.CLINICAL AND LEGAL PRESENTATIONS OF SEXUAL PROBLEMS
There are many ways in which sexual problems in Roman Catholic clerics
may present themselves to the cleric himself, the Chancery Staff,
or to the Auxiliary or Ordinary Bishops. further, there are very different
kinds of sexual problems which may present to these persons concerning
the clerics in the Dioceses.
TYPES OF SEXUAL PROBLEMS
The following are the most co~non sexual problems that have presented
to me personally and to my professional colleagues in Roman Catholic
(1)Compulsive Heterosexual/Homosexual Acting Out
It should first be stated that this is not necessarily a problem unique
to Roman Catholic clergy because of our vow of celibacy/chastity;
this is a problem among single and married people and is being addressed
more and more in the psychiatric world. For example, a new group called
S.A. (Sexaholics Anonymous) has begun under the philosophical principles
of A.A. (Alcoholics Anonymous) and from the work of Dr. Carnes in
his book, Sexual Addictions. In S.A., to which we send all of our
patients three times per week, a large number of married and single
persons are present in the group trying to deal with compulsive, repetitive
heterosexual and homosexual activity, especially in terms of "anonymous
" or "one night stands" or basically non relational sexuality.
In Roman Catholic clerics, it is my moral and psychiatric philosophy
that the vow of celibacy is what we are called to and that it can
be accomplished only as perfectly as one struggles psychologically,
spiritually, and with the help of grace in the Sacrament of Reconciliation
and Eucharist. We do not usually recommend inpatient treatment in
our own Saint Luke Institute for this problem in Roman Catholic clerics
because this is not the ''focus~~ or institutional purpose of the
Saint Luke Institute. This does not mean that it should not be addressed
at times in an inpatient setting. It is mentioned because of its frequency
of presentation only in this document.(2)Pedophilia or Sexual Molestation
This, of course, is the area which is the "newest" in the legal circles
and the area that brings most panic and concern to the Bishops with
respect to the clerics in their jurisdictions.
First, it should be made clear to all that pedophilia as described
in psychiatry may be quite different from psychologists definitions,
lawyers' definitions, or your own personal definitions (To add a little
levity to this document, 'a pedophile is not, as one of our older
clergy stated a few nights ago, a kind of bicycle!)
In the Diagnostic and Statistical Manual of Mental Disorders (Third
Edition), which is accepted in the United States as the master manual
or dictionary for mental disorders defines pedophilia as follows:
"A. The act or fantasy of engaging in sexual activity with prepubertal
children as a repeatedly preferred or exclusive method of achieving
B. If the individual is an adult, the prepubertal children are at
least ten years younger than the individual. If the individual is
a late adolescent, no precise age difference is required, and clinical
judgment must take into account the age difference as well as the
sexual maturity of the child."
Adults with the disorder are oriented toward children of the other
sex twice as often as toward children of the same sex. The sexual
behavior of these two groups is different. Heterosexually oriented
males tend to prefer eight to ten year old girls, the desired sexual
activity usually being limited to looking or touching. Most incidents
are initiated by adults who are in the intimate interpersonal environment
of the child. Homosexually oriented males tend to prefer slightly
older children. The percentage of couples in this group who know each
other only casually is higher than in the heterosexually oriented
group. Individuals with undifferentiated sexual object preference
tend to prefer younger children than either of the other two groups.
Most individuals oriented homosexually have not been married, whereas
most individuals oriented heterosexually either have been or are married.I
have been surprised by the clinical ignorance of many of my own psychiatric
colleagues in this area and by other mental health professionals.
I state this to you so that we may put in a kind of context why the
problem of sexual molestation of children may be such a "strange phenomenon"
to you also. It is not that. we are ignorant people in the area of
human behavior; instead, it is that the public has allowed a greater
tolerance for all types of sexual behaviors and discussion of different
sexual behaviors in the past twenty years. In the past three years,
I would say that the area of incest and specifically child sexual
abuse has been a topic opened up in the media and now in all states
with respect to changes in the law. Please do not feel "preached to"
or that your past views and ways of dealing with this disorder have
been "wrong." We,in the Roman Catholic Church specifically, have all
been surprised by the abuse of the public image of the cleric that
is now being challenged and "smeared" by the media in many ways. The
purpose of this document and your discussion in Collegeville at Saint
John s Abbey this past suxnmer is to educate you as much as we can
in our professional capacities and try to help keep you abreast of
developments in this sensitive and devastating area of human behavior.
One natural question that should emerge as you read this first section
would be: "If a priest has recurrent fantasies and/or sexual activity
with a fifteen year old boy, does this fit the psychiatric definition
of pedophilia?" The answer is not However, it is inappropriate behavior
from many viewpoints, not the least of which is that it is illegal
in all fifty states. Another question related to this situation might
be: "Does this mean that we are dealing with the same 'disease as
pedophilia even though it does not strictly fit the definition in
the DSM III manual I quoted to you above?" The answer is a difficult
one, but generally we could say that we are basically dealing with
a similar or parallel disorder with the age preference simply shifted
to post pubertal young adolescents instead of prepubertal children.
According to the law in most states you are dealing with the same
legal liabilities and questions.
Why would clerics or anyone prefer youngsters for fantasy and/or sexually
acting out behaviors? To be a purist, I would have to say that this
question is just being investigated in a scientific fashion. We have
been hampered in our profession by extreme moral judgmeu.talism, if
I may use the phrase, and it is only in very few medical schools in
this country that the issue is treated or even addressed properly.
The Johns Hopkins Hospital Sexual Disorders Clinic run by Dr. John
Money and Dr. Fred Berlinis probably the "authority" scientific community.
I know personally bath of these highly respected scientists and I
am very appreciative of their efforts to bring this psychiatric disorder
out of the shadows and into the "scientific daylight" so that we can
begin to see the disorder as a psychiatric disease and not a moral
weakness. We are at approximately the same point in time with pedophilia
in the medical/psychiatric world as we were with alcoholism in the
late 1950 s when the American Medical Association finally agreed that
alcoholism was a disease of its own right and not a weakness or a"personality
disorder" or "personality defect". I am professionally working with
Dr. Fred Berlin, both in his research endeavors with this disease
and clinically with respect to legal testimony in different jurisdictions
to help educate the court jurisdictions about the "hope" for treatment
and rehabilitation of persons with this disease.
Despite my disclaimer at the beginning of this page, I would say as
a very careful "thinker" in this area and a person well aware of the
scientific research in this area that the etiology of this disorder
is most likely biological with a strong contribution of premature,
early childhood introductions to sexual behaviors as being the environmental
co etiologic contributor. In the simplest terms, it is highlyal firm or another firm
who is f likely
that in utero a type of programming of the brains of all persons takes
place that contributes to the later expression of sexual behaviors
in humans. This includes sexual orientation (i.e., heterosexual, homosexual,
bisexual), sexual energy level (i.e., libido, a term coined by Sigmund
Freud to describe sexual erotic drive), and perhaps even erotic age
preference (i.e., pedophilia vs preference for age appropriate partners).If,
and when, this biological basis for human sexual behaviors becomes
more accepted scientific "fact" in the future years, the Roman Catholic
Church is going to have to look very hard at our current "constructs"
in moral theology and reassess some of our basic "Statements" which
have been codified and accepted without question for many years, if
not centuries in some cases. But my point is not one in the area of
moral theology; my point is that if there is a biological contribution
to the behaviors, such as pedo philia, there is likely to follow biological
"helps" to these persons and hope for better treatment modalities
can be envisioned. This is already the case in the use of medroxyprogesterone
(Depo Provera) which is a drug which has brought new hope to this
area of treatment in psychiatry and something that will be discussed
in depth in another section of this document.
Finally, I would like to make a point about the "behaviors" that present
as pedophilia or present as illegal behaviors to minors on the part
of clerics. Obviously, performing oral sex (fellatio) on a minor or
child or having anal intercourse with a male child or vaginal intercourse
with a female child are sexual acts that fall in the category of pedophilia
or sexual molestation of minors.
However, in my clinical experience, this is not the usual presentation
of pedophilia or sexual molestation of adolescents. Some of the following
would be examples that may surprise you:
(a) A cleric who touches the toes of a minor with a Q Tip, explaining
to the young child that it is a scientific experiment, while sexually
excited by this, constitutes an unusual presentation of pedophilia.
(b) A cleric who has young children act in plays with their shirts
off and playing ostensibly "games", touching the child s chest only
or hair may be a presenting form of pedophilia.
(c) A cleric who sleeps in the same bed with a child without touching
the genitals is but just holding the child in an affectionate manner
is a common presenting, form of pedophilia.
(d) A cleric who touches the hair, chest, buttocks of a sleeping child
without the child awakening ever or responding sexually in return
or ever being ai of the touching could be a co~on presenting form
These four unusual examples would represent only the "surface issues"
for these clerics in terms of their sexual proclivities or psychiatric
disease. It takes a psychiatrist or psychologist with great skill
and patience to be able to obtain from such persons the "real story"
of their preference for children or adolescents. This disorder may
begin at any time in adulthood; most frequently it begins in middle
age. In my experience, most of the pedophiliac clerics I have seen
and my colleagues have dealt with are homosexual pedophiles and not
heterosexual pedophiles; this is surprising since the greater percentage
in the general population is the opposite.
As will be discussed later, the recidivism (relapse) rate for pedophilia
is second only to exhibitionism, particularly for homosexual pedophilia.
This is whether the person has received ''traditional psychiatric
treatment or not.
This is a very fascinating disorder and is defined as a psychiatric
disease by the DSM III referred to previously:
"The essential feature is repetitive acts of exposing the genitals
to an unsuspecting stranger for the purpose of achieving sexual excitement,
with no attempt at further sexual activity with the stranger. The
wish to surprise or shock the observer is often consciously perceived
or following treatment. There is hoclose to conscious awareness, but these
individuals usually are
not physically dangerous to the victim. Sometimes the individual masturbates
while exposing himself. The condition apparently occurs only in males,
and the victims are female children or adults."
This disorder is not seen that frequently in clerics, but enough that
it should be mentioned here in this document. It represents one of
the "victimless crimes" but the legal sanctions and prison sentences
for these individuals may be long and unfair with reference to the
lack of harm it does to the "victim."
It is the most resistant paraphilia to treatment in any form, followed
as mentioned above, by homosexual pedophilia as the second paraphilia
most resistant to treatment.
TYPES OF PRESENTATION TO THE DIOCESES
The most common way that it is made known to the Ordinary that a cleric
may have a sexual disorder such as pedophilia is for a parent of a
child to go to their local Pastor, Chancery official or the Bishop
himself and express concern or make an accusation against a cleric
for sexually touching or molesting their child. To date, this kind
of presentation has been the most helpful one for us all since usually
the parent is Roman Catholic and confused, concerned about the child
and also confused and concerned about the priest or cleric.
Another presentation may be simply an attorney calling the Chancery
and informing the Bishop that a criminal action has been filed or
a civil suit has been filed against one of his clerics. This is a
most distasteful and dangerous way in which the information can come
to the attention of the Ordinary. In general, and please make sure
you understand me here, it has been my experience that such presentations
come only when the Ordinary has already been aware of sexual misbehaviors
before and no action has been taken in the past except perhaps to
move the cleric to a new assignment.
The least common, but most helpful, presentation is when the cleric
himself comes to his Ordinary and admits that he has sexual difficulties
that could endanger himself legally as well as jeopardize the Diocese
as an entity. We have only seen this in the recent past where Ordinaries
have done workshops in their Dioceses educating their clerics and
administrators or schools abou the disease of pedophilia, incest,
physical child abuse. Clerics have come forward after such compassionate
presentations. and asked for help. It is for this reason, and many
others, that I would advise that every Diocese in the U.S. in the
next year have such a presentation done by an attorney, a psychiatrist
who is familiar with this disease (very few psychiatrists know anything
about pedophilia), and the Ordinary himself.