But anti-porn crusaders have sometimes insisted that they have proof of what Judith Reisman calls "erototoxins" as powerful as the most addictive drugs. In 2004 she testified before a Senate subcommittee on the "science behind pornography addiction," saying that advances in neuroscience had revealed the effects of erototoxins.

Now, though, her Lighted Candle Society is asking for donations to fund scientific studies to produce the evidence she told Congress already existed, evidence McGill says he’d like to generate, too.

McGill’s own Ph.D. in psychology (he is not currently licensed as a psychologist, needing, he says, to complete one more test) comes from Azusa Pacific University, a self-described "evangelical community of disciples and scholars who embrace the historic Christian understanding of Scripture." (His thesis project was the creation of a Bible-based sex-addiction program to serve the homeless in Los Angeles.)

The university believes that "sexuality is to take place within the context of a marriage covenant between a man and a woman and that individuals remain celibate outside of the bond of marriage. Therefore, we seek to cultivate a community in which sexuality is embraced as God-given and good and where biblical standards of sexual behavior are upheld."

Cost of breaking a sex addiction
McGill is a board member of the Society for the Advancement of Sexual Health, a group created by Carnes, and is certified by the International Institute for Trauma and Addiction Professionals, another Carnes creation. Therapists can achieve certification as sexual-addiction specialists by completing IITAP courses. A five-day intensive training course, for example, costs $1,250.

The standard in-patient 45-day treatment at the Gentle Path facility in Mississippi costs $37,100. If all 350 patients McGill says Gentle Path has treated since 2005 paid the regular amount, the organization has taken in almost $13 million in two years.

"The sexual disaster industry makes so much money out of scaring the hell out of people," Klein argues.

None of which is to say that the work going on at Gentle Path does not help some people or that pathological sexual behavior does not exist. Inappropriate and destructive sexual expression certainly does exist and people do suffer from what renowned sexologist Eli Coleman, director of the human sexuality program at the University of Minnesota, prefers to call "compulsive sexual behavior." Sexual compulsives may have some other underlying problem, like obsessive-compulsive disorder, depression or bipolar disorder, he says.

"Or they are psychotic," Klein says, "and the vehicle they use to express that happens to be sexual behavior. If we lived in a culture that was more comfortable with sexuality and not hysterical about it, we would not get hung up on the sexual content of their behavior but rather would focus on the problematic decision-making … when people wash their hands 20 times a day we do not send them to a hand-washing clinic, we treat their OCD." It could also be, Klein says, that some "sex addicts" are just selfish and prefer not to exert control over their sexual lives.

McGill agrees that other psychological problems may underlie pathological sexual expression, but says it can work the other way around: that the sexual addiction itself can create depression or anxiety, for example.

Dr. Thomas Mick, a psychiatrist at Mount Sinai School of Medicine in New York, agrees with certain points of both sides.

While there is no physiological dependence in "sex addiction" like there is with alcoholism or narcotic addictions, and while there are no physical withdrawal symptoms, people who are kleptomaniacs, pyromaniacs or "sex addicts" can exhibit some of the same behaviors as those who are chemically addicted, he says. No matter what you call it, some people are in distress.

Klein, McGill and the others do agree on one thing. If the form of sexual expression is not creating problems in one’s life, there is no need for treatment. In fact, the definition for "male hypersexuality," another term thrown into the mix, includes having more than seven orgasms per week, only because most men do not have more than seven orgasms per week. It could be that a man who does has a problem, or just has a very fulfilling marriage.

The debate over sexual addiction highlights concerns over whether society can literally impose a diagnosis by declaring certain activities unacceptable. This was the case with homosexuality, which was once a diagnosable disease mainly because society frowned on it.

This cultural influence is why sexologist Coleman, who has tried to seek a middle ground in the debate, has a word of caution. "In order to avoid overpathologizing," he has written, "it is important for professionals to be comfortable with a wide range of normal sexual behavior — both types of behavior and frequency of behavior. And it is important to look at all sexual behaviors in context."

MSNBC.com columnist and Glamour magazine contributing editor Brian Alexander’s book, “America Unzipped: In Search of Sex and Satisfaction,” will be published Jan. 15 by Crown/Harmony Books.

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