by Jim Duffy
The sexual victimization of children is a subject so horrifying that it’s difficult even to address. As a society, we approach it from two extremes. Most of the time we avoid it. When forced to confront it, we run to the opposite extreme, flying into a rage, voices full of fury.
With that said, it’s time to face up to another fact: Rage is not an emotion associated with clear thinking and sound public policy. Child sexual abuse is not a subject that lends itself to the sort of rational, dispassionate decision making so essential to scientific practice. Instead, it’s a subject where the playing field seems always tilted toward punishment rather than prevention.
This is the challenge that the Bloomberg School’s Department of Mental Health is now taking up. William Eaton, PhD, the Sylvia and Harold Halpert Professor and chair of Mental Health, says the decision to do so is based not only on alarming numbers—80,000 confirmed cases annually, tens of thousands more unreported—but also on the devastating impact these incidents have on victims for decades after the crime.
“One thing that has come as a surprise to me is the way people with a history of being abused sexually as a child have a much higher risk going forward of so many major mental disorders,” Eaton says. He ticks off a list: depressive disorders, personality disorders, drug abuse, schizophrenia, suicide and more.
“This is one of the leading risk factors for the entire range of mental disorders,” Eaton says.
Worst of all, these crimes can fuel a brutal cycle, as victimized boys are at higher risk for becoming sex offenders themselves. Fred Berlin, MD, founder of the Johns Hopkins Sexual Disorders Clinic and director of the Sexual Behavior Consultation Unit, has seen this cycle play out in his four decades of work in this area as a psychiatrist at the School of Medicine. A mother whose son was victimized angrily confronted Berlin in a courtroom. “Years later I get a call from this same mother. Her son had now committed a sex offense, and she was wondering if there was something I could do to help. There is just so much tragedy in this.”
With the help of private donors, Eaton’s department has sought to bring public health expertise to bear on child sexual abuse. It established a partnership with Berlin and then in 2011 hired researcher Elizabeth J. Letourneau, PhD.
Letourneau and Berlin took time recently to discuss the road ahead as they seek to move prevention-based strategies and policies to the forefront. One big challenge: combating the myths that have come to dominate public discussion of the topic.
The work will not be easy—and it might be controversial at times. But Eaton is confident that the effort will have results. “We will never eliminate child sex abuse from the picture altogether,” he says, “but I believe there are opportunities out there to lower the rate of it—and perhaps lower it by a lot.”
In recent years, researchers have set out to dig past the 80,000 annual cases confirmed by the U.S. Department of Health and Human Services and gauge the real extent of child sexual abuse in this country.
On the lower end of the spectrum, a review of 16 studies published in Child Abuse and Neglect estimated that 7 percent of boys and 14 percent of girls in this country are sexually victimized as minors. A Psychological Bulletin article that averaged the results of 23 studies estimated 17 percent of boys and 28 percent of girls were victims.
Such numbers signal a public health problem of the first order, especially considering the mental health problems victims might endure in later life, problems that spread to the lives of countless siblings, spouses, future children and sometimes even whole communities, as recently demonstrated by the child sexual abuse scandal at Penn State University.
Seated in her tidy office at Hampton House during an interview, Letourneau reviews the extent of this wreckage and makes the case that society’s current response to it is out of balance. On the one hand, there is the criminal justice system, where expensive policies are increasingly the norm—things like maintaining vast online databases of sex offenders and seeking extended civil commitment in specialized mental health facilities for some convicted offenders who have completed prison terms.
“We don’t put anything like those resources into prevention,” Letourneau says. “There’s virtually no money for this stuff. This is a field where it’s a big deal if the Centers for Disease Control puts out a single $1 million grant every couple of years for work on prevention.”
A few days later in his Mount Vernon office, Berlin says he shares Letourneau’s frustration on this front. His work with sex offenders has stirred occasional controversy over the years. Some have worried that his efforts to better understand offenders, their mental states and their behaviors might have the effect of destigmatizing—or “normalizing”—their abnormal behaviors, though Berlin has never suggested decriminalizing harmful sexual acts.
Questions have also arisen over his support for limited use of testosterone-reducing medications that induce “chemical castration.” In recent years, however, the use of such medications to help individuals maintain control of their sexual desires has gained increased acceptance.
“We cannot legislate this problem away, and we cannot punish it away, but that’s all we keep trying to do,” Berlin says. “That’s not the right approach here any more than it is with problems like alcoholism or drug addiction. We need a law enforcement component, yes, but this is a field that needs the surgeon general as well as the attorney general.”