No easy cure for sex abusers

Church cases put focus on complexities of pedophilia

It’s a devastating mental illness that doctors and therapists can’t cure or even diagnose until the damage is done.

Pedophilia, the disease that allegedly afflicted at least three Massachusetts Catholic priests convicted of molesting children and may have been a factor in scores of other alleged cases of child abuse involving priests, isn’t usually discussed outside of scholarly journals and academic conferences.

But disclosures that the Roman Catholic Boston Archdiocese did little to stop the alleged child abuse priests — including John J. Geoghan of Scituate, accused of molesting more than 100 children in Hingham and other communities — have focused public attention on pedophilia.

The issue is “difficult for people to deal with” but important to discuss, said Barbara Green, a Hingham psychologist.

Green said she does not treat pedophiles but believes facing the problem will break “the lock of silence” that makes sexual abuse of children so devastating to victims and their families.

Not every child molester is a pedophile. To be diagnosed, a person must exhibit persistent, intense arousal by children ages 12 and under; must show problems with work, emotions or social life; and be at least 16 years old and five years older than his or her victim, according to the mental health profession’s bible, the Diagnostic and Statistical Manual of Mental Disorders.

Treatment may involve electric shocks to discourage attraction to children and medication that depresses the male sex hormone. Experts disagree on whether pedophiles can ever recover enough to work with young people.

There’s no way to tell whether a person has pedophilia until he or she molests someone, said Dr. Martin Kafka, a psychiatrist and Harvard Medical School professor who treats pedophiles at McLean Hospital.

Moreover, “it can be easily hidden and people are loath to speak of it,” Kafka said.

Pedophiles have no common psychological history that makes them stand out. Having suffered abuse as a child is no indicator that a person will abuse children as adults, psychiatrists say.

Most pedophiles are male and the illness usually begins in adolescence. Pedophiles tend to work in jobs involving children, such as teaching, pediatrics or the ministry.

“They’re sexually attracted to children so one of the things they try to do is be around children,” Kafka said.

He said there’s no hard evidence that the vow of celibacy makes Catholic priests more likely to be pedophiles.

But the church’s ban on sexual relations for priests may contribute to the problem by preventing them from having normal sexual ties to adults, Kafka said.

Others disagree that Catholic priests pose a higher risk than other clergy. “If you look around, in the context of the past 20 years, almost every major religious group has a much heightened awareness that this is a problem,” said Andrew Walsh, a historian and associate director of the Leonard E. Greenberg Center for the Study of Religion in Public Life at Trinity College in Hartford.

He cited the 1998 conviction of Greek Orthodox priest Emmanuel Koveos for molesting a 12-year-old girl at a church in Burlington, Vt.

Koveos, who was defrocked by his church, was a pastor at St. Catherine’s Greek Orthodox Church in Quincy in 1991 and 1992.

Gary Schoener, executive director of the Walk-In Counseling Center in Minneapolis and a consultant on sexual misconduct by clergy, said he has worked with “all the major Christian denominations” as well as Jewish congregations and Hindu centers.

Therapists and other experts agree that pedophiles can never be cured but they differ sharply on how well patients can learn to control their behavior.

Kafka and other mainline psychiatrists say treatment can bring significant improvement.

“I would agree that it’s an extremely difficult condition to treat. That does not mean it is not treatable,” said Dr. David Fassler, a child and adolescent psychiatrist in Burlington, Vt., and professor at the University of Vermont.

But Schoener, the Minneapolis psychologist, said pedophiles can never control their behavior enough to be safe with children.

“There is no doubt that some persons who are pedophiles can show fairly dramatic improvement some of the time,” he said. “I would still say there is no way they should go back as a priest.

Treatment can include “aversive therapy” such as electric shocks to discourage sexual fantasies involving children, Fassler said.

Psychiatrists may also try to promote interest in normal sex by encouraging patients to have sexual fantasies involving adults, Kafka said.

In addition, most treatment programs include therapy designed to convince pedophiles how severely they have hurt victims and their families.

Some pedophiles respond to anti-depressants and another class of drugs that suppress the male hormone testosterone, psychiatrists said.

It is not clear whether Geoghan and James Porter, another priest convicted of molesting children, took drugs during or after their stays at several treatment centers chosen by the Catholic church.

In Geoghan’s case, therapists several times approved his return to parish work, where he allegedly abused more children.

Sue Reinert may be reached at sreinert@ledger.com.