9. Child Sexual Abuse as a Construct Reconsidered

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,

[Page 46]

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.