My father sleeps with prostitutes. This is his late-life confession to us, his children and his wife, and he makes it on the shore in Florida: Florida, the state with the prettiest name and the skankiest underside; Florida, a place where the beach is as white as a baby's bed sheet, and there are hookers galore, feathered, bangled, pointed and pierced, blooming like hothouse flowers above the black sewer grates of the southern city near where my father lives.
     From the beach where we sit, I can smell that city, Miami. I can see the high-rises, sharp as syringes, poking through the hot smog. But it all seems so far away. Here, on the sand, my father is a little man. He is an older man, his red hair fading to gray. "I'm sorry," he says. His wife, my stepmother, looks pale, with trembly lips. My father turns over his wrist, so we can all see the display of veins, trefoiled and stringy. Very deliberately, he raises one forefinger and palpates a vein, over and over, and then makes a little whisking motion, as though to slice it.
     "Dad?" I say.
     Meanwhile the waves flounce in and out, each one frilled as a petticoat.
     "Dad?" I say again.
     "It's a disease," he says. "I have a disease."
     "Sex," I say, "is a disease?"
     "Not sex," he says, "but sex addiction, which is what I'm telling you I have. It's been diagnosed."
     That's that then. Say the word "diagnosis" and all the other doors — the ones that open onto sin, or spirituality, or responsibility — click closed. Diagnosis is slim as a test tube, its circumference confining but safe. My father has a disease.
     He then tells us, there on that beach in Florida, that his behavior, which of course he's kept hidden from us, has been going on for the past ten years. He tells us what the disease of sex addiction consists of — its symptoms, so to speak, which include compulsive sexual behavior concealed from family and friends, repeated failed attempts to stop the behavior and persistent sexual fantasies that interfere with functioning. He tells us that he loves us all very much, that he loves his wife, that he is sorry. He reports that he's in treatment: a twelve-step group called Sex and Love Addicts Anonymous; four-times-weekly behavioral therapy and psycho-therapy; a cartload of medications, pills for depression and anxiety; and then, at last, a particularly ominous sounding medication, what he calls — what is called — an antiandrogen, a testosterone-suppressing compound that evaporates the libido.
     I listen to all of this. I feel so many things. I feel sad for my stepmother. I worry that they will now divorce. I can't believe my father, my little rabbinical father, has so much roar and romp in him. Part of me is proud. Part of me is horrified. Part of me is pissed and very suspicious.
     This "illness" thing. This disease. Does he think we'll let him off the hook if he can concoct a pathogen? We leave the beach and go home. Tomorrow I will fly back to Boston. Tonight, in my father's house, I go through his cabinets, skeptical. My father apparently loves disease. I find his sleeping pills (is sleep a disease, or lack of it?), I find his antidepressants, his dexedrine (is laziness, indolence, a disease?) and then what I guess are his antiandrogens, smooth pills, pink pills, of course, I put one on my tongue and it tastes confectionary, tastes pastille, a little bit like peppermint, and later on that night, alone in my bed in my father's house, I touch myself and feel dead.

I want to talk about disease. I am not dead. I am in my mid-thirties. I am married and have sex and have a child. I am a writer and also a psychologist, which means I have the type of training that involves many mice and fat rats, elaborate mazes and smears of brie cheese, measurements, tissue samples, stimuli. In the world of the scientist, a world psychologists claim they are a part of, disease has anatomical correlates. It can be viewed beneath a microscope. It appears in tangles and plaques. Disease is the wayward cell, the hole in the lining of the stomach. Diseases are the swollen ventricles on the schizophrenic's brain, or the lit-up lobes of the obsessive's, all stoplight-orange and crisis-red, a burning.
     If sexual addiction, as my father and his bevy of experts claim, is indeed a disease, then it must have physiological or biochemical manifestations. This is what I think. I think it that night, in my father's house. I think it the next day, flying back on the plane. I think it in Boston, where I live. Call me cold. Call me frigid. I should want to soothe my father, or my stepmother, a beautiful, showy woman with perpetually moist red lips and adorable toes, each one a little pearl-dropped doll. I should think about the family, not the science, but I am a little cold. People tell me so. "You know," people sometimes tell me, once they know me well, "you can be a little cold." At parties I stand in one corner and do my fair share of glaring. I am decidedly not demonstrative, except with my dogs. Dogs are perfect.
     Human beings are not, and biological explanations have created the great moral loophole through which we all now seem to slip. I can't; I must; I have to; it's inherited. It's in my genes. And yet, if sex addiction is an illness, then who's to say that its chemical cousin, sex itself, or lust, or even love, are not sub-clinical expressions, or minor diseases, themselves? Maybe sex is to sex addiction what the common cold is to pneumonia. Maybe every arousal, every kiss, every baby is not an expression of health, but of decay, of death.
     The point, the real point: If sex addiction is a disease, I want to find it. I want to hold it in my hand, like a cholesterol-clogged heart. I am driven in part by curiosity, in part by love for my father. I decide to do some research.
     I am surprised by how much pops up on my computer screen. There are sex addiction FAQs and self-administered tests that deliver a diagnosis pronto, a yea or nay, a judgment, an absolution. One test, called the Sexual Addiction Screening Test (SAST), consists of twenty-six questions ranging from "Were you sexually abused as a child or an adolescent?" to "Do you regularly engage in sadomasochistic behavior?" to "Have you ever participated in sexual activity in exchange for money or gifts?" Many of the questions focus on fantasy, which seems to be a core component of sex addiction: repetitive masturbatory dreams. It is impossible, reading through the questions on this test, not to imagine my father in a way more intimate than I would like. The prostitutes I can handle, as there is something slightly exotic and even Bukowskian about the whole thing — red lights, ladies of the night — but the masturbation. Does he really do that? Solo sex is suddenly, here, the ultimate taboo; we know our parents as a part of us, relentlessly relational, and yet they're not, he's not. I imagine him, because I cannot help it, passing hours, days, lost in a hot haze, his penis huge in his hand, the compulsive choking while a cocker spaniel sleeps in the well-appointed living room; this is not my father. But apparently it is. And if genes are catchy, which we all know they are, then in some sense, this is me too.
     As for the gene or set of genes responsible for sex addiction, none have been definitively identified. I do, however, find a set of biochemical theories, pioneered in part by the psychiatrist Martin Kafka (an unfortunate last name indeed for a sexologist). Kafka has explored what he calls the monoamine hypothesis of sex addiction. "Monoamines" is an umbrella term for three crucial neurotransmitters in our brains: dopamine, norepinephrine and serotonin. According to Kafka (who is an assistant professor at Harvard Medical School and an attending psychiatrist at McLean Hospital in Belmont, Massachusetts), people with deviant or compulsive sexual behaviors may have a disturbance in the neurotransmitters of one or all of these chemicals. The most probable culprit is serotonin. Although a debate currently rages in the psychiatric community as to whether serotonin levels consistently correlate to any kind of psychiatric disorder, Kafka, for one, suspects serotonin exists in unusually low levels in people with sex addictions. One study published in a respected psychiatry journal found that decreasing serotonin levels in rodents and cats led to an increase in mounting behavior. Conversely, increasing serotonin levels, through good friends like Prozac and Zoloft, is known to inhibit the sex drive.
     This hypothesis is interesting in all sorts of ways, primary among them, its implication for how we view depression. Depression is also associated with low serotonin levels and many sex addicts carry a secondary or primary diagnosis of dysthymia, or low-grade depression. The most obvious assumption is that a sex addict engages in sex to relieve depression. However, sex, or hypersexuality, may in fact be driven by depression, may be a part of the depression, not its misguided cure. If this is the case, then depression is not only diminishment, but a disregulation in either direction; it can exhibit itself as enhancement, appetitive; it can provoke hunger as well as numbness, jagged peaks as well as white flatness, depending on who it's targeting. Depression as an aphrodisiac, a stimulant, an inducer of orgasms — how odd.
     "And yet," says Dr. Charles King, a psychologist who specializes in the study and treatment of sexual addictions, "this is all in a speculative stage. Hormones probably play a role as well as monoamines, but no studies have shown any consistent findings." That ninety-five percent of the sexually addicted population is male, however, does suggest that testosterone may be implicated.
     "So do you think," I ask Dr. King, "that sex addiction is primarily the result of faulty chemistry — that it's a disease?"
     "Yes," he says, and that depresses me.
     I suppose I should come clean here. I have my own impressive history of eating disorders and other psychiatric ills. Myriad addictions flow through my family's blood lines. I have a one-year-old daughter with half my genes (don't let her be doomed). I had always thought my father was the one more or less healthy outpost, a strong branch in our family tree. With his confession, I now cannot point out a single first-degree relative who is not somehow sick. I would rather be sinful than sick. A sinner, after all, can be saved, but a patient whose illness exists at the level of genes, at the level of inherited chemistry, such a patient cannot be cured. Such a patient can at best be given an Eli Lilly or a SmithKline Beecham crutch.
     Dr. King tells me about Sex and Love Addicts Anonymous (SLAA), where many people with the diagnosis go for treatment. This is the twelve-step group my father mentioned. Late at night, I call information for the number. Do I imagine it, or does the operator deliver the listing to me in a voice of disapproval? "Come to bed," Benjamin, my husband, says. "I feel strange," I say, and lying next to him, I keep picturing the operator, and in my mind she has hair in a prim little bun, and her hands are very old. The house we live in is also very old, and suddenly I am sure the smoke detectors don't work. A fire crackles. The baby cries. Outside a bird is picking picking picking at the scab of the sky. Sometimes sounds hurt. Sometimes babies cry. "Shhh," my husband says to me, and we make love, or make disease, and when I stand up afterwards, semen pours from me like pus.

©2000 Lauren Slater and Nerve.com, Inc.