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from Clinical/Therapeutic Issues
The Pedophilia Debate Continues
--And DSM Is Changed Again
by Linda Ames Nicolosi
The very fact that APA admits to holding a
moral viewpoint on a psychological issue ought to
have opened up a broad new challenge to
psychology's authority as our culture's secular
priesthood.
For many years now, psychology has been locked into a
philosophical quandary. Exactly what is a "psychiatric disorder"?
Many critics despair of ever devising a catalogue of
mental illnesses which can be considered to represent science.
Exactly how puzzling this quandary actually is, will be illustrated
in an upcoming issue of the Archives of Sexual Behavior.
The Archives is the official publication of the International
Academy of Sex Research. That journal will feature a
symposium with at least one prominent psychiatrist arguing
that pedophilia is in fact (at least in some contexts) a
disorder--while another prominent clinician says that it is
not.
But if pedophilia isn't a mental disorder, then just what is?
If any man who violates the innocence and integrity of a
child can be judged to "have nothing psychologically
wrong with him"...then has the public in fact broadly misunderstood
psychology's scope and explanatory power?
APA Reverses Diagnostic Change on Pedophilia
Although pedophilia remains illegal, and our culture still
considers it morally wrong, recent changes in the APA's
own diagnostic and statistical manual (DSM) have
reopened the discussion of the psychological dimension of
pedophilia.
History of the Diagnosis. In the DSM-III, the American
Psychiatric Association contended that merely acting upon
one's urges toward children was considered sufficient to
generate a diagnosis of pedophilia. But then a few years
later, in the DSM-IV, the APA changed its criteria so that a
person who molested children was considered to have a
psychiatric disorder only if his actions "caused clinically
significant distress or impairment in social, occupational or
other important areas of functioning."
In other words, a man who molested children without
remorse, and without experiencing significant impairment in
his social and work relationships, could be diagnosed by a clinician
as a "psychologically normal" type of pedophile.
Challenged by NARTH to defend the change, the APAstated
categorically that it had, in fact, no intention of normalizing
pedophilia. However, "man-boy love" advocates
cheered that DSM shift as good news.
Pedophile-Friendly Study Soon Follows
And a door indeed appeared to have been opened by the DSM
change, because soon afterward, a journal of the American
Psychological Association published the infamous Rind, et al.
article--a study which downplayed the effects of, in particular,
man-boy sex. Rind supported his argument with the finding
that quite a few of the boys remembered their childhood
sexual experiences positively.
As a result of the provocative Rind study's appearance in
an APA journal, the American Psychological Association was
struck with an embarrassing wave of criticism--what it called
"the political storm of the century." That public-relations
nightmare hit "with gale-force winds raging from the media,
congressional leaders, state legislatures, and conservative
grassroots organizations," according to the Association's journal,
The American Psychologist.
The APA apologized for the study --- following later with
another statement which sounded like backpedaling (with
the Association insisting that researchers have a right to
scientific freedom). Then it issued a new and quite surprising
official statement.
APA said that no matter what the research showed about
the psychological effects of pedophile relationships--
pedophilia remained, in its opinion, "morally" wrong.
Moral Philosophy and the Pedophilia Problem
Morally wrong? This was an odd statement indeed from a scientific
organization. What, then, was the APA's moral position
on, say...adultery or abortion? What about the morality of
sexually open relationships? Would APA follow up with an
official position on, say, the morality of polygamy?
The very fact that APA admitted to holding a moral viewpoint
on a psychological issue ought to have opened up a
broad new challenge to psychology's authority and its presumptions
as our culture's arbiter of practically every
social and moral issue now under debate.
Indeed, the time was then ripe for layman to issue a fruitful
challenge to the entire concept of psychological
health--its inherent limitations, its value-laden nature, and
its meaninglessness without dependence on an underlying
social-moral philosophy.
Most of all, the discussion could have addressed psychology's
inability to scientifically answer the essential, basic
questions upon which any meaningful psychology must be
based...foundational questions such as, "What is good?"
And, "What is the meaning and purpose of sexuality?" Or,
"How does one define 'self-actualization'?" "What exactly
is our distinctively human nature? How does our nature
require that we live?"
In an age when even our culture's moral leaders feel obligated
to look to science to defend their positions, such a discussion
could clarify to the public what psychologists
already know but tend to be loathe to publicly admit--that
science alone has a limited capacity to either define or
resolve our social-moral problems.
APA Recognizes the Threat to its Authority
The Psychological Association must have been aware of
the implications of its own pronouncement that
pedophilia was immoral, because the March 2002 issue of
the American Psychologist carried an official article stating
that the association had learned something from the Rind
fiasco. Two of those lessons learned were that, first, the
APA must build bridges to conservative groups, and second,
in the future, psychology must be prepared to
defend its validity as a branch of science.
The DSM Quietly Changes Again
Soon afterward, public outrage from the Psychological
Association's fiasco may have moved on to touch the
Psychiatric Association as well.
In fact, the Association has just quietly instituted a change in
its most recent diagnostic manual--the Text Revision of the
DSM-IV--regarding the definition of pedophilia. In a return
to its previous standard, now, merely acting upon one's
pedophilic urges is sufficient for a diagnosis of disorder.
NARTH Scientific Advisory Board member Russell
Hilliard, along with psychiatrist Robert Spitzer, have just
published a letter in the American Journal of Psychiatry
which points out that in contrast to the DSM's statement
that "no substantive changes" had been made in the latest
DSM-IV Text Revision, "in fact, DSM-IV-TR has made a
substantive change" in its criteria for pedophilia.
"Would it not have been better," Hilliard and Spitzer note
about the APA's obvious silence, "for the DSM-IV-TR editors
to have acknowledged that there were a few substantive
changes in the criteria, and that for the Paraphilias they
were correcting a mistake made in DSM-IV?"
The Missing Moral Dimension
But still, one thorny foundational question remains. How
do we define the "harm" in pedophilia? Is that harm psychological,
characterological, or both? How can psychology
recognize harm resulting to the integrity of one's character?
And what can psychology know about character, anyway?
Many religious traditions recognize pedophilia as an inherent
affront to the integrity of the person--but such a characterological
and spiritual concept may be difficult to conceptualize,
and even more difficult to assess, in narrowly
psychological terms.
Perhaps the harm done by pedophilia will be difficult to
measure because it is subtle and values-laden. Maybe the
molested boy will grow up to routinely sexualize his samesex
relationships. Maybe he'll have difficulty with marriage
and mature intimacy. Maybe he'll not only have a distorted
concept of gender differences, but a distorted understanding
of generational distinctions as well--which could
lead to the sexualizing of his own mentoring relationships
with children.
How Social Science Studies Mislead
In fact, the molested child who has been hurt the most, in a
moral and characterological sense, may actually be the boy
or girl who grows up as an adult who truly believes--and
who reports to researchers (as many of those cited by the
Rind study did, in fact, state) that they "remember the sexual
relationship positively."
The man whom these psychological studies trumpet as being
"unharmed" by their childhood molestation may, therefore,
have been the most harmed by the experience--and he may be
the person most likely to reenact it on another child.
Perhaps, indeed, many of the deepest harms to the child,
and to the perpetrator, are largely outside of scientific psychology's
understanding. So, in a curious twist, maybe the
APA--in throwing up its hands and saying pedophilia was
"morally wrong"--was right.
Psychologist Gerard van den Aardweg has observed that the
Rind study didn't find significant harm to all molested children
because Rind was " looking through the wrong glasses."
Perhaps the pedophilia debate will challenge psychology to
begin to openly incorporate the missing moral dimension--
recognizing our human nature in all its intertwined psychological,
moral and spiritual complexity.
Updated: 2 September 2008
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