PORNOGRAPHY AND THE BRAIN

Understanding the Addiction Donald L. Hilton, Jr., MD Lighted Candle Society Annual Banquet May 13, 2009

Introduction We are grateful to the Lighted Candle Society for all they represent in lighting and leading the way in this battle for the hearts, minds, and souls of men and women. I am particularly grateful for the Society‘s dedication to illumination. In my profession as a neurosurgeon, I perform surgery on the brain and spine. My academic interest is in minimally invasive spinal surgery, and it is in this field that I primarily lecture and publish. In these procedures we perform delicate surgery on the spinal cord and on other neural structures through very small incisions. These operations would be impossible without the neuro-capable microscope. The microscope provides illumination and magnification, and these two principles are essential in safely accomplishing the objectives of minimally invasive surgery. It is my hope that by better understanding pornography addiction, we will have even more illumination and magnification of the etiology of this addiction, and thus be more prepared to act decisively. To illustrate the concept of illumination and magnification, I would like to share an experience our family had a few years ago on a safari in Africa. On the way to our camp on the Zambezi River, we stayed at Victoria Falls, the world‘s largest waterfall in terms of volume. The beauty of the falls was captivating as the Zambezi plunged 360 feet into the gorge below. At our camp on the river, we were cautioned that while beautiful, the river held dangers. Hippos and crocodiles were plentiful, and we were told to exercise caution around the water. While on a game drive along the river, our ranger commented on the adrenaline grass growing along the banks. I asked him why he used the word adrenaline, and he began to drive slowly through the grass. Abruptly he stopped the Land Rover and said ―There! Do you see it?‖ ―See what?‖ I asked. He drove closer and this also changed the angle of the light. Then I understood. The lion was hiding in the grass watching the river, just waiting for some ―fast food‖ to come get a drink. Why could we see it? Illumination and magnification! As far as the word adrenaline, we were sitting in open air Land Rovers with no doors and no windows. I then understood why it was called adrenaline grass as I felt my heart pound. We were told that if we stayed in our seat and remained still, the lion would look at the Land Rover as a whole and not see us as individuals, and fortunately this was the case for us. I very quickly understood that I was seeing a powerful object lesson. Addiction to Pornography Is a True Brain Addiction I think one of the fundamental problems in addressing pornography addiction now is understanding it for what it is. As physicians, we must make the correct diagnosis and understand the mechanism of the disease process to adequately treat the

patient. As we cast the illumination and magnification of science on this problem, we will better understand what it is, a true brain addiction. I believe until we accord pornography addiction the respect and weight we accord alcoholism and drug addiction in terms of treating it with appropriate long-term therapy and group support, we will fail in providing adequate treatment. In the past, compulsive pornography use has been viewed by many professionals not as a true addiction, but rather as a behavioral/moral issue. Certainly this is the view taken by the pornography industry, which makes billions in profit each year. For instance, a senior editor of a pornography industry organization, when asked whether pornography was addictive, said, ―While much has been written and said about pornography being addictive, on par with drugs, booze and cigarettes, it's important to consider that this misinformation has been based upon questionable ‗science‘ and the opinions of anti-porn activists—not upon any legitimate, unbiased research. Consider also the fact that ‗drugs, booze and cigarettes‘ are all physical, chemical agents that are ingested and can indeed have measurable, harmful, addictive effects. The mere viewing of any type of subject matter hardly falls into this category and, in fact, belittles the very real battles that addicts face over drugs, booze and cigarettes—all of which can be lethal. No one ever died from looking at porn. While some compulsive types can be ‗addicted‘ to anything, such as watching a favorite television show, eating ice cream or going to the gym, nobody suggests that ice cream is akin to crack cocaine and should be regulated to protect people from themselves—instead, these compulsive actions are rightfully viewed by society

as personality defects in the individual.‖1

We will review some of the ―legitimate, unbiased research‖ he refers to with regard to changes in the brain in addiction. For instance, he denies any similarity between overeating and cocaine addiction, and also includes excessive exercise and hyper-sexuality as simply compulsive actions rather than as real addictions. I invite you this evening to consider recent scientific studies specifically relating to each of these behaviors, and then judge whether or not these compulsions are addictions. Before we discuss these studies, consider another example of how many view pornography addiction, as summarized in this statement of a Wall Street executive whose mainstream company profits discretely from pornography: ―I‘m not a weirdo or a pervert, it‘s not my deal. I‘ve got kids and a family. But if I can see as an underwriter going out and making bucks on people being weird, hey, dollars are

dollars. I‟m not selling drugs. It‘s Wall Street.‖2

Pornography Is a Drug Actually, pornography is a drug! In every sense of the word, as we will see, it fulfills what we, as physicians, call a drug. Consider the drug adrenaline. Every hospital has this drug available in crash carts ready to give immediately to a dying patient whose heart has stopped. Adrenaline, also called epinephrine, can help the heart begin to beat again. The doctors, patients, pharmaceutical labs, and FDA all consider this to be a powerful drug. Yet when I saw the lion, cells in the locus coereleus of my brain and in my adrenal glands produced adrenaline, and I felt my heart thumping in my chest. It turns out

this drug is also produced in the anticipation and acting-out phase of pornography addiction. Is it a drug only if the pharmaceutical lab makes it, and not if the brain makes the same chemical? What about dopamine? It‘s a catecholamine like adrenaline, and differs from it only by a methyl group. It also functions as an excitatory neurotransmitter. This important drug is used in Parkinson‘s disease. It is obtained by prescription, made by a lab, and controlled by the FDA, as is any drug. Yet if this same chemical is made in the brain, is it not a drug, just because of where it is produced? Dopamine is not only important in movement systems, and therefore important in Parkinson‘s disease, but also important in the brain‘s pleasure systems and an integral component in pornography addiction. The problem with pornography is that adrenaline, dopamine, and other powerful brain drugs are being used without a prescription. Pornography is actually a form of

prescription drug abuse when viewed in this light.

LIMBIC SYSTEM

Understanding the Neuroanatomy and Chemistry of the Brain Let‘s review the basic neuroanatomy and chemistry important in the pleasure systems in the brain. (See Figure 1.) The outside, or thinking part of the brain is called the cortex. This frontal area of the cortex is important in control and judgment. If our brain were a car, this area would be the braking system. Beneath the cortex is the limbic system, which provides appetitive drives important in survival. The nucleus accumbens is a key component of the pleasure centers, and is stimulated by several

important brain chemicals, or drugs. Dopamine is an important stimulatory chemical, produced in the ventral tegmental area or VTA, of the midbrain. This system is called the mesolimbic dopaminergic pathway, or the VTA-NAc pathway. When a stimulus from the cortex comes into the brainstem, the VTA causes dopamine to be released from the ends of the nerve cells, where it crosses the synaptic cleft, or space, and binds to receptors on the pleasure cells in the nucleus accumbens. There are other chemicals also binding to specific receptors, such as the natural brain opioids, the endorphins and en-cephalins. It may be that dopamine is more important in wanting pleasure, and the endorphins are more important in liking

pleasure, and thus the imbalances seen in the addicted state may be responsible for the disconnection between the ―wanting‖ and ―liking‖ that those in addiction frequently describe. Many in addiction report that they don‘t even like the addictive stimulus, yet the wanting and craving is more powerful than ever. Other areas such as the amygdala and the hippocampus are important in deep emotional and sexual memory, and likely feed relapse by stimulatory input into the VTA and thus the nucleus accumbens. These areas are modulated by the frontal control areas as a check and balance. Is There a Common Pathway for Addiction? Is there a difference in changes in the brain in drug addiction as compared to ―natural‖ addiction, such as overeating, pathological gambling, and sexual addictions? Dr. Eric Nestler, who is currently Director of the Brain Institute and Chairman of Neuroscience at Mount Sinai School of Medicine in New York and one of the leading addiction scientists in the field, published a landmark paper in the journal Nature Neuroscience in 2005 titled, ―Is there a common pathway for addiction?‖ In it he stated, ―Growing evidence indicates that the VTA-NAc pathway and the other limbic regions cited above similarly mediate, at least in part, the acute positive emotional effects of natural rewards, such as food, sex and social interactions. These same regions have also been implicated in the so-called „natural addictions‟ (that is, compulsive consumption of natural rewards) such as pathological overeating, pathological gambling and sexual addictions. Preliminary findings suggest that shared pathways may be involved: [an example is]

cross-sensitization that occurs between natural rewards and drugs of abuse.‖4

As we will see, more recent studies from Dr. Nestler and others now provide additional strong evidence that addiction is present when there is continued compulsive pleasure-seeking behavior despite adverse consequences, whether the

stimulus is ―from a chemical or an experience‖ as stated in the journal Science.5

Addiction affects the brain in several ways that can be seen in brain scans. In a normal nerve cell the electrical signal travels along the wire, or axon, to the space across from the

next nerve cell. In addiction, the process is overutilized and greatly accelerated. As a defense mechanism, when we overstimulate the mesolimbic dopaminergic pleasure systems, they shut down, or downgrade, as a defense mechanism of sorts. In a way, it‘s as if the brain is trying to say, ―Pleasure is good, but this is too much.‖ The person is overstimulated with a specific pleasure to the point of addiction, and the brain decreases the production of dopamine and the number of receptors on the pleasure cells in the nucleus accumbens in an attempt to return to normal, and dopamine producing cells in the nucleus accumbens and frontal control neurons can actually atrophy, or shrink.

But now there is a new normal! (See Figure 2.) In this new resting state, the person finds a dearth of dopamine, and lives in a state of craving. To return to satisfaction, the person in addiction must act out to boost the dopamine back to levels sufficient to feel ―good.‖ Now, normal marital sexual relations with a spouse will no longer suffice, and progressively more powerful stimuli are required to satisfy an incrementally more persistent craving. The person in addiction has fewer dopamine receptors to bind the dopamine, and fewer molecules when a pleasurable experience is encountered, so it now takes a massive stimulus, i.e., acting out in addiction, just to feel ―good.‖

The process of recovery is so difficult because the sensitive checks and balances in the pleasure systems have been pathologically reset, and restoring them to normal function will take time, support, and a desire to change. Willpower alone, however, will not be enough, as this is a real change in brain structure and chemistry. These changes in dopamine metabolism and in receptor numbers can be measured with fMRI, PET, and SPECT scans. The frontal control and pleasure cells can shrink in a negative feedback loop, and this can be seen structurally using sMRI with a technique called voxel-based morphometry, or VBM. In neurosurgery we treat patients injured in motor vehicle accidents. In a wreck such as shown in Figure 3, just as the front of the car is damaged, as the brain decelerates into the skull of the forehead, the frontal lobes can be damaged as seen in the CAT scan (white spots, upper left) in Figure 4.

―Studies of addicts show reduced cellular activity in the orbitofrontal cortex, a brain area we rely on to make strategic, rather than impulsive, decisions. Patients with traumatic injuries to this area of the brain display problems–aggressiveness, poor judgment of future consequences, inability to inhibit inappropriate responses–that are similar to those observed in substance abusers.‖ –Drs. Fowler, Volkow, Kassad, and Chang of the National Institute of Drug Addiction

Patients with frontal lobe damage from trauma, or from tumors or other problems, exhibit impulsivity, compulsivity, impaired judgment, and emotional lability. We in neurosurgery call this ―hypofrontality.‖ Interestingly, scientists studying addiction have noted that those in addiction act like those with traumatic brain injury. Drs. Fowler, Volkow, Kassad, and Chang of the National Institute of Drug Addiction state: ―Studies of addicts show reduced cellular activity in the orbitfrontal cortex, a brain area we rely on to make strategic, rather than impulsive, decisions. Patients with traumatic Brain injuries to this area of the brain problems—aggressiveness, poor judgment of future consequences, inability to inhibit inappropriate responses—that are similar to those observed in substance abusers.

Indeed, studies of structural MRI scans show actual volume loss, or shrinkage, in the frontal control and in the pleasure areas. This technique is called voxel based morphometry, or VBM. For instance, this scan in Figure 5 from a paper published in 2002 in the journal Biological Psychiatry, shows shrinkage in the frontal areas in

cocaine addiction,7

and this image in Figure 6, published in the Journal of Neuroscience in 2004 shows similar findings in methamphetamine addiction (note:

the blue is normal, the red and green are areas of volume loss).8

A skeptic might say, ―But these studies involve bolume loss in drug addiction, not a behavioral problem from a natural compulsion.‖ Yet a study published in 2006 in the journal Neuroimage

shows similar shrinkage of these same areas in pathologic overeating leading to obesity;9

(see Figure 7); and, pertinent to our present subject, in 2007 a paper out of Germany published in the Journal of Psychiatric Research showed essentially the same

findings in a sexual addiction, pedophilia.10

(See Figure 8.)

So we have four studies, two drug addictions and two natural addictions, and they describe similar findings. I went through the description of the areas of the brain affected in each of these, and found that all involved the frontal control areas, and

the sexual addiction paper described a more pan-involvement of the brain, with more areas of atrophy being described. I hypothesize that based on these studies involving both drug and natural addiction, severe pornography addiction will also show a visible and measurable hypofrontality, and we are currently designing protocols for a morphologic study utilizing VBM to study subjects addicted to pornography. Other techniques studying addiction show changes in both drug and natural addiction as well. While we would expect an fMRI study published in the American Journal of Psychiatry in 2001 to show abnormalities in metabolism in cocaine

addiction,11

we might be surprised to find that fMRI also shows damage in activation of the dopaminergic reward system in pathologic gambling, which was published in the

journal Nature Neuroscience in 2005.12

Overeating leading to obesity, another natural addiction, showed a decrease in dopamine receptor binding and function,

as published in the journal Lancet in 2001.13

In a recent issue of the Philosophical Transactions of the Royal Society, the current state of the understanding of addiction was reported as it was discussed by some of the world‘s leading addiction scientists at a meeting of the Society. The title of the journal issue reporting the meeting was ―The neurobiology of addiction—new vistas.‖ Interestingly, of the 17 articles, two were specifically concerned with natural

addiction (pathologic gambling14

and overeating15

), and a third addressed animal

models of natural addiction as well with regard to ΔFosB. 16

ΔFosB is a chemical which Dr. Nestler has studied, and appears to be found exclusively in the neurons of addicted subjects, whereas other chemicals in the Fos family are rapidly degraded. Interestingly, it was first studied in drug addiction, but

has been seen in models of overeating and more recently, in hyper-sexuality. 17

It is thus a marker of addiction, and gives additional strong support to the physical, organic basis of pornography and sexual addiction. Addiction Physically and Chemically Alters and Damages the Brain As we can see from these studies, addiction physically and chemically alters and damages the brain, regardless of whether it is caused by ingestion of a drug from outside the body, or production of a drug inside the brain itself, whether the addictive

pull comes from ―a chemical or an experience,‖ as previously stated.18

Chemical changes at the cellular level, now called long-term potentiation and long-term depression, occur in both drug and natural addiction, and are seen in PET and

SPECT scans. The dopamine pleasure systems of the brain are downgraded, and this can be visualized in both drug and natural addictions with PET and SPECT. Atrophy, or shrinkage, is seen in both drug and natural addiction, and is quantified with structural MRI, and fMRI demonstrates decreased metabolism in affected pleasure and control areas in both drug and natural addiction. Recent studies suggest clinical recovery may actually be imaged in brain scans. One is a

methamphetamine study (see Figure 9) showing return to more normal dopamine

recaptor metabolism with up to 18 to 24 months of recovery,19

and an obesity study showed return to more normal white matter volumes with dieting. Thus we can ―see‖ recovery, not only clinically, but on visible imaging scans.

Also figuring prominently in sexual addiction is the role of oxytocin and vasopressin. Oxytocin is a powerful bonding hormone in females, and allows lactation and is

released during sexuality,20

and increases trust in humans.21

Vasopressin is released in males during the sexual act, and it is likely that these hormones also bond the

person to the object of the sexuality.22

Thus, consummatory sexuality associated with pornography bonds the person to a virtual mistress of sorts. Is Pornography Hastening the Decline of the Species? It is beyond the scope of this address to attempt to define the damage pornography addiction inflicts on those addicted, on their loved ones, and on their productivity. But I would like to address one societal aspect of this problem that perhaps has been overlooked. I recently lectured in Australia at the University of Melbourne and at the University of New South Wales on minimally invasive spinal surgery at the invitation of Professor Derek Denton, founder of the Howard Florey Institute in Melbourne, Australia. Considered a world authority on the brain‘s basic survival drives, I was interested to note a passage from his book, The Primordial Emotions, published by

Oxford Press. In describing the sexual drive, he said it would not be advantageous

for a species to experience full sexual reward in the brain without accomplishing the physical procreative act. He said, ―In fact, it would be rather bad for the continuity of

the species if this were easily feasible as a substitute for the reality.‖23

Yet this is precisely what pornography is doing, and I believe it is a factor contributing to the ebbing and fading fertility rates. It might be argued that correlation does not prove causation but I believe causation is supported by a powerful lesson and example from nature. It has been reported that 90% of chemical insecticides have been eliminated in Australia by the use of natural insect sex attractants, called pheromones. In nature, the female insect exudes the pheromone, enabling the male to find her. It was in the journal Nature that the first paper describing the use of synthetic pheromones to inhibit reproduction was published. Note the title of the paper: ―Insect population

control by the use of sex pheromones to inhibit orientation between the sexes.‖24

Also pertinent is this summary from the abstract of the paper: ―We have for the first time obtained experimental confirmation that pre-mating communication between the

sexes can be disrupted by permeating the atmosphere with an insect pheromone.‖25

The gypsy moth was the first insect to be controlled by the use of pheromones, which work by two methods. One is called the confusion method. An airplane scatters an environmentally insignificant number of very small plastic pellets imbedded with the scent of the pheromone, and only a few of these pellets per acre are enough to overpower the male‘s ability to find the female. He is thus desensitized to the natural scent of the female by this compelling scent. The Australian article describes the confusion method as follows, ―The male either becomes confused and doesn‘t know which direction to turn for the female, or he becomes desensitized to the lower levels of pheromones naturally given out by the

female and has no incentive to mate with her.‖26

The other method is called the trapping method, in which the male moths enter traps from which they cannot exit looking for the female, only to find a fatal substitute. Sound familiar? It was Tom Wolfe, author of The Right Stuff, who said, ―The bigger pornography gets, the lower

the birthrate becomes.‖27

Does he have a point? ―The bigger pornography gets, the lower the birthrate becomes.‖ —Author Tom Wolfe It is interesting that in the 1950s every country now in the European Union had a fertility rate above the 2.1 needed to sustain a population. Now none of them do, and several are at or near the 1.3 rate called the ―lowest low fertility,‖ from which it is virtually impossible to recover. As one German government official said, if the birth

rate didn‘t pick up, the country would be ―turning the light out.‖28

It was in the late ‘60s, and early ‘70s that this decline began, which corresponds precisely with the dawning of the sexual revolution. I believe there is a direct correlation in the growing cultural dominance of the sexual revolution and the diminishing birth rate, and I also

believe that causation can be inferred by examining the pheromone effect of pornography. In my library I have the 11-volume Story of Civilization by historians Will and Ariel Durant. Their description of the fall of Rome is instructive: Biological factors were more fundamental. A serious decline of population appears in the West after Hadrian. . . . Aurelius, to replenish his army, enrolled slaves, gladiators, policemen, criminals. . . . So many farms had been abandoned . . . that Pertinax offered them gratis to anyone who would till them. A law of Septimius Serverus speaks of a penuria hominum—a shortage of men. Bishop Dionysius said the population had halved during his time, and mourned to ―see the human race diminishing and constantly wasting away.‖ Only the barbarians and the Orientals were increasing, outside the Empire and within. What had caused this fall in population? Above all, family limitation. Practiced first by

the educated classes, it had now seeped down to a proletariat named for its fertility. By AD 100 it had reached the agricultural classes. . . . Sexual excesses may have reduced human fertility: the avoidance or deferment of marriage had a like effect.... Moral decay contributed to the dissolution . . . men had now, in the middle and upper classes, the means to yield to temptation. . . . Moral and esthetic standards were lowered by the magnetism of the mass: and sex ran riot in freedom

while political liberty decayed. 29

[emphasis added] I believe pornography is a visual pheromone, a powerful brain drug that is changing sexuality even more rapidly through the cyber-acceleration of the Internet. It is ―inhibiting orientation‖ and ―disrupting pre-mating communication between the sexes

by permeating the atmosphere‖30

and Internet. Dr. Norman Doidge, a neurologist at Columbia, in his book, The Brain That Changes Itself, describes how pornography causes rewiring of the neural circuits. He notes a study on men viewing Internet pornography in which they looked ―uncannily‖ like rats pushing the lever to receive cocaine in the experimental Skinner boxes. (See Figure 10.) I thought of the words of Kauer and Malenka in their Nature Reviews Neuroscience paper on the effects of addiction at the cellular level in the brain when they said: ―Addiction represents a

pathological, yet powerful form of learning and memory.‖31

Like the addicted rat, they are desperately seeking the next fix, clicking the mouse just as the rat pushes the

lever.

Pornography addiction is frantic learning, and perhaps this is why many who have struggled with multiple addictions report that it was the hardest addiction for them to overcome. Drug addictions, while powerful, are more passive in a ―thinking‖ kind of way, whereas pornography viewing, especially on the Internet, is a much more active process neurologically. The constant searching and evaluating each image or video clip produced for potency and effect is an exercise in neuronal learning and rewiring, limited only by the progressively rewired brain. Masturbatory

conditioning, a term described by Dr. Victor Cline,32

is likely potentiated and bonded with oxytocin and/or vasopressin. This locks the person in to this electronic pleasure medium where women are reduced to mere objects of pleasure. This is exacerbated in adolescent males, where imprinting the hippocampus and amygdala are forming deep emotional memories and preference patterns, and are setting the sexual pleasure thermostat. It is likely then, that three primary neural mechanisms are at work to produce pornography addiction, with the first two being general to all addictions, and the last specific to pornography and sexual addiction. First, a state of cortical hypofrontality. The brakes are broken, and the brain can‘t stop on its own. Second, a state of downgrading of the mesolimbic dopaminergic systems, with decrease in numbers of dopamine receptors and of the output and function of the cells. This produces a state of dopamine craving, temporarily relieved when the person medicates by acting out to pornography. Third, strong emotional bonding to pornography, likely mediated by the oxytocin/vasopressin axis, and exacerbated particularly in adolescent males by amygdalar and hippocampal imprinting. Other factors likely contribute, and I am confident these will become more apparent as the line between drug and natural addictions continues to evaporate in the eyes of science. The Importance of Understanding Pornography Addiction

Why is it important to understand the physical basis of pornography addiction? Because if we continue to treat it simply as a moral weakness, or a behavioral defect alone, we will continue to fail societally and individually. Trying to shame those in addiction into recovery will only drive them into secrecy, isolation, and back into the abyss of addiction. We must recognize that therapy and 12-Step group support become the substitute frontal lobes until there is healing, and then ongoing involvement in helping others provides a venue for a lifetime of strengthening and service. It is interesting that the methamphetamine addiction scans showing recovery of dopaminergic pleasure pathway function strengthen at one to two years. Dr. Patrick Carnes, one of the leading experts in the world on sexual addiction, finds that growth

phase occurs at approximately two years into strong recovery.33

He describes those who achieve growth phase as follows: Another characteristic of this growth stage is a deep abhorrence of one‘s old behavior. Once people in recovery have enough distance from their old problematic behaviors, they often have extremely visceral reactions when they think about them. Many say they look back almost in disbelief at some of the things they‘ve done. By the time recovery reaches the growth stage, it no longer involves false starts. Consciousness of sobriety and of richer relationships has brought the person to a new level of being. And it‘s at this stage that people in recovery often talk about the compulsion of addictive behavior as a gift. They have experienced a depth of humanity that many people never achieve. Their compulsive or addictive behaviors and subsequent recovery have given them a greater perception, compassion, and presence. Not only do they serve as models for other recovering people who follow

them, but they are literally helping our whole society heal.34

When environmentalists see species declinations of the sort the Europeans and others are experiencing, they sound the alarm bell. Thomas S. Monson, president of the LDS Church, recently used this word in describing the numbers of individuals

becoming entrapped in pornography as ―extremely alarming.‖35

Pornography is a visual pheromone shrinking relationships, populations, and brains, and we must bring it into the light of understanding through the illumination and magnification of knowledge. We must understand what pornography causes, a true brain addiction in every sense of the word. As Dr. Jeffery Satinover of Princeton University said, ―With the advent of the computer, the delivery system for this addictive stimulus has become nearly resistance-free. It is as though we have devised a form of heroin 100 times more powerful than before, usable in the privacy of one‘s own home and injected directly to the brain through the eyes. It‘s now available in unlimited supply via a self-replicating distribution network, glorified as art

and protected by the Constitution.‖36

An article published in January of 2008 in the Journal of Adolescent Research describes 87% of young men and 31% of young women viewing pornography, with half viewing weekly and one in five daily or every other day. The time for waiting for

others to fight this is over. As John Harmer said, ―Pornography is everyone else‘s

problem until it becomes a problem in your home.‖37

Every home will be affected, directly or peripherally. And with regard as to ―for whom that alarm bell tolls,‖ John Donne reminds us:

No man is an island, entire of itself; every man is a piece of the continent,

a part of the main. If a clod be washed away by the sea,

Europe is the less, as well as if a promontory were,

as well as if a manor of thy friend‟s or of thine own were:

any man‟s death diminishes me, because I am involved in mankind, and therefore never send to know

for whom the bell tolls;

it tolls for thee.38

Conclusion I believe the reason we seem to be falling behind in treating this ―soul sickness‖ is that we haven‘t made the correct diagnosis in the past. Just as it would be critical that a physician not treat pneumonia with cold medication, we must be careful not to treat pornography addiction as simply a bad habit. If we can look back and learn from the past, I believe it is fair to say we have underestimated this problem, primarily in two areas. First, the prevalence. Pornography addiction crosses all ages, socioeconomic and educational boundaries, and religious affiliations. Second, we have underestimated the effort required to extract even one from addiction. ―Whoso saves one life, saves the world entire.‖ —The Jewish Talmud In speaking about treating pornography addiction in adolescents, Dr. John Mark Haney, a PhD therapist in Austin said, and it applies to adults equally:

With pornography, professionals sometimes fail to understand the power of the

compulsion youth are facing, and it is not uncommon for school, religious, or private-sector professionals to advocate a simple treatment plan that is based upon

willpower or moral character. Since pornography can be an addiction, these “just say no” types of approaches are likely to only create more frustration and self-defeating ideation in teenagers who do not have the willpower to stop. For such young people who can no longer control their actions, the intervention and treatment modality must

recognize the problem as a full addiction, and treat it with the same consideration

given to alcohol or chemical substances.39

It is my hope that we will educate ourselves and others as to the nature of this true brain addiction, and accord it the substantial effort that will be required to address it. And may we reach out in

love and acceptance to those already afflicted; acceptance not for the addiction, but for the person, and provide them a safe place to come and heal. May we also remember the words from the Jewish Talmud: ―Whoso saves one life, saves the

world entire.‖40

Those fighting pornography are often accused by those defending it of doing so from a religious/moralist perspective. It is an accusation about which we need not apologize. It is essential that God be involved in healing this sickness of the soul, which is comprised of the spirit and the body. Twelve-Step support brings God into the clinical setting, and it is the one treatment of which I am aware based on dependence on the Higher Power which even the scientific literature recognizes as effective. There are many papers published in secular journals describing the effectiveness of God in healing those who struggle with addiction. Those in the secular world treating addiction know they can‘t do it without God. Paul, who faced the Roman world of sexual promiscuity the Durants described, understood the concept of addressing both the spiritual aspect of healing through repentance, and also the physical aspect of healing through recovery with all that entails. To Timothy he said, ―And the servant of the Lord must not strive; but be gentle unto all men, apt to teach, patient, In meekness instructing those that oppose themselves; if God peradventure will give them repentance to the acknowledging of the truth; And that they may recover themselves out of the snare of the devil, who are taken captive by

him at his will.‖41

Thank you, and may God bless us all in our efforts in this most important cause.

ENDNOTES

1. Interview with Stephen Yagielowicz, senior editor of XBIZ, http://www.postregister.com/special/pandorasboxxx/story.php?accession=1013-08292007.

2. Koerner, Brendon I., “A Lust for Profits,” U.S. News & World Report, March 27, 2000, 44.

3. W. Dean Belnap, A Brain Gone Wrong; Hope for the Troubled Teen, Meridian Publishing, 2008, 12.

4. Nestler, E.J., “Is there a common molecular pathway for addiction?” Nature Neuroscience 9(11):1445-9, Nov 2005.

5. Holden, Constance, “Behavioral Addictions: Do They Exist? Science, 294 (5544) 2 November 2001, 980.

6. Joanna L. Fowler, Nora D. Volkow, Cheryl A. Kassed, and Linda Chang, “Imaging the Addicted Human Brain,” Science and Practice Perspectives, April 2007, 4-16.

7. Teresa R. Franklin, Paul D. Acton, Joseph A Maldjian, Jason D. Gray, Jason R. Croft, Charles A. Dackis, Charles P. O’Brien, and Anna Rose Childress, “Decreased Gray Matter Concentration in the Insular, Orbitofrontal, Cingulate, and Temporal Cortices of Cocaine Patients,” Biological Psychiatry (51)2, January 15, 2002, 134-142.

8. Paul M. Thompson, Kikralee M. Hayashi, Sara L. Simon, Jennifer A. Geaga, Michael S. Hong, Yihong Sui, Jessica Y. Lee, Arthur W. Toga, Walter Ling, and Edythe D. London, “Structural Abnormalities in the Brains of Human Subjects Who Use Methamphetamine,” The Journal of Neuroscience, 24(26) June 30 2004;6028-6036.

9. Nicola Pannacciulli, Angelo Del Parigi, Kewei Chen, Dec Son N.T. Le, Eric M. Reiman and Pietro A. Tataranni, “Brain abnormalities in human obesity: A voxel-based morphometry study.” Neuroimage 31(4) July 15 2006, 1419-1425.

10. Boris Schiffer, Thomas Peschel, Thomas Paul, Elke Gizewshi, Michael Forshing, Norbert Leygraf, Manfred Schedlowske, and Tillmann H.C. Krueger, “Structural Brain Abnormalities in the Frontostriatal System and Cerebellum in Pedophilia,” Journal of Psychiatric Research (41)9, November 2007, 754-762.

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12. Jan Reuter, Thomas Raedler, Michael Rose, Iver Hand, Jan Glascher, and Christian Buchel, “Pathological gambling is linked to reduced activation of the mesolimbic reward system,” Nature Neuroscience 8, January 2005, 147-148.

13. Gene-Jack Wang, Nora D. Volkow, Jean Logan, Naomi R. Pappas, Christopher T. Wong, Wei Zhu, Noelwah Netusil, Joanna S. Fowler, “Brain dopamine and obesity,” Lancet 357(9253) February 3 2001, 354-357.

14. Marc N. Potenza, “The neurobiology of pathologic gambling and drug addiction: an overview and new findings,” Philosophical Transactions of the Royal Society, 363, 2008, 3181-3190.

15. Nora D. Volkow, Gene-Jack Wang, Joanna S. Fowler, Frank Telang, “Overlapping neuronal circuits in addiction and obesity: evidence of systems pathology,” Philosophical Transactions of the Royal Society, 363, 2008, 3191-3200.

16. Nestler, Eric J., “Transcriptional mechanisms of addiction: role of ΔFosB,” Philosophical Transactions of the Royal Society, 363, 2008, 3245-3256.

17. Ibid. 18. Holden, Constance, “Behavioral Addictions: Do They Exist?” Science, 294

(5544) 2 November 2001, 980. 19. Volkow et al., J. Neuroscience, 2001. 20. Karen L. Bales, Julie A. Westerhuyzen, Antoniah D. Lewis-Reese, Nathaniel

D. Grotte, Jalene A. Lanter, C.Sue Carter, “Oxytocin has Dose-dependent Developmental Effects on Pair-bonding and Alloparental Care in Female Prairie Voles,” Hormones and Behavior 52(2), August 2007, 274-279.

21. Michael Kosfeld, Markus Heinrichs, Paul J. Zak, Urs Fischbacher and Ernst Fehr, “Oxytocin Increases Trust in Humans,” Nature, 435, 2 June 2005, 673-676.

22. Larry J. Young , Zuoxin Wang, “The neurobiology of pair bonding,” Nature Neuroscience 7, 2004, 1048-1054.

23. Derek Denton, The Primordial Emotions: The Dawning of Consciousness, Oxford Press, 2005, pg. 179.

24. L.K. Gaston, H. H. Shorey, and C. A. Saario, “Insect Population Control by the Use of Sex Pheromones to Inhibit Orientation between the Sexes,” Nature 213, 1155, March 18, 1967.

25. Ibid. 26. Salleh, Anna, “Sex Pheromones Cut Pesticide Use,” ABC Science Online,

October 16, 2000. 27. Talking With Tom Wolfe, Rolling Stones 40th Anniversary Interview, posted

5/2/07, http://www.rollingstone.com/rockdaily/index.php/2007/05/02/rolling-stones-40th-anniversary-talking-with-tom-wolfe/

28. The EU’s Baby Blues, BBC, news.bbc.co.uk/1/hi/world/europe/4768644.stm March 27, 2006.

29. Will Durant, The Story of Civilization, Caesar and Christ, Volume 3, Simon and Shuster, Inc., 1944, 665-666.

30. L.K. Gaston, H. H. Shorey, and C. A. Saario, “Insect Population Control by the Use of Sex Pheromones to inhibit Orientation between the Sexes,” Nature 213, 1155, March 18, 1967.

31. Julie A. Kauer, Robert C. Malenka, “Synaptic Plasticity and Addiction,” Nature Reviews Neuroscience, 8, 8440858 November 2007, 844-858.

32. Victor B. Cline, Pornography’s Effects on Adult and Child, http://mentalhealthlibrary.info/library/porn/pornlds/pornldsauthor/links/victorcline/porneffect.htm.

33. Patrick Carnes, Don’t Call It Love, Bantam Books, 1991, 207.

34. Patrick Carnes, In the Shadows of the Net, Hazelton Foundation, 2001, 142. 35. Thomas S. Monson, LDS General Conference, Sunday afternoon session,

April 5. 36. Jeffery Satinover, MS, MD, (Princeton University), Senate Committee on

Commerce, Science, and Transportation; Subcommittee on Science Technology, and Space; Hearing on the Brain Science Behind Pornography Addiction and Effects of Addiction on Families and Communities, Thursday, November 18, 2004.

37. John L. Harmer, James B. Smith, The Sex Industrial Complex, The Lighted Candle Society, 2007.

38. John Donne, Devotions upon Emergent Occasions" XVII: Nunc Lento Sonitu Dicunt, Morieris, 1623.

39. John Mark Haney, Article 10, “Teenagers and Pornography Addiction: Treating the Silent Epidemic,” http://counselingoutfitters.com/vistas/vistas06/vistas06.

40. Jewish Talmud, Sanhedrin 37a. 41. 2 Timothy 2:24-26.