Commentary on social and moral issues of the day

Psychiatric Association Reverses Pedophile Diagnostic Change, Returns to Original Criteria

Linda Ames Nicolosi

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For many years now, psychology has been locked into a philosophical quandary. Is "mental illness" something that's unhealthy according to an objective, scientifically "neutral" standard? The truth is, there are no universally agreed upon, external validating criteria that can objectively prove most psychiatric diagnoses to be illnesses.

This problem has come to the fore now in the case of pedophilia. Child molestation is illegal and our culture considers it morally wrong--but some clinicians say an attraction to children can't be considered a mental illness.

In fact, a prestigious psychiatric journal will debate that very question in a soon-to-be-published issue...with at least one prominent psychiatrist arguing against the idea of pedophilia as a pathology.

APA Reverses Diagnostic Change on Pedophilia.

Recent changes in the APA's diagnostic manual may have encouraged pedophile advocates.

In an earlier version of the diagnostic manual (DSM-III) , the American Psychiatric Association contended that merely acting upon one's urges toward children was considered sufficient to generate a diagnosis of pedophilia.

But then a few years later, in the DSM-IV, the APA changed its criteria in a way that made room for the psychologically normal type of pedophile. A person who molested children was considered to have a psychiatric disorder only if his actions "caused clinically significant distress or impairment in social, occupational or other important areas of functioning." In other words, a man who molested children without remorse, and without experiencing significant impairment in his social and work relationships, could be diagnosed--at least theoretically--as a "psychologically normal" type of pedophile. NARTH brought that DSM shift to public attention.

The APA stated categorically that it had, in fact, no intention of normalizing pedophilia. However, "man-boy love" advocates cheered the DSM shift as good news, and a door appeared to be opened, because soon afterward, a major journal published a pedophile-friendly meta-analysis of the evidence surrounding the effects of, in particular, homosexual pedophilia.

After that version of the DSM was issued and before the next one appeared, an event occurred which may have encouraged the psychiatric association to rethink the effects of its shift in diagnostic criteria. "The political storm of the century" hit the field of psychology. According to the March 2002 issue of the Psychological Association's official journal, the American Psychologist, that storm hit "with gale-force winds raging from the media, congressional leaders, states legislatures, and conservative grassroots organizations."

The fiasco the Psychological Association was referring to had followed its own publication of a controversial study by Rind, et al. which concluded that man-boy, "consensual" sexual relationships were not necessarily harmful and might even be positive. The Rind study marked the first time, the APA said, that it had been called into the public arena to defend publication of a study.

After a public apology of sorts--followed later by another statement which sounded a bit like backpedaling (insisting that researchers had a right to scientific freedom) the Psychological Association issued a new and quite surprising official statement.

APA said that no matter what the research showed either way about the psychological effects of pedophile relationships--pedophilia remained, in its opinion, "morally" wrong.

Moral Philosophy and the Pedophilia Problem

Morally wrong? This was an odd statement indeed from a scientific organization. What, then, was the APA's moral position on, say...adultery or abortion? What about sexually open relationships? Would APA have an official position on polygamy? The very fact that APA admitted to holding a moral viewpoint on a psychological issue ought to have opened up a broad new challenge to psychology's authority and its moral presumptions as our culture's new secular priesthood.

Indeed, the time would was then ripe for moral philosophers to issue a fruitful challenge to the entire concept of psychological health--its inherent limitations, its value-laden nature, and its utter meaningless without dependence on an underlying social-moral philosophy.

The Psychological Association must have been aware of the implications of its statement about the immorality of pedophilia, because the March 2002 issue of the American Psychologist carried an official article stating that what the association had learned from the Rind fiasco was--among other lessons--that 1) APA must build bridges to conservative groups, and 2) in the future, psychology must be prepared to defend its validity as a science.

The DSM Changes Again

Public outrage from the psychological association's fiasco must have touched the American Psychiatric Association as well, because psychiatry just instituted a change in its most recent diagnostic manual--the Text Revision of the DSM-IV--regarding the definition of pedophilia. Now, as before, merely acting upon one's pedophilic urges is sufficient for a diagnosis of disorder.

But still, the question remains--do we regularly see psychological harm to the victim of adult-child sex, and to the perpetrator himself, as a result of a pedophile act?

The Missing Moral Dimension

Catholic moral philosophy, for example, recognizes pedophilia as an affront to the integrity of the person--but such a characterological and spiritual concept may be difficult to conceptualize, and even more difficult to assess, in narrowly psychological terms.

Perhaps the harm will be difficult to measure because it is subtle and values-laden. Maybe the molested boy will grow up to routinely sexualize his same-sex relationships. Maybe he'll have difficulty with marriage and mature intimacy. Maybe he'll not only have a distorted concept of gender differences, but a distorted understanding of generational distinctions as well--which could lead to the molested boy's sexualizing of his own mentoring relationships when he grows to adulthood.

In fact, the molested child who has been hurt the most, in a moral and characterological sense, may actually be the one who grows up as an adult who truly believes--and who reports to researchers (as many of those found by the Rind study did, in fact, state) that they "remember the relationship positively."

But these harms are difficult for psychology to measure. Perhaps, indeed, many of the deepest characterological harms to the child--and to the perpetrator--are outside of contemporary psychology's understanding. So, in a curious twist, maybe the APA--in saying pedophilia was "morally wrong"-- was right.

Psychologist Gerard van den Aardweg said the Rind study didn't find significant harm to the molested child because Rind "was looking through the wrong glasses." Perhaps the day will come, sometime, when psychology recognizes and openly incorporates the missing moral dimension--recognizing our human natures in all their intertwined psychological, moral and spiritual complexity.

And when we recognize that these characterological and spiritual aspects of our natures are in fact inseparable from the psychological dimension, then the pedophilia puzzle, too, may come into focus.

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The National Association for Research and Therapy of Homosexuality (NARTH), founded in 1992, is composed of psychoanalysts, psychoanalytically-informed psychologists, certified social workers, and other behavioral scientists, as well as laymen in fields such as law, religion, and education.

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