Does Clinton need sex therapy?

Is he a sick man, hooked into a repetitive series of sordid encounters despite his every effort to resist?

IN THESE supposedly rational times, the spectacle of someone repeatedly engaging in sexual behaviour which is dangerously risky, and, potentially, exceedingly self-destructive, provokes many people to resort to some psychopathological explanation. Many see President Clinton as an Artful Dodger who just got caught, or just someone who, as Gore Vidal once memorably argued of powerful men, has more opportunity than most to seduce impressionable women.

The more psychologically minded wonder whether he is a sick man, unable to control his sexual impulses, hooked into a repetitive series of sordid encounters despite his every effort to resist - in other words, addicted to sex.

The problem with the indiscriminate application of the term "addiction" to unwanted, disreputable, or seemingly inexplicable and repetitive behaviour, is that it more often than not involves a circular argument. So, in relation to Bill Clinton's sexual activities, there is more than a touch of the "Clinton cannot keep his hands off pretty, young women because he is addicted to sex - Clinton is addicted to sex because he cannot keep his hands off pretty, young women" kind of reasoning. Nothing very much is explained by labelling Clinton's sexual indiscretions the result of an addiction, unless there is some additional, supporting evidence, distinct from the behaviour the label is supposed to explain.

In the maelstrom, it is possible to detect a temptation to resort to the world of psychopathology and psychotherapy for cause-and-effect explanations - the President himself has spoken of "feeling pain, closure and healing" - and there has even been discussion as to whether he has sought, or been offered, psychiatric treatment. But it is a temptation, like all those other temptations, that might be better resisted.

Psychiatrists and psychologists, criminologists and philosophers, have all wrestled with the problems of impulse control for years now: problems of people peculiarly prone to relentless acts of mindless violence; repetitive stealing; fire-setting; pathological drinking; drugs and gambling. In the case of addiction to drugs and alcohol, there is supporting evidence of mind-altering effects of drugs such as opiates, alcohol, barbiturates and the benzodiazepines. Take enough of certain mind-altering drugs for long enough and then, when suddenly deprived of them, your body and mind experience a variety of well-recognised and distressing withdrawal symptoms.

Even here, however, there is room for argument. Modern cognitive therapists insist that it makes better sense to see the persistent misuse of alcohol, not as evidence of some physiological "addiction", but as a result of the way that the individual, over time, has learned to use the substance, taking into account the interaction between the individual's personality, and the social and cultural context in which the substance abuse occurs. Using such a argument, Clinton's sexual behaviour is not so much the result of some kind of physiological addiction, as the consequence of a learned view of masculine sexual activity, conditioned by the environment in which he developed, and a culture within which he works.

When it comes to addiction to work, shopping, food or sex, the problem becomes much more complicated. There is a dearth of consistent physiological findings to support true physical addiction, although there is much speculation concerning changes in brain neurotransmitter functions, endorphins (the opiate-like substances produced in the brain), and in amines such as serotonin and neuroadrenaline, believed to be highly important in the regulation of mood.

In the American Psychiatric Association's classification guide, the 4th edition of the Diagnostic and Statistical Manual, or DSM-4 as it is called, there is a section devoted to problems of impulse control. Sexual addiction does not figure, but there are references to kleptomania, pyromania and pathological gambling. In each of these activities, there is a common cluster of behaviours. First, there is a persistent failure to resist impulses to steal objects that are not needed for personal use or gain (kleptomania), to set fire to things (pyromania) or to gamble. Then, there is an increasing sense of tension immediately prior to performing the pathological behaviour, and pleasure, gratification or relief at the time of performing it. In the case of pathological gambling, there are repeated unsuccessful efforts to control, cut back or stop gambling, and lies to family members, therapists and others, to conceal the extent of involvement, and the individual's marriage, job, and educational or career opportunities, are invariably jeopardised because of the gambling.

Extrapolating from the categories of gambling or kleptomania to sex is not difficult, and there has been no shortage of experts prepared to do so in the case of President Clinton. There is the President's seeming inability to control his sexual impulses. There are the lies, evasions, justifications and deceits. There is the very obvious risk and jeopardy to family, public status and job. There may, or may not be, various psychological and physiological tensions prior to his indulging the behaviour, and relief, additional to sexual relief, afterwards. But the question begged by this purely descriptive approach is the question that the categories are supposed to be all about: how far can Clinton be said to have some impairment of control over his behaviour?

We know he didn't control it. But do we know whether he wanted to control it, whether he tried repeatedly to control it, and repeatedly failed?

And this is where it starts to become even more complicated. Despite the enormous detail concerning Clinton's sexual behaviour contained in the Starr Report, we don't know that much of Clinton's own view of it. The President has spent so much time lying and deflecting and denying, that it is not possible to conclude, with any confidence, whether he himself felt he could not control himself, or believed that he really did not have to.

It is an important distinction. Monica Lewinsky's account does suggest that he tried to terminate the relationship on 19 February 1996, because he "no longer felt right about their intimate relationship", but within six weeks they were meeting again. Could he have stopped? Did he have distressing physiological and psychological symptoms when he refrained from seeing her? Did he have a sexual relationship with anyone else in the meantime? And does any of this really matter now, since, addicted or not, Clinton now has little choice but to cease his impulsive behaviour?

But, yes, it does matter - for the sting in the tail of the addiction argument, if one can put it so inelegantly, is that it plainly categorises the President as a pathologically sick man who needs therapy. And the therapy he needs is plainly more than the spiritual ministry provided by the Reverend Jesse Jackson and his friends. It also has profound implications for the presidency, in that it suggests that the man with responsibility for the security of America, and indeed the world, suffers from a pathological inability (as distinct from a chosen refusal) to control his impulses.

Many may prefer to accept that Clinton freely chose to involve himself in repeated sexual encounters with a 21-year-old White House employee, rather than being helpless and in the grip of a pathological disturbance of behaviour. Anyway, we will almost certainly never know Clinton's sexual motivation, for even if he were to tell us, we would not know whether to believe him.

More repetitive than the sexual behaviour, is a pattern of lying, going back to whether or not Clinton had been drafted, and before. To speak of pathological lying might be semantically more accurate than to speak of sexual addiction. And it may be the lying rather than the sex that will bring the President down.