The CNN piece on sex addiction is actually quite well crafted, but doesn’t get at the real reason that psychiatry has persistently refused to characterize “sex addiction” as a disorder: namely, that every male between the ages of 15 and 25 would qualify for it.  It is like making “belching after meals” a disorder.

To be sure, there are psychiatric situations where sexual driven-ness does qualify as a disorder, such as mania.  In turn-of-the-century Vienna, a well-brought up young woman came down to breakfast one morning with a sailor.  She was immediately diagnosed as “manic.”   Today, people would shrug.

Culture Influences the Diagnosis

Enter culture.  Manifesting a lively interest in sexuality was once seen as a disorder (in women, “nymphomania,” in men, satyriasis”).  These so-called disorders went by the board as culturally determined when, after the 1960s everything opened up and active sexual desire in women became accepted as normal.

So, the Atlanta shooter:  did he have a “sex addiction”?   The term springs so readily to the lips as a portmanteau explanation:  “Yes, he killed eight people, because he was a sex addict.”  Yet this is really nonsense, because “sex addiction” does not meet the classic addiction criteria: no escalating dosage, no withdrawal phenomena, and  (almost) no drug-seeking behaviour beyond the cultural norm of the pickup bar.

What Is Wrong With the Atlanta Shooter?

What might be actually going on with the Atlanta shooter?  In psychiatry, this kind of wild, unfocused behaviour may be evidence of catatonic agitation (formerly called “furious mania)” with its insensate eruptions of violent destructiveness.  The behaviour still exists, but psychiatry has generally forgotten about it as society has calmed down. (But the police still face it.  See my book, What Psychiatry Left Out, Routledge, 2015).

The term, furious mania, will produce puzzlement among most clinicians today.  But it has nothing to do with sexuality,  and the Atlanta shooter’s evocations of sex in his own case may be more a rationalization of his agitation rather than evidence of true sexual content in this violent agitated form of behaviour.  (Yet the media are on sex like a dog on a bone, just as they are featuring the episode as putative evidence of “anti-Asian” prejudice.”)

The massage parlors may have been a focus for him, because he evidently patronized them.  But I don’t think that they, per se, were a wellspring of his actions.