When it comes to sex, Americans are hooked on the lewd and excel at the punitive; if we think of the erotic at all, it’s as something strange and vaguely European, or maybe something cheesy in the mode of Fifty Shades of Grey. In the ’80s, Jack Morin, a psychologist in San Francisco, became convinced that a society that didn’t understand the erotic would invariably panic when confronted by it. So he set out to catalog the strange and wily nature of lust. In what he called the Sexual Excitement Survey, he asked more than 350 adults of different ages, races and sexual orientations about their most potent sexual experiences and fantasies.

He published the results in a book, The Erotic Mind, in 1995—the same year that movie star Hugh Grant got arrested for an encounter in a car with a sex worker, to the puzzlement of everyone. Grant was dating Elizabeth Hurley! Millions of women wanted to have sex with him! When the actor appeared on “The Tonight Show,” Jay Leno asked him, “What the hell were you thinking?” Morin’s book has plenty of answers.

“Whereas sex can be simple, by its very nature Eroticism is complex,” he explained. “Eros is energized by the entire human drama,” including “unruly impulses and painful lessons.” His survey respondents described their most memorable sexual encounters as being stoked by longing and anticipation, or by knowing that they were breaking social conventions. For many, the possibility of getting in a little bit of trouble was exciting. (Fortunately, for most people, the possibility of getting in a lot of trouble is a turnoff.)

Morin also found that his respondents’ sexual fantasies were “highly specific and focused” and that people tend to return to their most compelling ones again and again. For some, once a personal erotic script gets written, it can exert an obsessive grip on the imagination. “When someone pursues lustful aims with complete detachment from tenderness and affection,” Morin wrote, “erotic attention narrows to a laser-like focus on maximum genital arousal. The result is often a level of excitation that is qualitatively different than any other kind—hotter, more insistent, a unique psychophysiological high.”

You can detect these compulsions in the stories of, say, Spacey and Nassar. Harry Dreyfuss, the son of actor Richard Dreyfuss, described how when he was a teenager, Spacey once cupped his genitals in the presence of his father while the latter was busy reading a script. (Spacey has denied this allegation.) Likewise, Nassar, the former USA Gymnastics medical coordinator, often had girls’ parents sit in the room while he inserted his ungloved fingers in their daughters, casually blocking the view with his body or a towel. As prosecutor Angela Povilaitis said at Nassar’s sentencing: “To unnecessarily and without warning penetrate an unsuspecting minor for your own selfish sexual gains while her parent sat just feet away, unknowing, had to be part of the rush or the thrill for this defendant.”

It’s possible to see the kind of repetitive script that Morin described acted out by Bill Cosby. The comedian would get a young woman into his hotel room, sometimes his home, ostensibly to offer career advice. Noting that she seemed tense, he’d offer a glass of wine or another beverage (or pills, calling them her “friends”). He’d tell her to swallow—there was something disconcertingly insistent about this—then wait for the drugged woman’s eyes to flutter shut. After that, he could do with her what he wanted, experiencing, perhaps, the excitation that is different than any other.

How an abnormal focus like Cosby’s comes to be is not fully understood, but most experts agree that it often begins well before a person is explicitly aware of sexual feelings. Children, wrote Krafft-Ebing, experience “bodings and yearnings” and “mysterious sensations, foretastes and impulses.” The advance of puberty then develops these vague and undefined impulses “into conscious realization of sexual power.”

We tend to think of puberty as a hormonal levee break, in which tweens are suddenly flooded with chemicals that remake their bodies and minds. But it’s really more like an ongoing engineering process, with valves steadily discharging increasing amounts of hormones over time. Michael Vigorito, a sex therapist who co-authored the textbook Treating Out of Control Sexual Behavior with fellow sex therapist Doug Braun-Harvey, told me about a little-known phase of development called adrenarche, a precursor to the sexual maturation that occurs during puberty, when the adrenal glands in both boys and girls start releasing androgens, the male sex hormones. Adrenarche starts for most children between the ages of 6 and 8, and it seems that many sexual proclivities get fixed around then. “By the time someone reaches puberty,” said Vigorito, “what turns them on is likely there, and is for them to discover.”

When people discover what’s there, a specific fantasy, sometimes very specific, can get endlessly reinforced through masturbation. In The Erotic Mind, Morin described a patient who recalled receiving a fire truck when he was a child. It was large enough to ride on, and it came with a yellow raincoat. Driving around, he’d enjoyed the “tingling” sensations from riding, and the sense of himself as a brave fireman. As an adult, his most intense orgasms occurred when he masturbated while wearing a yellow raincoat. He found his fetish deeply dismaying, calling it a “sickness” he couldn’t shake.

Curiously, an intense arousal can be attached to something not sexual at all—and why this happens for some people remains unknown. In “The Butterfly Effect,” a podcast about the effects on society of unlimited pornography, host Jon Ronson explored “custom porn,” in which clients pay filmmakers to enact their private erotic dramas. One man requested a film of a woman in the kitchen exasperatedly swatting at an invasion of flies. Ronson interviewed another man, “Mike from Ohio,” who explained that when he was a kid, his mother had not allowed any talk of sex and only let him watch old TV sitcoms that she deemed free of sexual references. One day, Mike was watching an episode of “The Dick Van Dyke Show,” in which Mary Tyler Moore got her toe stuck in the faucet of a bathtub. This scenario has been the locus of Mike’s sexual arousal ever since. He paid to have a film made that showed what “The Dick Van Dyke Show” didn’t: the fully naked woman unable to extricate her toe.

Such scripts may cause distress only to the person with the fetish. But scripts that involve other parties have the potential to go awry. “Some people fantasize about something autoerotically for a long time, then they spring it on somebody,” said Russell Stambaugh, a psychologist and sex therapist in Michigan. “They don’t have the social script for negotiating their fetish with a partner.”

And so the story of Enlightenment philosopher Jean-Jacques Rousseau, who in 1782 described in his Confessions the origin of his spanking fetish. Shortly after his birth, Rousseau’s mother died, and eventually he was sent to live with a woman named Miss Lambercier. Of the spankings she inflicted on him, Rousseau wrote, “Who would believe this childish discipline, received at eight years old, from the hands of a woman of thirty, should influence my propensities, my desires, my passions, for the rest of my life.” Rousseau’s arousal required scornful superiority from the woman punishing him: “To fall at the feet of an imperious mistress, obey her mandates, or implore pardon, were for me the most exquisite enjoyments.” In search of this, he would go out and expose his buttocks, hoping for disapproval and a smack from passing women.

All the therapists and researchers I consulted said there’s no single explanation for the range of sexual behavior that crosses the line. In their book, Braun-Harvey and Vigorito explore some of the psychological roots. They describe how for some men, sexual situations trigger a specifically sexual narcissism; when these men are aroused, they can engage in exploitation they later justify to themselves. “There is a sense of entitlement and a lack of empathy,” Vigorito told me. So perhaps to the case of Louis C.K., who is reported to have posed this startling question to female colleagues: Could he masturbate in front of them? Sometimes he got a stunned yes, and he did. In a written statement, Louis C.K. acknowledged how he rationalized his actions: “I said to myself that what I did was O.K. because I never showed a woman my dick without asking first.”

The therapists also describe a pattern of sexual behavior called “avoidant attachment.” People with avoidant attachment patterns, they write, often have difficulty forming adult relationships. Even if these individuals are in a primary romantic relationship, they are more likely to seek sex elsewhere. Meanwhile, people with unconventional turn-ons may feel shame or embarrassment, so they avoid exploring their desires with a partner, preferring the reliability of masturbation. They can engage in out-of-control sexual behavior to regulate the threat of emotional closeness. Or, as Morin wrote, “Lust is most likely to turn destructive when it is split off from the rest of life, where it festers and grows hostile.”

Despite our societal preoccupation with sex—keeping penises erect is, after all, a multibillion-dollar industry—the specifics of who or what turns people on, how they express their desires and how this can go wrong remain largely mysterious even to experts. There’s not even general agreement among medical and psychological professionals about what to call the behavior that repels and puzzles us—let alone treat it. Is it “compulsive sexual behavior”? “Sex addiction”? Is it a moral failing, a social problem, a medical issue?

In the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, atypical sexual arousal is considered a “paraphilia,” the umbrella term for sexual fetishes and similar behaviors. The manual describes paraphilias that range from an obsession with a body part (for example: feet, hair) to engaging in certain conduct (exhibitionism, voyeurism) to a fetishistic focus on an object (shoes, rubber). Sexual attraction to children, or pedophilia, is a paraphilia, as are sexual masochism and sadism.

So paraphilias range from the harmless to the criminal. But paraphilias are not themselves a problem, according to the DSM. Until five years ago, a person with a paraphilia was considered psychologically ill. Now, however, the most recent edition of the DSM classifies most paraphilias as normal sexual variations that become problematic only when the person with one is distressed by it or acts on it in a way that violates others. This change was a triumph for the BDSM and other sexual minority communities that lobbied to bring it about.

Most of what we know about people with sexual compulsions or harmful paraphilias comes from research on those who end up in the criminal justice system or who seek psychological help on their own (or at the insistence of a spouse or employer). However, a Swedish study published in 2006 provides a window into the lives of “hypersexual” people in the general population. Based on a survey of sexual practices and psychological health in Sweden, the researchers identified a subset of men and women who had more sex than average. It turned out these subjects could be neatly divided. Those who were going at it in the context of a stable relationship tended to be happy Swedes. Those who had high rates of impersonal or solitary sex, not so much.

This second group started having sex earlier in life, had it more often and sought more variety than others. Their sexual menu included “paying for sex, exhibitionism, voyeurism, and masochism/sadism.” (Almost twice as many men as women fit the study’s criteria for hypersexuality, and the men masturbated three times as often as the women.) The researchers found that this group also tended to have romantic troubles and a history of sexually transmitted diseases. Hypersexuality itself was linked to a general propensity toward risky behavior, poor social adjustment and unhappiness.

The psychiatric profession is still grappling with how to categorize this behavior. The APA decided against “hypersexuality” as an entry in the latest DSM, but the International Classification of Diseases, an influential database maintained by the World Health Organization, recently included the diagnosis of “compulsive sexual behavior disorder,” described as “a persistent pattern of failure to control intense, repetitive sexual impulses” that “causes marked distress or significant impairment.” (The prevalence of this disorder is unknown, but estimates range from 1 to 6 percent of adults globally, with recent estimates at the lower end.)

Engaging in hypersexual behavior or having a paraphilia isn’t an explanation for why someone sexually transgresses. People can be hypersexual without having a paraphilia and vice versa. Not all sexual violators are sexually compulsive. There are also people whose key sexual fantasies are about behaviors harmful to themselves or others who do not act on those desires. But the Swedish study found a “strong association between high rates of impersonal sex and paraphilic interests,” giving support to the idea that hypersexuality and paraphilia can have a synergistic effect.

Many mental and physical maladies seem to act as a tripwire for hypersexuality. A paper by Meg Kaplan, an associate clinical professor of psychiatry at Columbia University, and her husband and fellow Columbia associate clinical professor of psychiatry, Richard Krueger, listed some of the related conditions, including bipolar disorder, brain injury, dementia, substance abuse, obsessive-compulsive disorder and impulse-control disorder. There may also be a connection, wrote Krueger and Kaplan, between hypersexuality and certain personality disorders, such as histrionic and narcissistic personality disorders. Other studies have found high rates in sex offenders of antisocial personality disorder. These are people, such as psychopaths or sociopaths, who are aggressive, callous and manipulative.

Similar to the Swedes, Americans who have lots of sexual partners do not appear happier than their more buttoned-up fellow citizens, according to a recent analysis of American sexual behavior by sociologist Nicholas Wolfinger. Based on nearly three decades of data from the General Social Survey, Wolfinger found that the average American man has had five sexual partners and the average woman three—but there is a sliver of the population, about 5 percent, who have had many more partners. In this subset, the men had roughly triple the number of partners as women: 50 or more for the men compared to 16 or more for the women.

Which brings us to the unavoidable conclusion arrived at by most mental health experts: When we are talking about harmful sexual disorders, we are talking about a phenomenon that occurs predominantly in men.

Like many single women, Kerry Quinn was looking for a romantic partner on dating apps. And like many single women, she had been the unwilling recipient of an extraordinary number of dick pics. As she’d later write in a story for Thrillist, she was sick of “unexpected visual boners intruding on my day.” So she decided to conduct a little experiment: She would show men what it was like to get an unsolicited photo of female genitals.

Quinn picked a random picture of a “cute” vagina from the internet, then set her dating parameters wide—men between the ages of 22 and 60. After she matched with a man and exchanged some flirty texts, she hit him with the photo. Just as she’d expected, the men were grossed out and pissed off.

OK, I made up that part. To Quinn’s surprise, the men to whom she sent the photo responded with descriptions of how they planned to pleasure her and happily complied with a request to send a very personal photo of their own. Quinn decided to up the shock value. On the next round, she sent the photo immediately after the initial hellos, and her collection of photos of male genitals grew considerably. For a final round, Quinn dropped the hellos entirely and just sent the picture. More delight ensued, with men offering explicit descriptions of how they would improve her life.

Quinn’s experiment, in other words, was an abject failure. “Given that men like to send dick pics, I suppose their enthusiasm for v-pics makes sense,” she wrote. There’s no doubt that many dick pics are sent with the intent to shock and humiliate. But it’s also apparently a male trait to overestimate the female desire to see one’s genitals. Krafft-Ebing’s patient who liked to jump out of the bushes with his penis exposed explained to the doctor that, after finding the examination of his own genitals satisfying, he had “the lustful thought that this sight must be very pleasant to women.” In an article for Psychology Today examining the impulse behind the dick pic, psychologist David Ley noted that among gay men, sending such a photo would be meant not to offend but to entice. In a sexual world without women, many men happily speak dick pic semiotics.

When compared (in general) to female sexuality, there’s more moreness to male sexuality, and therefore more potential for it to go amiss. It’s popular in certain circles to assert that differences between the sexes are a construct, but the people I spoke to who deal with sexually troubled patients cautioned against ignoring the very real biological differences that do exist. Of course cultural forces greatly shape behavior, and generalizations will always be subject to dispute. But if we want to understand sexual misconduct, we must also acknowledge the places where our sexual wiring diverges.

Ley, who practices in Albuquerque, New Mexico, wrote the book The Myth of Sex Addiction, in which he ticks off the many (broadly general) differences between male and female sexuality, citing research and his own clinical experience. Men are more sexually aggressive, which can be welcome or frightening. Men think about sex more than women and want to have sex more than women. Men would be more likely than women to have sex with a stranger or with a group. Men are more likely to get a boost of self-esteem from a casual sexual encounter than women. Men are more likely to watch porn.

In The Erotic Mind, Jack Morin also discovered essential differences in men and women’s peak erotic encounters. The contrast was made especially clear when comparing gay men and lesbians to heterosexuals. Men were almost twice as likely as women to describe anonymous sex as a peak encounter. Almost 50 percent of the gay men in his survey described an encounter with a stranger or acquaintance as peak, compared to 1 percent of lesbians. Women were far more likely than men to have feelings for someone preceding the peak encounter.

Morin believed that the differences begin in the obvious place: the penis, insistent as a puppy, relentlessly demanding attention from its owner. “The penis is an instantaneous and unavoidable arousal feedback system,” he wrote, with favorite fantasy images reinforced by masturbation. On the way to a satisfying sex life, most men have to learn to restrain their orgasm, while many women must learn to access theirs. There have been experiments to measure arousal, in which women and men privately watched erotic films in a lab while hooked up to devices that gauge genital response. The scientists found that, objectively, most subjects experienced arousal, a point confirmed by the men but disputed by the women. The latter often said, in contradiction of physiological evidence, that they were not turned on at all. (Theories include women’s arousal being less obvious than men’s, even to women themselves; women being socialized to repress their sexual response; and women lubricating even if not aroused as an evolutionary adaptation to reduce injury in case of rape.)

Several therapists I interviewed talked about the need for a more empathetic understanding of male sexuality, for the sexual burdens and expectations that men carry. In our mating rituals, men are supposed to initiate, read signals and be forceful, all to a precise degree. Courtship is full of feints, double-entendres and mixed messages. “Men are taught from a young age that they must be sexually competent and sexually powerful with exaggerated and impossible ideals,” wrote Ley. “Compared to women, men are far more insecure and anxious about their sexual performance.” This pressure and insecurity, Ley continued, can also breed resentment.

But there’s more to male sexual vulnerability than performance anxiety. Ley writes that the popular caricature of male sexuality as either foolish or malign misses the enormous role that sex plays in men’s emotional lives. Often lacking the kind of physically expressive emotional support that women have with friends, men turn to sex to feed a craving for intimacy and tenderness that is “often starved near to death.” Men, Ley writes, use sex to “let down boundaries and drop our armor enough to be emotionally vulnerable.”

None of these differences excuse sexual violations. But when male psychological vulnerabilities aren’t recognized and addressed, the results can be dire. Negative emotional states, discovered Morin, can actually act as “unexpected aphrodisiacs.” Even more perversely, states of anxiety, guilt and anger are sexual fuel for some. As Morin put it, low self-esteem and high arousal can produce “the most overwhelming and destructive turn-ons.”

Like Harvey Weinstein, Michael spent years in Los Angeles exposing himself to women. Weinstein is accused of shedding many bathrobes in his favorite venue, a Beverly Hills hotel suite. Michael’s venue of choice—of necessity, really—was the county bus. Michael (not his real name), who is 58 and no longer lives in California, can, like many people with a paraphilia, trace the origins of his behavior back to childhood. He grew up in a small town in the Midwest as an outsider, the only mixed-race child in his school. He says he’s a combination of Native American, white and African-American, but his classmates saw him only as the n-word, an epithet he says he heard regularly. (The sex offender registry classifies Michael as black.) His father was not around, and when his older brother beat him, his mother sometimes laughed.

So Michael spent as much time away from home as possible. From ages 10 to 12, that meant hanging out at the house of one of his few friends—let’s call him David—who lived with his stepmother and a stepsister in her mid-teens. Michael said the stepmother walked around the house in a bra and panties. The stepsister liked to pull up her top and show Michael her breasts. “I remember feeling excited, if that’s what it was,” he told me. “Or scared. A little bit of both, I guess.” Mixing lust with negative emotions, as Morin documented, can create a powerful fusion. As Michael says: “I think it screwed me up.”

By high school, many of Michael’s classmates were pairing off romantically, an opportunity he felt was unavailable to him because of his race. Instead he focused on how excited David’s stepmother and stepsister had made him. He thought that if he stood in the window and exposed himself to passing girls, they might get excited too—although he didn’t do it.

The day he turned 17, Michael joined the Army. A few years later, honorably discharged, he moved in with his grandmother. His bedroom overlooked the street, and he would leave the blinds open while he changed clothes; young women his age, he said, would walk by and sometimes look. So he started masturbating at the window, and when he did, some of them watched. Eventually, his shame was greater than his excitement, and he came to feel it was time to leave the Midwest for good. He ended up on a bus to Los Angeles. During the several-day trip, a young woman sat across from him. “I exposed myself,” he said. “She kept looking. I masturbated. She watched. Then I sat next to her. And we had sex on the bus while everyone was asleep.” Afterward, they held hands until she reached her destination.

James Cantor is a psychologist and associate professor at the University of Toronto’s faculty of medicine whose expertise is in atypical sexual expression. He characterized exhibitionism in a way that sounded almost fanciful: that there might be a biological glitch that gives some people an impulse to expose themselves, akin to courtship display rituals in other species. “It’s like it’s an ancient behavior normally suppressed in the human brain,” he said. (The DSM actually categorizes exhibitionism, voyeurism and frotteurism—touching or rubbing up against a nonconsenting person—as “courtship disorders.”)

It was striking how closely Cantor’s description matched Michael’s thought process when he was exposing himself: “I was looking for somebody to like me and want to be with me,” Michael told me. When he said that he had received enough positive responses to keep going, I found this hard to believe; I have encountered flashers four or five times, and each time I felt violated and repelled. But Michael said, “I was looking for a woman who liked it. Who would look directly at my penis, smile, and continue watching while I masturbated. I got a lot of those. I’m a little surprised you’re shocked.” Of course there were also plenty who didn’t smile. Michael hadn’t wanted to frighten women, and when he did, he was filled with guilt and self-loathing. “Some women were livid,” he told me of his many bus rides. “One of them—she pulled out a knife and said, ‘Put it away or I will cut it off.’”

Living in southern California, Michael tried a variety of odd jobs, including being a stripper and porn actor, but being paid to expose himself wasn’t exciting. The bus trips became the centerpiece of his life. “It developed into a coping skill,” he told me. “Kind of like a drug high. When you’re feeling stressed, afraid, it takes your mind off it. While you’re doing that, you’re not feeling anything else.”

He was eventually forced to confront the effects of his behavior. In 1991, he was sitting on the bus next to a woman of about 20 and pulled out his penis. She kept staring at his crotch, so, assuming she was interested, he took her hand and put it on his penis. She squeezed, then asked him why his penis was “like that.” He said it was hard because she excited him. She then said, “I can’t breathe.” He explained that was because he excited her. Soon she let go and got off the bus, and he followed. “I thought it was going to be a love connection,” he said. Instead she flagged down a police officer.

Because he had put her hand on his penis, the charges were elevated to sexual battery. Michael said he later came to realize that the woman probably couldn’t breathe because she was afraid. “She had no way of knowing I wouldn’t hurt her. I knew that, but she didn’t know.” He ended up serving two years in prison.

After more arrests and more incarcerations—at least eight—Michael was eventually diagnosed with bipolar disorder. Depression and despair led him to attempt suicide. David Ley, the Albuquerque psychologist, explained that men with depression or anxiety learn early on that “masturbation or sex is a fabulous way to feel better for a while.” There’s nothing inherently wrong with masturbating to boost one’s mood (that’s one of the nice things about it); the problem comes with where, when and how much.

The concept of sex addiction therapy has been popular in the public mind since the ’80s—an idea bolstered by high-end rehab centers like the one in Arizona where both Weinstein and Spacey have been spotted. But leading organizations of sex therapists and researchers do not consider sex addiction a real medical condition. They say the diagnosis confuses symptom for cause, and the use of an abstinence model is not ideal when healthy sex, not celibacy, is the goal. The preferred approach requires getting a detailed individual history, diagnosing any co-occurring disorders (as in the case of Michael) and using cognitive behavioral therapy, group therapy, systems of accountability and medication if necessary.

One of the central goals is to correct what therapists call “cognitive distortions” and the rest of us call “self-delusions.” “Someone who takes out his penis in a non-consenting way often says, ‘Why did she stare? She must have liked it,’” explained Meg Kaplan, who has heard every kind of excuse in her decades as a therapist. In treatment, these ideas have to be confronted and the harm to the victim acknowledged. Another goal is to dispense with the belief that arousal is a kind of magical state that removes individual agency. Clients must take responsibility for what they do, Michael Vigorito told me, instead of seeing themselves as being overtaken by forces beyond their power. (Larry Nassar, in a court statement, used this kind of distancing language when he described his decades of penetrating young gymnasts as “a forest fire out of control.”)

In prison, Michael took classes on anger management and impulse control. “I learned that urges only last a matter of seconds or minutes,” he told me. “If you can get past that, you’re good to go for a while.” After his release, he continued with individual and group therapy for years. A growing spiritual sense was also crucial to his recovery. He now sees a clinical social worker once a week to keep himself on track, and he’s studying online to become a paralegal. Michael believes his story offers hope to those in a similar struggle, though he had a stern warning. “If they want to recover, they have to look in the mirror and say, ‘You are the problem,’” he said. “You are what needs to change, not the world.”

The DSM states that a person can gain long-term control of harmful sexual disorders: Someone is considered to be in “full remission” if he is functioning well in life and has not engaged in nonconsensual behavior for at least five years. In her recent book, Desistance From Sexual Offending, criminologist Danielle Arlanda Harris notes that, contrary to popular belief, desistance—that is, ceasing the behavior—is an empirical reality. “It happens,” she writes, “and it happens most of the time.”

For Michael, it’s been more than 15 years. He recognizes that he deserved imprisonment but despairs that he is on the sex offender registry for life, with no opportunity to get off no matter how long he goes without committing an offense. “Either we believe in recovery, and people can change, or we have to stop telling people we believe it,” he said. “Because we don’t act like we believe it’s possible.”

In Michael’s case, facing his actions and their consequences changed him. He was forced to do so because he didn’t have a fancy hotel suite, ruthless lawyers, ex-Mossad agents, combative representatives and the ability to make or break film careers. In other words, unlike Harvey Weinstein, he didn’t have power.

The idea that sexual violations are driven by power and nothing else has its origins in the mid-1970s, when feminist author Susan Brownmiller released her path-breaking book on rape, Against Our Will. “Man’s discovery that his genitalia could serve as a weapon to generate fear must rank as one of the most important discoveries of prehistoric times, along with the use of fire and the first crude stone axe,” wrote Brownmiller. She added that rape “is nothing more or less than a conscious process of intimidation by which all men keep all women in a state of fear.”

Her work has had enduring influence. Two decades later, Jack Morin observed in The Erotic Mind that abuse of power is a “fashionable explanation” for sexual violations as people seek “to shield themselves from the dark side of lust by insisting that predatory sexual behavior isn’t really sexual at all.”

Harvard psychology professor Steven Pinker explored the limitations of such explanations in his 2002 book, The Blank Slate. He credited Brownmiller with documenting many historical injustices against women. But he cautioned that her pronouncements were rooted less in prehistory than in 20th-century ideological struggles. Brownmiller’s work on male predation, he wrote, smashed up against a central cultural imperative of the 1960s—to free people from repressive sexual strictures—and thus meant compartmentalizing: “Sex is good because sex is natural and natural things are good. But rape is bad; therefore, rape is not about sex.”

As this year’s Pulitzer Prize-winning stories in The New York Times and The New Yorker have shown, male workplace sexual abusers have exploited their enormous power. But we cannot ignore that their histories of sexual violations often predated that power. Harvey Weinstein has been accused by several women of sexual assault in the late 1970s and early ’80s, when he was a college dropout working as a music promoter in Buffalo, New York. One woman, Wende Walsh, told The Buffalo News that when she was waitressing at a bar, Weinstein, her former boss, came in one night, stayed until closing, then begged for a ride. In the car, she said, he forced her to perform oral sex. A few nights later he showed up at her apartment, exposed himself, then got kicked off the property when the landlord heard yelling.

Most sexual violators start one step at a time, several researchers told me, seeing what they can get away with. Larry Nassar has been accused of molesting a girl, under the guise of doing a study on flexibility, as early as 1992, when he was still bumbling his way through osteopath school. When abusers like him gain the resources or social standing that allow them to successfully cross boundaries and suffer no consequences, they can amass vast numbers of victims. What distinguishes these powerful violators, said psychologist James Cantor, is not just that they fool themselves about what they’re doing—that’s an inherent quality in many who commit sexual misdeeds—it’s that they can create an environment in which they go unchallenged: “The more they get away with, the more they can push the envelope.”

As the histories of Weinstein and Nassar show, adroit predators can also pursue a career that provides unquestioned access to their preferred targets. Weinstein perfected a system: calling a meeting with an actress or other woman seeking career advancement, having her brought to an office, restaurant or hotel bar by an assistant (preferably female, to put the woman at ease), arranging that the assistant leave, then moving the meeting to a hotel suite. The women who resisted or complained might receive flowers in an attempt at mollification, and a threat of career damage if the flowers didn’t work. Meanwhile, in Nassar’s case, gymnasts were required to submit to his abuse; being treated by him was compulsory for inclusion on the USA Gymnastics team. When several of them complained, doctors, coaches and trainers brushed aside their concerns as if they were naive girls who didn’t understand the special nature of Nassar’s therapy.

These men enlisted a disturbing number of colleagues to enable and cover up their deeds. The Washington Post, for example, reported how Yvette Vega, the longtime executive producer of the “Charlie Rose” show, responded to stories of Rose’s treatment of young female employees—which allegedly included nudity, groping and sexually charged come-ons. When a 21-year-old employee complained about Rose’s late-night calls, in which he described his fantasies of her swimming in his pool, Vega replied, “That’s just Charlie being Charlie.” Shortly before the dissolution of the show, Vega told the Post that she regretted not standing up over the years for the young women.

Glen Gabbard, a professor of psychiatry at Baylor College of Medicine in Houston, notes that this kind of collusion with an entourage can feed a sense of omnipotence. Gabbard has treated or reviewed the cases of hundreds of therapists and analysts who had sex with their patients, a gross violation of authority by people who are trained to know better. A small number were psychopathic predators, he wrote in his 2016 book, Boundaries and Boundary Violations in Psychoanalysis—mostly men who “systematically prey on female patients who seem vulnerable.” But there were other therapists whom Gabbard labels “profoundly narcissistic.” These individuals, he told me, rose to the top of their profession, the acclaim fueling their grandiosity and entitlement. Confronted with their sexual transgressions, they often refused to acknowledge them. Gabbard told me, “I’ve heard many times: ‘I have earned this. If someone else did this, I’d be concerned, but I know what I’m doing.’”

I asked several therapists if having a patient with power changes or complicates treatment. They emphasized that it’s crucial to thoroughly evaluate each patient without making assumptions based on that person’s social status. There’s no effective treatment for a sociopath, Kaplan explained, and such a person is very different from a patient whose behavior is intertwined with the use of drugs or alcohol, for example. Further, just as there is no one path that leads to crossing sexual boundaries, there is no one path to stopping. Professional and social standing aside, some people realize on their own that what they are doing is wrong, while others “age out.” For still others, facing an arrest or firing is enough to end the behavior.

But, Vigorito said, power can make it more challenging for certain people to recognize that they have crossed the line. An essential feature of therapy is having patients recognize the discrepancy between their self-justifications and the damage their behavior causes, then using these uncomfortable insights to prompt change. If people with power are able to avoid consequences, sometimes such insights may just not come—even after a reporter calls with a long list of questions.

In the wake of Me Too, the worst of the predators have been forced to face what they did: Larry Nassar is serving what will be a life sentence, Bill Cosby has been convicted, Harvey Weinstein was recently indicted. There is an astonishing promise in Me Too: a workplace (a world!) that seriously addresses sexual harassment and abuse. We can hope that this reexamination will curb much bad behavior. But as Krafft-Ebing wrote, the man with pathological sexuality “is in constant danger of violating the laws of the state and of morality.” There will always be such people.

Already, some of the accused are reportedly seeking a return after a time-out of a few months. Journalist Tina Brown has said she was approached about producing a comeback for Charlie Rose: a talk show in which he would interview other disgraced men. (Rose has characterized his decades of sexual harassment as acting on what he believed were “shared feelings.”) It apparently is not happening, although it could have been worth watching if they all appeared in their bathrobes.

As employers and the public weigh if, and how, specific men may resume their professions, any return must take into account the myriad individual factors that go into evaluating someone who has been accused. The therapeutic profession has its own model for this. Gabbard, the Houston psychiatrist, described how his field evaluates whether therapists who have committed sexual violations can return to work. Some of them are found to be people whose acts and psychological conditions mean they have forfeited forever their right to practice. Others are offered the opportunity for professional rehabilitation based on “how the person conceptualizes what they’ve done, how much remorse they have, and how determined they are that it never happen again.” Such therapists are required to have ongoing psychological treatment, and a separate “rehabilitation coordinator” should monitor the therapist’s progress and return to practice.

While we strive to right genuine wrongs, we have to look directly at sex in all its complexity and potential for good and ill. If in order to protect our children from predators we tell them that most touch is suspect, a precursor to abuse; if in order to prevent them from becoming predators we make them feel their “mysterious sensations” are shameful and potentially dangerous, we risk distorting their healthy sexual development—and creating more of what we’d like to prevent.

More than 20 years ago, when Jack Morin released The Erotic Mind, he wrote that he was living in a time in which lust was held in low esteem, linked with sexual abuse, harassment and sex addiction. Not much has changed. But it is “very important not to reject lust,” he warned, “no matter how relentless the antisexual clamoring may become.” If we assume our drives and desires are a source of destruction, we push lust to the shadows. There it doesn’t disappear; sometimes it detonates.