Insights into sexual abuse have evolved

As we see Catholic clergy swept up in scandal, let us consider how our understanding of sexual abuse has changed over time, suggests Pittsburgh psychiatrist JOHN P. NELSON

In ancient times, the messenger who brought bad news from the battlefield often was killed by the king or his men. It was an early example of guilt by association.

Nowadays, we often fall into the same fallacy by rushing to judgment based on news headlines, especially when they include adjectives such as blockbuster, bombshell, shocking or outrageous to describe reports about the infamous, disgraced, accused or indicted.

I am not surprised that such adjectives are being applied to the recent Pennsylvania grand jury report on the history of child and teen sexual abuse by Catholic clergy overthe past 60 or 70 years. It spelled out all the sordid details in anatomicaland physiological detail.

But I do see some killing of the messenger in the blame cast on those clergy and bishops who were most active in trying to weed out the abusers and encourage victims to come forward. This is not to say they made no mistakes, especially as we look back with the perfect vision we have when our backsides are turned to the future. It is only to say that their actions should be considered in the context of our society’s evolving understanding of sexualabuse.

Allowme to explain.

When little was known

I have been a practicing psychiatrist since finishing my training in 1975. I attended Harvard Medical School, trained in psychiatry at Harvard after medical school, worked and taught residents there for seven more years and then worked and taught at the University of Pittsburgh for another 12 years before going into private practice.

In my training years and well beyond, I never heard a lecture on child abuse and I evaluated only one child abuser. He had been abusing his 8-year-old daughter, according to court documents, and was at our clinic only because he’d been ordered to go there. I saw him for only afew sessions; then he quit coming.

There was nothing more to be done. The court seemed to have lost interest; there was no equivalent to Child and Youth Services that had authority to investigate or mandate treatment; there was no continuing police involvement, and neither I nor my supervisors had any experience in this area or had any power to follow up on the case.

Also, none of us understood the depth of trauma that sexual abuse could cause.

Sigmund Freud was partially to blame. When he was starting out as a psychiatrist, he thought many of his patients had suffered sexual abuse as children — a belief that brought down much scorn upon him. Later, he concluded that reports of abuse were fantasies, the product of the strong emotional conflicts that all children experience. As a result, this view was taught by most of the psychoanalysts who dominated the field into the 1970s.

I have had adult patients who suffered sexual abuse as children, usually by adults who had ready access to them, such as teachers, neighbors, clergy, apartment janitors and even their own parents or siblings.

Sometimes they had found the courage to tell someone. Often they ended up physically and emotionally abused by the very person they confided in. Sometimes a mother knew that her husband was abusing their daughters, but, fearing his temper, or fearing abandonmentand financial ruin, or having been traumatized by abuse during her own childhood, she would come to deny her child’s abuse to herself, then react irrationally if her child tried to reveal it.

Usually, abused children, especially younger ones, would end up denying the abuse themselves, believing that “I am the bad one,” as abusers often would tell them, or fearing that threats of violence against themselves or their parents would tear apart their world. No wonder an abused child might feel deep pangs of guilt in later years when reminded of theseexperiences.

Only rarely until recent decades would abusers be criminally prosecuted. Who would make the complaint, risking so much to do so? A child feared not being believed. Neighbors or friends or relatives feared the consequences of family breakup, of violence by the accused, of social punishment and scorn for daring to accuse another of such a crime. And often, how could they be sure? Could they bring forward evidence? Who was to investigate? The police were just as ignorant as the psychiatrists and psychologists; they didn’t know how to investigate and didn’t want to. Thieves and killers they could understand: The evidence often was clear; it was good guys versus bad guys; it all made sense. In cases of sexual abuse, no policies or procedures were inplace to guide them.

When things began to change

So how did we get to wherewe are now?

I’ve seen a gradual process that has led clinicians and others to realize that abuse — sexual, emotional and physical — is much more common than previously thought. It was almost as if everyone began to see the world as the youngFreud had seen it.

I am not a historian of these changes, but over the past 30 or 40 years, both the reality and frequency of abuse has been increasingly recognized. The severe psychological consequences of abuse have became clearer. Publication of egregious examples of abuse has led victims to recall their experiences and has encouraged them to tell someone, and even to tell the world. Their stories have helped everyone understand that guilt, fear and self-blame for abuse are common distortions in the minds and feelings of victims — and they have encouraged yet more victims to talk of their experiences.

These insights seemed to arrive in waves. As one scandal erupted, another followed, triggered by increased awareness among victims and a better understanding of abuse by clinicians and civic leaders and the police. Laws came to protect those who reported abuse and even mandated reporting, first by emergency room staff who saw evidence of it, then more and more by teachers and others in responsible roles who have regular contact withchildren.

When reports of abuse exploded

The revelations in the 1980s of Catholic clergy abuse of children was an especially powerful story because church teachings about the importance of sexual purity stood in such stark contrast to what was beingreported.

The church had its own legal system for such matters, dating back to its earliest days and modeled on Roman law. The church had its own courts and investigative procedures. Codes of silence guarded the reputations of the falsely accused, but also, as we know now, came to shield the guilty from exposure. Avoiding scandal — which could lead the faithful into sin or discredit the church’s moral lessons — was seen as a duty of bishops and other leaders, part of their being good shepherdsto the flock.

Over the centuries, the church legal system ceded most of its powers to civil authorities, with the relationshipbetween the two often confused. When did the church turn to civil law and when not, especially regardingpersonnel issues?

As reports of sexual abuse began to proliferate three decades ago, church leaders feared scandal and were ignorant of the effects of abuse on victims — as were most medical practitioners — believing that victims would “get over it.” There were no policies or procedures to cooperate with the police or courts, which also were probably reluctant to get involved.

I was asked in the late 1980s to join a committee of the Diocese of Pittsburgh to study sexual abuse in the church and help formulate policies and procedures to address the issue. The committee comprised two other psychiatrists (also lay Catholics), a psychologist and some leading church officials — including Father David Zubik at times, who wasnot then a bishop.

In previous decades, it had been widely believed that specialized psychotherapy could adequately evaluate alleged abusers and predict how dangerous they would be if allowed back in ministry. The depth of personality disorders in child sexual abusers was not fully understood, and so neither were the risks. Gradually it became clearer that those who abused prepubescent children (pedophiles) were especially resistant to personal insight or behavioral change, were effectively incurable and were likely to continue to be serial abusers if allowed regular contact with children.

Over time, the legal system increasingly removed serial pedophiles from society as they were given long prison sentences. Other abusers targeted pubescent children, whose sexual feelings and interests were growing but whose personalities were immature and easilymanipulated.

Abusers of both types often picked on those who had unstable family or personal lives, who were looking for adult mentoring or affection and who were not aware of the power that adults had over them — especially when their relationships were endorsed by society, such as those with clergy, teachers, scout leadersor coaches.

Catholic priests were especially socially endorsed: They represented Christ on Earth and were assumed to be holier than the average person. They had dedicated their lives and given up marriage and sex as a personal sacrifice to God and for the good of the church. They enjoyed the trust of parents and were given special access to children. The Pennsylvania grand jury report describes in excruciatingdetail how deeply abusive priests have betrayed their church, their vows andtheir fellow Catholics.

When we look ahead

My caution now is that, in the wake of the grand jury report, we not rush to judge those who tried to deal with the painfully difficult issues of sexual abuse at a time when those issues were not well understood, greatly feared and widely avoided throughout society. Let’s not kill the messenger.

When the abuse cases of the early 1980s became public, some bishops and other clergy tried desperately to do the right thing, as they did in Pittsburgh, but they also were conditioned by the ignorance that prevailed among medical professionals and the confused relationship between church and civil authorities. So it was not surprising that the first attempts to address the situation were neither coherent nor consistent. It was in this context that the Pittsburgh Diocese formed the advisory committee on which I served.

Concrete actions did follow from this self-examination. Increased cooperation with the police and the judicial system has led to the prosecution of many abusers. Educational programs for seminarians, clergy and laity have been instituted and mandated for every person who has contact with children. The Virtus program, for instance, instructs everyone on proper behavior with young people and how to observe and act upon evidence that suggests another adult might bea predator.

Psychotherapy and other treatments for victims of sexual abuse are a more difficult problem. Each case is different and, as with post-traumatic stress disorders resulting from military combat, rape and other traumatic experiences, too little is known to guide treatment. Much research is underway, but our knowledge of how to overcome trauma remains thin. Treatment is prolonged and expensive.

There is no easy cure for victims of sexual abuse. But there is compassion. And, most important of all, prevention.