Considering Sex Offenders

 

 

Considering Sex Offenders: A Model of Addiction

 
By Judith Herman, MD

 

Published in Journal of Women in Culture and Society 1988, vol. 13, no. 4

 

P. 704

 

    Failing to find any readily apparent mental disorder that characterizes sex offenders, psychological investigators have increasingly focused on aspects of their developmental histories that might offer clues to understanding their behavior. The hypothesis most frequently entertained is that sex offenders were themselves sexually victimized in childhood or adolescence. The sexual offense is thus a reenactment of the trauma or an attempt to overcome it through the mechanism of “identification with the aggressor.” Proponents of this theory often invoke the concept of a “cycle of abuse,” or of “generational transmission,” whereby the sexually victimized children of one generation become the victimizers of the next.
    The “cycle of abuse” concept is extremely popular. It is commonly invoked to explain most crimes of violence occurring in the private sphere, such as wife-beating and child abuse. It is generally accepted for several reasons: first, most experienced clinicians have seen cases that do indeed illustrate a multigenerational pattern of violence and abuse. These are among the most difficult, complex, and memorable cases that clinicians encounter. Second, the concept is intellectually satisfying: it is congruent with well-documented clinical observations of reenactment of trauma and heightened aggression in abused children. These short-term observations are simply projected unmodified into the future and the transformation of victim to offender is readily imaginable. Third, the concept is emotionally satisfying: it permits clinicians to empathize with offenders and also offers the comforting assurance that their behavior is an understandable result of a pathological history. Finally, such a concept is politically advantageous for the mental health professions. Expenditures for treatment of offenders are more easily justified to a punitive and economy-minded public if the mental health professions can claim that treatment will interrupt the cycle of abuse and prevent the development of the next generation of offenders.

 

P. 706

 

    Histories of abuse do appear to be particularly common in pedophiles who prefer boy victims. The members of this group have a number of characteristics that distinguish them from other sex offenders. Their deviant behavior often has an early onset, they may lack any significant interest in consenting sexual relations with adults (this is the group that Groth describes as “fixated” offenders in Men Who Rape 1979), their behavior is often extremely compulsive and resistant to treatment, and they tend to have many victims. In one series a group of 146 homosexual pedophiles at large in the community had committed an average of 279 assaults each. Impressionistic reports from several treatment programs indicate that while psychiatric diagnoses of any kind are uncommon in this group, sexual abuse histories are particularly common, ranging from 40 to 60 percent. In one outpatient treatment program, the staff estimated that 55 percent of the child molesters had been victimized, most commonly by male babysitters. They further observed that young men who raped women did not appear to have unusually frequent abuse histories, but that young men who raped men were almost uniformly victims of sexual abuse. Taken together, these data suggest the possibility that childhood sexual trauma in boys may be a particularly significant risk factor for the development of sexually abusive behavior directed at males. The cycle of abuse theory may turn out to have some prediction power for this population.
     At best, however, if the cycle of abuse theory is fully borne out by future research, it can only demonstrate that boyhood sexual victimization is one among many factors that increase the risk for the later development of sexually abusive behavior. It is highly unlikely that the concept will prove applicable to the majority of sex offenders. At this point, based on the best available research data, we have to assume that most sexually abused boys do not become sex offenders, and that most offenders themselves were not abused as boys.

 

A model of addiction  pp. 710-16

 

An incestuous father writes: “Once I started it continued, there was no stopping point for me. I told myself it would pass, but it did not, and as my daughters grew and became women I would fondle and touch them. I became addicted to their favors, and with addiction they lost a father. It was just terrible.” Clinicians who work closely with sex offenders often describe them as addicts. As one author put it: “We suggest that you consider sexual deviants as special types of junkies. Self-control will in every case be a full-time job, every waking hour for the rest of their lives.”
    Though the analogy of addiction is commonly invoked by offenders and clinicians alike, the implications of an addiction model are rarely elaborated, either in the feminist social analysis of sexual violence or in the psychological literature on offenders. Yet the concept of addiction offers a point of intersection for the observations developed by psychologists and those of social theorists. A model of addiction also offers clear guidelines for the development of offender treatment programs, for preventive educational work, and for legal and regulatory strategies.
    It is known that sociocultural factors play a major role in creating a climate of risk for addiction. Alcoholism, for example, flourishes in cultures that do not allow children to learn safe drinking practices (i.e., moderate alcohol consumption integrated with social and family life), and that glorify or excuse adult drunkenness. By analogy, compulsive, exploitative sexual behavior may be fostered in cultures that do not permit children to learn safely about sex, and that glorify or excuse sexual violence. American culture, in which sex education for children is generally lacking and in which sexual violence is often admired, would qualify as a high-risk culture. Some subcultures might be particularly likely to produce sex offenders if childhood sexual curiosity is severely punished or if high levels of interpersonal violence are tolerated. This would explain the frequent presence of extreme religious fundamentalism and rigidly punitive sexual attitudes in the backgrounds of sex offenders. Similarly, this would explain the findings that associate membership in a violent peer group with commission of sexual assaults in adolescence.
    The virtual male monopoly on sexually assaultive behavior is also congruent with a model of addiction. In most, if not all, compulsive antisocial behaviors (alcoholism, drug dependency, gambling), men consistently outnumber women by a ratio of at least three to one. The greater social latitude and tolerance accorded to antisocial behavior in males undoubtedly fosters addictions. Another contributing factor may be the impoverishment in male development of the emotional resources of intimacy and interdependence. Lacking these resources, men may be more susceptible to developing dependence on sources of gratification that do not require a mutual relationship with a human being: the bottle, the needle, or the powerless, dehumanized sexual object.
    The concept of addiction is also useful in identifying a spectrum of behaviors within a population at risk. In our culture, for example, although social exposure to alcohol is almost universal, the range of drinking behavior is very broad, encompassing abstainers, social drinkers, and alcohol abusers. The line of demarcation between heavy social drinking and alcohol abuse is unclear, and drinking patterns vary even among problem drinkers. Alcohol abuse may be situational, appearing only transiently in response to particular cultural demands (adolescent initiation rituals, for example); it may be episodic, as in the case of “binge” drinkers; or it may become compulsive and relentlessly progressive at any time in the life cycle, from adolescence onward.
    A similar spectrum of behaviors exists in the general population with regard to sexual assault. As Koss, Gidycz, and Wisniewski demonstrated in their college student survey, a small group of young men abstained from sexual relations, the majority engaged in socialized, consensual relations, and a considerable minority engaged in coercive or frankly violent sexual activities. The line of demarcation between socially acceptable and abusive sexual behavior was unclear in the minds of her informants: for example, a considerable number of the young men who had achieved sexual relations by force or threat of force did not label their behavior as rape, nor did many of their victims.
    Not all offenders develop an addictive pattern of sexually coercive behavior (nor, conversely, is all addictive sexual behavior criminal or coercive). An addiction model of sexual assault would predict a range of behaviors from the opportunistic to the highly compulsive. Some offenders might commit assaults only in response to peer pressure in a male-bonding situation where the social rules permit or encourage such behavior (i.e., a fraternity party or military adventure); others might develop a “binge” pattern of episodic assaults; and a third group might develop a repetitive or escalating pattern of sexual violence relatively uninfluenced by the social setting. This range of behaviors is evident in the clinical literature.
    Both alcohol abusers and sex offenders rarely run afoul of the law. The harmful effects of a compulsive drinking pattern are generally felt first by the drinker’s family, detected somewhat later at his workplace, and even later by his physician. An arrest for an alcohol-related offense (most commonly driving while intoxicated) seldom occurs until the alcoholism is fairly advanced and the alcoholic has been driving drunk for a considerable period of time. Similarly, most sex offenders who do get arrested have already developed a well-established compulsive pattern. Because they are rarely detected until they have reached an advanced stage of addiction, we know very little about the early and middle stages in the development of the pattern of sexual assault. Retrospective reconstructions by apprehended offenders commonly reveal histories of sexual offenses beginning in adolescence, or even before puberty. The existing clinical data suggest that early onset of abusive behavior indicates a syndrome that is extremely tenacious and resistant to change, while later onset may be associated with a more episodic course. Unfortunately, assaults committed by juveniles are often cavalierly dismissed either as adolescent experimentation (in the case of child molestation, date rape, or gang rape), or insignificant nuisance activities (in the case of peeping, exhibitionism, obscene phone-calling, or fetishism). Early signs of an addictive (that is, repetitive and progressive) process are generally denied or overlooked under the assumption that these behaviors will be outgrown.
    Because so little attention has been paid to the early stages of compulsive sexual behavior, at present we have no reliable criteria for distinguishing between men who commit situational sex crimes, which are truly unlikely to be repeated, and men who are likely to develop a repetitive pattern of sexual assault. Current clinical attempts to codify recidivism risk in young offenders focus mainly on assessing the degree to which clear symptoms of compulsive behavior are already apparent.
    Sex offenders subjectively describe a cyclical pattern of altered mood and behavior that appears relatively impervious to conscious control. Environmental or internal stimuli may trigger sexual fantasies that develop into a compelling craving to carry out the fantasied act. A trance-like excitement builds, heightened by risk and danger as the offender stalks and secures access to his victim. An intense “high” during anticipation and completion of the act may be followed by fear, disgust, depression, and remorse, coupled with a short-lived resolve never to repeat the act. This dysphoria is relieved by increasing preoccupation with sexual fantasies, and the cycle is repeated. The behavior develops a repetitive, compulsive quality which is only transiently interrupted by internal inhibitions. Some offenders describe a progressive pattern in which increasingly risky or violent assaults are required to produce the desired “high.” In the words of one child molester, “It’s like drugs. After you lose the effect of one drug, you go on to a different one. If I hadn’t been in this program . . . I’m pretty sure I would have gone up to rape.”
    The offender clearly does retain some capacity for self-control, but he uses it only when he perceives that external controls are present, in order to avoid detection or other adverse consequences to himself. It is this partial loss of internal control that makes the offender so confusing and difficult to understand. Is he in control of his behavior or is he not? Is his a moral or a medical problem? Does he lack will power or is he suffering from a “disease”? Such questions have been debated about alcoholics and other addicts in every historical epoch, without clear resolution or the development of a public consensus.
    Behavioral as well as subjective descriptions of sex offenders suggest that they share many of the characteristics of alcoholics or other addicts. The offender behaves as though his primary attachment is to the mood-altering addictive activity. All other relationships are sacrificed or manipulated in the service of this activity. An elaborate defensive structure develops, the purpose of which is the protection and preservation of the addiction. Denial is the primary defensive most employed, but in addiction, an extensive body of paranoid defenses and rationalizations may be developed. If the addict acknowledges his behavior at all, he generally blames other people for it. An unhappy childhood, stormy marriage, or frustrating job provides the justification and the excuse for the addiction. The rapist’s cry and the alcoholic’s are one and the same: “She drove me to it!”
    In the case of alcoholism, these rationalizations no longer have credibility in the professional literature. Early childhood trauma, marital conflict, depression, and situational stress were once thought to be causative factors in the genesis of alcoholism. With the advent of more sophisticated research, however, such notions have been discredited. The inadequacies and personality defects commonly observed in alcoholics are now understood to be a result of addiction rather than their cause. Whatever the alcoholic’s history or preexisting personality structure may have been, once he becomes addicted he develops a personality disorder and generally recalls his childhood as miserable. Furthermore, alcohol abuse is likely to lead to depression, marital dissatisfaction, and situational stresses. As in the case of now discredited theories of the etiology of alcoholism, psychodynamic formulations of the psychology of sex offenders are unlikely to be borne out by well-designed research in the general population of offenders. The concept of sexual assault as a potentially addictive behavior has major implications for treatment and social rehabilitation of offenders. The first implication is that at present, the commission of one sexual assault cannot be dismissed as “adolescent curiosity” or any other benign, self-correcting problem. In the absence of well-documented criteria for distinguishing situation offenders from early addicts, it would seem prudent to consider all offenders potential addicts.
    The second implication is that when dealing with a sex offender, one cannot assume that he has any reliable internal motivation for change. The offender may have lost effective control of his behavior, though he has not lost moral or legal responsibility for it. External motivation for change must therefore be provided. Legal sanctions and careful, sustained supervision (e.g., intensive probation or parole, and in some cases incarceration) are the appropriate source of external motivation. Professionals who attempt treatment must ally and cooperate with law-enforcement authorities and obtain a waiver of confidentiality from the patient. Though such measures may seem punitive or anti-therapeutic, they are both therapeutic and necessary when a patient represents a clear danger to himself or others. Sex offenders are dangerous. They cannot be treated or rehabilitated unless their behavior is effectively controlled.
    The third implication is that the primary focus of any therapeutic effort must be on changing the addictive behavior itself. For alcoholics, this means that the central focus of treatment is on drinking. For sex offenders, this means that treatment must focus in concrete detail on the unacceptable sexual behavior. The offender’s patterns of sexual fantasy and arousal, his modus operandi for securing access to his victims and evading detection, his preferred sexual activities, and his system of excuses and rationalizations must be painstakingly documented, and changes must be closely monitored. The offending sexual behaviors cannot be wished away by describing them as attempts to meet nonsexual “needs” for mastery or nurturance. Some experienced therapists require that a statement from the victim describing the offender’s crime and its impact on her life be made available in the record before any form of treatment is attempted. Frequent review of this document is necessary to counteract the tendencies toward denial and minimization of the offense which both patient and therapist may share.