Richard C. Friedman, M.D.,
225 Central Park West, No. 103, New York, New York
10024
(e-mail: rcf2@columbia.edu )
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Schmidt perceptively observes that behavioral expression of the need that some men have for sexual relationships with children always involves an unequal relationship between partners. Consensual morality is, therefore, not possible.
Schmidt illustrates this with an example of a man who invites a 10-year-old boy to play with electric trains. He shows that the subjective meaning of the narrative that follows is likely to be quite different from the child's perspective in comparison to the adult's. He observes that denial and deception may well be part of the motivation of adults involved in sexual activity with children. Schmidt cites Gagnon and Simon (1973), who emphasized that
The image of blissful, unrestricted sexuality is basically a romantic one. People who embrace this may be drawn to the idea that if only we human beings could stop being so puritanical, we could all live like frisky, happy bonobos. The idealistic construction -- "natural man" -- has had no shortage of advocates, but is problematic.
Rousseau, for example, generally considered the father of Romanticism, thought that the "heart" should be more important than the mind in influencing human affairs and he idealized the "noble savage." Bertrand Russell (1945, p. 694) remarked that
the heart says different things to different people. Some savages are persuaded by the 'natural light' that it is their duty to eat people, and even Voltaire's savages who are led by the voice of reason to hold that one should only eat Jesuits, are not wholly satisfactory.
In order to bring alive the fact that sexual transactions are embedded in psychosocial context, one has only to imagine the range of sexual situations depicted in literature (e.g., Shakespeare's plays).
Think of an 8-year-old child "freely" negotiating about entering a sexual relationship with Richard III or Othello. The issue of terminating relationships must, of course, also be considered. What about a child "freely" deciding to dump Henry VIII?
In fact, sexual motivations of adults are often embedded in a wide range of virtues and vices, including loving and caring, but also treachery, duplicity, deceit, the desire to control, dominate and inflict suffering, the need for revenge, and so on.
Children are not capable of coping with the often mixed motivations of adults. Many adults, despite much life experience and far greater abstract reasoning capacity, fund of knowledge, and skills than children have, stumble over sexual negotiations.
Much has been made of the meta-analytic study of Rind et al.
(1998; see, e.g., Dallam et al., 2001; Ondersma et al., 2001).
As Schmidt correctly points out, this review included many investigations in which definitions of sexual abuse varied, often being quite global. In fact, subpopulations of vulnerable people have certainly been traumatized by childhood sexual abuse
(Beitchman et al., 1992, Davies & Frawley, 1994).
The fact that trauma may occur as a result of inequalities that are inherent in sexual activity between adults and children is an important reason that the acts are, in Schmidt's view and mine, morally unacceptable. The notion that such activity must necessarily be injurious in every case is not necessary in order to reach this conclusion.
A gay man in his 50s was seduced during childhood by a beloved woman teacher. He freely entered into the sexual relationship, which continued for years. The woman was admired, was helpful in furthering his development as a musician, and he desperately sought her approval. Although his genital organs fully responded during this sexual activity (his first with another person), it felt "unnatural" for reasons he was not aware of.
Years later, he realized that one crucial reason that this was so was that he was gay.
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In fact, the traumatic consequences of apparently freely chosen sexual activity, with a person who seemed to experience herself as loving and caring, contributed to his self-hatred at being gay. It was this self-hatred that led him to seek psychotherapy.
Although this example comes from the clinical domain, and happens to have involved a female pedophile, the issues raised seem relevant to Schmidt's discussion. Schmidt is also on moral high ground, however, in his concern that society not demonize people who are drawn to sexual activity with children. As he perceptively observes, the sexual desires of the pedophile can be a burden that leads to suffering, and people who experience these desires should certainly not be responded to with contempt or discriminated against.
Green argues that pedophilia should rightfully be considered a moral and legal problem but not a psychiatric one. He points out that the age of consent in England, "a nation that for six centuries was already graduating students from Oxford and Cambridge," was 10 until the late nineteenth century.
Presumably, many people who engaged in sexual activity with children and purchased the services of child prostitutes were well educated. Education, however, seems to be but a modest influence on the moral development of we humans. For example, in the early nineteenth century America, many slaveholders were also quite well educated.
To return to Green's point, the very notion of childhood as we understand it today has emerged relatively recently. The rights of children, whether to be free of any type of labor exploitation, sexual or otherwise, must be understood in historical context.
There can be little doubt that assessment of much past behavior from the vantage point of the present can lead to a sense of unreality, as if one were Alice in Wonderland. Did people as recently as the nineteenth century actually believe that masturbation produced physical and psychological illness?
Throughout history, physicians and surgeons have responded to the needs of ill people with well-intentioned interventions. Very frequently these ministrations had little empirical support.
Indeed, the notion that therapy should be buttressed by "scientific knowledge" is also quite a recent one. Nonetheless, knowledge, as existed at any given phase of history, was codified at periodic intervals. Codified manuals then provided guidelines for "therapy." The early editions of the DSM of the American Psychiatric Association were such compendia. In thinking about these editions of the DSM, it is humbling to recall what was known and not known about natural and psychological phenomena generally. I was born in 1941 and although I am not sure how I would react had I been transported back to 1952 (when DSM-I was published).
I know that, in 1952, had someone described cyberspace to me, I would have been certain that he had escaped from Wonderland. The past seems quite primitive, even the recent past that occurred during my own childhood.
(American Psychiatric Association, 2000).
Although Green limits his critical observations to pedophilia, they really apply to many of the paraphilias. For example, exhibitionism, frotteurism, sexual sadism, and voyeurism share with pedophilia the common features of recurrent, intense sexually arousing fantasies, and sexual activity, or marked distress or interpersonal difficulty because of the fantasies. There is also a category for additional paraphilias not otherwise specified.
 | Should paraphilias that meet these criteria be considered mental disorders? |
| Should mental health professionals turn away people requesting treatment for these conditions and instead refer them to the legal system? |
It seems to me that this is a practical question. A response in the negative would mean that mental health services should not be provided such individuals. Since "treatment" would not be carried out, outcome studies would also be curtailed. A dual frame of reference -- medical and legal -- is certainly untidy and far from ideal.
It might, however, be a better way of thinking about the paraphilias than any alternative. Despite the limitations in the present state of knowledge about pedophilia, and the other paraphilias as well, it seems to be more helpful than harmful to consider them psychiatric disorders at this particular point in history.