sex addiction essay

Sexual addiction 25 years on: A systematic and methodological review of empirical literature and an agenda for future research

Affiliations.

• 1 Department of Psychology, Bowling Green State University, Bowling Green, OH, USA. Electronic address: [email protected].
• 2 Department of Psychology, Bowling Green State University, Bowling Green, OH, USA.
• 3 Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
• 4 Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA.
• PMID: 33038740
• DOI: 10.1016/j.cpr.2020.101925

In 1998, Gold and Heffner authored a landmark review in Clinical Psychology Review on the topic of sexual addiction that concluded that sexual addiction, though increasingly popular in mental health settings, was largely based on speculation, with virtually no empirical basis. In the more than two decades since that review, empirical research around compulsive sexual behaviors (which subsumes prior research about sexual addiction) has flourished, ultimately culminating in the inclusion of a novel diagnosis of Compulsive Sexual Behavior Disorder in the eleventh edition of the World Health Organization's International Classification of Diseases. The present work details a systematic review of empirical research published between January 1st, 1995 and August 1st, 2020 related to compulsive sexual behaviors, with a specific focus on evaluating the methodologies of that literature. This review yielded 371 papers detailing 415 individual studies. In general, the present review finds that, although research related to compulsive sexual behaviors has proliferated, much of this work is characterized by simplistic methodological designs, a lack of theoretical integration, and an absence of quality measurement. Moreover, the present review finds a virtual absence of high-quality treatment-related research published within this time frame. Implications of these findings for both clinical practice and future research are discussed.

Keywords: Behavioral addiction; Compulsive sexual behavior disorder; Hypersexuality; Pornography addiction; Sexual addiction.

Copyright © 2020 Elsevier Ltd. All rights reserved.

Publication types

• Systematic Review
• Behavior, Addictive*
• Compulsive Behavior
• Mental Health
• Paraphilic Disorders*
• Sexual Behavior

Essay on Sexual Addiction

Today, specialists have no doubt that sex can be the object of addiction just like food, shopping or gambling, alcoholism or drug addiction. In cases when a person becomes sexually addicted intimate relationships become the keystone, while all life priorities quietly fade into the background and eventually disappear altogether. The only occupation a person devotes one’s own energy and thoughts to is the striving for pleasure, incessant desire to experience sensual delight. As a result, sexual addiction leads to the loss of ability to control thoughts, feelings and actions.

The physiological basis of addiction consists in the fact that sex and love provoke the production of the same chemicals in the brain as heroin and cocaine do, and therefore people suffering from sexual addiction obtain from sex the same experience that drug addicts get from drugs, and alcoholics from alcohol: extremely pleasant sensations, incomparable to anything else in their lives. Sexual relationships become for them the only way to lift the spirit. From the standpoint of psychological roots, the addicts use sex in order to suppress such feelings as sadness, anger, anxiety or fear, as well as get rid of the burden of everyday life. Current observations show that this need is so great that sexually addictive people, like alcoholics, are almost unable to resist their addiction, and therefore the emergence of the disease should not be socially justified by hypersexuality or treated as libertinism, another sexual disorder. Further in this paper, we will attempt to draw this line, considering the epidemiology, causes and course of sexual addiction, as well as will discuss possible therapeutic solutions.

Understanding sexual addiction: symptomatology and causes

Sexuality is an integral human need, a source of pleasure and positive emotions. But this is only a part of life, one of the many human needs, and most people do not put it to the forefront among the others. Harmony is violated in the case when for one reason or another, one of the needs, in this case sexual, becomes an obsession, gains distorted shapes and subordinates all person’s thoughts and actions.

However, where is the line distinguishing the normal human need for sex from a mania? On the one hand, as Karila et al. (2014, p. 4018) state in their research, some specialists long used to deny the existence of sexual addiction as a mental disorder and rather attributed it to libertinism. On the other hand, the differences between promiscuity and engagement in the perverted forms of sexual relations and addiction as such are quite obvious. In particular, similarly to other kinds of addiction, sexual addiction is characterized by such main symptoms as the inability to control one’s own sexual impulses, obsessions with sex ideas, inability to say “no’ and promiscuity of choice (Coleman-Kennedy & Pendley, 2002, p. 145-47; Schaeffer, 2009, p. 154-55). As Karila et al. (2014, p. 4019) rightly put it, regardless of the particular type of sexual behavior, it turns into addiction when it gains elements of compulsiveness and complete disregard for the consequences.

In this way, sexual addiction should be understood as a compulsive sexual behavior that is subconsciously used to achieve psychological comfort and pleasure. Sex addiction symptoms are manifested in (Coleman-Kennedy & Pendley, 2002; Giugliano, 2003; Karila et al. 2014; Schaeffer, 2009):

• implicit emotional obtrusiveness and psychological instability,
• low level of moral values,
• regular uncontrolled sexual impulses arising suddenly and not eliminated by the efforts of will and intellect,
• gradual increase in the frequency of sexual impulses,
• signs of “withdrawals” (abstinence syndrome) after a short abstinence
• penchant for casual sex with strangers,
• inability to maintain a long communication and sexual intercourse with the same partner
• persons’ uncontrollability in other spheres of life.

In this way, for a sexual addict sex is the only valuable and desired thing in life, in which one can express independence and natural talents, as well as to assert in society. However, the number of sexual partners increases together with a sense of inner emptiness (Giugliano, 2003, p. 181). Considering a person of the opposite sex only as an object for sexual satisfaction, addicts appear not to be able to build long-term relationships or experience emotional bond in existing communications. Inability to fulfill the increasingly burgeoning sexual fantasies often leads to aggression, irritability, sudden mood changes, and depression (Giugliano, 2003; Riemersma & Sytsma, 2013).

In psychoanalytic understanding, the basis of sexual addiction is all-consuming anxiety (Giugliano, 2003; Coleman-Kennedy & Pendley, 2002; Maté, 2012). According to Giugliano (2003, p. 179), this anxiety often originates in the disorder of sexual structure of personality: for example, in the sexual need for suppression of painful feelings during early sexual trauma, as well as for overcoming the state of infantile rage, depression, or anhedonia (irritation and displeasure). Reasons of sexoholism can be serious psychological problems related to childhood rape, unsuccessful first sexual experience, parents’ sexual misconduct and distorted set of priorities (Maté, 2012, p. 58-61). Thus, basing on 2012 research of childhood trauma by Gabor Maté, the factors responsible for the development of sexual addiction for women may be, for example, mother’s chronic depression and hyperstimulating sexualized relationship with father. In the case of men, these might be degrading and rejecting parental figures, especially mother, demonstrative exception of the boy from parental love relationships.

In general, expects agree that the lack of love, care, and attention from parents, and especially mother, has a great influence on the formation of future patterns of behavior with the opposite sex (Giugliano, 2003; Maté, 2012; Schaeffer, 2009). An “underloved” child who lacked affection, gentle mother kisses and hugs finds it difficult to feel confident in adult life even with a good outlook. Such people with low self-esteem constantly feel the desire to assert themselves at the expense of attention of the opposite sex. Men tend to prove to each new partner, to themselves and others their power and “sexual might”; women conquering another man subconsciously look for acknowledgement. Thus, deviant behavior patterns mainly form as a response to psychological trauma, and have a fairly strong tendency to develop into a full-fledged addiction.

Dealing with sexual addiction:

epidemiology, risk groups, and their most common behavior patterns

Thus, numerous studies claim that today about 6% of people are obsessed with the constant idea of sex (Karila et al. 2014, p. 4013). It should be noted that the most or nearly 70% of sexoholics who search for skilled medical help are men (Riemersma & Sytsma, 2013, p. 307). As Riemersma and Sytsma (2013, p. 309) describe it, a typical portrait of a sexual addict is a heterosexual man in his forties, married (or having a permanent partner), a professional who leads quite a normal life in all other aspects. At the same time, the situation with identifying dependencies among women is uneasy. According to experts, due to the still-preserved system of double standards, they often do not admit having any disorders and do not seek medical help. Nevertheless, the number of women experiencing constant irresistible need for sex is not less than 30% and shows rapid growth in recent years (Riemersma & Sytsma, 2013, p. 312).

According to Giugliano (2003), some people are more prone to addiction than others. For example, such traits may indicate that the person is able to get hooked on sex: suggestibility and imitation, curiosity and the constant search for new sensations, risk appetite and adventurism, fear of loneliness (Young, 2008, p. 23-26). According to Maté (2012); observations, potential sexoholics often have uneasy relationship with the parent of the opposite sex. Dependence is often provoked by a crisis situation like, for example, a betrayal when the deceived partner seeks to dissociate oneself from pain by using one of the patterns of deviant sexual behavior (Schaeffer, 2009, p. 159).

In general, psychiatrists distinguish 12 behaviors that are often associated with sex addiction (basing on Coleman-Kennedy & Pendley, 2002; Giugliano, 2003; Karila et al., 2014; Riemersma & Sytsma, 2013; and Schaeffer, 2009):

• Compulsive masturbation reaching in some cases 20 times a day,
• Numerous sex and extramarital sexual relations, a high demand for sexual intercourse,
• Promiscuity in sexual partners, frequent “one night” relationships,
• Obtrusive use and watching of pornographic materials, pornophilia,
• Sex with strangers without using condoms and other contraception and protection against STDs,
• Phone sex, constant participation in sexual forums on the Internet and social networks,
• Obsessive dating through electronic and conventional dating services,
• Frequent use of prostitutes or gigolos,
• Exhibitionism,
• Voyeurism (watching other people have sex),
• Sexual harassment and sexual abuse,
• Propensity for sexual abuse and incest, and other paraphilias.

If a person’s behavior matches at least four of the above symptoms, there is high probability that an individual is a sexual addict (Karila et al., 2014, p. 4015).

Essay on  Sexual Addiction part 2

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Pandemic Revealed Unique Aspects of Sexual Addictions

• Kenneth P. Rosenberg , M.D.

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Psychiatrists need to apply especially rigorous clinical criteria when evaluating patients for sexual addiction.

The COVID-19 pandemic has both opened and closed windows on addictions. My patients with chemical addictions—from alcohol to opiates—spent the pandemic locked in their rooms and hidden from the in-person gaze of health care professionals, friends, and family. Fueled by these circumstances, their addictions got worse.

My patients with gambling addiction sought new ways to feed their compulsions. While in-person poker games and casinos were shut down, a plethora of new online sites increased their access to gambling.

Those with sexual compulsions (“sex addiction”) behaved differently. Many people with sexual addictions continued their virtual experiences during the pandemic, including porn, sexting, and cybersex. Yet, out of fear for their lives, most of my patients with sexual addiction completely abandoned the forbidden, in-person hookups and daily commercial sex with sex workers. Does this deliberate curtailment make their addictions any less real?

Nowadays, we think of addictions as more than mere physiological dependency on chemicals like alcohol, cocaine, and opiates. We view them according to a disease model as experiences culminating in brain interactions that highjack the dopamine-reward system. Consequently, addictions now include behaviors like online gaming (video games), gambling, and problematic and compulsive sex.

Today, with COVID-19 precautions receding, sexual addiction among my patients is back on the rise. Does the fact that those addicted to sex abstained from life-threatening encounters with strangers during a global pandemic suggest their addiction is a fake disease? If not, why was it so responsive to pandemic fears?

Already highly controversial, a diagnosis of sexual addiction as a dependency is further complicated, and often dismissed, because it responds to opportunities in the culture. Dependencies never occur in a vacuum. The repeal of prohibition increased alcohol consumption and alcoholism. The Vietnam War introduced heroin to a subset of men vulnerable to addiction. Substance use is influenced by any number of forces in our culture and environment, which is why I encourage my patients to support their sobriety by avoiding people, places, and things associated with their addictive substance or behavior. But just because outside factors can help feed or freeze addictive behaviors doesn’t make the addiction any less real.

All addictions are a consequence of a person’s psychology, culture, and biology combined with affordability, anonymity, and access. Knowing this, therapists use disincentives to treat addictions. With chemical addictions, medications that counteract the substances—disulfiram, which turns alcohol into poison, and naltrexone, which prevents the euphoria of opiates—help stop the abuse. Some therapy programs successfully use token behavioral reinforcements, essentially paying people to refrain from using drugs.

Sex is a vital and healthy human drive that most of us have learned to manage. Nearly everyone gets obsessed with a sexual relationship at some point in their lives. Consequently, I am regularly asked, with an air of deep skepticism, How can we become addicted to sex—a drive essential to our species’ survival? My response: If we can become addicted to anything, it would be sex . Our brains did not evolve to become turned on by opiates or alcohol, but our minds did adapt to become driven by behaviors essential to our survival, such as eating and procreation. Sometimes, the wires get crossed.

Sexual addiction is a subversion of the healthy, adaptive instinct to connect, seek pleasure, and procreate. Significantly, however, this compulsion does not lead those affected to pursue lots of sex with available partners. Instead, my patients tend to have terrible sex lives with their available partners. And, at the expense of their jobs and families, they spend hours of most days on porn, seeking out “bad” (by their own definition) sexual encounters or become obsessed with commercial sex. Their compulsive behaviors cause irreparable damage to their lives and relationships and can result in great anguish and even suicide.

As psychiatrists, our ideas about sexual addiction are evolving. In the last full revision of DSM in 2013, APA understandably did not include sexual addiction. ( DSM-5 lists only gambling disorder as the sole behavioral or nonchemical addiction.) However, in the 2019 revision of its diagnostic manual, the World Health Organization added compulsive sexual behavioral disorder to the category of “Impulse Disorders.” As a consequence, APA Publishing published a 2021 book on the diagnosis, Compulsive Sexual Behavior Disorder: Understanding, Assessment, and Treatment . I contributed to the chapter “Clinical Evaluation of CSBD.”

Perhaps the most controversial and explosive concern about this diagnosis is that sexual addiction can be used as an excuse for bad behavior. Is an unfaithful spouse a sex addict? Some of the time, but rarely. How about sexual offenders, people who commit sexual assaults against others? For most clinicians, the sexual addiction diagnosis is reserved for people who engage in consensual sex and is not used for those who engage in sexual crimes.

We need to apply especially rigorous clinical criteria when evaluating it as a disorder. Because so many people are embarrassed by some hidden sexual desire that they consider “sick,” it’s a diagnosis that some patients embrace too quickly. Over the course of my career, I have met religious people who desperately seek treatment as “sex addicts” simply because they want to masturbate. I’ve met with patients who would choose chemical castration rather than confront their deep desires for people of the same gender. I’ve counseled these people against sexual addiction treatment and urged them into psychotherapy to deal with shame.

For two decades, I’ve judiciously used the diagnosis of sexual addiction because it provides patients with a path from compulsive behaviors to recovery. People benefit from psychotherapy, medications, and “sex” 12-step recovery fellowships that follow a format similar to that of Alcoholics Anonymous. Treatment can save lives. But like everything else in psychiatry, the diagnosis needs thoughtful discernment. To apply it carelessly or to dismiss the diagnosis completely would mean casting aside life-changing recovery options for patients and their families now struggling with deep, yet treatable pain.

The pandemic has killed over six million worldwide and traumatized hundreds of millions of others. It has revolutionized virology. In the area of mental health, COVID-19 made us painfully aware of the psychological costs of isolation and stress, launched the widespread use of teletherapy and telepsychiatry, and revealed the lasting brain consequences of a viral illness (so-called long COVID). It has also demonstrated the malleability and variability of mental disorders including addictions. We can only hope that our knowledge will be put to good use. ■

More information on “Bedlam”

More information on the book Compulsive Sexual Behavior Disorder: Understanding, Assessment, and Treatment

Kenneth P. Rosenberg, M.D., is an addiction psychiatrist in private practice in Manhattan. A longtime filmmaker, he is a Peabody Award–winning producer and director of documentaries on mental health issues. One of his recent projects, “Bedlam,” was a Grand Jury Prize nominee at the 2019 Sundance Film Festival. He contributed to the book Compulsive Sexual Behavior Disorder: Understanding, Assessment, and Treatment and is the author of Infidelity: Why Men and Women Cheat .

The Unhelpful Concept of Sex Addiction

Sex addiction is a popular buzzword, but is it clinically endorsed.

Posted September 28, 2021 | Reviewed by Abigail Fagan

• What Is Addiction?
• Find a therapist to overcome addiction
• The concept of 'sex addiction' is an invented one and is not scientifically endorsed.
• Clinicians relying solely on 'sex addiction' for their income have an investment in perpetuating the concept.
• Contemporary sexology offers a paradigm shift in understanding sexual compulsivity better and offering better care for clients.

Most people have heard of the term ' sex addiction .' It has been around since the ’80s and is associated with sensational stories of celebrities booking themselves into a 'sex addiction ' clinic after being caught for bad sexual behaviours, some of whom have committed a sexual offence.

Before the term ‘sex addiction’ became popular, the psychoanalytic profession in Freud ’s time observed sexual behaviours that looked out of control using diagnoses such as ‘nymphomania’ for female behaviours and ‘satyriasis’ for male behaviours. Although psychoanalysts misunderstood human sexuality , they were curious about it.

A few decades later, in the early ’80s, the term ‘sex addiction’ took off. It was in the particular backdrop of the AIDS epidemic, a dark time when the entire world was afraid of sex. Gay men were mostly pathologised as they were the ones most affected by the virus but also because their sexual promiscuity (or their freedom of sexual expression, as I would prefer to call it) became more visible when ‘ homosexuality ’ stopped being a criminal offence.

I don’t blame the experts calling sexual compulsivity an addiction in the early ’80s because these behaviours definitely looked like an addiction. People described their struggles as a strong urge resulting in repetitive and unwanted sexual behaviours that made them feel out of control. At the time, the field of sexology was almost non-existent and there was no other frame of reference apart from the addiction model to understand such complex sexual behaviours.

As soon as the term ‘sex addiction’ was invented, the entirety of the clinical thinking around sexual compulsivity was pushed into the same framework of known addictions such as alcohol and drugs. Experts tried very hard to make all their conceptualisations fit within the addiction model. This is when the field of ‘sex addiction’ started to become problematic: unlike psychoanalysts, there was no more curiosity. Experts wanted to maintain the certainty that the addiction-thinking was the only right one. Questions such as: Could it be something else? Could we have different conceptualisations? Might we have a blind spot? became forbidden, and clinical discussions became reductive.

Since the '80s, clinicians could only rely on the one and only ‘sex addiction’ model invented by a handful of experts. This model, however, was made from anecdotes and personal opinions, and no scientific backing, yet it remained unchallenged. Some of the reasons for not welcoming the questioning of the ‘sex addiction’ model were not clinical ones. One reason was to infiltrate a sex-negative and religious agenda to control sexual behaviours. The other reason was a financial one, as ‘sex addiction’ clinics started to make a lot of money charging exorbitant fees for their recovery centres in the USA.

Here, in the UK, we don't have a puritan culture but we do have a sex-negative one. When the 'sex addiction' concepts landed in the UK, it became Englishised, but its core addiction narrative remained.

The term ‘sex addiction’ is popular because it evokes emotive stories, and it is an easy fit for many people’s struggling with their heartbreak from sexual behaviours: ‘My partner cheated on me, he must be a sex addict’, ‘My partner enjoys looking at other people in the streets, she must be a sex addict’ , ‘M y partner wears revealing clothes that makes me uncomfortable, she must be a sex addict’ , ‘My partner watches porn every night, he must be a porn addict’ .

The clinicians whose income solely depends on treating ‘sex addiction’ have an investment in maintaining the narrative of the fear of sex so that people continue to come to their clinics and buy their treatments. Now that there is no more fear about AIDS, the ‘sex addiction’ narrative needed a new panic about their sexual behaviours. One of them is to conflate sexual compulsivity with sexual offending. The reality is much different: most people struggling with sexual compulsivity do so within consensual sexual boundaries and do not offend. Another current fear perpetuated by the ‘sex addiction’ field is the narrative of the ‘porn panic’. The so-called disorder of ‘ porn addiction ’ has not been clinically endorsed either, and much of its negative consequences (like porn causes erection problems) have been disproved. Although there is little scientific evidence, the fear-mongering stories abound.

‘Sex addiction’ trainings flourished too, teaching clinicians how to diagnose ‘sex addiction’ based on anecdotes, personal (and religious) beliefs and a major lack of understanding of gender , sex and relationship diversities. Therapists are trained in offering interventions that are primarily addiction-oriented helping their clients stop their so-called ‘sex addiction’ with hardly any knowledge of contemporary sexology. This is alarming because it means that many people who have normative (yet seemingly unusual) sexual behaviours may be unduly pathologised.

The tradition of addiction treatments is to recommend 12-step programmes, which may work very well for alcohol and drugs but is questionable for ‘sex addiction’ because there are so many sex-negative teachings that are incongruent with contemporary sexology. For example, the opinion of SAA and SLAA is that ‘sex addiction’ is a progressive disease and it is a character defect. This has never been endorsed by science. The ‘sex addiction’ movement deemed a vast amount of normative and functional sexual behaviours as ‘unhealthy’, which sends grossly inaccurate information to their followers. The ‘sex addiction’ field both in the USA and the UK pepper their treatment methods with overt or covert religiosity , promoting the power of prayers. Prayers are not used in any other psychotherapy treatments for depression , anxiety , eating disorders, trauma , OCD , self-harm , and so on, but it is prevalent in ‘sex addiction’ treatments.

The field of sexology has grown exponentially in the last 10 years, and we have now a larger body of research looking into sexual compulsivity. The results are clear: scientific data has not been able to confirm the existence of ‘sex addiction’, which is why both WHO and the DSM-5 consistently reject the conceptualisation of ‘sex addiction’. In 2018, the ICD -11 (WHO) came up with ‘compulsive sexual behaviour disorder’, clearly stating that it is not an addiction disorder but an impulse control disorder .

Now that we have the knowledge of contemporary sexology, clinicians need to take more responsibility for their interventions and recommendations as it can be harmful to offer addiction treatment for a problem that is not an addiction.

Amongst sex researchers and sexology scientists worldwide, the language of ‘sex addiction’ is disappearing fast, but amongst counsellors, psychotherapists and sex therapists in the USA and UK the term is still used widely. It is time for our profession to follow the scientific path of contemporary sexology because we have a duty to continue to be curious about clinical excellence and, ultimately, for the safe and ethical service to our clients.

Silva Neves is a COSRT-accredited and UKCP-registered psychosexual and relationship psychotherapist in London.

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Taking responsibility for sex addiction.

Dear Annie: My own experience tells me that your advice to Starving Wife may have overlooked another possibility.

I lived for years with what Starving Wife is experiencing. My sexual relationship began with my husband when he was 42 and I was 45. Our sexual relationship was good until we married three years later. Alas, he “just wasn’t interested anymore,” so he said. We went to counseling, and he lied to the counselor. He had his testosterone checked and it was normal.

After 15 years of living this hell, I learned that he was having sex with his secretary two times a week at lunch at her home. Her husband worked out of town. My husband was an executive vice president at a large company and a popular community volunteer, and I was a respected business owner. We both have college degrees. I learned this relationship with her had been happening for 20 years. It began seven years before I met him. Thus, during our courtship, he was having sex with both of us along with three other women. He no longer desired sex with me once we married because he was addicted to forbidden sex. Prior to learning of his relationship with his secretary, I sought counseling from a preacher who was also a registered family counselor. He told me that a healthy male that age is having sex, if not with me, then someone else. I didn’t believe it; I was dead wrong.

After I learned of his addiction, he without hesitation, received extensive counseling for his addiction. He beat the addiction. Today, years later, we have a good marriage including healthy sex.

Dear Healthy Sex: Thank you for sharing your letter; I hope it helps others who are in similar situations. I’m glad that you were able to work through things together and now have a marriage you are happy with. It’s important that your husband ultimately took responsibility for his actions and received counseling. If a cheating partner is unwilling to apologize and take the necessary steps to change, then I would always advise the other person to leave.

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When Makeup Sex Isn’t a Good Idea

A client who is new to dating, sex, and relationships recently asked me “Is makeup sex healthy?” The person, in their late 20’s, has been dating someone seriously for the first time. Things were progressing slowly sexually with his girlfriend, so their question about makeup sex struck me as a great one to ask before ever having the experience firsthand.

We discussed the pros and cons of having an argument that ended with sex, and I explained what I’ve seen as a sex coach. On one hand, it can feel really good to reconnect with a partner after a challenging discussion or verbal disagreement. Sex can be the ultimate display that the fight is over, allowing both partners to move on without any lingering ill will towards each other. On the other hand, makeup sex could be masking deeper issues in the relationship if it’s an ongoing strategy used to resolve conflict in the relationship.

Makeup sex feels like somewhat of a cultural phenomenon. We know it happens, and maybe it’s even happened in our own relationships. But, is it a good thing or something that should be avoided at all costs?

A quick scroll on TikTok reveals a wide range of opinions on the subject. Some people strongly advise against it as it could reinforce bad behavior from your partner. Many posts lean more towards the commonly held belief that makeup sex is a great way to bond after an argument . Other posts suggest that there is something qualitatively different about makeup sex, that includes a heightened state of emotions that you just can’t get to without a fight beforehand. And it's true that people who see makeup sex as more intense feel a carryover effect from their fight in the sexual experience that follows. This is called “ excitation transfer ,” which is when you are physiologically aroused by one thing and it transfers over to other areas of your life.

But there’s more to makeup sex than this. A 2020 study of 107 newlywed couples shed some light on what the benefits of makeup sex really are and how sexual quality is impacted by conflict. The study showed that when sex occurred after a flight, it had a greater impact on how people felt about the relationship by reducing the negative effects of conflict. This seems to coincide with the view that makeup sex is a way to feel closer to their partner. What’s surprising is that the study also showed that participants reported that the quality of sex after a fight was actually worse than the sex that occurred without a fight. So even though the sex itself wasn’t perceived as great, there were longer term emotional benefits for the relationship. This helps debunk the assumption that makeup sex is somehow just better than other sex. It also shows the real benefits of sexual connection after healthy conflict.

Where makeup sex gets tricky, though, is when it is used as the sole means for conflict resolution. Given that sex is one of the many ways we bond, it can be seen as an easier way to shift from negative emotions that are stirred up in a flight. But those negative emotions may still be there even after you have sex if you don’t take the time to process them yourself and with your partner. I’ve worked with couples where this dynamic is present and it can become very toxic over time. Feelings pile up that only get relieved through sex, which isn’t necessarily all that satisfying or pleasurable for one or both parties. There can be an aversion to sex for this reason and then feelings have nowhere else to go. This can cause ongoing tension at the least or periodic blow up fights at worst. As a result, people usually have to work with a couple’s therapist to develop healthy conflict resolution skills and be better communicators in general.

Read More: How to Make a Relationship Last

There is also a risk of having the perception that the relationship is on solid ground when it isn’t. I’ve heard from people that they have sex regularly, but feel stuck when it comes to day-to-day, non-sexual intimacy with their partner. When sex is the de-facto way to express emotions—joy, sadness, anger, or grief—there can be a lack of emotional closeness in the relationship. Makeup sex could be one way to avoid connecting with each other more deeply, resulting in what looks on the surface like a healthy relationship but is actually one without true intimacy.

Intimacy isn’t just the sex you have with your partner. It’s the ability to recognize the need for healthy conflict and repair. If you are in a healthy relationship where conflicts come up and are worked through, makeup sex can make you feel closer to each other. It’s a way to deepen the intimate connection that’s already there because you made it through something hard together. But it can’t— and shouldn’t—be the only way we connect with our partners. It’s just the cherry on top.

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'Our kids are not OK,' child psychiatrist Harold Koplewicz says

Terry Gross

The founder of the Child Mind Institute explains why young people are experiencing unprecedented levels of anxiety and depression — and what parents can do about it. His book is Scaffold Parenting.

TERRY GROSS, HOST:

This is FRESH AIR. I'm Terry Gross. There are so many reasons for children to be anxious today beyond all the standard childhood problems. There's the setbacks from the COVID lockdown, mass shootings in schools, feelings they're not measuring up to the great lives they see represented on social media, fears about the whole planet being in jeopardy. It's hardly unusual for parents to be unsure how to handle their child's anxiety, depression, learning problems, anger, tantrums. And it can be difficult for parents to evaluate whether their child should see a therapist or take medication.

My guest, child psychiatrist Harold Koplewicz, has dealt with these issues with many children and their parents. And there have been times he's been confounded about issues his own children faced. He's the founding president of the Child Mind Institute. Its stated mission is transforming the lives of children and families struggling with mental health and learning disorders by giving them the help they need to thrive. The institute also conducts related research.

From 1997 to 2009, he was the first director of the NYU Child Study Center. Koplewicz recently stepped down from his 25-year tenure as editor-in-chief of the Journal of Child and Adolescent Psychopharmacology. His latest book is titled "Scaffold Parenting: Raising Resilient, Self-Reliant And Secure Kids In An Age Of Anxiety." Dr. Harold Koplewicz, welcome to FRESH AIR. What are some of the problems and anxieties you're seeing now that you can connect to outside problems, like the COVID lockdown and its lingering aftereffects? How are you seeing that manifest in the children's anxieties that you're seeing?

HAROLD KOPLEWICZ: Well, I think our kids are not OK. And unfortunately, they weren't doing very well before COVID. But COVID has had a negative effect on all children. Children with mental health disorders and kids who are typically developing children being locked up for two years and living with fear that somebody close to you - someone near and dear - will die is very problematic. And we also know that 1 million Americans did die, which means that about 170,000 American children lost a caregiver or a parent.

And if we go back to 2001, after 9/11, we lost 3,000 Americans. And I can tell you that in New York, in certain pockets - Staten Island, where there were a lot of firemen, and Manhasset, where there were a lot of finance people who were in the building, and certainly people around ground zero - it was very hard to get kids to go back to school. Attendance rates didn't return to 9/10 - to September 10 levels for over a year and sometimes even longer.

So we do know that this kind of traumatic event is going to have lingering effects. And we have seen increases in anxiety disorders and in depression, particularly in girls but certainly even in boys. There are higher rates of kids trying to hurt themselves. And there is even an increase in the number of young people who have committed suicide. So there is no doubt that we had a problem before. And we have a greater problem now.

GROSS: The average child isn't necessarily, like, watching cable news or reading the newspaper. But you pick up a lot of this on social media. And it's also just in the air. Like, everybody's talking about these issues, like, environmental catastrophe, you know, political divisions. Is this the end of democracy? Is the planet burning? I mean, you're just - it's just in the air now.

KOPLEWICZ: Well, you know, there's something dramatically changed between 2010 and 2018. So the numbers start to jump when we started looking at children's mental health. There were higher rates of visits to emergency rooms by kids for suicidal thought and suicidal behavior. And the increase in the number of kids who died from suicide went from around 5,000 to 6,000. Now, just think about that. If it was diabetes, if it was cancer, that would have made the front page of every newspaper every single day. It would be on cable news 24/7. And somehow, we don't take mental health disorders as seriously as we take physical disorders.

And so, you know, what happened between 2010 and 2018 is that all of us started carrying a device with us that connected us to everybody on the planet 24/7. And that definitely had a negative effect on a certain percentage of the population. So I want to be clear that social media is not like smoking. It doesn't - it's not terrible for everyone. But it is particularly bad for kids who have mental health disorders. And we've really looked at this very carefully at the Child Mind Institute, where we had done a study before COVID that was looking for an objective test - a biological test. Psychiatry is the only discipline in medicine that doesn't have an objective test - doesn't have a chest X-ray or a blood test or a strep test. And therefore, that's the holy grail, right? We make the diagnosis with clinical information, which is how you start all diagnosis in every part of medicine. But you can confirm it with an EKG or with a brain scan. So psychiatry is missing that.

And so we started something called the Healthy Brain Network, where we offered any parent who was worried about their child - who was between the ages of 5 and 21 - a free psychiatric evaluation, free neuropsych testing, which looks for learning disabilities, a functional MRI and EEG, physical fitness, cardiovascular status, nutritional status. And this became the - and is still the largest collection of the developing brain of kids 5 to 21 that's ever been collected. And we share it with scientists around the world, who make an agreement with us that they won't try to find out who the subjects are.

GROSS: Wait. So is the point of this to figure out, is there a - like, a biological diagnosis you can make? Does the cohort of people who have, like, depression or anxiety or whatever share certain biological markers? Is that the point?

KOPLEWICZ: That would be the point. The real trick is, can you tell the difference between one atypical child and another? Not the difference between a typical developing child and someone who may have a mental health disorder or a learning disorder but the difference between Terry, who has anxiety, and Harold, who has depression. And is there something on the EEG or on the functional MRI? Can we find a definitive objective test? But the good news here is that when you collect all this data - and it turns out that 9% of the 7,000 kids that participated did not have a disorder. They had symptoms, but they didn't meet psychiatric criteria for a diagnosis. You now have described, very accurately and very specifically, phenotypically what these kids look like. And then you get COVID. And you find that their use of social media jumps. They are using the internet six to eight hours a day. And a...

GROSS: All the kids in the study?

KOPLEWICZ: No, no, no. Just a large percentage of them. And we start defining that as problematic internet usage. Not only are you using it a lot, but when you force them to stop, they get distressed. It almost feels like an addiction, right? And we do know that - it turns out for the 9%, who are typically developing kids, that when you use the internet more than six to eight hours a day, you will sleep less. You will exercise less. And you'll have less interactions in real life. All three of them are important for healthy brain development, but you don't become mentally ill. However, if you have a mental health disorder and you start behaving that way, your symptoms get worse. It's almost like a toxic agent. It turns out that the internet usage of over six to eight hours a day can make your symptoms of depression, your symptoms of ADHD significantly worse, which is a really important phenomena.

GROSS: Why do you think that is?

KOPLEWICZ: Well, it's a very good question. Why? Our guess is that for these kids, someone who has depression, they're already socially more isolated than the average person, and they start losing their skill set and their ambition to interact with the rest of the world. Kids with ADHD can get very hyper-focused with certain activities and at times feel very lost, very impulsive, feel very often like a failure when they can't pay attention in school or are missing things that everyone else is picking up. So what's important about this is that if you're a parent and you know your child has one of these disorders, you have to be very aware that their usage of social media, it could potentially be toxic and it has to be controlled. It can't be unlimited. Not that it's good for anyone to have unlimited, but it's particularly bad for those kids.

So we know that social media was out there between 2010 and 2018. And unfortunately, there's no regulation on it. And it means that parents have to be more aware. I mean, I think of it as, you know, a jungle, right? The jungle is an exciting place, very nutritious fruit and vegetables and lots of terrific stuff. Maybe medicines even can get discovered in the jungle. But it also has snakes, it also has dangerous plants that can kill you, it also has animals. And therefore, if you're going to let your child participate, you should be a very active participant in that permission.

GROSS: So if you think that social media can be very harmful to certain children, how would you suggest parents try to limit their time on social media? That's something that is really hard to do.

KOPLEWICZ: I think it is challenging, but I think it's very doable. We also have some good data. We know that parents who are using the internet in a, you know, problematic way are more likely to have kids that are doing it. Parents have to model this. They have to have periods where, we're putting the phone away at nighttime, and you're not allowed to look at it because we want you to sleep. We do want to look and see how much time you're spending on it, and we want you to be aware of how much time you're spending on it. So it's not, you know, punitive. It's a collaboration, especially if they're a teenager or a pre-teen. But I also think that, you know, it's time for us to get much more sophisticated about this.

GROSS: I want to talk with you a little bit about suicide since you brought it up. And I want to ask you first - just in terms of our show, we always give warnings when we're going to be talking about suicide. And we always give the suicide prevention hotline number, the idea being that hearing talk about suicide can almost be encouraging to someone who has had suicidal ideation. So do you think that's helpful?

KOPLEWICZ: Well, I think it's important to recognize that even if it's a small percentage, to give people that information - that lifeline is very important - and also to let them know that they're not alone. So I think the way to think about this is, why are teenagers so much more at risk than you or me? And the way to think about a teenager is, they feel everything. They're boiling. They're freezing. I hate you. I love you. You know, what happened to I'm warm or it's a little cool in here? That doesn't happen. And in some ways, it's really kind of terrific because they are so creative and they see opportunity everywhere. And they don't recognize risk very well.

I mean, there's some really interesting studies of a teenage boy who goes and picks up a friend to come into his car. And the teenager driver is wearing a seatbelt, and the teenage male who sits down next to him doesn't put a seatbelt on, and the teenage driver takes his seatbelt off. He goes and picks up a girl, and the girl gets into the car and she puts her seatbelt on, and the teenage driver now puts his seatbelt on.

So they're very easily moved by their peer group in a way that they hadn't been before. And parents should note this, that even though the peer group becomes significantly more influential when you're a teenager, parents are still the most influential factor in a kid's life. But it's important that parents keep talking, keep sharing their viewpoint, keep listening to their kid's viewpoint and not back off because their kids say, well, everyone's doing it.

GROSS: A child comes into your office, let's say a teenager comes into your office. You think that the possibility of this teenager attempting suicide is real. What do you do to try to prevent that from happening?

KOPLEWICZ: Well, it really depends on how serious they are about the attempt. Do they have a plan? Have they been thinking about it a long time? Have they stopped doing their usual pleasurable experiences? They no longer are hanging out with friends or not eating the food that they love. And you have to really recognize that if they are very serious about it, you have to intervene. You have to save their lives. You have to either say to them, I don't feel you're safe, or ask them if they feel safe, and then sometimes make the decision that they have to be in an environment where they'll be watched, in a hospital. Or you'll talk to their parents and see can they watch them until this mood and this ideation actually passes.

GROSS: So I just want to pause here and give the national Suicide and Crisis hotline number. And this is the number to call or to text. It's 988, so it's a simple number. Just three numbers, 988, to either call or text the national Suicide and Crisis hotline. So if you are having thoughts of suicide, please get some help. Well, let me reintroduce you. If you're just joining us, my guest is Harold Koplewicz and he is a child psychiatrist, the founding president of the Child Mind Institute. His books include "Scaffold Parenting: Raising Resilient, Self-Reliant, And Secure Kids In An Age Of Anxiety." We have to take a short break here, and we'll be right back. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: This is FRESH AIR. Let's get back to my interview with Dr. Harold Koplewicz. He is a child psychiatrist, he's the founding president of the Child Mind Institute, and his books include "Scaffold Parenting: Raising Resilient, Self-Reliant, And Secure Kids In An Age Of Anxiety."

You specialize in ADHD - attention-deficit/hyperactivity disorder. Why don't you define what the symptoms are and how to recognize it?

KOPLEWICZ: So it's a challenge for lots of people to think about it because they think, oh, aren't we all hyperactive at some time? But the difference here is a deficit in attention toward what's normal developmentally. So the attention span of a 5-year-old is very different than the attention span of a 10-year-old. But any individual who has ADHD is chronically less attentive, tends to be more impulsive, and if they have hyperactivity, they're moving around more. They can get themselves into physical problems because they basically have ants in their pants. They're constantly in motion. The diagnosis when you have hyperactivity is much easier to make than when you just have ADD without H. But it's a chronic illness, and therefore, it may change over time. Your symptoms might lessen. Hyperactivity might go away when you become a teenager. But you are always going to have a shorter attention span and going to be more impulsive than the average person your age.

GROSS: I think this is one of the problems in which brain imaging is starting to be used - fMRIs, where you can see, like, which parts of the brain light up in different situations and different thoughts. How are fMRIs being used in ADHD?

KOPLEWICZ: Right. It's the holy grail for us to find that objective test. One of the things we've discovered at the Child Mind Institute is that the way your brain connects to itself while a child's at rest turns out to be diagnostic. It's called connectomes. So does the front of the brain connect to the side of the brain or to the back of the brain?

And what's been very interesting is that we took a few hundred scans and sent them to a group of people who were statisticians, who were electrical engineers, and asked them if they could group those different scans in different buckets. And we found the group that actually won this competition were statisticians from Hopkins. And they said, well, these 150 scans go together, and these 50 scans go together, and these hundred scans go together. And these are individuals who have never seen a patient with psychiatric disorder. But what's really interesting - in bucket one, the overwhelming majority of those patients had ADHD. In the group of 50, they had autism. And the group of a hundred, they had both ADHD and autism. So we're really excited by the fact that we have found something that might lead us to a definitive, objective test.

Now, the important part for everyone to remember - it's not just one child. It's not a strep test - yes, you're positive or someone else is negative. It's a group difference. But that's the way we're going to get closer and closer to making a definitive diagnosis.

GROSS: So in a study like the fMRI study that you were referring to, how do you know whether the brain is reflecting the behavior or whether the behavior is predetermined by the brain? Do you know what I mean?

KOPLEWICZ: Sure. Well, it's...

GROSS: It's, like, if I move my left arm - if I say, I'm going to move my left arm right now, and I'm doing it with intent, it's going to register on an fMRI, probably. But it's not like I have a disorder that's moving my left arm. It's, like, I've decided to behave this way, and it's registering in my brain.

KOPLEWICZ: So, you know, let's think about this for a second. This is exactly where the field of research in functional MRI has gone to. You know, they used to give a trigger to a kid. You know, pay attention to this while you're in the machine, or we're going to show you scary faces and see what happened to the brain. It turns out that the most powerful way of doing this is just letting kids rest or sleep in the functional MRI. And your brain is incredibly active while you're at rest or sleeping. And that's when you're going to see most of these connections. So in the case of the study, we weren't triggering them. We weren't saying, you know, this clearly should be what makes the - you know, we'll catch them being inattentive, and then we'll look at the MRI. We're just looking at their brains at rest.

GROSS: Oh, that's really interesting. So has this affected your treatment at all?

KOPLEWICZ: So we're not there yet. You know, it's not ready for prime time. I wish it - you know, I could say, oh, we're going to give everyone EEGs, because they're only 60 bucks, and an MRI is 500, and we found some correlation. That's what I'm hoping for. But, you know, science has to wait for real data. So at this moment, we still have to rely on clinical diagnosis. You're asking parents what they think. You're asking teachers and report cards, because this is not something that just pops up when you're about to apply to college or because you didn't make partner at the law firm. This is a lifelong illness. And you can document that by looking at things from a longitudinal basis.

And then you have to examine the child. The child basically confirms the diagnosis or doesn't. I think it's fascinating when you do give a kid meds, and they do significantly better, that a young child will tell you the medicine's not working. And you say, really? What's changed? He said, my teacher is much nicer. I said, that's really interesting.

GROSS: (Laughter).

KOPLEWICZ: You take a pill and your kid - your teacher's much nicer. That really is absolutely amazing. And they said, yeah. You know, you're 8 years old. OK.

GROSS: Well, we need to take another break here, so let me reintroduce you. If you're just joining us, my guest is Dr. Harold Koplewicz. He's a child psychiatrist. He's the founding president of the Child Mind Institute. And his books include "Scaffold Parenting: Raising Resilient, Self-Reliant And Secure Kids In An Age Of Anxiety." We'll be right back after a short break. I'm Terry Gross, and this is FRESH AIR.

GROSS: This is FRESH AIR. I'm Terry Gross. Let's get back to my interview with Dr. Harold Koplewicz. He's a child psychiatrist and the founding president of the Child Mind Institute. His books include "Scaffold Parenting: Raising Resilient, Self-Reliant, And Secure Kids In An Age Of Anxiety." Your middle son has dyslexia. No one realized it at first. How did you discover what it was? Because this is, I assume, one of the issues that you treat as a child psychiatrist.

KOPLEWICZ: Right. Well, I think dyslexia has very often been put into another category until about the last 25 years, so that it was something educational experts did and not necessarily child psychiatrists. And brain scans and functional MRIs have changed that, but in the case of our family, he was 4 years old. We were visiting his grandmother for a day, and she was a pretty neutral individual, very careful not to say anything critical or even say anything overly praising, and she mentioned that she had trouble understanding him. And we said, Well, you know, his articulation isn't great. And she said, no, his stories are out of sequence, and I don't think he knows my name. I love listening to him, but everything seems a little mixed up. And I was the one who said, you know, we should listen to grandma here.

And we went on this journey to figure out what was wrong. We had him tested, and the tester said, oh, he's very bright. Well, at 4 years old, you don't read on these kinds of neuropsych testing, but she did mention that he had some word retrieval problems and that he couldn't name certain things, and she was concerned that maybe he didn't recognize the alphabet. And I remember at the time saying, What do we do about it? And she said, well, it's going to cost a lot of money, and it's going to take a lot of time. And I thought, well, he's 4 years old. He has a lot of time. And for this, we'll find a lot of money. We'll mortgage our house. He's got to learn how to read.

So we went on this journey, and it turned out that we wasted a lot of time. There were a lot of dead ends where we thought we were doing well, but it turns out he was memorizing words, that he couldn't decode the language. He couldn't tell the difference between Sally, Susan, and Sarah. And it was only by third grade, when math turned into word problems, that we saw how frustrated he was and how he recognized that he was ahead of kids in math but way behind them in reading, and he knew this was happening. And that gave us the moment to reevaluate and figure out a more evidence-based approach.

GROSS: Which was?

KOPLEWICZ: Well, it turns out that a multisensory approach to learning how to read, teaching kids the sounds of the language, brother sounds, what your lips look like, and there was a program called Lindamood-Bell, which is now in 50 states, and it's very intensive. You spend 4 hours a day doing these exercises with a different tutor every hour, and then you do another 30 minutes or 40 minutes of homework. And they basically teach you how to break the code, that the rest of us are learning how to read with only one side of our brain, and they are teaching you how to read thinking that, you know, your brain thinks it's Italian or Spanish, that you're learning a foreign language. It's really a remarkable intervention.

GROSS: I'm going to stop you. What do you mean by that, that your brain thinks you're learning a foreign language?

KOPLEWICZ: When we learn a foreign language, we use both sides of our brain. When we're learning...

GROSS: We do?

KOPLEWICZ: Yes.

GROSS: (Laughter). I hadn't heard that before.

KOPLEWICZ: Right. So when we're learning our native language, we activate one side of the brain, and kids with dyslexia underactivate that brain. And so when you teach them a new way of learning, it's like teaching them a foreign language, and so when you check what's going on in a functional MRI, they're lighting up both sides of their brain. The thing that's really awful about dyslexia, as far as I'm concerned, is what it does to kids' self-esteem. You know, once a year, I get to interview someone who's struggled with it, whether it's Orlando Bloom or Ari Emanuel or, you know, Lorraine Bracco, and you hear how bad they felt about themselves.

Think about it. Every day, you go to work, and every day, you feel like a failure, so it's not surprising that you think you're stupid or that you don't want to be there. And what they - all these successful people have in common is a great mom. You know, Barbara Corcoran has it, and she told me that the nuns were really giving her a tough time in parochial school. And her mother said, don't listen to the nuns. You are not stupid. They're stupid. Well, having a mom who's telling you you're still bright or Orlando Bloom's mom, who said, let's do poetry - you know, those are these great moms who are basically saying, I'm on your side, and we're going to figure this out. But for those who don't have those moms, school is impossible. There's high school dropout rates. There are high rates of getting involved in the juvenile justice system because you're not in school. And when we look at the juvenile justice system, we see that 70% of the inmates have dyslexia.

GROSS: You know, I used to think that dyslexia was a problem with, like, reversing words, so you'd have to read slowly 'cause words would get reversed in your mind, but it's much more profound than that. Can you give us, like, the latest understanding of what dyslexia is?

KOPLEWICZ: Sure. So that's a myth, you know, the d, the b. What it really is, first of all, it's a brain-based disorder, and there's two major symptoms. One is alphabet recognition, being able to look at the A and knowing it's an A and looking at the D and knowing it's a D. And we all learned that, kind of, you know, very easily. And the other (inaudible) awareness, hearing the sounds of the language, being able to say to yourself or let your brain recognize that S-L-O-W comes out slow and S-H-O-W comes out show. And so you have to be able to hear those two different phonemes. And I will tell you that now that America is recognizing that this kind of evidence-based learning is really important, that we have to teach kids phonemes, we have to teach them how to read no matter who they are, we are really addressing this in an earlier age, so kids who have dyslexia will be picked up sooner and will be able to get interventions that are more effective, again, before it affects their self-esteem.

GROSS: So let me reintroduce you here. If you're just joining us, my guest is Doctor Harold Koplewicz. He's a child psychiatrist, author of the book "Scaffold Parenting: Raising Resilient, Self-Reliant And Secure Kids In An Age of Anxiety" and founding president of the Child Mind Institute. We'll be right back. This is FRESH AIR.

GROSS: This is FRESH AIR. Let's get back to my interview with Dr. Harold Koplewicz, the founding president of the Child Mind Institute, author of the book "Scaffold Parenting: Raising Resilient, Self-Reliant And Secure Kids In An Age Of Anxiety." He's a child psychiatrist and has been one for how many years?

KOPLEWICZ: Almost 40.

GROSS: OK. So this is a kind of personal question, but knowing what you know now - and there's so much more research that's been done into childhood, you know, behavioral problems and mental health disorders - do you think you had any undiagnosed problems as a child?

KOPLEWICZ: I don't think so, but...

GROSS: And I don't mean that, like...

KOPLEWICZ: No, no, no.

GROSS: ...I recognize symptoms in (laughter)...

KOPLEWICZ: No, no, no. Yeah.

GROSS: ...In how you're behaving...

KOPLEWICZ: I - but I know - but I would tell you that I clearly became much more of a student when I was in college than I was in high school. I had Eastern European parents. I had parents who survived the Holocaust and got to the United States in 1949. And they didn't believe that education was a journey. It was a destination. And they couldn't wait until, you know, you graduated and go to college. And so I was two years younger than everyone in elementary school. And I think that was most probably not a great idea - that most boys developed, you know, late. And so that was a problem.

And I would also tell you that, you know, the parents that I had when I was growing up were much more traumatized by the Holocaust than the parents I had later on in life, when they were in their 80s and 90s and were less anxious and the nightmares had stopped and they felt more comfortable in the United States - and also comfortable that, you know, I was going to be successful. I had graduated medical school. I had children. They - I was married. And that seemed to really calm them down.

But I do recognize that they were overly invested in my being successful because they were trying to recreate stuff that they lost. My parents were both - by the way, my father had graduated law school in 1936, and my mother was in law school in 1938. And neither one of them ever practiced law. They came to this country as immigrants. They had to start all fresh again. My father started a business. I think they struggled financially. My mother eventually went back to school and got a B.A. and then an MSW. But there was this idea of what could have been if there wouldn't have been the Holocaust. And therefore, my sister and I had to carry, you know, that weight, which is, you know, understandable but was very unpleasant when it was happening.

GROSS: Were your parents in camps?

KOPLEWICZ: My father was literally in 14 concentration camps and the Warsaw Ghetto. And how is that possible? Well, at the very first camp, they asked, who knows how to make airplanes? And my father raised his hand. And when asked about that, he said, well, they had already killed the lawyers. And he figured, well, I know how to use a screwdriver. I'll figure it out. And he went from camp to camp. And he was with one other man who kept being moved with him, and they got a little piece of metal. And the other guy was very artistic, and he engraved a sailboat and a horn of plenty. And on the other side, every time they moved from one camp to another, my father inscribed the date and the name of the camp. And they were hoping that it would be at least a record, that what they were experiencing would be recorded and documented. And that piece of metal, by the way, is at the U.S. Holocaust Museum in New York - I'm sorry, in D.C., in Washington...

GROSS: Yeah.

KOPLEWICZ: ...D.C.

GROSS: Yeah. So you mentioned your - so your mother was in camps, too?

KOPLEWICZ: No. My mother got papers as a Catholic and - false papers as a Catholic and walked out of the ghetto. And in some ways, it was more trying for her in the respect that - think about it. You have fake papers, and if the Gestapo stops you and starts really examining the papers and starts asking you questions like, what is your mother and father's name? Oh, they're dead. OK. And what was your priest's name? And where are you from? It wouldn't take very long.

So she moved around 16 different villages, outside of Warsaw, working as a maid. And she was a terrible housekeeper, so it is really amazing how she managed to do that, because she - you know, she really had a very tough time and was very isolated and just basically, you know, surviving from day to day. And it was, I think, a little more than two years where she was moving around. The war ended first in Poland. And so my father didn't come and find her until several months later.

GROSS: Oh, they were married before the war started.

KOPLEWICZ: Well, I wish I could tell you that's true, and that was the story I was told. But it turns out that when my then-12-year-old son was doing a - my wife insisted that if he was going to be bar mitzvahed, it had to be intergenerational. So he kept asking my mother her life story and recording it. And at a certain point, my son said, I don't understand, Grandma. Where was the infrastructure in the ghetto for you to get married? And my mother said, oh, you know, in the Jewish religion, you can get married and become the stars and the moon. And my son said, I don't think that's true. I think you need a contract.

KOPLEWICZ: And she said, well, August 12. It was the day I lost my virginity with your grandfather. And he came home and said, I don't know if Grandma and Grandpa ever were married. I think they're celebrating the day they had sex. So I called my mother and said, I don't understand. Why did you tell him that? She said, I never slept with anybody else, and I thought, enough. And he asked much better questions than you ever did.

KOPLEWICZ: So I think they got married when they were leaving Poland to go to a displaced persons camp in Germany. But - and I have to tell you as an example, their people - my mother was madly in love with my father before the war. You know, she lusted for him. He was very attractive, and he was a lawyer already. And then after the war, when he returned, he was skin and bones. And, you know, he was truly a different person. And she was a different person. She was no longer a bit of a princess. She was a survivor. She knew hard (ph) - and she - he came and found her. And she said, I'm going to let you come in, but I'm leaving. I've got papers to go either to Palestine or to Australia or Canada or the United States. I'm not staying here. And he said, well, I am staying here. I'm a lawyer, and we're going to make a lot of money. And she said, that's OK.

The idea that they lived together for three months and she got the papers and he decided to go with her - it's really a very romantic story that they fell in love again. And my father, every year on their anniversary, would give my mother - if they had money, he gave her a red rose for every year they were together and three white roses for the three years they weren't together with the same note - life had no color without you. So they really rediscovered each other and I think gave - that bond was so close. In some ways, my sister and I sometimes felt out of it because they were such a partnership that that's what carried them through later on.

GROSS: What impact do you think it had on you as a child to know that they were having these nightmares, these concentration camp...

KOPLEWICZ: Oh, it was nightmares.

GROSS: ...Or posing-as-a-Catholic kind of nightmares? Did they tell you about that? Could you sense it? And in the same mode there, like, did they let on what they had experienced and how traumatic it was?

KOPLEWICZ: So the stories were never consistent or chronological, so you only got bits and pieces. You know, something about the showers - right? - that one of my grandmothers died in the showers. You know, I hate to tell you that they didn't explain the camps to me, but you also knew that they were so upset by it that you didn't pursue it. You didn't ask them a lot of things. And I can certainly tell you that since they weren't very Jewish by education or training, the holidays were just terrible. I mean, you know, most people light a memorial candle for all the people that have died in their family. Well, all their brothers and sisters and their parents and their cousins, so that, you know, there were, like, 10 yahrzeit candles, these memorial candles, but they weren't kept in the kitchen. Like, all the ghosts were on the dining room table for Rosh Hashanah or Yom Kippur. And it's kind of amazing the transformation they made over time - that, you know, they were literally able to become more stable and calmer and more effective as adults.

GROSS: You must have grown up with a very dark view of life.

KOPLEWICZ: At times, yes. You know, at time, yes. And yet the amazing part about my parents were they couldn't care less about material things. So other kids would live in houses near us in Queens and then in Nassau County, where the slip covers, plastic slip covers were put on the furniture, and my mother would say, What are they waiting for? You know, they'll be dead. If something broke in our house, my mother never cared about it. I mean, it really gave them a whole different attitude about what was important, and certainly, material things were not important to my parents. They had lost a lot because they stayed. You know, I used to say, why didn't you come to America, for God's sakes? and my mother would say, Al Capone and peasants - they came to America, not - you know, not the intelligentsia. You know, she's kind of snobby about, you know, her academic credentials and who her family was, but, you know, they lost a lot because they didn't want to leave property or whatever it was or the life that they had.

GROSS: So one last question. You know, some parents really want to be their children's best friend, and some parents really want to maintain their stature as the authority figure, not the best friend. And in terms of being a parent yourself, I'm curious where you fit on that spectrum, if you are comfortable talking about that.

KOPLEWICZ: Sure. Well, I'm not my kid's best friend, you know, and that's OK, because even though they're all adults now, which is a whole different kind of relationship... I mean, my children are 41, 37, and 35. It really is frightening...

KOPLEWICZ: ...To see that one of my kids has gray hair. You know, it's like, how did this happen? Because I'm still 35. You know, but all along, I think there is this pull that you certainly want your kids to love you because you love them so much, but it's OK for them not to like you because you do have to protect them. And when you protect them, there are certain things that they want to do that you know are dangerous for them or are just not good for them or not healthy for them. And so I think it's very hard, if not impossible, to be a friend, which is be a peer - right? - and share the same point of view and not have control. Your friend does not have control over you. It's much more equal. And I don't think that's possible as a parent. I think the best type of parenting, by the way, is an authoritative parent who has a lot of warmth but has a lot of control. So both the kid and the parent know, at the end of the day, the parent is going to make the decision, maybe with input from the child. But at the end of the day, it's not a democracy. It's going to be the parent who has the responsibility to make those decisions.

GROSS: Dr. Harold Koplewicz, thank you so much for talking with us.

KOPLEWICZ: Oh, it's been a pleasure, Terry.

GROSS: Dr. Harold Koplewicz is the founding president of the Child Mind Institute. His latest book is titled "Scaffold Parenting." After we take a short break, Justin Chang reviews what he describes as a marvelous new movie. This is FRESH AIR.

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