Mental health articles

Case for paedophilia Mr J was a 30-year-old man, admitted to hospital as a result of a period of severe depression. Prior to his depression he had been a teacher in a school in the north of England. Although there was no evidence that he had engaged in paedophile acts with any children, his name was found on a distribution list for child pornography kept by a paedophile ring. His house was raided and paedophile materials were found in it. He was therefore charged by the police, and found guilty of using child pornography. The school at which he worked was notifi ed of this outcome and he was immediately dismissed from his job. He was married at the time that this occurred, but was immediately asked to leave the marital home and his wife began divorce proceedings. He moved to London, where he could be ‘lost among the crowd’ and had some family contacts. There he became profoundly depressed, and was admitted to hospital where he entered into therapy for his depression. Long-term antecedents Mr J was homosexual, and had experienced a sexual preference for males since he became sexually aware. During his adolescence he had no sexual relationships with either boys or girls. However, while masturbating, his imagery focused on young adolescent boys. As he grew older and left home to go to university, he found both his homosexuality and sexual interest in young boys shaming and inappropriate. He therefore did not seek sex with young men, but did have a number of age-appropriate homosexual relationships prior to his marriage, but these had generally ended disastrously. As a consequence, in an attempt to conform to both his and his parents’ perceived norms, he began to date women towards the end of his university studies and was able to establish a long-term relationship with a woman with a low sex drive. He later married this woman. They lived together from the time he was at university to the time he was identifi ed as a paedophile. His marriage had been functional and pleasant, but not sexually satisfying. During this time, he had regularly used child pornography (with a particular interest in young adolescent boys) unknown to his wife. He taught physical education (and mathematics) at school so clearly had the possibility of seeing young boys with little or no clothing. He denied ever having abused this possibility, and no complaints had been made against him at school. Of course, the truth of his claims is diffi cult to determine, as however motivated he was to change, there is little benefi t to admitting behaviours that could be both embarrassing and put him at risk of legal action. Formulation Mr J did not fi t the ‘classic’ profi le of a paedophile. He was able to develop age-appropriate social (and to a more limited extent sexual) relationships both with men and women. He was not ‘driven’ to paedophilia as a consequence of an inability to engage with ageappropriate individuals. In addition, he did not condone his behaviour, and considered his sexual interest to be inappropriate and felt ashamed by it. He thought that while he claimed to have had no physical contact with young boys, even using photographs in this way was exploitative and morally unacceptable. His depression was a consequence of the loss of his job and his marriage, the probability that he would never fi nd work again, and the shame he felt as his behaviour had been made public. His interest in young boys was maintained by masturbation to their images. Intervention Mr J was motivated to engage in therapy because he found his sexual interests inappropriate and shaming. He began a programme of masturbatory reorientation. In this, he began to masturbate to images of young children to achieve sexual excitement, before shifting the focus of his images to those of more mature boys or young-looking men. He found the image of one young-looking male Hollywood star (who will remain nameless!) particularly exciting. This programme worked very well, and over time he found that he could become sexually excited by the images of age-appropriate men. Despite these gains and the claims he made about only using child pornography to provoke sexual excitement, his behaviour followed the pattern suggested by Pithers (1990) on at least one occasion. At this time he was feeling depressed, and decided to go for a walk, which drew him ‘accidentally’ to a shopping area frequented by local schoolchildren, and ‘he happened to pass by a [public] toilet’ when a young boy walked into it. At this point, he was excited by the thought of seeing the young child expose himself, and followed him into the toilet. There, he watched him use the urinal. The child was unaware of his presence, and there was no social or physical contact with him. Nevertheless, this reinforced the need to set up a relapse prevention programme, in which he drew up a list of alternative behaviours to do when he felt depressed or the need for sexual excitement. The alternative behaviours he engaged in were fairly limited, and included calling his family on the telephone or visiting them, and focusing on chores or tasks about the house. The one thing that he determined not to do was to leave the house at such times as this inevitably would lead to his ‘accidentally’ walking into high-risk areas. In addition, when leaving the house at all times he walked routes that did not pass schools or other places where young people might congregate, to reduce the likelihood of temptation. Despite this setback, both interventions appeared to progress well after this point, and Mr J was able to avoid putting himself at risk of offending for several months. He was eventually discharged, although with regular follow-up appointments in an attempt to monitor and prevent future problems.

Tags: paedophilia