A review and response to the book "He Restoreth My Soul: Understanding and Breaking the Chemical and Spiritual Chains of Pornography Addiction Through the Atonement of Jesus Christ" by Donald L. Hilton Jr., MD (Neurosurgeon).
This response addresses chapter two, "What Is Addiction?" pgs. 7–12.
Ambiguous, Opinion and Tangential
It would be reasonable to expect that a medical doctor specializing in neurosurgery, in a chapter called, "what is addiction?" would include a well-informed, formulated, medically-sound definition and explanation of addiction. But the reader is void of any such clarity. Instead, Hilton interjects ambiguity, opinion and tangential reasoning, which has little to no relevance to addiction or porn as an addictive behavior. The inadequacy of this chapter is embarrassing, let alone completely baffling for a medical doctor to have authored.
Hilton presumptuously and arbitrarily defines pornography as, "anything that induces an inappropriate sexual interest for that person."
This statement is potentially one of the most blatant evidences of Hilton's ignorance and inexperience on the topics of addiction and pornography. Nonetheless, his lack of experience aside, as a trained medical professional, I am confused as to how he can assert this as a "functional definition." It lacks complete functionality. As mentioned in chapter one's response, he leverages familiar terminology within the LDS culture but fails to deliver substance. This is far from a functional definition.
First, "anything that induces an inappropriate sexual interest" is completely subjective, cultural, individual and familial. Who defines "inappropriate"? The bishop? A therapist? Parents? Society?
For example, a 19-year-old woman meets with me regarding her confusion regarding "inappropriate" sexual thoughts and behavior. For the last three years she had been concerned with particular thoughts and behavior, which she at first thought were normal and "appropriate." However, after talking with her bishop a few years ago, he expressed a heighten concern and took "preventive" measures to prevent the behavior from escalating.
Although the young woman wasn't spiritually concerned and was only talking with her bishop because she felt it was the right thing to do, the bishop’s response made her feel she was committing a serious sin. Now, three years later she is experiencing anxiety and spiritual confusion. What complicates this situation more is how her new bishop at college has responded to the behavior. The young woman said the bishop "was not concerned in the least" with her thoughts and behavior. In fact, he emphasized that it was normal and not something to be concerned about.
In another example, one young man sought treatment for his "pornography addiction" and "inappropriate sexual interest." This young man at 14 experienced a life transition when his parent remarried and the step parent moved in with a 16-year-old daughter. In his words, she was beautiful and he was experiencing "inappropriate sexual interest." At an age when his erections are unpredictable and frequent, it was difficult for him to keep his mind "pure." He had no desire to be inappropriate, and he didn't act out any feelings; in fact, he ended up locking himself in his room most of the time to avoid any potential "thoughts." Based off Hilton's definition, this young man is experiencing porn.
Many adolescence and adults believe they are experiencing pornography based on the subjective definitions of other people. One couple had an agreement to not go to either the beach or the gym. The wife expressed concern that her husband seeing other women in bikinis would trigger inappropriate thoughts. The husband had the same concern for his wife going to the gym and seeing men lifting without a shirt.
Second, Hilton fails to understand the contradictory nature of his opening paragraph when he further states, "Each person knows in his own heart what is a temptation for him, and that is the true test." What?! That is your functioning definition of pornography?! He just made a highly subjective statement of "anything that induces an inappropriate sexual interest" then leaves it up to the individual to determine what is inappropriate. Hilton's profound lack of understanding human nature, cultural influences and family dynamics on an individual is glaring. As you will discover, this lack of understanding feeds into every aspect of his book.
Third, it’s no surprise Hilton’s "functioning definition of pornography" is incoherent and unscientific because there is NO functioning definition of pornography.
If you ask a thousand people to define pornography, you'll get a thousand different answers. It is the only treated "illness" that has no specific definition of the problem or recovery. Mark Kim Malan, Ph.D. addressed this significant problem in A New Taxonomy: Scientific Misuse of the Term "Pornography", the following are extracts from his paper.
"Since the term ‘pornography’ has no agreed upon scientific definition, and since it has evolved into a term associated with pejorative bias, what terminology can scientists use to replace the term ‘pornography with a more accurate unbiased variable?
Efforts to answer this question led to examining not only the many various definitions of the term ‘pornography’, but also when it is used as various parts of speech. Such usage effectively expands and multiplies its definitions. Usually the term is used as a noun to define an object, for example when a photograph is called pornography. But also, it is sometimes used with an adjective to describe an object, usually in a pejorative way. An example would be the term ‘political pornography.’ A third approach is using the term to express individual subjective interpretation of an object. In this case pornography is modified into an adjective to describe another noun. The statement, ‘The Edsel, was simply a “pornographic automobile design”,’ would qualify as such an expression."
Dr. Mark Kim Malan continues to explain in his paper,
"Historically the term ‘pornography’ has an unreliable history of usefulness as a scientific term. Instead, it is a social construct of the human mind. Its social use is vague, inaccurate and is often co-opted for use as rhetoric by those who use it to further their social or political agendas. Over time the term has taken on negative connotations, and is now, also used as a pejorative term, in expressions of disapproval. The term ‘pornography’ is like using the term ‘lemon’ to describe an automobile. It describes a negative quality of an object in the minds of many people.
Sexual scientists look ridiculous, at best, and unethical at worst, when we refer to therapeutic depictions of healthy sexual behavior as ‘healthy pornography’. To the public, who colloquially views the term as a pejorative expression, the term ‘healthy pornography’ becomes an oxymoron. To the public, it is a contradiction in terms. It is like hearing the term ‘healthy poison’.
The term ‘pornography’ has socially evolved over time into a negative term. It has become ‘sexy stuff’ with bad press. Now is the time for scientists to break a bad habit of using this socially biased, non-scientific term. As scientists we create problems for ourselves when we adopt unscientific terminology that has culturally evolved, and is loaded with cultural or moralistic bias. We handicap the social effectiveness of our research when we use such terms.
The term ‘pornography’ is not going to go away. The public, politicians, moralists and the press will continue to use it to promote their agendas. Replacing the term ‘pornography’ with ‘sexually explicit material’ is a step in the right direction, but still the problem remains of who decides what is ‘sexually explicit’. This term, like ‘pornography’ is a subjective interpretation of an object, or group of objects.
As a solution, I am proposing this taxonomy of objects and subjective human response, for use in naming, and specifically defining objects as scientific variables. Instead of using the term ‘pornography’, I suggest naming objects and the human subjective responses to them in a more specific and standardized way, using this taxonomy as a guide.
When others use the term ‘pornography’ in dialog with us, we can simply respond by stating facts: ‘The term “pornography” is not scientific. There is no agreed upon scientific definition. It is more scientifically accurate to talk about specific objects and how individuals subjectively respond to them’. It is our responsibility to teach the public to be accurate and think in scientific terms."
Defining Addiction – Wait what just Happened?
The reader is left to fill in a void as wide as the Atlantic as Hilton transition from a "functional definition" of pornography to a "structural definition" of addiction. Is he suggesting any and all pornography is a form of addiction? What is he saying? This is HUGE! Am I an addict?!
Nonetheless, Hilton fails again at any reasonable or coherent attempt to define "addiction." Instead, he quotes a "structural definition" of addiction, from what appears to be a random article in a journal published in 1979! "Addiction represents a pathological, yet powerful, form of learning and memory." (Memory deficits associated with senescence: a neurophysiological and behavioral study in the rat)
First, this is in no way a structural definition of addiction. At best, it’s an outdated hypothesis describing the potential effects of hard drug use.
Second, literally no clinician refers to, defines or explains "addiction" in this way. Furthermore, this is completely tangential. Hilton is making a false assumption and unsupported conclusion that hard drug use is the same as porn use.
Third, Hilton confuses and uses "process (behavior) addictions," compulsion, chemical addiction and sin interchangeably.
"Applying this definition (structural) to pornography, addiction is simply a repetitive behavior which damages the person and others in his life and which the person is unable to stop." (pg. 6)
Aside from this being a poor and problematic definition of addiction, this more closely describes a process/behavior addiction. Or rather, an unhealthy habit. His statement, "addiction is simply a repetitive behavior which damages … " suggests habit and is also confusing in the context of the chapter and book. Is the action "simply a repetitive behavior" that causes damage? Or is it,
"The impaired thinking alters the belief system, and the acting out becomes the drug that reinforces the impaired beliefs … . [the] Brain chemicals and the adversary synergistically act in an unholy alliance of soul-searing destruction." (pg. 11)
This definition, also problematic and not how medical or professionals refer to chemical addiction, is more closely aligned with substance abuse.
Also, take note of the unnecessary use of the adversary in this definition. This is a foreshadowing of the frequent misuses of the gospel to elicit fear. Hilton solidifies his ignorance regarding human behavior and the gospel with each similar statement. What value does he think he is providing by emphasizing "the adversary synergistically act in an unholy alliance of soul-searing destruction"?
Sin and the adversary's power is a function of our agency, not a biological impairment. This narrative of Satan and brain chemicals isn't unique to Hilton. It’s a popular pop-psychology idea adopted by inexperienced therapists and treatment organizations. For the purpose of drawing in the "religious" element of addiction, this topic is so convoluted and pervasive that I will need to address it throughout the various chapters. In short, this is a perfect example of men wresting the scriptures, mingling science, religion and the concepts of men. It’s damaging and destructive; ironically this misuse causes much unneeded "soul-searing destruction."
For example, a young man sat in my office with a blank look on his face. This kid was known as a model youth, charismatic, loving of the gospel and serving fully in his callings; however, as he sat and described the horrific despair and soul-crushing fear he possessed, one would have thought he committed the unpardonable sin, or murder. In his words, he was "evil." Why? Because he was "addicted" to pornography. This young man was on the verge of losing all hope. He is not alone; this is not an exception.
Although his porn use was habitual, it wasn't an addiction — far from it. But according to Hilton and his bishop, both untrained to provide this type of counseling, had nonetheless convinced this young man he was in danger of losing his salvation and being controlled/possessed by the adversary. After working with this young man, although his porn use was still being addressed, he returned to the joyful and hopeful teen he once was. By unlearning concepts like Hilton's statement, this teen is now on a path to recovery.
Habits, compulsion, chemical addiction and sin are sometimes overlapped. But they are NOT the same, these behaviors will be addressed why its critical to understand the difference for successful treatment. Hilton's failure and even neglect to define or adequately explain addiction is abysmal. Not a single reference to scientific literature, diagnostics manuals or research. He doesn't provide any clarity or insight in this chapter on "addiction". The reader is left to believe, whether they have had one "inappropriate" sexual thought or many, are addicts like those using hard drugs.
What does the medical field actually say about porn "addiction"?
Hilton's beliefs are not only wrong scientifically, he is going against the teachings of our leaders. Elder Dallin H. Oaks has said,
"We recognize these different levels, we also recognize that not everyone who uses pornography willfully is addicted to it. In fact, most young men and young women who struggle with pornography are not addicted. That is a very important distinction to make—not just for the parents, spouses, and leaders who desire to help but also for those who struggle with this problem." (Recovering from the Trap of Pornography)
Elder Oaks embraced a more scientific and correct view of (1) inadvertent exposure, (2) occasional use, (3) intensive use, and (4) compulsive use (addiction). Hilton on the other hand doesn't believe in such varying degrees of use.
As for the scientific definitions, neither of the two official medical classifications and diagnostic manuals, the ICD-11 (International Classification of Disease, used as a coding manual in healthcare) or the Diagnostic and Statistical Manual of Mental Disorders (DSM 5 or the DSM-IV-TR) contain a diagnosis for porn or sexual addiction.
This is a critical fact that Hilton neglects to address in this chapter. Its very possibly why he avoided the topic at all.
The most recent addition to the ICD-11 allows for a classification of "Compulsive sexual behavior disorder." This is a critical distinction from "addiction."
"Compulsive sexual behaviour disorder is characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour. Symptoms may include repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities and responsibilities; numerous unsuccessful efforts to significantly reduce repetitive sexual behaviour; and continued repetitive sexual behaviour despite adverse consequences or deriving little or no satisfaction from it. The pattern of failure to control intense, sexual impulses or urges and resulting repetitive sexual behaviour is manifested over an extended period of time (e.g., 6 months or more), and causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviours is not sufficient to meet this requirement." 6C72 Compulsive sexual behaviour disorder
Take note of the very specific language used in this classification, particularly to the last sentence: "Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviours is not sufficient to meet this requirement." Hilton's entire book is basing addiction on "moral judgement and disapproval about sexual impulses, urges or behaviours ... " An article about the ICD-11 explains compulsive sexual behavior disorder:
"Concerns about overpathologizing sexual behaviours are explicitly addressed in the diagnostic guidelines proposed for the disorder. Individuals with high levels of sexual interest and behaviour (e.g., due to a high sex drive) who do not exhibit impaired control over their sexual behaviour and significant distress or impairment in functioning should not be diagnosed with compulsive sexual behaviour disorder. The diagnosis should also not be assigned to describe high levels of sexual interest and behaviour (e.g., masturbation) that are common among adolescents, even when this is associated with distress.
The proposed diagnostic guidelines also emphasize that compulsive sexual behaviour disorder should not be diagnosed based on psychological distress related to moral judgments or disapproval about sexual impulses, urges or behaviours that would otherwise not be considered indicative of psychopathology. Sexual behaviours that are egodystonic can cause psychological distress; however, psychological distress due to sexual behaviour by itself does not warrant a diagnosis of compulsive sexual behaviour disorder.
Careful attention must be paid to the evaluation of individuals who self‐identify as having the disorder (e.g., calling themselves “sex addicts” or “porn addicts”). Upon examination, such individuals may not actually exhibit the clinical characteristics of the disorder, although they might still be treated for other mental health problems (e.g., anxiety, depression). Additionally, individuals often experience feelings such as shame and guilt in relationship to their sexual behaviour2, but these experiences are not reliably indicative of an underlying disorder." (Compulsive sexual behaviour disorder in the ICD‐11)
The diagnostics manuals have written the diagnosis in this way for two reasons. First, there is little to NO evidence that porn/sex is an addiction. Second, writers of the ICD particularly have identified a growing trend of self-diagnosis and clinicians misdiagnosing patients. Any medical practitioner understands the great risks in misdiagnosis individuals, but this concept seems completely lost on Hilton.
In chapter six "It is a Drug," Hilton argues that porn/sex are not only an addiction but are exactly like a drug. I'll address those specific studies he quotes and his failure to understand the research. Even when the authors of the research specifically say its not like a drug.
Currently, there is an active scientific discussion about whether compulsive sexual behaviour disorder can constitute the manifestation of a behavioural addiction. For ICD‐11, a relatively conservative position has been recommended, recognizing that we do not yet have definitive information on whether the processes involved in the development and maintenance of the disorder are equivalent to those observed in substance use disorders.. (Compulsive sexual behaviour disorder in the ICD‐11)
(Additional information about CSBD: Compulsive Sexual Behavior Disorder in ICD-11)
A Special Form of Insanity and Circular Reasoning
Hilton, without defining addiction or a meaningful criteria for pornography has effectively pathologized each reader. Dooming each reader to a terminal mental illness, he then moves directly into a section he calls "A Special Form of Insanity," in which he leads the reader to believe they are experiencing yet another mental disorder as a result of their "addiction" and "sinful" behavior. But when you don't think Hilton could be any more reckless in his misdiagnosis and labeling individuals insane, he categorically judges addiction as the "very definition of selfishness, the ultimate contracture of perspective."
In words that can only be spoken by someone who hasn't worked with addiction, Hilton boils this complicated and complex issue down to a "basic problem in addiction is rooted in perspective. Pride, stemming from a lack of gratitude, allows the person to entertain desires that selfishly disregard the consequences visited upon not only the addicted one, but also upon his loved ones." Furthermore he believes "willpower" is the means to sobriety.
A few years back, a bunch of friends of mine were praising an individual for his financial prowess. They were impressed with his insights into and strategies for "playing the market" and improving wealth. Because of my background in finance, my friends thought I would also be impressed with this individual’s perspectives. Although this individual knew I had a career in finance and a strong knowledge of the market, his confidence preceded him. Not five minutes into his dialog, it was clear he didn't actually know what he was talking about. He used the right lingo but out of order. There were nuances in his communication that would sound impressive to someone without a financial background but complete garbage to someone trained in the field. Sure enough, he was attempting to set up a ponzi scheme of sorts, which would have wrecked my friends’ financial futures.
Hilton confidence precedes him too; he uses all the correct lingo, but confuses basic terminology and is dangerously reductive, which can harm the reader. He plays a dangerous game of circular reasoning, leading the reader to believe that if they are denying, they are addicted; it’s because they are sinning and experiencing a form of insanity. The solution is willpower through the atonement and to give up being selfish. I cannot image the lives this chapter alone has wrecked.
Finally, and again, in a tone of irony that is carried throughout the book, the only "expert" he draws on in this "addiction" chapter is Patrick Carnes who famously self-promoted as, "the acknowledged expert in a field that until recently didn’t exist," who made his living and fame off diagnosing individuals with a non-existent illness. Hilton follows up in the next chapter "The Money Trail."