Shame: A Treatment Perspective
"Shame", a film by Steve
McQueen, is a window into the tragic life of a sex addict in New York City. Brandon Sullivan is a thirty-something advertising executive who seems to be constantly engaged in compulsive sexual activities. When his
troubled sister moves in, Brandon's addictive routine is disrupted, escalating his already destructive behaviors to the point of significant physical, emotional and spiritual pain. What are we to make of Brandon's
sexual behavior from a treatment perspective?
Sexual Addiction Criteria
In Facing the Shadow, Patrick Carnes lays out ten criteria that help identify a sex addict. According to Carnes, only three criteria have to be met for addiction to be present. First, sex addicts
experience "distress, anxiety, restlessness, or irritability if unable to engage in the behavior." This is apparent when Brandon's sister comes to live with him for a period of time. When his normal routine is
disrupted, he becomes frustrated and angry, further aggravating his addiction.
Second, sex addicts frequently engage "in the behavior when expected to fulfill occupational, academic, domestic, or social
obligations." Because of his sex addiction, Brandon often arrives late to work or is absent for large periods of time. Additionally, he has infected his company's computer network with a virus as a result of downloading
pornography while at work.
Finally, sex addicts experience the "need to increase the intensity, frequency, number, or risk of behaviors to achieve the desired effect." This progression is seen toward the
end of the film when in one night we see Brandon attempt to seduce a woman at the bar (which leads to him being physically assaulted), receive oral sex from an anonymous man, and have intercourse with two sex workers.
These criteria, among others, qualify Brandon as a sex addict.
Type of Sex Addict
According to Patrick Carnes, there are ten types of sex addicts: fantasy, seductive role, voyeuristic,
exhibitionistic, paying for, trading, intrusive, anonymous, pain exchange, and exploitive. Brandon is primarily a seductive sex addict that engages mostly in anonymous and paid sex, as well as masturbation fueled by
fantasy and voyeurism. The preponderance of fantasy and anonymity in Brandon's sexual behavior reflects his distorted view of people as sex objects used for gratification purposes only.
Capacity to Form Attachments
Brandon's impaired capacity to form attachments is evident throughout the film. His friendships lack intimacy, revolving instead around work, booze and the conquest of
women. He is unable to commit for a significant period of time to a romantic partner, citing four months as his longest relationship. Finally, he views his own sister as a burden and is unable to connect with her
emotionally, even after witnessing her perform a stunning rendition of Frank Sinatra's "New York, New York." Like all sex addicts, Brandon's life is ruled by isolation. Sex, in one form or another, is his number one
priority, preventing him from connecting with anyone, including himself.
We would recommend that Brandon come to individual psychotherapy once a
week to learn about his sex addiction and, through the therapy relationship, begin to form a healthy attachment. We would also have him join our ten-week psychoeducation group to further bring him out of isolation and
learn about the tools of sexual recovery. Finally, we would refer him to a 12-Step sexual recovery program such as
Sexual Recovery Anonymous, where he could develop supportive relationships, learn about the disease of sex addiction, and practice the tools of recovery.