In light of the current findings, it is appropriate to reexamine the scientific
validity of the construct of CSA as it has been generally conceptualized.
In most studies
examined in the current review, CSA was defined based on legal and moral, rather than
empirical and phenomenological criteria. This approach may form a defensible rationale
for legal restrictions of these behaviors, but is inadequate and may be invalid in the
context of scientific inquiry ( Okami, 1994 ).
In science, abuse implies that
particular actions or inactions of an intentional nature are likely to cause harm to an
individual (cf. Kilpatrick, 1987 ; Money & Weinrich, 1983 ). Classifying a behavior as
abuse simply because it is generally viewed as immoral or defined as illegal is
problematic, because such a classification may obscure the true nature of the behavior and
its actual causes and effects.
The history of attitudes toward sexuality provides numerous examples.
Masturbation was formerly labeled "self-abuse" after the 18th century Swiss
physician Tissot transformed it from a moral to a medical problem ( Bullough &
Bullough, 1977 ).
From the mid-1700s until the early 1900s the medical profession was
dominated by physicians who believed that masturbation caused a host of maladies ranging
from acne to death ( Hall, 1992 ; Money, 1985 ), and medical pronouncements of
dangerousness were accompanied by moral tirades (e.g., Kellogg, 1891 ).
This conflation of
morality and science hindered a scientifically valid understanding of this behavior and
created iatrogenic victims in the process ( Bullough & Bullough, 1977 ; Hall, 1992 ;
Money, 1985 ).
Kinsey et al. (1948) argued that scientific classifications of sexual
behavior were nearly identical with theological classifications and the moral
pronouncements of English common law in the 15th century, which were in turn based on
medieval ecclesiastic law, which was itself built on the tenets of certain ancient Greek
and Roman cults and Talmudic law.
Kinsey et al. noted that
"[e]ither the ancient
philosophers were remarkably well-trained psychologists, or modern psychologists have
contributed little in defining abnormal sexual behavior" (p. 203)
Behaviors such as
masturbation, homosexuality, fellatio, cunnilingus, and sexual promiscuity were codified
as pathological in the first edition of the American Psychiatric Association's (1952) Diagnostic and
Statistical Manual of Mental Disorders.
The number and variety of sexual behaviors
labeled pathological has decreased, but mental health professionals continue to designate
sexual behaviors as disorders when they violate current sexual scripts for what is
considered acceptable ( Levine & Troiden, 1988 ).
This history of conflating morality
and law with science in the area of human sexuality by psychologists and others indicates
a strong need for caution in scientific inquiries of sexual behaviors that remain taboo,
with child sexual abuse being a prime example (Rind, 1995 ).
As discussed previously, abuse implies that harm is likely to result from a
behavior. The results for SA male college students, using this scientific
conceptualization of abuse, highlight the questionable validity of the construct CSA as
defined and used in the studies examined in the current review.
For these male college
students,
37% viewed their CSA experiences as positive at the time they occurred; 42%
viewed these experiences as positive when reflecting back on them; and in the two studies
that inquired about positive self-perceived effects, 24% to 37% viewed their CSA
experiences as having a positive influence on their current sex lives. Importantly, SA men
across all levels of consent (i.e., both willing and unwanted experiences) did not differ
from controls in current psychological adjustment, although SA men with unwanted
experiences only did, implying that willingness was associated with no impairment to
psychological adjustment.
The positive reports of reactions and effects,
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along with normal adjustment for willing participants, are scientifically
inconsistent with classifying these male students as having been abused. Their experiences
were not associated with harm, and there appears to be no scientific reason to expect such
an association (i.e., predicting psychologically harmful effects from events that produced
positive reactions lacks face validity).
On the other hand, a minority of SA men did
report retrospectively recalled negative reactions, negative current reflections, and
negative self-perceived effects; moreover, unwanted CSA was associated with adjustment
problems.
Assuming that negative reactions were associated with unwanted CSA, the term abuse
may be scientifically valid for the latter students. Combining positive and negative
responders into a single category of abuse may incorrectly suggest harm for the former and
simultaneously dilute harm for the latter (Bauserman & Rind, 1997 ).
Some researchers have questioned their original definitions of sexual abuse
after assessing their results.
For example, Fishman (1991) borrowed from Finkelhor's
(1979) definition to classify sexual abuse of boys mostly on the basis of age
discrepancies
(i.e., sex between a boy of 12 or less and someone at least 5 years older,
or between a boy aged 13 to 16 with someone at least 10 years older),
stating that age
differences implied sufficient discrepancy in developmental maturity and knowledge to
indicate victimization. He found that SA men in his study did not differ from controls on
measures of adjustment and reported a wide range of reactions to and effects from their
CSA experiences (mostly positive or neutral). In-depth interviews confirmed and elaborated
the quantitative findings, leading Fishman to question his original assumptions.
He noted
that the men's stories altered his universal beliefs about the impact of inappropriate
sexual experiences on children, and stated that
"to impose a confining definition
onto someone's experience does nothing to alter the realities of that experience for the
person" (pp. 284-285).
Fishman concluded by arguing for the use of language of a more
neutral nature rather than labels such as abuse, victim, and molestation - in short, for use
of empirical and phenomenological criteria in conceptualizing early sexual relations,
rather than legal or moral criteria.
The foregoing discussion does not imply that the construct CSA
should be abandoned, but only that it should be used less indiscriminately to achieve
better scientific validity. Its use is more scientifically valid when early sexual
episodes are unwanted and experienced negatively - a combination commonly reported, for
example, in father-daughter incest. [*7]
[*7] Two of the three outliers identified in the sample-level meta-analysis involved
samples consisting largely of incest cases ( Jackson et al., 1990 ; Roland et al., 1989 ).
The CSA experiences of these women, associated with relatively large effect sizes, may
capture more accurately the essence of abuse in a scientific sense - that is, more
persuasive evidence of harm combined with the likely contextual factors of being unwanted
and perceived negatively.
In general, findings from the current
review suggest that sociolegal definitions of CSA have more scientific validity in the
case of female children and adolescents than for male children and adolescents, given the
higher rate of unwanted negative experiences for women.
Nevertheless, as Long and Jackson
(1993) argued, because some women perceive their early experiences as positive, do not
label themselves as victims, and do not show evidence of psychological impairment, it is
important for researchers to be cautious in defining abuse for both men and women in
attempts to validly examine the antecedents and effects of these experiences.
