Tuesday, September 9, 2014

Pornography, mental health, and spirituality

I updated and rewrote this. Footnotes are at the end.-JN
 
It’s tough to be a man today; even tougher to be a sexual, Christian man. Messages from the church and from feminism seem to suggest, for different reason, that there is something wrong and shameful about men’s sexual energies, so men tune them out. Efforts among Christian writers to support men seem too often simply to support stereotypes about men, such as that we can’t tolerate introspection or inaction. Meantime, the secular culture offers constant titillation—scantily glad supermodels on every newsstand cover and alluring sexualized messages on every advertisement, telling us that with a bit more libertine approach to our sexuality, men can truly gain fulfillment and pleasure. Yeah, it’s tough out there. Not the least of the secular challenges is the easy availability of every flavor of pornography a man could want. Is porn wrong? Is it okay? Confronted with what feels like the thought police on one hand (church and feminism) and the international criminal cartels on the other hand (lurking somewhere in the background of pornography), many men, even Christian men, throw up their hands. They conclude that “If it’s not hurting anybody, it’s probably okay” and leave it at that.
I suggest we can do better than that. Am I going to tell you not to use porn? No, I’m not going to tell you what to do at all. Am I going to tell you porn is a problem? Yes, it is. And we can pull some insight from the church, from feminism, and even from the secular culture to form some considerations to help us arrive at a morality that may be practical and thoughtful in relation to pornography. I focus on pornography because I get asked about it a lot, both as a Christian man and as a clinical psychologist. With unprecedented availability via the internet, pornography is real problem for many people, especially for men[1]. How do we form our own conscience around use of pornography? I write from the perspectives of a male clinical psychologist and practicing Catholic Christian. I hope these personal reflections will help you take a step forward in formulating your own morality in relation to porn.
I have to begin by acknowledging that the dilemma, the lack of adequate moral guidance from our church, is genuine. We now know a lot about human sexuality that we did not know even a few decades ago. Church teaching has not caught up, and still relies on centuries-old formulations of the meaning of sexuality. A disconnect between daily cultural and psychological experience and church teaching has reached a kind of breaking point as a result. Church teaching can seem totally non-useful. A reflection on pornography comes in this difficult context.
What are some basic principles? A first basic principal is that our priority as Christians and as humans is to know the Real, more and more, and in so doing, to encounter God (Christ), and in so doing become more and more human, and ultimately more Divine. So we seek something more than pleasure or denial; we seek an integrated, noble, way of life, a way of life that is desirable and attractive. An integrated life by definition includes integrating our sexuality. Yet Christian religion is typically seen as suppressing sexuality. Taboos and shame became attached to sexuality. One challenge then is to sort out misplaced shame from genuine moral direction, when it comes to pornography, as well as other sexual topics.
A second basic principal assumed here is that sexuality is a sphere where ethics and morality can apply and that therefore a relevant principal is the Catholic and Christian core moral principle of respect for the person—the integrity of each person, each person is sacred, an “end in themselves and not a means only” because they are created by God, and because they are endowed with interiority, freedom, and responsibility.
In psychology we promote mental health. That’s good, but now our psychotherapy-infused culture has come to almost to equate mental health or “healthy” behavior with moral behavior. Obviously health cannot be equated with virtue. If it could, everyone who risks his life for his brother, or stays up late to work for the community, would be sinning. At the same time, the health of something warrants consideration. God wants us healthy as well as virtuous.
So what is mental health? It is the ability to cope flexibly and successfully with reality. It also entails the ability to engage ones' full self, emotions, ideas, productively both in competence (e.g., work) and relationally (e.g., in friendships, families, community). The aims of psychological health converge, then, at the ultimate level, with the aims of holiness: To become psychologically whole is to become human, and thus converges with becoming holy. It implies not only effective functioning but access to our capacity for wisdom and compassion, for intimacy and mastery/achievement, and for social participation.
          Pornography springs first from fantasy. From a psychological viewpoint, fantasy is healthy and adaptive. It is how we practice for new situations, it is how we discover a way to cope with a difficult problem, it is the root of creativity and of art, and it is a way for us to enjoy and entertain and discover ourselves. Psychotherapists routinely inquire into the fantasy life as a way to gain insight into the psyche and the concerns of a patient. Carl Jung once noted, "without this playing with fantasy no creative work has ever yet come to birth. the debt we owe to the play of the imagination is incalculable."
           But can fantasy go too far? Can it degrade us our ability to engage reality—our ability to become whole human beings? Few would doubt that, at the extremes, it can. Where are those extremes? Today our society is immersed in particularly vivid fantasy opportunities and stimulation, promoted in particular by internet technology. These fantasy opportunities include fantasy football, video games, romance novels, movies, science fiction, and pornography and erotica. A recent Sunday New York Times cover story[2] featured massive interest in spectator “e-sports,” that is, crowds gathering to watch sports interactions between fantasy characters. This ‘overload’ of fantasy material has proven difficult to keep in balance for many individuals and I sometimes wonder whether it has had the collective effect of disengaging us from solving the very real problems in our world and in our communities. These days, most fantasy worlds are far more appealing than the real one at least as it appears in the media.
Pornography is one of these forms of available fantasy and escalates in that context. Pornography refers to sexually explicit, arousing, titillating, and intentionally riveting material available on the internet and other media (including books) that has as its primary intention evoking sexual arousal in the viewer, that is to ‘sell the image” rather than primarily to explore beauty. However, this definition is subjective: What one person considers pornographic, another may consider beautiful or at least to have artistic merit.[3] Yet even if some pornography seems defensible as art while other porn is so crude or degrading that such a defense seems strained, the line between the two is nonetheless arbitrary.
This brings up a perverse problem with Catholic moral teaching and secular discussion alike: sexual imagery is pornographic and offensive (and unfit for children), while violent or dehumanizing imagery is not, unless is sexual. I consider extremely violent imagery to be pornographic because, even if not sexual, its purpose is to shock, titillate, and rivet the viewer with the goal of “selling” the image. Psychologically there is no meaningful difference between extreme sexual and extreme violent images; naturally therefore they are often combined in hard core pornography. Both leave indelible images in the mind and can shape subsequent behavior by virtue of their emotional intensity. Thus, when it comes to the moral aspect, whatever can be said about moral problems with sexual pornography also holds for extremely violent images in movies, television, video games, and on the internet. Spiritually, they are also virtually indistinguishable: Like certain kinds of sexual pornography, violent imagery even when it is nonsexual tends to dehumanize, reduce dignity, confuse the engagement with reality, and interfere with peace of mind. One important distinction, however, may be that more so than sexual material, violent material is empirically demonstrated to damage subsequent behavior in some individuals by making them more aggressive[4]. On the other hand, sexual material may be more prone to becoming addictive (below).
With the arrival of internet pornography we can enter an idealized experience of interesting and potentially extreme images and stories easily and privately. Fantasy material has certainly been part of human society for eons, but at present it is uniquely available. This new situation allows us in our home, in private, to access vivid, gripping photos, drawings, movies, videos, and stories that can titillate and arouse, to immediately change the images, to explore in a very short time increasingly extreme and unusual images and graphics, and to be stirred up and aroused in ways we had not expected. Furthermore this material is readily available to the young, to adolescents, and to those of any age who may lack the maturity necessary to integrate what they see.
Can there be positive aspects to this new situation? Perhaps for some individuals at some times, internet fantasy material can provide a means to relief, to comfort, to self-expression, to self-awareness, even to shared intimacy if shared together with an equally interested sexual partner. Human sexual diversity and variation is much greater than the few categories approved by our social institutions, and this can cause a sense of oppression and suffocation for some individuals, and erotica or pornography may be an avenue for self-discovery, even validation, in this way, because it offers “something for everyone.” For some who are lonely or alone, who need visual stimulation in order to gain some degree of expression in private of their sexuality, the use of erotica or pornography may be the best option available for sexual outlet. It is possible that some, perhaps many, people use pornography without apparent harm, at least to themselves. 
Yet a dark side, a destructive side, accompanies pornography like a plague. Often, it is out of control and functioning like an addiction (whether or not it really is an addiction in a formal sense like a drug). The industry itself is exploiting and harming those who are its subjects.
The first issue then is that if I use pornography, I can easily participate in a denigration of people, most often of women. This occurs at two levels. At one level, this is a nasty industry: some women (and girls, and men) are exploited and wounded via participation in pornographic productions[5]. This is a serious moral problem because it sets a social norm that supports exploitation of some people for the pleasure of others. We see an economic link between sexual tourism and human trafficking, and between pornography and human trafficking in that some participants in pornographic material are forced. As a viewer, I cannot tell if this is the case. Thus, morally and spiritually, I enter into a potentially dark, perhaps even satanic world if I engage with at least some kinds of porn products as a consumer.
So two immediate moral considerations are suggested: Is the material degrading to people? And is it possible that it involves real people coerced into participating (real human actors, who I may assume wrongly are voluntary).
But there is a third, a spiritual danger. As I enter into fantasy with the pornographic image, I am in fact encountering a darker reality—the reality of the industry that is exploiting, perhaps even injuring psychologically, even physically, the people I am viewing. So what is real, here, is not actually my fantasy but their suffering. Unless I engage that, I am not moving toward God. Thus, the pornographic fantasy takes me precisely away from God in this instance. If this is true, I must be as interested in where my porn comes from as health conscious people are concerned about where their food comes from, or as sweat shop advocates are concerned about where their clothes and shoes come from.
Does this mean all pornographic material with human actors is immoral? This is difficult when we consider that for second wave feminism (late 20th century) women who participated in the sex trade (prostitutes, pornography) were inevitably dehumanized, and so any image that echoed exploitation of women was immoral to use. However, for third wave feminism, sexuality can be playful and it is argued that women have the option being sexual entertainers because it may be expressive or empowering for them, so long as they truly have free choice. However, for men as consumers of pornography, this distinction may be moot. Lest we use third wave feminism as an excuse to let pornography become a “morality free zone,” we have to caution that it is very difficult to know if the women I am viewing in my porn material are free. Still, efforts to develop criteria for “ethical porn” have grown out of this type of concern. For example, the Ethical Porn Partnership (http://ethicalporn.org/ accessed 11/1/2014) supports pornography that protects the rights and choices of the actors and actresses[6].
So this entire first level of concern is the social context of pornography, and the effects on the women (and the men) in the pornographic material.
A second level of concern is more personal. It is the subtle effect vivid, emotionally shocking and intense images on my mental life, assumptions, and implicit feelings and reactions to other people. This can have an effect on my character that may be difficult to track. In turn, particularly but not only for the young, it may shape and distort sexuality, sexual response, and self-understanding. Now, in the case of violence, some people prone to violence are a little more willing to be violent, a little more desensitized to human pain. In the case of sexual pornography, some people who may be prone to degrade or objectify women may now find they are a bit more prone, find it a bit easier to do. Thus, the entire human enterprise is subtly turned to the worse. While the prior social concern may be at least partly addressed by some sort of ethical porn if it could be found, here, we have to admit this risk can occur even with true fantasy material (stories, drawings); for that matter, it can occur even with fantasies I dream up in my own mind! Thus, the spiritual masters speak of guarding our thoughts as well as our speech and action.
This brings up addiction. The limited research is inconclusive as to whether, in a technical or medical sense, individuals become physically addicted to pornography. Regardless, the idea of addiction is helpful at a practical level. For some pornography use at least becomes like an addiction in its brain effects.[7] Behaviorally, he may find that porn cannot be let go of, it must be used, must be had, and use is driven by craving and continues or increases even when obvious ill effects are at hand, so that we may even prefer to use porn even if it costs our marriage[8]. In this situation, pornography creates a greater and greater demand for more and more titillation, more and more unusual or novel or extreme images. This may, in some instances, reach a point where the man can no longer be turned on by his wife, who is merely a normal person, and cannot match up to the idealized, perfected fantasy images that are now turning him on. He may find, even, that he has become impotent, and cannot perform sexually with an actual woman, and must have the idealized, fantasy image in front of him and can then only have an orgasm while masturbating and not during sexual intercourse.[9] Or, perhaps, he can get away with having the fantasy image in his mind while he has sex with his wife, but now he is not fully present to his wife while having sex with her, he is present to the image in his mind.
Why this happens can be understood by a simple analogy to the realm of food. Some people, exposed to sweets, overeat, while most people, in our society flooded with sweet calories, eat too much and gain too much weight. The reason for this is that our bodies evolved in environments in which sweet, calorie rich foods were rare and calories were precious. Successful adaptation meant that our body evolved to maximize its intake and use of sweets, and stored the fat, in that environment. This was very successful because overeating on sweets was not possible; there were not enough of them. Therefore, our bodies did not evolve able to handle the vast availability of sweet food now around us. In this analogy, we can speculate that our sexuality evolved in an environment in which unusual and exotic sexual opportunity and imagery was very rare; when it appeared, it was adaptive to engage in it and to remain aroused and seek as much as possible of this opportunity. This maximized reproduction. Because such opportunity was rare, our psyche did not develop a means for modulating and handling the unlimited exotic images that we can now access on the internet. The result is that we follow the evolutionary response pattern but now it leads to addiction.
            Yet another aspect of the problem can be seen by analogy to a gambling addiction. When casinos (and online gambling) emerge in a widespread way, many people do not engage at all, or only rarely. Others engage from time to time without harm. But some, more than we are comfortable admitting, become addicted and are ruined by their gambling addiction. The biology of addiction in the brain’s dopaminergic reward anticipation system is well-known, and in the case of sex it is compounded by the association with orgasm and associated opioids release, making sexual pornography potentially more addictive than gambling. However, the analogy is that when we make this available to our entire society, some, maybe many, are overwhelmed by it.
The analogy to food is limited because food is not optional, but pornography (but perhaps not sexual desire) is. Still another analogy is alcohol which, like pornography, can be fully abstained from if necessary. Thus, alcohol addiction can be managed by abstinence (recognizing that this is not easy, it is in principle, possible). Food addictions are more complex because food itself cannot be avoided. In parallel, we can avoid pornography, but we cannot avoid fantasies—we all have them. Thus, we may decide we can handle pornography addiction by abstinence, but then how are we to relate to our fantasies? Are some fantasies to resisted, like some thoughts? Many old time monks would say yes; thoughts must be curtailed just as speech and action must be curtailed. Are some fantasies more healthy than others? A freely roaming interior life is essential to a sense of freedom, to creativity, and to the ability to know oneself. Yet at some point, excessive interest in internal fantasy costs a man (or woman) the capacity to deeply appreciate and respond to the human reality around him.
The upshot of this is that over time, the man who is using more and more pornography, moving deeper and deeper into usage of it with more and more extreme images, is actually encountering reality less, not more. He is not encountering the actual person with whom he is having sex, he is instead in a less real, fantasy or imaginary world. This may still be real in a sense, but it is not as real, and instead of taking him closer to integration, wholeness, encounter, and God, and noble human fulfillment, it is taking him in the other direction, toward fragmentation, alienation, and ignoble life.
This brings us to the realization that sexuality is a powerful force, rooted in deep biological instincts that can overwhelm the person. This is the root, really, of sexual taboos. Those taboos attempt to channel and contain a force that can sweep us away, the deeply rooted life force that is also a death force within us. Pornography, therefore, taps into impulses and drives that are deeply biological—the urge to dominate or be dominated, to control or to lose and surrender all control, to penetrate completely and even destructively, to be penetrated completely; these in turn have been of course modified and shaped and developed by social and cultural forces, so there may be human universals and cultural particulars in the form of erotic and pornographic images, the distinctions among which I do not attempt to explore here. What is clear is there is an enormous variation of human sexuality and so different people are turned on by rather different aspects, hence the vast variety and diversity not only of pornographic images and stories but also of human sexual expression and experience.
For the individual person of faith, the moral risks of pornography use may in many instances be able to be addressed by abstaining from pornography. And yet, something more is needed, because for many people this “solution” feels confining, punishing, leave them with even fewer avenues for sexual expression and satisfaction and so they will not be able to follow this prescription alone. So we can ask, at a spiritual level, what is the balance that enables a journey toward wholeness (and thus, humanity, and thus holiness), that allows access to our sexuality, to the playful and exploratory, particularly for those lacking a meaningful sexual relationship, without succumbing to addiction and loss of freedom, and loss of capacity for intimacy and sexuality and thus loss of humanity?
How do we as a Church, as Christians (and Christian men), and as individuals address that? How do we govern our own behavior, open our communication, provide support, and discover appropriate norms for this new reality that enable personal expression and exploration while also keeping relationships healthy, women and girls safe and empowered, men fulfilled, and  marriages safe and healthy? At a practical level, what are treatment and prevention options?  What is the pastoral response to porn addiction? At the individual level, what are criteria for formation of conscience around pornography?
To begin with, we recognize that being human includes the erotic and the sexual (and fantasy about it), and also includes the capacity to be overwhelmed and addicted—at which point helping intervention is needed. As a first step, we have to accept both that some sexual fantasy is normal, but also that some limitation on use of pornography is a necessary discipline for a man seeking God, seeking wholeness, and seeking interior freedom. How much limitation? For some, this means fasting for long periods or abstaining completely. Should we go further? Should we say that a Christian man should “abstain” from pornography in all cases? Or should we instead commend, as we do for alcohol and gambling, responsible if sparing use when it is too difficult to abstain or when use can be deemed essentially harmless? From the viewpoint of an integrated psychology, spirituality, theology of the human, where do we locate sexual expression outside of the narrow and confining confines of the conjugal bed? Can the pornography “issue” spur us to better answers?
Should church communities refrain from use of alcohol (including communion wine) for the sake of the one who is alcoholic? Should they support one another in refraining from use of pornography for the sake of those among them who would be unable to use in a minimally harmful way? In terms of pastoral guidance, what is a better alternative that allows sexual expression that is healthy, integrated, and as real as possible? How does the value of chastity fit in? (That is, the moral imperative that we use people not as a means only, but as an end also). Chastity says that some expressions of sexuality are neither moral nor healthy. So what does the single person, the person without a partner do? What is the appropriate channel for them? Finally, what then is pornography? Ultimately, we are asking, which aids to sexual experience are “acceptable”? None? Some? All? These are questions ultimately for resolution within the church community as well as within society. Here, I provide some three guidelines for that discussion.
First, how violent and degrading is the content (whether visual or verbal/written)? This pertains to what kind of industry we are supporting and what kind of mental content we are nourishing in ourselves and our community. 
Second, does it involve real people or imaginary characters? This also pertains to what kind of industry we support and also what participation we may have in real violations of real people—something that cannot be acceptable to a Christian or, frankly, nearly any ethical or moral system. 
Third, how much time is being spent using or consuming this material and with what individual or relational consequences? This pertains to whether the use of the material is interfering with my ability to engage productively with reality.
The accompanying figure is intended to organize these fundamental three questions.  The figure illustrates my view that it is untenable to suggest that all pornography is morally neutral or spiritually okay. At the same time, it is untenable to suggest that all sexual fantasy material (pornography) is morally unacceptable
or spiritually harmful. To the extent that material is humanizing, usage does not interfere with other aspects of life, and actors are either non-existent (stories, cartoons) or voluntary and free, moral concerns are minimal to none. To the extent that material is dehumanizing, real human actors may or may not be free and voluntary, and usage is interfering with other aspects of life, serious moral and spiritual problems are encountered. But the “line” of acceptability is unclear, will differ for different faith or secular communities (and individuals), and most important, is not necessarily in the middle of the circumplex figure. Morally and spiritually acceptable use of erotic material may be close to one end of the spectrum portrayed.
Thus, from a psychological point of view, there may be human-affirming images that enable sexual comfort and expression. As we move into more degrading images that may involve real people in them, we move into more and more hazardous moral territory from the viewpoint of the *reality* that we are encountering (real people, a real industry, that we are participating in). From the point of view of thinking our fantasy is more real than that reality, we are moving *away* from a humanizing encounter with the Real and thus away from God.
What makes an image or story degrading? This could be developed readily with reflection, but I only sketch it here. For example, we can ask whether there is mutuality, whether there is exploitation, and so on.  Here we are asking, ultimately, what is humanizing—what enhances the human.  This is not to ask what is human (everything humans do is human!) but what enhances humanity. For instance, it may be human to be fascinated by degrading images but this does not make the degrading images humanizing. It may be human to be fascinated by domination or violence but this does not make those actions humanizing. So we have to distinguish what fascinates, even normatively, from what is humanizing in the sense of developing the human capacity for fulfillment, divinity-so develop humanizing fantasies, ideas, and desires that will help you want to develop positive relations that support development of others.[10]
            The second dimension is the realness of the material. For example, we can consider unrealistic cartoons, realistic cartoons, realistic but imaginary stories, on to real images, photos, movies, or stories about true events. However, the primary focus here should be not on whether an image or story is realistic, but rather, whether real people are involved and whether there is potential real harm to them.  The third dimension is amount of use. Here, again, my analogy is alcohol or gambling. Use for an hour or two a year would seem to have a different psychological and moral weight than use for an hour or two every day.
In conclusion, I suggest that modern pornography can overwhelm the basic human instincts for sexuality and fantasy. It can interfere with our psychological and spiritual quest for fulfillment by disrupting our journey to encountering ever more the real, and becoming in that way more human and more divine. At the same time, shame and taboo have made it difficult to develop a healthy sexuality in Christian churches and shut down discussion of pornography so that usage has gone underground. Fantasy of many forms is necessary to human health and happiness, to creativity, and to art, while complete suppression of all things erotic cuts off that same fundamental aspect of our human nature and makes us less free. To balance this further, a reflective approach can consider on one hand the very serious moral problems with most pornography including its exploitation and dehumanization of women and men, it connection to serious evil in the form of trafficking, and its pernicious effects on the psyche if overused. On the other hand, some forms of erotic material are likely to be unobjectionable, and can be evaluated with regard to how violent and dehumanizing, how likely to involve people who are not treated ethically or to support criminal enterprises, and how disruptive to real relationships and our real life. These reflections are intended not to provide final prescription, but to stimulate and start discussion toward direct engaging with and solving the problem that pornography has become for many men in the community. I hope that these reflections may be of assistance as readers consider their own formation of conscience within their community, within their own frame of morality, and that these reflections may spur productive discussion which can serve to clarify thought and raise our humanity in the process.


               [1] Examples are easy to find. For example, a recent Newsweek headline (9/24/2014) noted was titled, “Bill Would Prohibit Federal Employees from Browsing Porn at Work” due to findings of extensive porn use at work.
[2] Nick Wingfield, “In E-Sports, Video Gamers Draw Real Crowds and Big Money.” New York Times, August 30, 2014.
[3] Writers sometimes distinguish erotica (sexually or sensual material that may be explicit, but that in addition has artistic merit and the intention as well to portray beauty) from pornography (sexually explicit material perceived as having only the intention of selling sex). However, my remarks are not concerned with this distinction which, in any case, lacks agreed operationalizing standards. Erotica in the Oxford English dictionary is “Literature or art intended to arouse sexual desire;” in Miriam Webster it is “works of art or literature that deal with sex and are meant to cause sexual feeling”, both implying artistic merit. Pornography, on the other hand, is not defined as art and is, perhaps more explicit.  Thus, in the Oxford English dictionary, “Printed or visual material containing the explicit description or display of sexual organs or activity, intended to stimulate erotic rather than aesthetic or emotional feelings.” In the Miriam Webster dictionary: “movies, pictures, magazines, etc., that show or describe naked people or sex in a very open and direct way in order to cause sexual excitement, 1: the depiction of erotic behavior (as in pictures or writing) intended to cause sexual excitement; 2:  material (as books or a photograph) that depicts erotic behavior and is intended to cause sexual excitement; 3:  the depiction of acts in a sensational manner so as to arouse a quick intense emotional reaction <the pornography of violence>”. Note the last definition, to which I return in the text when in mention violence as pornographic.

[4] Anderson CA & Bushman BJ (2001). Effects of violent video games on aggressive behavior, aggressive cognition, aggressive affect, physiological arousal, and prosocial behavior: a meta-analytic review of the scientific literature. Psychological Science, Sep;12(5):353-9.

[5] This is widely documented; example statistics are available online at http://www.covenanteyes.com/2013/02/19/pornography-statistics/ (accessed 7/14/2014).
[6] Note that from a second-wave feminist perspective this is not possible in the present historical context. See one, perhaps unsatisfying, exchange about this at http://newint.org/sections/argument/2014/03/01/argument-can-porn-be-ethical/ (accessed 11/1/2014).
[8] We can here speak not only of individual use of pornographic images online, but also “internet sex” addiction, that is, exchanging sexual material with other people in online chat rooms and engaging in online sexual fantasy and role play with another person. See K. S. Young (2008), American Behavioral Scientist; 52(1) pp 21-37.
[9] Medical research on this allegation is scarce but clinical anecdote suggests it can and does occur. See commentary by one widely-quoted therapist at http://blogs.psychcentral.com/sex/2012/05/abusing-porn/ (accessed 7/14/2014); and a similar set of case reports in G Cavaglion  (2009); Cyberporn dependence: Voices of distress in an Italian internet self-help community. International journal of mental health and addiction, vol. 7, pp. 295-310.
              [10] Another dimension is intensity and novelty. Intensity and novelty add to addictive potential, because they increase dopamine release. Therefore, intense or unusual images are more risky in terms of possible addiction.