Does it matter if you have it all wrong?

Doctors we know sometimes lament the internet’s influence on their patient interactions. They spent years developing their medical expertise.  Their patients did not.  But, because medical information is widely available on the internet, patients often arrive at appointments with firmly-held, and incorrect, self-diagnoses.  Research shows doctors can mitigate the tension created by these false self-diagnoses by delivering quality care.  But, it’s clear the internet has the potential to interfere with doctor-patient relationships, and to cause everyone unwarranted (di)stress.

We suspect that people who seek mental health treatment for pornography use problems are as susceptible as any other kind of patient to erroneous self-diagnosis.  Because the public perceives porn use as potentially harmful, and addictions of all stripes are in the news nowadays, people are bound to show up in therapists’ offices believing themselves addicted to porn, some mistakenly so.  For this reason, at least one commentator, Dr. David Ley, has argued that the label “porn addiction” does far more harm to people than porn use does, and that a vast treatment industry unethically fuels “porn panic” for cynically commercial reasons. 

We are not so sure.  A recent article by Robert Weiss, LCSW, CSAT-S, acknowledges the potential for mistaken self-diagnosis (and professional misdiagnosis) of pornography addiction.  But Weiss also posits that most porn users who seek treatment for their porn use do so because they meet objective diagnostic criteria for addiction - namely, preoccupation to the point of obsession, loss of control characterized by frequent failed attempts to stop, and all manner of negative consequences.  (These are broadly the same criteria that are used for diagnosing other addictions, whether substance-related or behavioral.)  Weiss emphasizes the importance of adhering to these diagnostic criteria in choosing appropriate therapy for a person who seeks mental health treatment relating to porn use.

Weiss’s viewpoint seems to echo research that seeking mental health counseling represents a significant hurdle for many people, particularly young men.  Underutilization of mental health resources in the U.S. has been associated with negative attitudes about seeking help for a mental health problem.  We suspect that by the time the typical (young, male) porn user seeks counseling related to his porn use, more often than not competent mental health services will tend to do him good.

Of course, the devil is in the rigor of applying diagnostic criteria, in the choice of treatment indicated by the diagnosis, and in the quality of the treatment itself.  A misdiagnosis of porn addiction could harm a patient if it led to the wrong therapeutic approach, or if it caused more distress than it addressed. Then again, a false diagnosis might be harmless, or even lead (circuitously, perhaps) to positive outcomes.  After all, therapy aimed at one issue often results in revealing other, previously unrecognized areas for analysis and progress.  

The more salient question, we think, is whether it is societally harmful for people to be seeking treatment for a self-diagnosis of “porn addiction” in the first place, even if that diagnosis is incorrect.  This, it seems to us, is a key distinction between the viewpoints we’ve linked to above.  Dr. Ley sees harm in people diagnosing themselves as addicted to porn, because he believes the misdiagnosis can cause new mental health issues (depression, anxiety, etc.) in otherwise healthy people, and lead to treatment that amplifies that harm.  Weiss (one of those practitioners Dr. Ley seems to decry), in contrast, unmistakably adheres to the fundamental premise that competent mental health care is usually a net positive for anyone who feels distressed enough to seek it, even if seeking it for the wrong initial reason.  As Weiss makes clear, good therapy may include helping a patient who believes he is “addicted” to porn to see that he is, in fact, not.  But it also must acknowledge the potential for addiction treatment as an appropriate way to address problematic porn use.

For what it’s worth, here at PornHelp we think mental health is important, and that anytime a person seeks mental health counseling for something they find distressing, they are enhancing their opportunities for positive growth.  Though there may well be substandard (even crackpot) practitioners in the treatment field, we cannot subscribe to Dr. Ley’s view that only charlatans acknowledge porn use as a problem that can be addressed through established addiction treatment techniques, like cognitive behavioral therapy and twelve-step work.  Indeed, these approaches, when competently applied, foster discovery and analysis of the sort of “problem behind the problem” that Dr. Ley and Weiss both seem to agree can underly a person’s feelings of distress about porn use.    
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If you feel distressed by your porn use to the point of wanting help, you can explore your options here.