Despite Therapies, Pedophilia Eludes Cure

Impact of Drugs, Counseling is Limited
Pedophilia Cure Remains Elusive

By Ellen Barry
Boston Globe

Even after the Rev. John Geoghan’s crimes have retreated from the front page, many people will be left with the question that will not go away: How could a priest look down at a young child and see a sexual partner?

Two centuries after it was first criminalized in Europe, pedophilia — the sexual attraction of adults to prepubescent children — remains a dark psychological puzzle. The sprinkling of psychiatrists who have devoted themselves to the subject can no more pinpoint its occurrence among clerics than they can among the general population. They cannot agree on its origins, and many still use a package of different therapeutic approaches that range from castration to the electric shocks and foul odors of aversive therapy. Mental health professionals disagree on the question of whether it is an illness at all, or just — as many in the public would argue — an immoral appetite.

“At one time, the majority of people you would ask would have felt it might be possible to cure pedophilia,” said Frederick Berlin, a psychiatrist and one of the founders of the Johns Hopkins Sexual Behaviors Unit. “Now, we look at it more the way we learned to look at alcoholism. We can teach them ways not to succumb to these temptations. It’s a very different view than a cure. This is an enduring vulnerability.”

Most crucial is the question of whether scientists can prevent pedophiles from desiring sex with children.

There is almost no definitive way to measure success. Psychiatrists regularly monitor their subjects’ “deviant arousal” by showing them photographs of young children and measuring their penis circumference with an instrument called a plethysmagraph.

More commonly, treatment is assessed by studying rates of sexual offenders’ rearrest, which vary from 50 percent after three years (from an Ontario Mental Health Center) to 13 percent after five years, a conclusion arrived at by the researcher Kurt Hanson.

Statistics from Johns Hopkins University’s Sexual behaviors Unit are more optimistic: A five-year follow-up survey of 406 pedophiles who received treatment there found that the sexual recidivism rate for pedophiles was 7.4 percent, while pedophiles who were still undergoing treatment had a recidivism rate of 2.9 percent.

Still, the American Psychiatric Association warns that “unlike the successful treatment outcomes for other mental illnesses, the outlook for successful treatment of individuals with pedophilia is guarded.” And wen the clinical psychologist Maurice Yaffe sat down in 1981 to write about his experience treating pedophiles, he listed the cutting-edge approaches he and his colleagues were using, and hen he added, with apparent despair, one “last consideration.”

He said doctors could ‘recommend those whose motivation for change is minimal to move to an environment, e.g. parts of Morocco or Turkey, where legal and social constraints against non-coercive pedophiliac practices are less extreme than in our own society,” he wrote.

The last 30 years have brought radical change in the way researchers think about pedophiles — who typically desire sex with 8- to 10- old girls and/or slightly older boys. Pedophiles are overwhelmingly male, and according to the APA pedophiles targeting boys are twice as likely to reoffend.

Pedophiles’ thinking typically twists over time; most have become convinced that children are inviting them sexually, and that their acts have educational value or bring the children sexual pleasure. And many are simply less comfortable with adults. When psychotherapist Paula Erickson arrived for her job at the Massachusetts Treatment Center for Sexually Dangerous Persons in Bridgewater, she found that the pedophiles in the ward were sly, but mild-mannered.

“I could run a whole unit of sex offenders and they would never be a security risk, “Erickson said. “Look they used to watch ‘Sesame Street’ every day. Their mind is focused on children and getting access to children.”

In the 1950s and 1960s, psychiatrists sat pedophiles down for hours of psychotherapy, hoping to unravel the childhood traumas that prompted this deviant behavior.

“Their feeling was if everything was right in childhood development, we would all grow up and be attracted to same age members of the opposite sex, and, through introspection, we could help people figure out what went wrong,” said Berlin.

Added to the talk was aversive therapy, the conditioning so darkly depicted in “A Clockwork Orange.” In present-day clinics, pedophiles are instructed to begin fantasizing about having sex with a child, or to go to a mall and wait until they become aroused.

Then they are instructed to break a capsule under their nose, releasing a painful or disgusting odor — of ammonia, for example, or of rotting animal or human tissue. Robert Prentky, who treats pedophiles at the Massachusetts Treatment Center, asks his patients to practice envision the worst possible social outcome to a sexual act with a child.

“Just as you begin to be sexually aroused, all of a sudden your entire family circles around you and starts glaring at you,” he said.

Therapists also tried to nudge offenders into becoming sexually attracted to appropriate figures. Dennis Howitt’s 1995 textbook, Paedophiles and Sexual Offences Against Children, recommends showing subjects photographs of adults in sexual poses alongside photographs of children, hoping that desire will be transferred to appropriate objects. Psychiatrists at the Royal Ottawa Hospital encourage their patients to fall in love with adults, with the idea that sex will follow naturally once they have establish an emotional bond.

“If something is telling me that they are wishfully attracted to women, then we have something to work with,” said Prentky.

Starting in the 1970s, behavioral therapies were gradually supplemented by medical treatments like antiandrogen therapy, sometimes known as “chemical castration.” Antiandrogen drugs like Depo-Provera suppress the level of testosterone to the point where sexual appetite is negligible. But they also bring feminizing side effects.

More recently, psychiatrists began turning toward a different set of drugs: selective seratonin reuptake inhibitors, or SSRIs, such as Prozac. For Dr. Martin Kafka, a sexuality specialist at McLean Hospital in Belmont, the moment came like a thunderclap when he found himself treating patients with eating disorders on the same ward as two patients diagnosed with deviant sexual disorder. It was, he realized, the same problem: Uncontrollable urges, combined with a low-grade depression known as dysthymic depression that impairs impulse control.

“That idea was so powerful to me, and it contained within it the idea that we could do something about it,” Kafka said.” At that point, I was more interested in finding out the answer than my own discomfort [working with pedophiles.]”

SSRIs are gaining popularity as a treatment, taking their place beside relapse prevention, insight therapy, victim empathy treatment, orgasmic reconditioning, satiation therapy, socialization workshops, and castration in the history of grappling with this sexual appetite.

Yet, critics say none of these methods can assure that a patient does not offend further, and even caregivers concede the numbers aren’t there to prove effectiveness in a court of law.

“We have no decent data on treatment outcomes,” Prentky said. “There are a whole mishmash of results recorded. I don’t think it tells us very much.”

Bruce Carroll, an Arlington defense attorney who has represented sex offenders released from the Massachuset Treatment Center, said he’s watched treatment methods change so many times that he has no confidence in any of them.

“Maybe there isn’t any way to treat pedophilia and violent sex offenders,” Carroll said. “They say it’s quote-unquote ‘state of the art.’ Maybe the telltale word in that phrase is ‘art.’”