Dr. Berlin is Director of the National Institute for the Study, Prevention and Treatment of Sexual Trauma. He was Associate Professor, Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine, and Founder of the Sexual Disorders Clinic at the Johns Hopkins Hospital. Dr. Berlin has written extensively on sexual disorders for numerous distinguished journals, including The American Journal of Psychiatry, The New England Journal of Medicine, and The American Journal of Forensic Psychiatry. He was a consultant to the National Conference of Catholic Bishops' Ad Hoc Committee on Sexual Abuse from its inception to 2000. This interview was conducted September 8, 1997, in Baltimore.
Q. The problem of sexual abuse of minors has gotten a lot of publicity since the mid-'80s. Is this a new problem?
A. No, it's absolutely not a new problem. Some of the cases that are coming to light now were from before the '80s. What is new is our paying attention to the problem, recognizing the degree of distress that it can cause, the sense that the criminal justice system is going to deal with matters more sternly, and a recognition that we cannot cure, although we can sometimes successfully treat, these sexual disorders. So there are new aspects and new ways of understanding, but the problem itself, very sadly, has been with us throughout history.
Q. People refer to "pedophilia" and "ephebophilia." How do you distinguish these?
A. People are attracted not only by gender -- male, female -- but also by other factors such as age. The average man refrains from sex with a child not only because he's a moral person but also because a child does not tempt him sexually. The term used to describe an orientation toward pre-pubescent children is "pedophilia," of which there are two types. One is the exclusive type: the person is attracted only to children. The other is the non-exclusive type: there is some attraction to adults. Pedophilia can be same gender pedophilia -- a man attracted to boys; opposite gender pedophilia -- a man attracted to girls; or bi-sexual pedophilia -- attracted to both boys and girls. Ephebophilia is a condition in which a person is attracted not to prepubescent children but to children or adolescents around the time of puberty, basically teenagers.
Q. Generally when you read or hear in the news about "pedophilia," aren't the media using the term to refer to anyone who is a minor?
A. Yes. Generally, people use the term "pedophilia" to include ephebophilia. Most men can find adolescents attractive sexually, although, of course, that doesn't mean they're going to act on it. Some men who become involved with teenagers may not have a particular disorder. Opportunity and other factors may have contributed to their behaving in the way they do.
Q. What are the common characteristics you see in sex abusers?
A. I don't think there are common features in terms of the personality or temperament or even the intelligence level of the individuals. What these people share in common is difficulty in dealing with their sexual needs in a healthy and constructive fashion. The only common feature has to do with the privacy of their sexual lives and how they manage that.
Q. Are there any signs to help identify abusers before they act out?
A. Obviously if someone's had a prior record, we should be aware of that; or seems to be spending an inordinate amount of time with children and wants to do it without any chaperoning, these would be causes of concern. But a person's demeanor or conduct is not necessarily going to give us a clue of being a risk.
Q. Are some people born with an orientation toward children?
A. We don't know if it's because they were born that way or because they were damaged during their early psychological maturation. Regardless of the cause, it's not that they chose to be that way.
Q. Is abuse caused by some defect in body chemistry?
A. We're trying to understand much more about this. Certainly the sex drive itself is rooted in biology. It may have to do with various hormones, with chromosomes, and so on. Particular persons who have more intense drives than others may have more difficulty resisting temptations. There may also be some biological factors that determine the kinds of behaviors or kinds of partners that cause sexual arousal. There's a lot of research going on in that area, so it may be that we will find that there are more biological factors that contribute to the intensity and nature of sexual desire than we previously suspected. We also now have biological treatments -- not that we can change an orientation but if a person is hungering sexually for the wrong kinds of partners, to make it easier for them to resist acting on unacceptable sexual impulses.
Q. Do abusers fall into any one I.Q.-range?
A. No. Abuse can be perpetrated by people at any level of intelligence. They can have a spectrum of personalities from introverted to extroverted and anything in between. Their temperaments can be quite different in terms of whether or not they tend to have a short fuse or are very patient and docile. The only thing that they tend to share in common is that they are experiencing these attractions and acting on them. It has nothing to do with intelligence, personality, or social skills.
Q. Do abusers have healthy relationships in other areas?
A. Abusers may or may not have healthy relationships in others areas. Usually if they are attracted sexually to children, they are not having a good, intimate life in other ways. But having said that, I want to emphasize that there's a tremendous range of maturity and social giftedness, if I can put it that way, among those who abuse children. Some who are attracted to children are awkward and uncomfortable in adult relationships, but others can be very gifted with adults. The problem isn't that they're not able to relate to adults in a healthy way; it's that they are also experiencing attractions of another sort with which they have to deal.
Q. Do you have cases where a person is married and has what's considered a normal sex life but also is involved in pedophilia?
A. Yes. This could be what I referred to as a non-exclusive form of pedophilia. They're attracted to adults and to children but it may be that the attraction to the children is stronger, so the availability of an adult partner doesn't erase these other cravings or guarantee that they won't give in to these other kinds of unacceptable temptations.
Q. Is there a relationship between sex abuse and alcohol and/or drug abuse?
A. Alcohol and drug abuse does not cause one to become involved sexually with a child. On the other hand, if one is already vulnerable because of an attraction to youngsters and then takes an intoxicating substance which will impair judgment and lower inhibitions, it's like throwing gasoline on a fire.
Q. Can stress turn one to abuse?
A. Yes. We talk about the triggers that heighten the urges that people experience, and just as an alcoholic may drink to feel better when under stress, someone who has sexual difficulties may turn to sex to feel good during stress or depression or even boredom. Part of the treatment is to teach people about these triggers -- either internal states, such as stress or boredom, or external situations, such as spending time in the presence of youngsters -- which can heighten urges.
Q. Do sex abusers feel guilty?
A. Many sex abusers feel guilty once they begin to appreciate the harm that they've caused. When people have strong cravings and satisfying those cravings is pleasurable, people often rationalize. They can't be objective. They convince themselves it isn't really going to be that harmful. In treatment, when we confront these folks and force them to look objectively to see that they've betrayed trust, that they've caused pain and suffering, that they've asked children to keep secrets from their families, that families have been deceived and injured, we see, in many cases but not all, tremendous guilt and remorse and an actual horror about themselves and the kinds of problems that they have caused.
Q. At what age do abusers start abusing children?
A. People who are attracted to children often become aware of it at quite a young age, about the time most of us become aware of certain attractions. Then it takes a while before any of us ultimately acts on those attractions. Most priests that I've seen have begun to act on these attractions by the time they're in their early twenties or certainly their mid-twenties.
Q. How many victims does an abuser usually have?
A. We can't give a single answer to that. I have seen the entire spectrum from abusers who have had contacts with literally hundreds of children to those who had contact with one child and never repeated it. So any statistics that say that all abusers victimize either a very low number or a very high number of children need to be looked at, in my opinion, in a very critical fashion.
Q. Do you find that this applies to priest abusers as well?
A. Yes. We also have to be careful about what we mean by abuse. All of it is wrong, but if, for example, the pattern of the individual is to pick up teenage prostitutes standing on street corners three times a week and this has been going on for 10 years, that adds up to literally thousands of victims. However, that is not the same as introducing a naive child into sexual activity.
Q. Talking about introducing the naive person into sexual activity, how does this start?
A. It usually evolves insidiously and can go on for some time. The common misperception about people who become sexually involved with children is that they are just pretending to care in order to get at them sexually. In most cases, it's really quite different. The priest or whoever tends to have a genuine affection for the child and is interested in them in ways that would otherwise be quite positive. Then, sadly, because they feel sexually tempted and act on those temptations, what otherwise might have been a healthy and positive relationship becomes a damaging one. So it usually involves getting to know the child over a period of several weeks or even months, gradually progressing from a non-sexual to a sexual relationship and then, once it becomes sexualized, in some cases, it might go in for a number of years, before it ultimately comes to a conclusion.
Q. Are abusers attracted to the priesthood, and if so, why?
A. I don't know of any actual evidence that abusers are attracted to the priesthood. There's been speculation that perhaps some people who are having a difficult time in dealing with sexual feelings deceive themselves into thinking that it will become a non-issue if they take vows of celibacy and become priests. I suppose that's possible. On the other hand, I don't know of any evidence that shows it to be the case that there's a higher prevalence of conditions such as pedophilia within the priesthood than outside of it.
Q. Do you have an idea about what percentage of abusers are in the priesthood as compared to other professions, even in the general population?
A. There is no good data either from the general population or from the priesthood about numbers of pedophiles or people who have a vulnerability that increases their risk to children. The issue of sexuality, particularly of people who may have unusual kinds of sexual cravings, has been one that society has tended to sweep under the carpet. Getting that data is terribly important, but as of now I know of no systematic surveys that would allow us to come to any firm conclusions.
Q. Are the victims of priest abusers usually boys or girls or both?
A. It's both, but in a majority of cases that have come to light, it has been boys rather than girls. Why this is so is not clear. It used to be thought, even in general, that most of the children who were abused were female. We know now, and we're not just talking about priests, that boys are probably just as much at risk of being abused as are girls.
Q. How do priest abusers justify their activity?
A. Priest abusers justify it just as other abusers do, in a variety of ways. They know that they're feeling pleasure and they convince themselves that the youngster is too. They tell themselves that on the whole the child is better off. They have a difficult time appreciating that children are not miniature adults, that they cannot really consent, that there is a tremendous disparity between the child and the priest who is in a position of authority that affects how the priest is perceived by the child. It's often only with proper professional help that they begin to realize the extent to which they have been deceiving themselves.
Q. What are the "red flags" which could justify parishioners expressing concern to church officials about a cleric?
A. If a cleric shows an inordinate interest in their youngster, wants the youngster to stay over at any time under unchaperoned circumstances, wants to separate this young person from the family rather than being part of the family structure -- any of these should be red flags to look more closely and to make certain that everything is in order.
Q. You say "unchaperoned," and yet the priest is the chaperone.
A. I don't think a priest should be a chaperone with youngsters when there's only one priest present. As a doctor I don't examine patients unchaperoned myself. It doesn't mean that I'm a bad person, but it's for the protection of myself as well as for the protection of my patients. I think priests have to begin to think about it in those ways.
Q. What are the most common forms of sexual abuse?
A. Are you asking me in the priesthood or just in general?
Q. Let's say both.
A. There are many kinds of abuse, and the more harm that can be caused, obviously, the more concerned we become. The two big concerns for society would be those who coercively impose themselves against adult women and those who force, persuade, or cajole children into sexual activity.
Q. What would be the range of sexual activity that you would find in priest pedophiles?
A. In priests, we rarely see the physical or assaultive kinds of behavior. It's very rare to see rape other than statutory. The most common thing we see with priests is that they enjoy the company of youngsters, like the companionship, want to do good for them, and then, unfortunately, as a bond develops emotionally, begin to feel sexually tempted and persuade the youngster to go along with sexual activity. That's the most common scenario that we see in a priest. Of course the youngster, in respecting the priest and in feeling that the priest is not going to lead him astray, is at a tremendous disadvantage.
Q. What kind of sexual contact are we talking about?
A. Most sexual contact with children does not involve penetration, although it sometimes does. That's partly because it becomes more difficult to rationalize that you're not really causing much harm if you begin to see obvious signs of pain. With priest abusers, the majority of activity involves fondling, mutual masturbation, sometimes oral sexual contact. That's not to say penetration never occurs, but it's not by any means the most frequent sexual activity in these cases.
Q. How damaging is that kind of contact?
A. It's not the physical action necessarily that's going to hurt the most. It is much more the abuse of trust that tends to be the issue. We have a responsibility -- all of us -- to protect children. That responsibility is even heavier for those who are held in special positions of esteem, such as priests. A priest involved with a child is certainly going to want that kept secret from the child's parents. This puts the child in a difficult and confusing position. In addition, just as it's difficult enough for many of us as adults to deal with sexual feelings, it's even more difficult for children to deal with these powerful feelings when they're not mature enough developmentally to cope.
Q. How prevalent is sexual abuse of pre-adolescent children by priests?
A. My clinical impression -- there's been no systematic survey -- is that most of the involvement with youngsters by priests has been with those around the teenage years rather than the prepubescent.
Q. Does celibacy create frustrations which lead toward sexual abuse?
A. First of all, we have to respect the religious convictions of people, so if Catholicism embraces celibacy as something important, that has to be respected. It may, however, require assisting people. It may be more complicated than "just say 'no.'" We may need to counsel and assist people in achieving what is indeed for many a very difficult state to maintain. Pedophilia isn't caused by celibacy, but celibacy can lead to sexual frustration and tension. Some celibates may need help in learning how to deal with this in a healthy, constructive, positive fashion.
Q. Is it ever safe to return a priest abuser to any form of public ministry?
A. As a working guideline, I do not think that any priest abuser should be placed back into a position where he has unsupervised access to children. That's not to say that priests should not continue, in many instances, to be priests. In fact, I would argue that the Church can often do more not only to help the priest but also to safeguard the community by not requiring the priest to leave. The easiest thing for the Church would be to get rid of these people. If the real responsibility is to safeguard the community, there's often a great deal that the Church can do by holding on to them while making sure that they do not have access to children.
Q. So you don't feel an abuser should be placed back into work with children?
A. It would be neither an acceptable risk for the community nor proper treatment. We teach people who have an attraction to children that they should not unnecessarily risk temptation. If you're an alcoholic, you don't go to work in a bar; and if you have problems with pedophilia, you shouldn't be in a position where you have unsupervised access to children. In treating these folks we have to remember that the bottom line is that if treatment fails, innocent people suffer.
Q. Would you put him in a parish setting where he's saying Mass on weekends?
A. I would not, in general, put a priest who's been involved with a child into a parish setting, because I think the potential is there for further problems to develop. Having said that, there can be occasional exceptions. When there has been the rare case of a single, completely isolated instance of abuse, I think it has not been unreasonable for that priest to be returned to the community, particularly if the community knew about his background and was anxious to have him.
Q. What determines if an abuser will abuse again?
A. There are many factors: the strength of his drives, his motivation not to do it again, the kinds of social supports that are either in place or lacking, the quality of treatment that he has an opportunity to receive or conversely may not have an opportunity to receive, the attitude of his peers -- all of those factors can influence whether or not the abuse will re-emerge.
Q. So pedophilia is almost impossible to cure.
A. There's no cure for pedophilia. There is, however, effective and successful treatment. As with alcoholism, where there are many similarities, we talk about successful treatment but not cures. There's something about your makeup that makes you vulnerable and you need to pay attention every day to make sure that you don't, so to speak, fall off the wagon. If you think you're cured, meaning that this vulnerability is somehow removed, that's dangerous because you can let down your guard, stop maintaining vigilance, and gradually slip back into old habits. Years back, the Church, very sadly, was misled by mental health professionals. The Church was one of the earliest organizations to recognize that pedophilia existed and to send people for help. Unfortunately, back in the late '40s and '50s, and even the '60s, psychiatrists who didn't understand what we do now thought that these people could be cured. The Church, after talking to the authorities of the day and believing that these people were going to be safe, put them back into the community. The fault there was not the Church's.
Q. Do you see a difference in how the Catholic Church deals with this problem now as compared to the early '80s when people began to learn that sexual abuse of minors existed in the Catholic Church?
A. I have met a number of extremely conscientious and dedicated priests who are absolutely determined to do everything they can to deal with this problem as effectively as possible. I personally believe there has been too much Church-bashing. The Church has made mistakes -- we've all made mistakes -- and sadly there may still be mistakes that individuals will make as time goes along. The notion that somehow priests in general don't care about the well-being of children, or that they're insensitive to their parishioners, or that they would turn a blind eye and allow children somehow to be harmed -- that's not true. From what I've seen of all the hard work, there's a tremendous dedication to doing everything possible to minimize these kinds of problems and, to the extent that they can be eliminated, to try to do that as well.
Q. Is there anything that can be done to keep pedophiles out of ministry?
A. There is no screening that would identify a pedophile. We can do some common sense things, such as background checks. We can do more education. We can provide more treatment so that pedophiles can get help. But there is no way that we can identify ahead of time a pedophile who's not previously been identified and who wants very much to keep secret his own sexual yearnings.
Q. What can be done to educate adults about pedophilia?
A. Adults need to know that there are people who are attracted sexually to youngsters. Most of us can't imagine that because we don't have those kinds of feelings, so education is extremely important. Once people realize the problem some of the steps fall into place: Don't allow unchaperoned situations; let your children know that they ought to talk with you if somebody approaches them in a sexual way; and teach them it's okay to say 'no,' even to a priest, if it involves something that ought not to happen. Also more treatment has to be made available for pedophiles. People who experience these cravings need to know that treatment is available. Society is so punitive and stigmatizing about this problem that people with these desires have to be encouraged to get help by assuring them that they will be assisted rather than hurt. All of these things can ultimately make a difference.
Q. Are many accusations of sexual abuse false?
A. It would be a terrible tragedy not to respond to a child who's been sexually abused. It is also tragic to hold someone responsible for an act of abuse that they did not do. Even though false allegations are made, every allegation has to be taken seriously and looked at carefully and objectively. The mission of those looking into it is to get at the truth.
Q. During the mid-'60s, boundaries between clergy an laity were de-constructed. Is there a need to re-define boundaries and if so, how?
A. As a physician, it 's terribly important that I have boundaries between myself and patients, but those boundaries shouldn't interfere with my showing a genuine concern and care. That's also the issue for priests. They need to be clear, for example, that they should never be in an unchaperoned situation with a child. The boundaries, however, should not cut off a genuine concern and emotional bonding with parishioners.
Q. Are there any kinds of rules to guide behavior?
A. Efforts are being made to teach priests. I saw an excellent film made recently to educate bishops and priests about boundary issues, not only with children but also with adults, for example, how to show concern for a woman who's grieving over the death of her husband in a way that will not be misinterpreted. These are tricky issues. They require education. They don't necessarily come to us through intuition.
Q. Is there anything else on which you would like to comment?
A. Yes. The Church needs to recognize that the first priority must be the parishioners, to let parishioners know that there is a genuine sense of concern. Lawyers need to help the Church accomplish this without creating a "we-vs.-them" mentality. In other organizations, if somebody's suing, it is "we-vs.-them." But the Church is in a unique position where it should never be "we-vs.-them." The people whom I've met in the Church want the first response to be that of ministry, to be what the Church is supposed to be. The question is how to do this in modern American society where the legal system is very adversarial.
Q. Any other comments?
A. For some, it's easy to write off human beings as disposable commodities, but the Church can't. It needs, first of all, to protect society, when it comes to pedophilia. There is no doubt about that. It also needs to be true to its belief in the possibility of salvaging the human life that's gone astray. Forgiveness and atonement -- those shouldn't just be words. Though these concerns must never interfere with safeguarding parishioners, at the same time, the Church cannot be true to itself, if it treats the pedophile priest as though he is less than human. The Church cannot give up its very essence in dealing with this difficult problem. In the understandable anger and outrage that people feel, the reaction can be to treat these people like disposable items. But that's not the way the Church can function and still be Church.