Can pedophiles' urges be tamed?

Gulf of opinion between MDs, public baying for blood

By Gillian Woodford

Pedophiles, particularly the unrehabilitated variety, have been on people's minds a lot lately. The bizarre murder confession of John Karr brought the unsolved JonBenet Ramsey case back in the public eye. Here in Canada, the recent high-profile kidnapping of two Prairie boys by convicted pedophile Peter Whitmore has everyone asking: can anything be done to treat these people and stop them hurting other kids?

"It's a myth we can't treat them," says Dr Lea Studer, a psychiatrist and director of the Phoenix Program, an inhospital treatment program for sex offenders at the Alberta Hospital in Edmonton. "It's absolutely not true."

Michael Seto, PhD, a clinical psychologist at the Centre for Addiction and Mental Health in Toronto, agrees. But he cautions that pedophiles can't be cured. "We're moving toward the idea that this is a stable sexual preference," he says. "It's not something that goes away — this is true of them for the rest of their lives."

So how should pedophiles be treated? Voluntarily, says Dr Studer, who doesn't believe forced programs work. "They have to say 'Yes, I have a problem'." Once they admit that, there are several treatment options, adds Dr Seto. "Cognitive behavioural therapy [CBT] teaches people skills to control their urges," he says. "There are also sex-drive reducing meds. Some psychiatrists prescribe SSRIs because there's often a link between sexual behaviour and mood. And they have the added side effect of reducing sex drive."

NO HELP FOR CONS
For child sex offenders in the prison system, CBT is the current standard — if treatment is available at all. Dr Studer recently published a study challenging this approach, which she says ignores the biggest social hurdle pedophiles face: dealing with other people. "Look at their relationships," she says. "It's universal — pedophiles have bad relationships with adults." She says there are a variety of reasons for this, often including early childhood trauma, and she's pretty sure it's at least part of the reason these men (there are very few women pedophiles) are attracted to children. But even if she can understand it, Dr Studer doesn't whitewash things. These people are repulsive. "You think, 'I don't want anything to do with this person' — they're awkward, they're belligerent, etc. So we do role modelling with them," she explains, "to show them what an appropriate adult relationship is.

"We work on this ad nauseum. And that's where CBT falls short — they don't look at this."

Peter Whitmore Photo credit: RCMP

Peter Whitmore's lawyer, Daniel Brodsky, says his client — who's been in and out of the prison system for years, mostly for parole violations — is a victim of insufficient treatment options. Mr Whitmore has been treated "in spits and spurts" and should go to a psychiatric hospital, Mr Brodsky says. But he thinks he'll need to be pushed. "He has no insight at all as to whether he can do it on his own — that's one of the symptoms," he says. "Hospitals are resourced differently than prisons — they do a better job."

Dr Studer and her colleagues at the Phoenix Program — a three-stage inpatient and community group therapy program — have been compiling data over the last several years on the people they treat, and those they don't. Recidivism is just 3.3% for program completers. The number is around 10% for those who don't see the program through, and 20-25% for people who don't get any treatment at all. By comparison, a 2005 analysis of the California Sex Offender Treatment and Evaluation Project (SOTEP), which used a CBT approach, reported no significant difference between treated and untreated offenders. Because CBT is so much commoner, argues Dr Studer, the latter outcomes are commoner, too, forcing many of the few available programs in Canada and the US to close their doors.

WHO TO TREAT?
With limited resources in the prison system and pressure to lock repeat offenders up and throw away the key, how do we know who to treat? One of the major debates raging in the field of pedophiliac research is whether all child molestors are pedophiles. In the public's view, they're one and the same, but most experts believe that a person can sexually abuse a child and not be a pedophile. However, some are now questioning whether the distinctions are actually meaningful. For instance, one commonly held belief is that incest offenders are a danger to their family, but not to general society, and thus probably don't need treatment. This assumption is strongly challenged by a 2000 study by Dr Studer and her team, which found "a history of nonincestuous offenses in more than half of a group of adult incestuous offenders."

Dr Studer has taken this idea a step further. In an article in the August issue of Medical Hypotheses, she and her colleague A Scott Aylwin argue that diagnosis has become "irrelevant" and that "the category of pedophilia should be dropped from future issues of the DSM as it appears the lines between psychopathology and legal description have become blurred."

WHAT ABOUT PORN?
Police in Colorado have decided not to charge John Karr with JonBenet Ramsey's murder, but he's still under investigation in California for child porn possession. Are people who look at child porn pedophiles? Dr Seto thinks there's a good chance they might be. He published a study in the August Journal of Abnormal Psychology that concluded that child pornography offences are a good diagnostic indicator of pedophilia. Interestingly, the study found that those caught with child porn who hadn't abused children and those who did "did not significantly differ from each other, but they had significantly higher average pedophiliac indices" than the non-child porn offenders in the study.

Dr Seto thinks there's a good chance convictions for child porn possession will swell the number of patients diagnosed with the disorder. "There is a real increase in the number of people being identified. The police are putting money into this. It could increase the numbers of diagnosed pedophiles. We have to ask ourselves, how do we deal with that?"

With more and better treatment programs, says Dr Studer, instead of "feeding the idea that nothing works. It's cheaper for the government and looks good on paper," but does nothing to fix the problem.

As for Peter Whitmore, Daniel Brodsky is going to try to get his client declared not criminally responsible so he can get the psychiatric treatment he needs. But there's a good chance the Attorney General of Saskatchewan will recommend Dangerous Offender status, meaning he'll be thrown in a penitentiary with practically no chance of parole — or therapy.