: The Short History of Sex Addiction
Barry Reay •Nina Attwood •Claire Gooder
Published online: 26 April 2012
Springer Science+Business Media, LLC 2012
Abstract This article takes a critical look at the recent history of the concept of
sex addiction, an archetypal modern sexual invention. Sex addiction began as a
1980s product of late twentieth-century cultural anxieties and has remained
responsive to those tensions, including its most recent iteration, ‘‘hypersexual dis-
order.’’ Its success as a concept lay with its medicalization, both as a self-help
movement in terms of self-diagnosis, and as a rapidly growing industry of therapists
on hand to deal with the new disease. The media has always played a role in its
history, ﬁrst with TV, the tabloids, and the case histories of claimed celebrity
victims all helping to popularize the concept, and then with the impact of the
internet. Though it is essentially mythical, creating a problem that need not exist,
sex addiction has to be taken seriously as a phenomenon. Rarely has a socio-
psychological discourse taken such a hold on the public imagination—and proven
an inﬂuential concept in academic circles too. We argue that this strange, short
history of social opportunism, diagnostic amorphism, therapeutic self-interest, and
popular cultural endorsement is marked by an essential social conservatism—sex
addiction has become a convenient term to describe disapproved sex. Sex addiction
is a label without explanatory force.
Keywords Sex addiction Internet Hypersexual disorder
Sexual conservatism Cybersex
B. Reay (&)N. Attwood C. Gooder
Department of History, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
Sexuality & Culture (2013) 17:1–19
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In America, if your addiction isn’t always new and improved, you’re a failure
(Palahniuk 2002, p. 203).
Tiger Woods claims to be addicted to sex. Bullshit! These are hot women he
was having sex with. If he was having sex with a dead chicken, I’d say, wow,
that guy is addicted to sex (Rogell 2011).
Patrick Carnes is the acknowledged expert in a ﬁeld that until recently didn’t
exist (Promotional quote for Carnes 2001).
Peter Cryle and Thomas Laqueur have discussed the role of the ‘‘thing’’ and the
‘‘word’’ in the history of sex (Cryle 2009a,b; Laqueur 2009). We know, for
example, that there was same-sex sexual behavior before homosexuality was named
in the nineteenth century, but that the thing was never the same after it had been
written as a category. In Michel Foucault’s ever-quoted words, ‘‘The nineteenth-
century homosexual became a personage, a past, a case history, and a childhood, in
addition to being a type of life, a life form, and a morphology…The sodomite had
been a temporary aberration; the homosexual was now a species’’ (Foucault 1979,
The relationship between words and things, however, is by no means as
unproblematic as this paradigm implies. Masturbation (the act) was practiced and
recognized before it became onanism and then was actually called masturbation; the
meanings attached to that practice changed—dramatically—but, apart from the
reﬁnements of technological facilitation, the bodily act remained much the same
(Laqueur 2003). On the other hand (so to speak), some practices were both new and
newly named. Fisting (ﬁst-fucking) is the example normally given, claimed as ‘‘the
sexual invention of the twentieth century’’ (Zizek 2004, p. 293). Annamarie Jagose
has added the fake orgasm as another modern sexual construct. Orgasm has been
refashioned over the centuries, but the fake orgasm is peculiarly modern (Laqueur
2009; Jagose 2010). Or we could consider the example of the internet-aided
creation, asexuality, the rather contradictory sexual identity of those who…well…
lack sexuality. Presumably people who ‘‘do not experience sexual attraction’’ have
always existed but the ‘‘Asexuality Visibility and Education Network’’ is a
phenomenon of the twenty-ﬁrst century (Scherrer 2008).
The aim of this article is to trace the history of another new sexual concept, one
that is the antithesis of the aforementioned asexuality (although we will see that they
share an afﬁnity to the internet) but which, like ﬁsting and the fake orgasm, is an
archetypal, modern, sexual invention: sex addiction.
The historiographical starting point for what follows is Janice Irvine’s 1995
argument that sex addiction, a name for perceived, out-of-control sexual behavior,
was a socially constructed, 1970s/1980s reinvention of what the nineteenth-century
sexologists called perversion, and very much a product of late twentieth-century
cultural anxieties (Irvine 1995). As two other early critics put it, ‘‘The concepts of
sexual addiction and compulsion constitute an attempt to repathologize forms of
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erotic behavior that became acceptable in the 1960s and 1970s’’ (Levine and Troiden
1988, p. 349). The principal facilitators in this making, Irvine argued, were an
addiction discourse (gambling, alcohol) that leant itself, almost seamlessly, to sexual
matters; a strange, and momentary, combination of conservative Christian and radical
feminist social purity; and the initial impact of AIDS in the 1980s that so dramatically
intensiﬁed such sexual apprehensions (Irvine 1995). She also stressed the rapid spread
of the concept, aided by its imprecision: ‘‘Claims about what constitutes sex addiction
are so vague…that they can potentially include large numbers of the population’’
(Irvine 1995, p. 438). Its success as a concept lay with its medicalization, both as a self-
help movement in terms of self-diagnosis, and as a rapidly growing industry of
therapists on hand to deal with the new disease (Irvine 1995). And the media played a
vital role: TV, the tabloids, and the case histories of claimed celebrity victims all
helped to popularize this newly invented term (Irvine 1995).
However, Irvine was writing and researching in the early 1990s. By the time her
article appeared, the sexual addiction specialists had their own journal, Sexual
Addiction & Compulsivity: The Journal of Treatment and Prevention (founded in
1994). Irvine’s ‘‘sexualized society’’ was on the eve of what Linda Williams has
described as ‘‘on/scenity,’’ capturing pornography’s everyday visibility and
presence—in huge volume—in the early twenty-ﬁrst century (Williams 2004; see
also McNair 2002; Attwood 2006). Irvine’s media was a media without the power of
the internet and the ubiquity of internet sex (see, for example, Wysocki and Childers
2011; Brickell 2012). Indeed when the contributors to the Handbook of clinical
sexuality for mental health professionals (2003) wrote their section on sexual
compulsivity (sexual addiction) a decade later, they immediately focused on ‘‘online
sexual compulsivity’’ (Cooper and Marcus 2003, p. 313).
If sex addiction was a response to cultural anxiety—a historical construction—
what of its more recent history? What happened to its early-hinted social
opportunism and diagnostic amorphism? Did the combination of therapeutic self-
interest and popular cultural endorsement persevere? We know that by 2010 sex
addiction had a more recent variant, ‘‘hypersexual disorder,’’ but what of the history
Let us be clear about our approach. We are cultural historians, not clinicians, but
we have read the clinically related literature—as contemporary history—and remain
unpersuaded of the existence of this supposed malady. (Why we are so skeptical
will become clear by the end of the article.) Though it is essentially mythical,
creating a problem that need not exist, sex addiction has to be taken seriously as a
phenomenon. Rarely has a socio-psychological discourse taken such a hold on the
public imagination—and proven an inﬂuential concept in academic circles too.
What follows is an examination of the power of the idea and its cultural and (short)
It seems an axiom of sexual addiction that the problem is both widespread and ever
increasing. ‘‘Sexual compulsivity seems more prevalent now than ever,’’ warns the
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Handbook of clinical sexuality for mental health professionals (2003). Even these
rather restrained advisors are somewhat unrestrained in their estimates: up to 22
million Americans were addicted to sex in 1998 and perhaps 40 million had ‘‘online
sexual problems’’ by the year 2000 (Cooper and Marcus 2003, pp. 311, 316). The
sex addiction workbook (2003) says ‘‘Although we have no good data on the
prevalence of such problems, they appear to be escalating at an alarming rate,
possibly because of the impact of modern technology, in particular the Internet’’
(Sbraga and O’Donohue 2003: foreword). One believer is blunter still: ‘‘Like it or
not, sexual addiction is a rapidly growing problem, and predicted to be the next
tsunami of mental health’’ (McCall 2011).
The link with an expanding addiction industry was clear from the early days, as
outlined in an interview with a rare creature, a lesbian sex addict:
I didn’t realize that I was a sex addict until I stopped drinking and doing drugs.
I was in Alcoholics Anonymous (AA) at the time. I realized that I had to stop
having sex or I would start drinking again. I was using sex with men to avoid
dealing with my sexual feelings about women. I decided to go to Sexual
Compulsives Anonymous (SCA).
The poor woman was obviously addicted to addiction:
Yes, I’ve spent my whole life juggling my addictions to stay alive. I went to
Overeaters Anonymous (OA) ﬁrst for bulimia…Then I was sent to AA by
OA. For years I substituted one addiction for another. I’ve been addicted to
alcohol, drugs, sex, food, caffeine, cigarettes, shopping, and gambling
(Edwards 1986, p. 2).
This was an extreme case but does capture a logic of addiction discourse that still
continues. Susan Cheever’s muddled memoir of sex addiction, Desire (2008), draws
constantly on alcohol addiction (she is an alcoholic too) but also refers to ‘‘the way
different addictions pair with and nestle inside each other,’’ citing money, eating,
and shopping disorders, as well as addiction to sex, drugs, and alcohol (Cheever
2008, pp. 122–124). One sex addiction guidebook claims ‘‘38 % of sex addicts also
struggle with an eating disorder’’ (Carnes 2001, p. 29). Cybersex unplugged (2011),
a new workbook for cybersex addicts, moves from sexual compulsivity to other
dependencies—chemical, eating, gambling, spending, and working (Edwards et al.
2011, pp. 65–71).
And the designation has become even more inclusive. Sexual compulsivity,
Cybersex unplugged explains, can occur ‘‘in the absence of sexual behavior’’; it can
include ‘‘sexual anorexia’’ or avoidance of sex (Edwards et al. 2011, p. 4). One
London psychotherapist has reputedly claimed that it was possible to be a
monogamous sex addict: ‘‘I’ve had a case of a man who was sex addicted to his
wife. It was a problem because it was depersonalising—he turned her into an object
rather than treating her as his wife’’ (Laurance 2008).
If the New York Times can be used as a rough guide to educated popular usage,
there has been an increasing familiarization with the concept of the sex addict since
the early 1990s.
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References to ‘‘sex addict’’ in New York Times
There is little doubt that much of the hype around sex addiction—either in
endorsement or denial—is media-driven, even in quality publications like the New
York Times and The Guardian: ‘‘Duchovny in rehab for sex addiction,’’ ‘‘The truth
about sex addiction. Are people becoming addicted to sex because of the ﬁnancial
crisis?’’ ‘‘Are you addicted to sex?’’ are just some of the titles in the latter in the
By the second decade of the twenty-ﬁrst century, the term has become ﬁrmly
entrenched in popular culture. Steve McQueen’s ﬁlm Shame (2011), about sex and
the internet in contemporary New York, is based on ‘‘discussions with sex addicts.’’
Thanks for sharing, another ﬁlm, in production as we write this piece and starring
Gwyneth Paltrow, Tim Robbins, and Mark Ruffalo, is a ﬁlm about ‘‘sex addicts.’’
Sex addiction has certainly featured in some memorable and forgettable cinema.
But even when the references are humorous or mocking they are still invoking the
concept. Victor Mancini, the main character in Chuck Palahniuk’s novel Choke
(2001), is a sex addict who has sex with the female addicts whom he sponsors—in
toilets, in a janitor’s closet—while meetings are in progress. He never progresses
beyond the fourth of the twelve steps, the listing of his sexual contacts, and he treats
sexaholics’ meetings as ‘‘a terriﬁc how-to seminar. Tips. Techniques. Strategies for
getting laid you never dreamed of. Personal contacts.’’ ‘‘Plus the sexaholic recovery
books they sell here, it’s every way you always wanted to get laid but didn’t know
how.’’ He hangs about in the recovery section of bookshops to pick up female sex
addicts. It is a hilarious novel about casual sex (‘‘her name’s Amanda or Allison or
Amy. Some name with a vowel in it’’) that positively revels in its subject matter, but
with serious things to say about the addiction industry and American culture as this
article’s ﬁrst epigraph suggests. Its message is the antithesis of everything that
believers in the concept of sex addiction hold dear: ‘‘The magic of sexual addiction
is you don’t ever feel hungry or tired or bored or lonely’’ (Palahniuk 2002,
pp. 16–17, 182, 213). When the ﬁlm from the novel appeared in 2008, its
distributors promoted it with gifts of anal beads (Salkin 2008). Yet as Patrick Carnes,
one of the earliest proponents and popularizers of the concept of sex addiction,
reportedly observed, ‘‘The fact that pop culture is making jokes about sex addicts is a
sign that awareness of the condition is percolating in mass consciousness’’ (quoted in
For the former, see Zahedi (2006). For the latter, see Brutsman (2001).
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Celebrity has played a role in this familiarization. A recent addiction workbook
suggests that clients familiarize themselves with a case of a celebrity sex addict as a
way of broaching the subject with those they envisage as a support person (Edwards
et al. 2011, p. 26). Michael Douglas, David Duchovny, Russell Brand, Rob Lowe,
and of course Tiger Woods are the usual suspects, though it is interesting that the
evidential base for most reporting is very slender and that some seem to have been
in rehabilitation for alcohol rather than sex.
Russell Brand was indeed treated for sex addiction in the KeyStone Center in
Philadelphia in 2005 but it is unclear whether this treatment was a bid for career
publicity or part of his comedy act. One diary entry, written during his stay there,
stated that he had to write ‘‘a victim’s list—a litany of the women I’ve wronged as a
result of my sexual addiction. I feel like Saddam Hussein trying to pick out
individual Kurds’’ (Brand 2009, p. 344). In fact Brand makes the career value of the
rehab experience very clear by claiming that he wrote his daily diary ‘‘in the sort of
style which suggests I knew that a couple of years later I’d be reading it out in front
of a live audience (which I did when I did a stand-up show called ‘Better Now’) and
a couple of years after that transcribing it into my autobiography’’ (Brand 2009,
p. 313). The outcome was that when Brand embarked on the book-signing tour for
the memoir that contained details of his sex addiction, he seized on it as an
opportunity for further sexual excess:
I am not proud of the morality employed during this indulgent time but one
has to marvel at the efﬁciency. This operation travelled all over the world and
effortlessly assimilated into any culture it encountered, New York, Sydney,
Hull—it was all the same: wristbands issued, rooms ﬁlled with women in their
dozens, day after day…it was a one-man, multi-woman sex epidemic (Brand
2011, p. 274).
Nonetheless, the linkage between celebrity and sex addiction (however spurious)
has been an important means of publicizing the latter. So too have the memoirs of
non-celebrity sex addicts, though the non-celebrity chronicle is harnessed to another
machine—the therapy industry. Clearly written after experiencing twelve-step
programmes for sex addiction, these books adopt the language of addictionology,
associating sex with the pursuit of the next ‘‘high’’ or ‘‘ﬁx,’’ ‘‘that love-heroin sex-
saturated hit’’ (Ryan 1995; Silverman 2001, p. 42; Cohen 2008; Resnick 2008,
p. 117). ‘‘The amazing thing is how any addict ever stops using before he dies. The
substance I used was human beings’’. Michael Ryan’s memoir begins unambigu-
ously, his framework is clear: ‘‘I took out a yellow pad and wrote down what they
call in twelve-step programs for sex addiction ‘bottom-line behavior’—behavior
driven by shame and producing shame’’ (Ryan 1995, pp. 5, 7). ‘‘Thanks to a twelve-
step program for love junkies, I have stayed clear of obsessive harmful relationships
for more than two years,’’ writes Rachel Resnick at the start of an account of those
very relationships (Resnick 2008, p. 22). Sue William Silverman’s memoir morphs
This was the case for Michael Douglas and Rob Lowe, constantly touted as two of the earliest cases of
celebrity sex addiction. Douglas and Lowe went to rehab for alcohol issues, and the press reported it as
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continuously with the addiction workbooks she is given in therapy; we (the reader)
attend Sex Addicts Anonymous meetings with her, and she includes a copy of a
questionnaire aimed to determine whether the ‘‘user’’ is a sex addict (Silverman
2001, pp. 33–34, 36–37, 136–143, 159–161, 247–254). The referential mode
continues with The sex addiction workbook (2003) promoting Silverman’s work
(Sbraga and O’Donohue 2003, p. 140). Cheever’s Desire (2008) draws constantly
on the work of Patrick Carnes (Cheever 2008, pp. 19, 57–58, 66, 72, 111, 129, 135).
She also embraces the addictionologist’s tendency to detect addicts everywhere:
‘‘Every day there are stories about sex and love addiction in the newspaper, but they
are rarely reported that way’’ (Cheever 2008, p. 153). Her famous father, the writer
John Cheever, is, of course, retrospectively (and posthumously) classiﬁed as a sex
addict (Cheever 2008, p. 156).
Unlike most claimed medical disorders, self-diagnosis is an important strand of
sex addiction. Many sex addicts are either self-deﬁned or labeled as such by
offended partners or loved ones. ‘‘Does you partner spend an inordinate amount of
time thinking about sex? Has your relationship been damaged by his sexual
activities? Are there times when his sexual urges, thoughts or images seem to
control him? If so, he—or she—may not be merely an untrustworthy cad but an
addict in need of psychiatric help.’’ This was the opening of an article in Britain’s
newspaper The Guardian in 2003, which ended with links to sex addiction treatment
organizations and therapists (Atkins 2003).
It is important to grasp that the notion of sex addiction includes partners as well
as actual addicts and thus generates another literature of guides for partners so
afﬂicted, some of which are published by Patrick Carnes’s Gentle Path Press
(Wilson 2007; Carnes 2011; Steffens and Means 2010; Corcoran 2011). The
commercial potential of sex addiction has increased with its therapeutic extension to
include the partners (and families) of sex addicts. There are no innocent bystanders
in the sex addiction business, rather co-dependents, enablers, or victims of post-
traumatic stress. The logic is that ‘‘two sick people’’ ﬁnd each other—the sex addict
and the co-addict—and that they need separate therapy for their own diseases. Then,
because there is no cure for their disease, ‘‘the best he or she can hope for is
remission. Remission, as with cancer, is achieved when there are no longer any
Hence sex addiction becomes co-sex addiction and the sex addict has a
co-sex addict (Carnes 2011, pp. 11–12; see also Carnes 2001, pp. 117–145).
Although Barbara Steffens and Marsha Means critique the notion of the co-addict
and call for a ‘‘paradigm shift’’ in the labeling of the addict’s partner, they do not
question the seriousness of sex addiction and endorse both the efﬁcacy of the
twelve-step programme and the usual therapy options. For them, the suffering of the
spouses of addicts is best treated as a form of post-traumatic-stress disorder
(Steffens and Means 2010, pp. 41–42). What these approaches (or ‘‘models’’ as the
authors refer to them) have in common is their insistence on the reality of the
disorder being experienced—physically and psychologically. Whether suffering
from co-addiction or stress, partners ﬁnd themselves requiring psychological and
For the co-sex addict idea, see Carnes 2011. The quotes are taken from a book more critical of this
notion of co-dependency: Steffens and Means 2010, pp. 24–25.
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physical help. And whatever the model, the sex addiction therapy industry is there to
administer that help.
Historians may be skeptical, but a perceived condition, once located by those who
believe in its etiology and the possibility of its cure, can then be treated by experts who
also believe in its existence. As Stephen B. Levine has expressed it, ‘‘What ever the
concerns about the validity of the concept of sexual addiction, the diagnosis is well
rooted in the public’s mind and has seeming clarity for individuals and institutions
that provide treatment.’’ The concept, therefore, was ‘‘useful’’ (Levine 2010, p. 263).
A more critical response to the phenomenon is to think in terms of what
Robert Aronowitz has termed ‘‘feedback loops between consumers and producers.’’
Once a type of behavior is assessed as a medical problem in a consumer society,
it can unleash highly proﬁtable ‘‘consumer-oriented health restoring responses.’’
‘‘These responses,’’ writes Aronowitz, ‘‘have their own economy shaped by the
perceived needs of the addicted as well as the actions of the promoters of different
programs, health care professionals, and third party payers’’ (Aronowitz 2008, p. 6).
Aronowitz was referring to the more general framing of addiction as a health problem,
and had in mind video poker addiction, but sex addiction draws on sexual
consumerism as well as medical consumerism—a potent combination.
Sex addiction is the sexual co-dependent of the sexualized society that its
supposed sufferers so vociferously denounce. It is no coincidence that in the early
days of the Sexual Addiction Self Test potential testees had to run a web-page
gauntlet between links to pornography sites. Sex and shame have such an enduring
relationship that it was easy to popularize the concept of sex addiction. As a concept
characterized by certain moral deﬁnitions of ‘‘normal’’ sexual behavior, there are
the emotional concomitants of guilt and shame for those who transgress those
conﬁnes. And we want to hear and read about sex, especially its excesses and
‘‘disorders’’: redemption for some and titillation for others. Like the paradox of
pornography—where condemnation is to repeatedly represent the subject of
denunciation—treating these ‘‘problems’’ is to participate in the viliﬁed ‘‘porno-
graphication’’ of society, referred to earlier, of which sexual addiction is an integral
part (McNair 2002, p. 12). The ﬁnancial incentives of both the therapy industry and
the wider sexualization of our culture have fed into and continue to feed the growth
of sex addiction as a construct. Billions of dollars are spent on the representation of
sex and emphasis on sex as pleasurable to human experience, and this is refracted in
the millions spent on creating and treating the disorders allegedly wrought by this
experience. The psychotherapist Marty Klein, a long-term critic of the concept of
sex addiction, has referred to the voyeurism surrounding the lives of alleged
celebrity sex addicts and the confessions of ‘‘recovering sex addicts’’ as ‘‘Our
addiction to Tiger Woods’ ‘sex addiction’’’ (Klein 2010).
It is fascinating that the earlier-mentioned, non-celebrity memoirs also offer
something quite at odds with their central premise of eliciting sympathy and
offering hope and redemption for those suffering the disorder of sex addiction:
pornographic prose almost as explicit as anything on the market. These sexual
stories dwell on the sexual exploits that led their authors to seek therapy in the ﬁrst
place. Michael Ryan’s elegant Secret life contains descriptions of what he wanted to
do to a friend’s ﬁfteen-year-old daughter, disturbing details of his molestation at the
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age of ﬁve, his longing for his sister’s friend Sharon, his secret touching of a class
mate Sheila, menstruating toilet sex with Sally, and persistent paperboy fantasies
(Ryan 1995, pp. 8, 16–18, 203, 218–219, 265, 323). Rachel Resnick’s less than
elegant Love junkie—‘‘when the second Magnum condom breaks’’—recounts
numerous sexual fantasies (‘‘Then I kiss her very slowly, seeking the pulse of her
carotid artery’’), rough menstruating sex, urolagnia, and group sex (Resnick 2008,
pp. 42, 83, 87, 89–90, 94–5, 102–3, 107, 113, 117). Even her ﬁrst sex addiction
meeting is sexualized; she becomes ﬁxated on one of the men in the program and
has sex with a woman whom she meets in a ‘‘support group for love junkies’’—
which occasions further descriptions of lesbian sex (Resnick 2008, Chap. 8). [Susan
Cheever said such behavior was known as ‘‘thirteenth-stepping,’’ experienced
addicts taking advantage of newcomers to take them beyond the twelve steps
(Cheever 2008, p. 22).] Sue William Silverman’s Love sick lures the reader through
adulterous hotel-room encounters, sex with the unnamed driver of a red Corvette,
and her continuing sexual obsession with an ancillary staff member at the addiction
clinic (Silverman 2001, pp. 15, 67–68, 171–174, 182–183, 214–215, 219–220). The
sex addict’s memoir relives the sexual history that led them to the very therapy and
redemption that the memoir itself is supposed to serve.
Yet the irony seems lost on the purveyors of the various sex addiction
programmes. ‘‘Spending your money on sex supports the sex industry…The sex
industry may be the largest money empire in the world. Your contributions are
making it even richer and more powerful,’’ opine the authors of The sex addiction
workbook (2003), ‘‘You are making prostitutes and strippers out of people who
could and would do something else for a living if they had a reasonable choice. You
are paying people to risk their health so you can get some sexual kicks’’ (Sbraga and
O’Donohue 2003, p. 132). They do not mention their role in the empire. Tiger
Woods is said to have spent £40,000 on his six-week sex addiction treatment, and it
can cost several thousand dollars just to be assessed and ‘‘evaluated’’ at Pine Grove
in Mississippi, where he was treated (Henley 2010;http://www.pinegrovetreatment.
There is certainly no perceptible gap between popular perceptions of sex addiction
and academic discourse, for the concept has proven inﬂuential in academic circles
too. A 2010 survey in the Journal of Sex & Marital Therapy located over 700
research and clinical articles on sex addiction and its variants compared to just over
300 in a literature search a decade earlier (Hook et al. 2010). Indeed it is fascinating
how reluctant investigators are to question the veracity of the actual syndrome when
their own investigations beg such a challenge, and it surely indicates the concept’s
diffusion among therapists as well as patients. When two clinical psychologists
applied a widely used mental health test to a group of patients seeking help for
hypersexual behavior they found no evidence of ‘‘addictive tendencies’’ or that they
were particularly obsessive or compulsive. Yet their conclusions were that
‘‘hypersexual patients are a diverse group of individuals’’ (Reid and Carpenter
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2009). Hypersexuality survived its lack of addictiveness, obsession, or
compulsiveness! As we will see, a New Zealand survey questioned the frequency
of compulsive sexual behavior but never considered its status as a concept: the
article’s keywords include sexual addiction and hypersexuality (Skegg et al. 2010).
There is certainly no shortage of tools of assessment of sexual compulsivity. The
Journal of Sex & Marital Therapy study reviewed nearly twenty such measure-
ments, both self-reporting and clinical assessing: the Sexual Addiction Scale;
Compulsive Sexual Behavior Inventory; Sexual Dependency Inventory; Perceived
Sexual Control Scale; Garos Sexual Behavior Index; Sexual Compulsivity Scale;
Sex Addicts Anonymous Questionnaire; Sexual Symptom Assessment Scale;
Sexual Addiction Screening Test (including versions for women and gay men
respectively); Internet Screening Test; Sexual Outlet Inventory; Diagnostic
Interview for Sexual Compulsivity; Yale-Brown Obsessive Compulsive Scale—
Compulsive Sexual Behavior; Cognitive and Behavioral Outcomes of Sexual
Behavior Scale; Compulsive Sexual Behavior Consequences Scale (Hook et al.
2010). The impression that the reviewers give is of a ﬁeld where a great deal of time
has been devoted to measuring an assumed problem without bothering to interrogate
the nature, or even the existence, of that perceived disorder.
One of the more recent developments in sexual addiction’s short history is the
way in which its various forms—sexual addiction, sexual desire dysregulation,
sexual impulsivity, and sexual compulsivity—have morphed into the new sexual
malady, ‘‘Hypersexual Disorder,’’ currently seeking recognition in the American
Psychiatric Association’s inﬂuential Diagnostic and Statistical Manual of Psychi-
atric Disorders (DSM) (Kafka 2010a). Hypersexual disorder’s proposed diagnostic
criteria are merely those of sexual addiction with a more reﬁned gloss. The arbitrary
designation of a period of at least 6 months of ‘‘recurrent and intense sexual
fantasies, sexual urges, or sexual behavior’’ and the associated (and equally
arbitrary) meeting of three or more of the ﬁve criteria involving time lost in pursuit
of sexual gratiﬁcation, repetitive sexual engagement, loss of sexual control,
disregard for others, and use of sex for relief from the stresses and anxieties of
everyday life, would all have been in keeping with the earliest discourses of sexual
addiction. So too would the diagnostic speciﬁcation of a wide range of perfectly
normal activities rendered abnormal by their intensity and frequency: masturbation,
use of pornography, casual sex (‘‘Sexual behavior with consenting adults’’),
cybersex, telephone sex, resort to strip clubs, and (that catch-all) ‘‘Other’’ (Kafka
2010a, Table 1, p. 379). As for quantiﬁcation, the hypersexual disorder literature
resorts to a rather quaint, Kinsey-like, counting of orgasms: ‘‘From these clinically
deﬁned data, hypersexual desire in adult males was deﬁned as a persistent TSO
[total sexual outlet] of 7 or more orgasms/week for at least 6 consecutive months
after the age of 15 years’’ (Kafka 2010a, p. 381).
Thus the search for acceptance continues but it has to be said that some of the
studies published in the journal Sexual Addiction & Compulsivity seem unlikely to
advance this quest for professional endorsement. The participants in two recent
studies of the roles of shame and guilt in hypersexuality were users of Candeo, an
Once-a-day does not seem especially hypersexual.
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online treatment program for pornography use and masturbation, and 40–50 % of
these users were Mormons, hardly a representative cross-section of society (Hardy
et al. 2010; Gilliland et al. 2011). The research conclusion of one of these studies
that there is a ‘‘signiﬁcant’’ relationship between ‘‘shame-proneness and hypersex-
uality’’ and that ‘‘shame reduction and resolution is essential in remediating patterns
of hypersexuality’’ does not indicate a very high level of analytical sophistication
(Gilliland et al. 2011, pp. 12, 15).
There are also the trademark problems of measurement. Why is the indicator of
compulsivity set at 11 h (or more) per week of reported online sexual activity?
(Cooper et al. 2000, p. 8). Then there is the issue of the actual available data—
ﬁndings at variance with the signiﬁcance accorded to the perceived problem. A
survey made available on the MSNBC web site in 1998 actually showed how
uncommon the problem of compulsivity was, even using the sexual addiction scales
of measurement. Only 5 % of the nearly 10,000 people surveyed were deﬁned as
sexually compulsive; a mere 1 % were cybersex compulsive (that is scoring high on
the sexual compulsivity scale and spending more than 11 h per week on internet
sex). And yet the overall import of the study was to stress the problem of online
sexual compulsivity (Cooper et al. 2000).
Although she did not elaborate, Irvine detected the main themes of 1980s sex
addiction. It was, as she put it, a ‘‘discourse of excess and control.’’ Whatever the
differences of approach, the variation in nomenclature of the myriad support
networks or order of the steps to recovery in the many manuals of advice, the focus
was on ‘‘the danger of uncontrolled sexuality’’ (Irvine 1995, pp. 430, 432). If
anything, the claims have intensiﬁed since sex addiction’s early days. One of the
early features of sex addiction was its adaptability; the way in which it responded to
contemporary cultural anxieties, indeed reﬂected those concerns. Nowhere is this
more evident than with the role of the internet in the history of sex addiction.
In the preface for his 2001 edition of Out of the shadows Carnes reﬂected on
societal shifts since the book was ﬁrst published in 1983: the ‘‘sexual landscape has
changed dramatically. First, there was the AIDS epidemic…Then there was former
President Clinton and the intern Monica Lewinsky…Almost simultaneously came
the cybersex revolution’’ (Carnes 2001, p. xiii). And while AIDS and the Clinton
affair may have indicated a cultural shift in sexual attitudes, it was the ‘‘cyber sex
revolution’’ that seems to have had the most impact from Carnes’s point of view: the
new edition of Out of the shadows included a new chapter on cybersex addiction, as
well as promotion of the signiﬁcantly named In the shadows of the Net (2001), his
book entirely devoted to cybersex addiction (Carnes et al. 2001). In contrast,
Carnes’s 1993 book addressing addiction, A gentle path through the twelve steps,
made no mention of the internet (Carnes 1993).
On-line sex has achieved a privileged place in the checklist of sexual addiction.
The internet, advises the chapter on compulsive sex in a current handbook for
psychiatrists and psychologists, ‘‘has introduced millions of people to a venue where
The Short History of Sex Addiction 11
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the most explicit and varied sexual fantasies can be accessed all too easily, leading
some men down the slippery slope of compulsivity’’ (Cooper and Marcus 2003,
p. 311). The internet, a sex addict reportedly told fellow sufferer Susan Cheever, is
‘‘like crack cocaine’’ (Cheever 2008, p. 14).
Internet sex addiction is a kind of
double addiction: to sex and to the internet. But the checklist of ‘‘warning signs for
cybersexual addiction’’—using the internet to ﬁnd on-line and real-life sexual
partners, ‘‘masturbating online while engaged in erotic chat,’’ switching gender
roles, viewing pornography, sharing sexual fantasies—could, in a more sex-positive
context, be read as a list of the main attractions of cybersex (Grifﬁths 2001, p. 336).
The interpretation lies with the analyzer. For the therapist of sex addiction,
cybersex’s ‘‘endless variety of partners,’’ idealized sexual encounters, ‘‘intense
orgasms from the minimal investment of a few keystrokes,’’ and ‘‘illusions of power
and love’’ are indicative of sexual dysfunction: ‘‘courtship disorder’’ (Schwartz and
Southern 2000, pp. 128, 139). But for others this is its precise appeal and this
‘‘world of illusions’’ is not at all incompatible with ‘‘courtship’’ or longer-term
It is ironic that so much of the popular success of sexual addiction as a concept—
the impact of the self-diagnostic sex addiction tests, the web presence of the various
treatment centers—is due to the inﬂuence of the internet, and yet so much time and
effort goes into combating the perceived evils of what has proven to be such a useful
servant. The KeyStone Center’s website (the treatment center in Philadelphia where
Russell Brand stayed) includes audio links, multimedia presentations, and links to
twenty-ﬁve other internet sites where ‘‘users’’ (in both senses of the term) can read
about Patrick Carnes, the 12-Step philosophy, Sex Addicts Anonymous, as well as
other treatment facilities and support groups for people suffering from sex addiction
(http://www.keystonecenterecu.net). Carnes created the website, SexHelp.com,
which functions as a one-stop shop for information and links for assessment,
diagnosis and therapy for the sex addict and their signiﬁcant others (http://www.
sexhelp.com). The internet is now the ﬁrst port of call for any form of self-
Therapists who employ the idea of sexual compulsivity or sexual addiction often
deny that they are anti-sex and argue that it is the issue of lack of control that is the
problem. The authors of Cybersex unplugged distinguish between acceptable
recreational cybersex and more problematic compulsive users (Edwards et al. 2011,
pp. 37–39). Eli Coleman has warned professionals away from ‘‘overpathologizing…
normal sexual behavior’’ (Coleman 2003, p. 13). Yet there is no denying a strong
strand of sex-negativity in the discourse. An indication of what is considered non-
normative heterosexual behavior is provided in the examples of loss of sexual
control given in The sex addiction workbook (2003): ‘‘frequenting prostitutes, using
pornography obsessively, engaging in Internet or telephone sex, having serial
affairs, frequenting massage parlors, going to strip clubs obsessively, going to
bathhouses for sex, frequenting topless bars obsessively, feeling driven to have sex
many times a day’’ (Sbraga and O’Donohue 2003, pp. 12–13). The participants in
the earlier-cited Candeo/Mormon study ‘‘want to reduce, and in most cases
The link between cybersex and crack cocaine was originally made by Cooper et al. (2000).
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completely eliminate pornography use. Many, but not all, would also like to reduce
or eliminate masturbation’’ (Hardy et al. 2010, p. 253).
Coleman’s warning is clearly not always observed. Indeed when Levine reviewed
the cases of thirty men who had either been referred to him or self-presented for sex
addiction, he found that despite the readiness of spouses (and family doctors) to
attribute sexual lapses to sexual addiction, most were engaging in extramarital sex
or not particularly unusual, masculine behavior: ‘‘Many men masturbate to
pornography, go to strip clubs and buy a lap dance, procure a prostitute’s service,
or have affairs…partner distress must be discounted as a sufﬁcient criterion for the
label.’’ Levine concluded that though they presented as such, 75 % of his patients
were not sex addicts (Levine 2010, p. 272).
As critics of the concept of sexual addiction have always maintained, it is
sexually conservative, deﬁning breaches in an entirely normative moral code. The
sexual lapses of the alleged male sex addicts of Meg Wilson’s church-going
community seem relatively minor: viewing pornography and a ‘‘nonphysical
encounter with a woman’’ were sufﬁcient to invoke charges of sexual compulsivity
(Wilson 2007, p. 15). Although Maurita Corcoran’s husband had at least admitted to
a hundred extramarital affairs, the threshold of deﬁned sexual addiction was lower
for some of the members of her support group. One woman had never recovered
from the one affair that her husband had had; ‘‘getting over his death to cancer had
been easier than getting over his single affair that had happened more than twenty
years earlier’’ (Corcoran 2011, p. 89). Marty Klein has summarized the differences
between the sex-positive, sexologist clinician and therapists of the ‘‘sex-negative,’’
sex addiction movement. Twice-daily masturbation, extramarital affairs, sadomas-
ochism, use of internet pornography, resort to commercial sex, non monogamy, and
fetishism—all were the mark of a sex addict in the sexual addiction model, whereas
a clinical sexologist might diagnose such behavior either as not necessarily a
problem (the masturbation) or as sexual adventurousness (the non-monogamy)
It must be shame that distinguishes the ‘‘celebrity sex addict,’’ when he or she
actually exists, from the celebrity who just has lots of shameless sex. Where there is
no shame there are no diagnoses. Hence the guiltless Bill Wyman, Motley Crue, and
Steven Tyler, whose memoirs, apart from a ﬂeeting reference by Tyler, contain no
talk of sexual addiction at all despite sexual behavior that in other life stories would
be constructed and interpreted differently (Wyman 1990; Lee et al. 2002; Tyler
2011). Their sexual interactions, though excessive by most standards, are rarely
medicalized in the manner encountered in the pages above. Tyler, no stranger to
rehab, resisted the urge to pathologize: ‘‘I had six or seven isms hung around my
neck: drug addict, alcoholic, sex addict, codependent, family concerns, anger
management…. Oh yeah, I had a full range of life issues.’’ He recalled that
counselors ‘‘were constantly trying to label me and ﬁgure me out…to make me
recognize shame—feel bad about my bad self’’ (Tyler 2011, p. 267).
Sexual addiction is what Klein has termed ‘‘pathology oriented’’ (Klein 2003,
p. 8). Its key words are shame, inadequacy, anxiety, pain, superﬁciality, solitariness,
damage, malaise, and disorder (Cooper and Marcus 2003, pp. 311–312). Meg
Wilson’s account of her husband’s supposed addiction refers continually to
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darkness: ‘‘dark land,’’ ‘‘dark feelings,’’ and ‘‘the dark of hopelessness’’ are all on
the one page (Wilson 2007, p. 12). Sexual compulsivity is ‘‘a relationship disorder,’’
a ‘‘disorder of intimacy’’ (Cooper and Marcus 2003, p. 312). Internet sex addicts
‘‘are those who use the Internet as a forum for their sexual activities because of their
propensity for pathological sexual expression’’ (Grifﬁths 2001, p. 336). Cybersex is
a ‘‘courtship disorder’’ (Schwartz and Southern 2000, p. 139). It encourages ‘‘virtual
adultery,’’ ‘‘online inﬁdelity.’’ ‘‘Reports are suggesting that electronic communi-
cation can lead to marital discord, separation, and possible divorce’’ (Young et al.
2000, p. 59). AIDS is used as a threat or consequence of non-normative sex and
therefore one of the ‘‘risks’’ of sexually addictive behavior. Workbook readers are
told they can have a ‘‘safe fantasy’’ with the thought of group sex but ‘‘In reality,
you don’t want to have sex with more than one partner because you are worried
about AIDS.’’ As part of their admonishment for their complicity in pornography
readers are told that the porn industry is not glamorous and porn stars ‘‘do not love
sex. They do not get rich. They do not become legitimate Hollywood actors. Instead,
they get AIDS’’ (Sbraga and O’Donohue 2003, pp. 109, 132). In his attempt to gain
acceptance for his new sexual disorder, Martin Kafka has stressed the public health
consequences of the claimed condition: hypersexual disorder can result in ‘‘severe
pair-bond dysfunction, marital discord, divorce, sexually transmitted diseases
including HIV infection, substantial ﬁnancial expenditures, job loss, and unplanned
pregnancies’’ (Kafka 2010b, p. 277). Sexual disorder indeed.
A New York sex therapist and psychologist and consultant to the Gay Men’s Health
Crisis reported that as early as 1982 gay men were approaching him ‘‘extremely
concerned about their own behavior as a risk for AIDS.’’
After interviewing several men with this complaint, certain common
characteristics emerged. In general, these men were highly anxious about
AIDS and the risk that their sexual behavior seemed to hold. They reported not
feeling in control of their sexual behavior, reported having more sex than they
wanted, and reported feeling victimized by their frequent sexual activity,
sometimes in a variety of ways beside the risk of AIDS. Many reported
spending far too much time, by their own deﬁnition, in the pursuit of sex
(Quadland and Shattis 1987, p. 287).
This could have come straight from the pages of a sexual addiction self-help
manual, and it was only a matter of time until the measures of sexual compulsivity
were applied to gay men and such tests were used to predict ‘‘a potential association
between sexual compulsivity and HIV transmission risks’’ (Kalichman and Rompa
2001; Parsons and Bimbi 2007; Grov et al. 2010, p. 941).
Yet AIDS and the homosexuality with which it was so ﬁrmly linked in the early
1980s have not proven as central to the sex addiction project as one might have
predicted when the initial phase of the impact of AIDS was seen as an opportunity
to rethink issues of sexual control. Perhaps this is because a double standard is
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operating with respect to homosexual sex in matters of sex addiction. With
heterosexual sex, as we have seen, almost any casual encounter can come into the
territory of troublesome and addictive behavior. This contrasts with the advice given
to gay male sex addicts in Cruise control (2005) which reassures the reader that
Not everyone who engages in anonymous sex, sees prostitutes, has multiple
partners, is involved in the B/D-S/M or fetish scene, or participates in public
sex is a sex addict. Not everyone who has affairs, unsafe sex, or keeps sexual
secrets is a sex addict: indeed most people who ﬁt these descriptions are likely
Sexual addiction is thought to exist—hence the book—but the moral parameters are
vastly different, the deﬁnitional criteria more restrictive. Robert Weiss, the author of
Cruise control and founder of the Sexual Recovery Institute in Los Angeles, sees
sexual addiction in gay men as hidden in a culture generally supportive of (safe)
casual sex: ‘‘a counterculture of unfettered sexual expression can also serve to
enable the denial of men who are locked into destructive addictive sexual patterns.’’
(Weiss deﬁnes the line being crossed as the point at which ‘‘you lose the ability to
choose whether or not you are going to be sexual.’’) Of course this invisibility only
serves to reinforce the claims to the ubiquity of the malady claimed by industry
practitioners and noted earlier in this article. Without any veriﬁcation, Weiss asserts
‘‘Approximately 10 % of gay men are sex addicts’’ (Weiss 2005, pp. 20–21).
The signiﬁcant point, however, is that the preoccupation has been with
heterosexual rather than homosexual loss of control. As beﬁtting a normative
discourse in a heteronormative culture, sexual addiction has been remarkably
heterosexual in its predilections.
The connection between sex addiction and the other addictions noted in Irvine’s
early work shows little evidence of fading and will doubtless add to the growth of
new ‘‘addicts’’. It is 10 years since American psychiatric nurses were advised to
assess substance abusers for sex addiction when presenting for treatment because
‘‘sexual addiction often coexists with substance addiction’’ (Coleman-Kennedy and
Pendley 2002, p. 143). But a recent article in the journal Evaluation & the Health
Professions explicitly linked sex addiction with tobacco, alcohol, illicit drugs,
eating, gambling, internet, love, exercise, work, and shopping addictions. Unsur-
prisingly, the authors reported that nearly half of the US adult population was likely
to suffer from ‘‘maladaptive signs of an addictive disorder over a 12-month period’’
(Sussman et al. 2011, p. 3). A skeptic might ask whether such widespread behavior
should be deﬁned as normal rather than ‘‘a problem,’’ though it certainly holds out
the promise of many, many clients.
To achieve a sense of perspective on the issue of sex addiction, it is instructive to
consider a study of the general population carried out in New Zealand and published
in 2010. It forms part of a unique longitudinal study of a cohort of more than
a thousand people born in the city of Dunedin in 1972/3 and studied and surveyed
(on matters other than sex mainly) at various stages in their development. The
investigation of their reported sexual behavior and attitudes targeted 940 people, the
bulk of the surviving cohort interviewed at the age of 32 and willing to discuss their
sexual experiences and attitudes. The advantage of this study is that it surveys a
The Short History of Sex Addiction 15
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sample of the general population rather than an unrepresentative, targeted one
(Candeo’s Mormons, for example). The participants were asked if, in the last
12 months, they had had ‘‘sexual fantasies, urges or behavior’’ that they had felt
were ‘‘out of control.’’ These were called ‘‘out of control sexual experiences’’—that,
it should be noted, are different to out of control sexual behavior. They were asked
whether both their out of control sexual experiences and their actual sexual behavior
had interfered with their lives.
What is interesting about the study is that while 13 % of men and 7 % of women
reported out of control sexual experiences in the preceding year, very few of the
total group—4 % of men and 2 % of women—thought that it actually interfered
with their lives. Most of the reported anxiety involved fantasies and urges rather
than actions. Few reported that their actual behavior affected their lives adversely (a
huge part of the sexual addiction rationale): less than 1 % of all men and even fewer
women were so affected. As the researchers conclude, ‘‘This suggests that the
clinical syndrome of out of control sexual behavior may be unlikely to occur as
frequently as has been previously surmised’’ (Skegg et al. 2010, p. 977). Though
they do not state it, the disparity between the levels of reported out of control sexual
experiences as fantasy or impulse (on the one hand) and actual sexual behavior (on
the other) may suggest the anxiety-producing effects of sexual addiction discourse.
While there is little doubting the impact of the discourse, the strange situation of
sex addiction’s clinical and popular impact without the imprimatur of the American
Psychiatric Association has meant a continuing search for legitimacy, an uncertainty
in psychological classiﬁcation. The concept of sex addiction, as Lennard Davis has
put it, ‘‘resides in some interstitial space between science and culture’’ (Davis 2008,
For all the vast literature referred to earlier, there seems little evidence either of
theoretical reﬁnement or advancement in the collection of empirical research data—
what one scholarly article termed ‘‘many conceptions, minimal data’’ (Gold and
Heffner 1998). A UK academic who surveyed the work on cybersex in 2001, though
sympathetic to the concept of internet sex addiction, conceded both that the
empirical evidence for its existence was weak and that the ‘‘ﬁeld is still in
conceptual crisis’’ (Grifﬁths 2001, p. 339). Another academic survey, similarly
unquestioning of the actual existence of its subject, also noted conceptual ﬂaws:
‘‘the ﬁeld is hampered by weak theory that identiﬁes precisely what sexual addiction
is, what its worst symptoms and consequences are, and how to make accurate
diagnoses and prognoses’’ (Hook et al. 2010, p. 256). Davis, clearly a skeptic, refers
to ‘‘weak theories’’ and ‘‘impressionistic and confused’’ diagnoses (Davis 2008,
It should be noted that this imprecision has its dangers. A 2007 update on the
syndrome in the journal Directions in Psychiatry—by psychiatrists for psychia-
trists—drifts into pedophilia, incest, exhibitionism, and studies of sex offenders in
its discussion of the deﬁnitions and epidemiology of sexual addiction, yet with a
conceptual indistinctness that by no means inhibits treatment. For the same
psychiatric refresher-piece outlines the employment of a range of psychopharma-
cological solutions with sometimes terrifying side effects (Vesga-Lopez et al. 2007).
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We have argued that sexual addiction’s strange, short history of social
opportunism, diagnostic amorphism, therapeutic self-interest, and popular cultural
endorsement is marked by an essential social conservatism—sex addiction has
become a convenient term to describe disapproved sex. For all the discussion, the
central issue remains: sex addiction is a label without explanatory force. As a study
of ‘‘sexual compulsivity’’ among students at (appropriately) Alfred Kinsey’s
University of Indiana concluded, ‘‘What may appear to be pathological compulsive
sexual behavior to researchers and health professionals may actually be experienced
as normal sexual exploration by college students’’ (Dodge et al. 2004, p. 349). And
this, though somewhat more crudely, was Greg Rogell’s point in the epigraph about
Tiger Woods and the dead chicken.
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Author's personal copy