I recently had the pleasure of speaking with Fred Berlin, MD PhD, of the Johns Hopkins Medical School in Baltimore and founder of that same institution’s ‘Sexual Disorders Unit’. I had wanted to keep our conversation short as I felt somewhat unjustified taking up a renowned doctors time when I myself have absolutely no credentials, but found him so attentive and willing that I wished I had prepared a set of more focused and detailed questions. Below I’ll paraphrase his responses to the general topics I inquired about while my memory is still fresh. As a quick disclaimer: I do not propose or intend that these views be taken as those of Dr. Berlin, of Johns Hopkins Medical School, or of any affiliated institutions. These are simply my own interpretations from a brief telephone interview.
Child Sexual Abuse as an Underreported Phenomenon
I personally am very concerned that underreporting could be an issue, that victims may slip by unnoticed and even be subjected to further victimization. While this may have been more severe in the past, perhaps even on the scale of “an order of magnitude”, it is less so now. Not to say that underreporting is not still a problem, but not so much as it has been. Current widespread fear regarding pedophilia has probably helped to assure that parents and authorities are very much on guard for these things after they have occurred. The preference would of course be that they not occur in the first place.
Pornography depends on the viewer, and how it is viewed. For a healthy individual it may serve to “diffuse sexual tension”, not necessarily so for an individual with problematic sexual attractions (paraphilia). Like alcohol, drugs, and even food, youtube or television, the problem is not in the medium but in the user and in the particulars of how it is used.
Relations between Adults and Adolescents
As I had hoped and expected, Dr. Berlin did not see any need for facilitating these sorts of interactions, and that instead the problem lies more in a lack of understanding and support for healthy intimate relations between adolescent peers. Want the best way to shield your child against pedophiles? Try allowing and encouraging them to be involved with people their own age, taking a limited but active role in screening. The outcomes of dating significantly older individuals is “not helpful” at the very best, and we are all too aware of just how bad it can be in the more common of circumstances.
Parents who are open about sexuality, including their own child’s potential homosexual interests or interests in individuals a couple years different in age my be best for shielding their adolescents from interference by adults. For parents of young children it more likely centers around being aware of a child’s crushes and curiosities, allowing them to explore healthy avenues of development with peers.
Neuropathology and the Legal System
As any rational individual would expect the best way to integrate understandings of mental illness (for which neuropathology is the broader umbrella) is to facilitate communications between the criminal justice system and public health officials. To elaborate we can envision this as ranging well beyond simple expert testimony (which is a cost-ineffective, case by case approach) to more collaborations on policy and legal reform, to the development of specific inter-disciplinary journals. One place to start might be the Journal of Correctional health Care.
From a public health perspective current laws may even be much of the problem. In a 1991 publication Dr. Berlin cited changes in Maryland state law that had caused self-referrals to his sexual disorders clinic to drop to zero in one year. The change was in requiring that therapists report all instances of sexual misconduct involving minors – be it past or present- reported in confidence by patients.
The Internet and Self-Regulation
The internet has been a problematic invention in terms of sexual misconduct; “clinicians may encounter a number of cases where the presence of the Internet itself seems to have been the primary impetus for such (paraphilic or pedophilic) conduct.” (Paraphilias and the Internet in Sex and the Internet: A guidebook for clinicians). Both previous offenders and those who worry they might be at risk of offending have a duty to self-regulate. Possibilities discussed included purchasing professional blocking software (such as NetNanny) or giving the account password for an internet enabled PC to a family member, so it can only be used with their permission or even presence.
There is a more drastic approach to individuals dealing with problematic sexual urges. It has earned the unfortunate name ‘chemical castration’ though it is no such thing. Chemical intervention can refer to any sort of psychoactive drug use to control behaviour. These could include general therapies like SSRI’s or anti-anxiety medications. More specifically (and generally from the Doctor’s responses, much more effecitve at dealing with sexual misconduct disorders) is the approach of androgen reduction therapy. Dr. Berlin here emphasized the importance of informed consent; that a patient really know what they are getting in to. Our society is generally moving away from forced drug therapy, like that which may have led to the untimely death of scientist Alan Turing. Coercion is an issue, and forced administration a blatant abuse of human rights, but offenders or potential offenders should know of the types of drugs available for this so they can make their own decisions regarding treatment. Unfortunately stigma and certain laws make it difficult for individuals to seek treatment or even information.
I wanted to publish this first portion as I said, while my memory is still fresh, and because of the nature of the visits I have been getting to my blog. While there have not been many comments, my earlier post has garnered a lot of hits, and WordPress even goes so far as to provide search terms that led browsers to the site. Terms such as “how to prevent pedophilia in the family”, “why is sexual abuse of children so prevalent in our society” and “what to do if you think you have been a victim of pedophilia” are heart-wrenchingly common. I hope to start a collaborative blog project soon with a view to further exploring the nature of this societal problem, and more importantly to develop a wealth of free and thoughtful resources for anyone affected by pedophilia.
Anyone interested please stay tuned or simply comment on this post; I’ll get back to it once I finish my search for existing forums and domains that might fit the bill.
In the mean time try a Google Scholar search on Dr. Berlin – he’s quite a prolific author and the abstracts alone are quite interesting if you (like me) don’t have means to access the full articles.
A couple of links suggested by Dr. Berlin: