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Is pedophilia a mental disorder?

Discussion in Archives of Sexual Behavior

Report by Frans Gieles

The December 2002 issue is a special about pedophilia.
Richard Green argues for the removal of pedophilia from the DSM, the famous handbook that defines psychiatric illnesses, among which is pedophilia, albeit under certain conditions.
Gunter Schmidt says that not all pedophiles are per se unscrupulous molesters; instead pedophiles have a problem of conscience, a moral dilemma, and they deserve respect rather than condemnation.
There follow peer comments from 21 authors give peer comments, after which Green and Schmidt reply.
Ipce members should buy and read this special issue.
In this Newsletter, I give the following report.

Green's article

Richard Green was very actively involved thirty years ago in the removal of homosexuality from the DSM list of mental disorders. As is known, homosexuality was successfully removed in the early seventies. Now he argues for the removal of pedophilia from the same list.

Green makes a distinction (also made by the Rind team - and by me) between three kinds of discussions or discourses: the legal one, the moral one, and the medical one. To give my own examples: starting a war may be legally correct, - IMHO it is morally incorrect - but it is not a medical illness. Smoking hash or drinking alcohol before a certain age may be legally wrong, but one might see no moral objections; a doctor might counter-advise it, but it is no illness per se.
A pedophile who activates his or her desires into action may infringe the law; one may discuss if it is morally right or wrong, but another kind of question is if her or his is actions are the outcome of a mental disorder. Moreover: does a pedophile who inhibits her or his behavior within any legal or moral limits, still have a mental disorder through his feelings per se? No, says Green.

Green starts by presenting cross-cultural arguments. Intimacy between generations is spread worldwide among so many cultures and in so many eras, that one cannot reasonably argue that all those people have a mental disorder. They may have different cultural customs and opinions. Additionally many primates have these kinds of costoms.

The next group of arguments refers to personality characteristics of people with pedophilic feelings. Here we have a sampling problem, because most research has been performed on clinical and legal samples. If problematic characteristics are found, the choice of the sample, as well as the clinical or legal situation might cause these problems.

"Cause and effect here is arguable between social consequences of pedophilia and psychiatric problems promoting pedophilia".

Green refers to a study of a non-legal and non-clinical sample:

A unique study at the Institute of Psychiatry of the Maudsley Hospital in London evaluated non-prisoner, non-patient pedophiles (Wilson & Cox, 1983). The men were obtained through the Paedophile Information Exchange. The psychometric instrument utilized, it being a Maudsley study, was the Eysenck Personality Questionnaire (EPQ). The EPQ is scored on three main axes of personality: extraversion, neuroticism, and psychoticism. There is also a "Lie Scale" to assess "faking good." A total of 77 pedophiles were studied, with an age range of 20 - 60. They were compared with 400 controls.

Pedophiles were significantly more introverted. Psychoticism, or thought disorder, was slightly elevated but not to a pathological level. Occupational groups with similar scores to the pedophiles are doctors and architects. Neuroticism scores were slightly higher than controls, but not clinically abnormal. Pedophile scores were similar to actors and students. The lie scales did not differ. Wilson and Cox (1983) concluded that

"... the most striking thing about these results is how normal the paedophiles appear to be according to their scores on these major personality dimensions - particularly the two that are clinically relevant [neuroticism and psychoticism]. ... introversion ... in itself is not usually thought of as pathological." (p. 57)

Another researcher, Howitt (1998), reached a similar conclusion:
"The possibility of finding a simple personality profile that differentiates pedophiles from other men has appeared increasingly unrealistic as the research and clinical base has widened. Simplistic notions such as social inadequacy driving men to sex with children become unviable as highly socially skilled pedophiles are found" (p. 44).

Another argument for the normality of pedophilic feelings are the percentages of 'normal people' who are said to feel attracted to children (about 20 to 25%), and who react with penile erection to 'pedophilic' stimuli: more the 25%. One cannot reasonably argue that about one quarter of the population is mentally ill.

The last group of arguments refers to the DSM itself: its inconsistencies.

So what then of the pedophile who does not act on the fantasies or urges with a child? Where does the DSM leave us? In Wonderland. If a person does not act on the fantasies or urges of pedophilia, he is not a pedophile. A person not distressed over the urges or fantasies and who just repeatedly masturbates to them has no disorder. But a person who is not distressed over them and has sexual contact with a child does have a mental disorder. The APA position with its DSM catalogue is logically incoherent.

Confronted with the paradox that in contrast to other conditions designated a mental disorder, such as with persons who hand-wash to the point of bleeding and can't touch a door knob, or who are harassed by voices threatening their personal destruction, many pedophiles are not distressed by their erotic interest, aside from the fear of incarceration. Some celebrate their interests, organize politically, and publish magazines or books.

So to deal with this paradox, DSM dug itself deep into a logical ditch. If a person's erotic fantasies are primarily of children and masturbatory imagined partners are children, that person does not have a mental illness, without more. Never mind these mental processes, those readers of DSM who are psychiatrists and treaters of the disordered mind.

These people with these fantasies do not have a mental disease unless that person translates thought into action. This turns psychiatry on its head. Certainly a society can set rules on sexual conduct and proscribe child-adult sex and invoke sanctions for transgressors. But that is the province of the law and the penal system. The DSM should not provide psychiatry with jurisdiction over an act any more than it should provide the law with jurisdiction over a thought.

Green concludes:

Sexual arousal patterns to children are subjectively reported and physiologically demonstrable in a substantial minority of "normal" people. Historically, they have been common and accepted in varying cultures at varying times.
This does not mean that they must be accepted culturally and legally today. The question is: Do they constitute a mental illness? Not unless we declare a lot of people in many cultures and in much of the past to be mentally ill. And certainly not by the criteria of DSM.

Gunter Schmidt's article

Schmidt argues for a reasonable discussion based on facts, not on moral prejudices or emotional indignation. Also Schmidt refers to the different kinds of discussions or discourses that are involved here.

However, the tendency to polarize and over-generalize is strong. Both, those inclined to de-emphasize the severity of the problem and those bent upon blowing it out of all proportion, distort the reality of children who are drawn into sexual contact with adults, colonizing their experience, their memories, and their own assessments.
It seems to me that one of the prerequisites for a more reasonable discussion is to disentangle the confusion of moral and clinical discourses. This requires that we argue,

from a moral standpoint, where morals are at issue and,

from a clinical point of view, when it comes to traumatizing effects.

 

Above all, we should not clothe moral judgments in the garb of clinical "expertocratic" language.
I shall preface my attempt to disentangle the confusion of these two levels of discourse [...].

There are two discourses going on now concerning this subject:

[...] we find ourselves in the midst of the moral discourse, or rather of the moral discourses, for there are at least two, and even they must be clearly distinguished from one another.

The first of these is the traditional one, the one I refer to as the child molester discourse. It is blunt, highly emotional, over-generalized, full of prejudices -- you find it in the boulevard press but not only there. [...]

Today, there is a second form of moral discourse, which presumably has a much greater impact on the current social situation of pedophiles today than the loud outcries of fundamentalists or barstool moralists. It represents a view based upon a broad social consensus. As an enlightened discourse on morality, it is particularly virulent in liberal circles, in groups which were once rather more inclined to caution and concession in their judgment of pedophiles.
This is the discourse of sexual self-determination or equal rights, which has assumed a dominant role in the general view of sexuality today.

 

In the modern discourse between the free and intimate citizens, many forms of erotic and sexual behavior are freed from old conservative morals; nowadays, they are seen as free choices of free citizens. Except pedophilia.

Does pedophilia inexorably and categorically violate the morality of consent and intimate citizenship? Of course, there can be no question that it does so wherever violence, coercion, extortion, and emotional manipulation are employed. Thus, we must articulate the problem more specifically. Can there be sexual consensus at all between adults and children?

Many pedophiles say there can be, arguing roughly along these lines: "I want nothing more than what the child wants. I can enjoy it only when the child enjoys it as well."
This message comes across in a number of different versions. In numerous conversations with pedophiles seeking advice, I have rarely found myself compelled to doubt the subjective truth of such statements.

Schmidt then gives an example, a scenario in which a boy and a men play with an electric train. One might imagine the end of the story. Schmidt argues that the boy and the man "are on different pages" or have different scripts, different interpretations of the situation. The boy wants to play, the man desires more intimacy. There seems to be consent, but there is none.

Thus, the problem of sexual consensus between the adult and the child lies in the disparity of scenarios. Only by ignoring the aspect of social meaning is it possible to see consensus or at least the absence of dissent in such a situation.

Only the adult is aware of the disparity of scenarios and only he is in a position to overcome it, simply by saying what it is he really wants -- and in that case the boy's "no" would undoubtedly come more quickly and emphatically.

[...]I find it difficult to imagine consensual sexual acts between children and adults. There are undoubtedly exceptions, which would include cases of boys just entering puberty and who have masturbated or had other sexual experiences leading to orgasm with peers, that is, of boys who can be expected to know "what the score is" and who have experienced their own sexuality without adult participation and perhaps become curious about how adults would react in contact with them and about what they might experience with an adult.

Schmidt then mentions Kinsey's research, and describes the modern discussion about 'trauma or no trauma'. This discussion is one with two opposed camps. He proposes two fundamental points to have in mind for a more rational and scientific discussion:

(1) Sexual contacts between adults and children pose a risk of lasting trauma for the latter even when they do not involve violence or the patent use of force, the risk is presumably greater the younger the child is, and is likely to rise in proportion to a number of other factors [...]

(2) There are many cases of nonconsensual sexual contacts between adults and children that are not traumatic for the child, although they do indeed violate his or her right of self-determination. Nonconsensual experiences are not categorically traumatic; what is morally unacceptable is not necessarily injurious. [...]

 

Schmidt quotes Kinsey and the Rind et al. research to lay the foundation for the second statement. The first statement, however, describing the risk of trauma, places the pedophile in a dilemma.

The dilemma is tragic because the pedophile's sexual orientation is deeply rooted in the basic structure of his identity. Pedophilia is as much a part of him as is love for the same or opposite sex for the homosexual or heterosexual man or woman, the difference being that the one is accepted, while the other is categorically forbidden and virtually impossible to realize.
In view of the pedophile's burden, the necessity of denying himself the experience of love and sexuality, he deserves respect, rather than contempt.

The peer commentaries

I shall give a short overview, summarizing the 21 authors in my own words.

Fred Berlin 

agrees with both authors in as far as he says one might treat pedophiles, but one should not reject them, rather respect them. Because a child is not always traumatized, one should not routinely give treatment to any child who had any sexual experience, nor to every person with pedophilic feelings.

Wolfgang Berner 

agrees with the normality of penile erections to 'pedophilic' stimuli - he quotes a 27.7% from literature - but adds that this is not necessarily a reference to a sexual orientation. An orientation is more than a single reaction of the body.

Vern Bullough 

accepts the conclusions of Wilson & Cox (1983) that people with pedophilic feelings are quite normal people who not should be demonized. Some behavior might be socially incorrect, but that is not the same as pathological. As long as these people limit themselves to have fantasies, nothing is wrong. If some people have to change their behavior, this is a case of re-educating those people, not of treatment or curing an illness.

Alan Dixson 

is simple in his comment: that pedophilia is a mental distortion: "bizarre", "abnormal". End of discussion.

Julia Ericksen 

gives a good summary of what both authors have said. She remarks that it may be so that intergenerational intimacy has been or still is quite normal in other eras and cultures - we still live in our time and culture. It is the culture that determinates one's sexual orientation. So, a 'deviant' orientation is not per se a pathological deviance, but a cultural one. Thus, for insight of the phenomenon, have a look at the culture one lives in, not at the person. Ericksen does not believe in a genetically fixed sexual orientation.

Dean Fazekas 

agrees in so far as he says that pedophilia, child molester, or incest offender, cannot be a diagnosis. However, he does not believe in the possibility of consent. He acknowledges that not all pedophiles behave wrongly. He provides a remarkable argument that there is always harm to the child: we spend so much resources and time to treat children as well as the offenders, that there must be harm.

Richard Friedman 

agrees only on the point that one should not demonize pedophiles. One should keep giving them treatment, including changing their too romantic, thus distorted, ways of thinking.

George Gaither 

disagrees with both authors. We need the DSM, he remarkably argues, so that we have the resources to continue our treatment and research. He keeps viewing a pedophilic orientation as a mental disorder to be treated and changed. He disagrees with the APA view that this is not possible.

Richard Krueger & Meg Kaplan 

also disagree with both authors. In other times and cultures pedophilia surely has been viewed as a disorder. They make comparisons with drug dependency and suggest that pedophilia can better be viewed as a disease than as an immoral act; for immoral acts, there is only a prison, but for diseases, treatment is possible. Thus, let's keep the DSM, and the possibilities of treatment, as they are. Only then understanding is possible.

Ron Langevin 

pleads for revision of the DSM paragraph about pedophilia, but not for removing it. OK, let other cultures have their view, that is no argument: we have our own view. He sees biases in the research quoted by Green, and refuses to see a penile erection as a sign of a sexual orientation.

Michael Miner 

also says that we do not live in Polynesia in far-off times, but in our own time and culture and its views. As with our culture, Miner sees pedophilia as a disorder, just because the effects of pedophilic behavior: bring harm to the child, and shame, social isolation and prison to the adult. The disorder is not one of sexual orientation as such, but lack of impulse control - just as it is in cases of pathological gambling, drugs or alcohol use.

Charles Moser 

strongly agrees with Green. None of the paraphilias should have a place in the DSM list of disorders. A sexual desire can never be a disorder. Sexuality is lead by culture, not by illnesses.

Emil Ng, 

from China, shows the politeness and the preference for nuances of his country's culture. Doing so, he gives a cross-cultural view on the phenomena, putting narrow Western views into a broader perspective. Chinese literature does not ascribe any mental or medical diagnosis of pedophilia or homosexuality to "romantic affairs" between children or between adults and children, although they are not difficult to find in that tradition. Since ages, people marry quite young in China.

His comments on the Western ways of thinking and acting are quite incisive. The Western discussion about consent and traumas is "hypocritical", he says. Only in sexual matters western adults worry about consent and traumas, not in all other matters, from baptizing the child after birth until its education ends with a diploma.

Hence, the seemingly righteous and humanitarian debate on child self-determination and consent in sex is just another game adults play to impose their own values on children. For most of the everyday adult-assigned children's activities on which the adults hold no discrepant values, debates on child consent are taken as irrelevant and best to be forgotten for parental convenience.

Yet, for child sexual activity, the debate is raised only because not all adults hold the same value judgment. Despite what the debaters on each side may say, it does not follow that any of them are actually more concerned with children welfare and rights than the others. Both sides are only fishing out and exploiting the children's rights issue to support their own preconceptions or needs on child sexuality.

Paul Okami 

strongly agrees with Green. He agrees with Schmidt as far as "Schmidt rightly attempts to distinguish questions of wrongfulness from those of harmfulness. These concepts have become hopelessly entwined in the discourse on pedosexuality".
He also disagrees with Schmidt, but in the other direction from other peer comments. He especially disagrees with the presumption that there always is a power imbalance in contacts between children and adults.

The problem with the 'balance of power' argument is that dyadic power can be in constant flux within a relationship and, in any event, is always multidimensional.
[...]Moreover, there is nothing logically intrinsic in power discrepancy that violates principles of justice or fairness in sexual relationships or that is necessarily harmful to the "less powerful" participant, unless one views sexual relationships as similar to hand-to-hand combat (e.g., heavyweight vs. flyweight contestant).

The instability and multidimensionality of dyadic power and the fact that a "power-balanced" relationship is clearly mythological (in the sense that it can never be logically ascertained) lay to rest as useless the "power imbalance" argument. At best, this argument is a fine example of late twentieth century cultural-feminist silliness.

So, Okami gives another interpretation of Schmidt's example of the electric train playing and the intimacy following it. He sees "straw man arguments" in Schmidt's argument.

Robert Prentky 

agrees with Green and criticizes the DSM list. As an example, he speaks about Lewis Carroll, the author of Alice, and James Barrie, author of Peter Pan. Mentally ill people? Surely not. If there must be a criterion for a mental disease, it should be self-control or the lack of it.

Bruce Rind 

agrees with Green, but disagrees with Schmidt's moral statements. Rind also refers to the dynamics in the power balance and disagrees that there always should be an imbalance.

Most objectionable from a scientific and philosophy of logic perspective is Schmidt's willingness to test a universal proposition with a single confirming hypothetical case. Appropriate testing would consist of determining whether disconfirming empirical cases can be found. I provide such cases. [...]

These cases, involving five men who had sex as boys around age 10 with men, dispute Schmidt's claim that there can never be sexual consensus between prepubescents and adults.

Michael Seto 

views pedophilia as a disorder, but the DSM has not defined it well. One should not define behavior as an illness. And one should define pedophilia so that it only concerns a sexual desire for sexually still immature pre-pubescents.

Robert Spitzer & Jerome Wakefield 

criticize Green. They agree that not all pedophile behavior refers to a mental disorder, only some behavior does. But they miss clear definitions in Green's argument. Clear definitions should discriminate between normality and disorders.

Kenneth Zucker, 

who, as the Editor of the magazine, has opened the special issue, now, with the "Z" in his name, ends the list of peer commentators by giving the history of the DSM from 1973, the year that homosexuality was removed from the DSM list. However, there are too many differences between homosexuality and pedophilia. Thus, the arguments cannot be the same. One should study how DSM defines a mental disorder and then see if pedophilia fits with this definition or not. Other arguments are irrelevant. The end of the debate is still unsure.

A comment from the reporter

Several peer commentaries reject the cross-cultural argument, by saying "we don't live in Polynesia in a far-off age" or so.
In my view, this seems to me a typical case of Americanism: the ultimate in the (post-)modern Western way of thinking:
'We have found the light of the real truth; other cultures have for ages walked in the darkness of the wrong insights.'
In my opinion, this is not true.

Replies of the authors

Green 

starts with the cross-cultural arguments:

At the outset, thank you to those commentators who added to my list of historical and cross-cultural examples of child-adult sex:

the child-brides and grooms of China;

Charles Dodgson (Lewis Carroll), who brought us Alice;

James Barrie, who brought us Peter Pan;

Muhammad, who brought us Islam; and

St. Augustine, who brought us Christianity.

 

He replies more or less comment by comment, which is too long for this report, but an issue repeating itself is the question of harm. Some comments said: 'because there is always harm, there is always a distortion'. In reply to Spitzer & Wakefield, Green repeats his own words:

"Consensual same-sex adult-adult sexuality does not suggest the element of harm to one participant ... " and he adds:
Suggesting the element of harm does not equate with the universal certainty of harm.

In reply to Berlin:

He correctly states that pedophilia can create both psychological burdens and impairments (as can heterosexuality or homosexuality, I would add) but (like heterosexuality or homosexuality), must it? Why then declare pedophilia a disorder for all?

In reply to several commentators who took up Green's nuance that harm is not always present, and that there are lots of pedophiles who only have their fantasies:

No harm, no foul.

And in other words, picking up the cross-cultural arguments:

If a society does not condemn a behavior, more will participate. I do not agree that those who continue to participate when society does condemn are necessarily mentally ill. Antisocial behavior may be criminal (it often is), but it need not be a mental illness (it often is not).

Schmidt 

acknowledges in his reply that dyadic power is always unstable and multidimensional. He refers to Ng, Okami and Rind who

"argue that we are upset by this lack of consensus only when sexuality is involved, and this they regard as an ideological reaction. Neither argument can be effectively refuted. Yet, both Okami and Rind fail to make it clear whether their reference to these truisms means that they recognize no special characteristics of child-adult sexual interaction. [..T]hey avoid the central question underlying the debate on pedophilia: Is there anything special about adult-child sex ual relations?"

This is the central question for Schmidt. He is not convinced by Rind's five cases, which he sees as "exceptions" and the seeing of a general trend in these cases "breathtakingly simple and na´ve".

Schmidt agrees with the commentators who have rejected the cross-cultural variance as an argument. 'The people of Sambia cannot help us'. So, he does not develop the argument, but he has great respect for these contributions:

"They sow doubts about positions that have come to be taken for granted in Western societies, and they keep the discussion open in a direction to which too little attention is given today: fairness against pedophiles. And they demonstrate admirable courage."

The reporter looks back

A very good initiative to make this special issue.
We could not expect unanimity, but we have seen reasonable thinking and polite arguing with a lot of subtle differences in approach.
The main recurring points of discussion were:

(1) The distinction to be made between the different discourses;

(2) The distinction to be made between the rich variety of pedophile behavior;

(3) The question of harm, especially inevitable harm;

(4) The question of whether a deviancy should always be regarded as an illness;

(5) The validity of the cross-cultural arguments.

 

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