1-4 Is a pedophile a pervert? Conceptualizing pedophilia through Lacan’s notion of perverse structure
Who-who-who was going to love me? Hmm? Since you got your degree, and you know every fucking thing—who was going to love me? Who-who-who was gonna make me feel good? …. So when you sit there, and you writing them fucking notes on your pad about who you think I am and why I did it and all of that—because I didn’t have a man. –Mary, Precious (Daniels, 2009)
Pedophilia is a mental disorder that is difficult for clinicians to treat because it elicits many countertransferential feelings of disgust, condemnation, and aversion. Additionally, because many pedophiles are often court-mandated into treatment—often under the threat of re-incarceration if they do not comply—there is a vested interest for the individual to not divulge any persistent sexual interest with prepubescent children (Gabbard, 2005). Additionally, as a psychiatric issue, most models of pedophilia focus on risk assessment, identifying those behaviors that trigger pedophilic thoughts, fantasies, and behaviors in an effort to decrease the possibility of recidivism (i.e., re-offending). While it is important to keep an eye on the behavior, this approach of sex-offender treatment ignores much of the developmental and dynamic implications as to what might cause someone to offend in the first place (Swales, 2012; Gabbard, 2005). Any approach that lacks insight into these personality factors and their possible etiology begins treatment with no direction of approach.
The opening quote of this paper is uttered by the character Mary, played by Mo’Nique, in the movie Precious (Daniels, 2009), during the film’s climactic scene, in which Mary’s daughter, Precious, and her daughter’s therapist confront Mary about the on-going physical and sexual abuse that Precious endured in the household. Mary stammers and stumbles onto what seems to be a moment of emotional lucidity—that her sexual misconduct with Precious was not motivated by an ongoing attraction to her daughter or other underage individuals but because of her own loneliness.1 Mary makes the mistake of conflating intimacy with sexual expression—in this case, with her daughter. I raise the question: Is this enough to qualify her for the diagnosis of pedophilia? In this paper, I intend to present an understanding of pedophilia that is not reduced to behavioral criteria but situated within a larger psychoanalytic understanding of personality. I present the diagnostic criteria of pedophilia within today’s cultural climate and identify how its inclusion in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V; American Psychiatric Association [APA], 2013) as a sexual dysfunction has been heavily criticized, particularly on psychiatric (and not forensic) grounds and how the Internet has presented more complications in understanding the diagnosis. I argue that the one possible way to understand pedophilia is by situating it within a larger, cohesive theory of perversion, and I use Lacan’s formulation of perversion as a structure through which to discriminate between perversely structured individuals and behaviors deemed as perverse through DSM-V diagnostic categories. This difference will help guide clinical practice in the treatment of sex offenders.
Diagnostic criteria for pedophilia and its criticisms
To qualify for a diagnosis of pedophilia, the DSM-V (APA, 2013) indicates that fantasies, behaviors, and/or urges of some sexual activity with a prepubescent child (i.e., under the age of 13) must be present. Additionally, these fantasies, thoughts, and/or behaviors must have persisted for at least six months, and the individual must have either acted upon these preoccupations or report some distress about them. The DSM also specifies that the individual with the diagnosis should be at least 16 years old, and the object of his/her preoccupations must be at least five years his/her junior.
Malón (2012) identifies the controversy over including the diagnosis of pedophilia in the DSM, as there is no agreement as to what aspects of sexuality constitute a mental disorder. The most embarrassing event highlighting the shaky foundation for pathologizing sexuality was the withdrawal of homosexuality as a psychiatric disorder from the DSM, second edition, in the 1970s, the diagnosis was arbitrarily removed because of social and political pressure. Since the deletion, the issue of whether any of the paraphilias—and pedophilia in particular—have any psychiatric validity within the DSM has been continuously brought into question. This event was also significant, as homosexuality was commonly linked with pedophilia in the cultural and diagnostic arenas.
There are several arguments against the current diagnostic criteria of pedophilia, the first of which is that it is possible to be a pedophile yet to not qualify for the diagnosis. Individuals that are sexually aroused by prepubescent children but have not acted upon their feelings and do not report distress cannot (diagnostically) be considered pedophilic; conversely, those individuals who do not express persistent pedophilic fantasies or thoughts yet have acted as such (for example, as in singular cases of child molestation) for any variety of reasons can be diagnosed with pedophilia. The latter instance—although controversial—is important to differentiate in treatment so that the clinician gains more insight into whether a patient’s pedophilia is a symptom or a systemic sexual attitude. For example, in the movie Precious, Mary seems to engage in pedophilic actions that are motivated by her own unstable attachment pattern for mitigating her loneliness and despair (Daniels, 2009), which would orient a clinician to different treatment modalities and planning that are different from the offender who describes it as a persistent sexual orientation.
Additionally, the publication of the DSM, fourth edition, in 2000 could not have predicted how pedophilia would be further thrown into question. With the advent of the Internet, child pornography can be easily distributed among sex offenders. With the current diagnostic criteria (APA, 2013), any individual who has accessed child pornography may be diagnosed as a pedophile. Seto, Cantor, and Blanchard (2006) conducted phallometric research, measuring the penile blood volume of both Internet child pornography viewers who were previously convicted for a contact offense and compared them to Internet child pornography viewers without a contact offense. They found that child-pornography offenders show greater sexual arousal to pedophilic images than prior contact offenders, and they use their findings to conclude that child pornography viewers meet the diagnostic criteria of pedophilia regardless of any prior contact convictions.
However, there are issues with the argument that Seto, Cantor, and Blanchard (2006) put forth. The primary issue is that the conditions of the laboratory setup were weighted against the child-pornography viewers; the subjects were instructed to look at pictures of nude models—which is the modus operandi of achieving gratification for heavy pornography viewers. Also, does an interest in a particular theme of pornography or passing sexual fantasies qualify one for a psychiatric diagnosis in clinical practice? For instance, one would be hard pressed to classify someone as homosexual who has never engaged in homosexual conduct yet had passing homosexual fantasies and occasionally watched same-sex pornography, yet a similar argument has been posed about child pornography offenders (Matór, 2012). This argument does not refute Seto’s, Cantor’s, and Blanchard’s argument, however, but highlights the complex nature of sexuality and the difficulty with pathologizing sexual attitudes and expression.
Additionally, research has shown that there is a significant difference between contact offenses and child pornography offenses. Individuals who are charged with possession and/or distribution of child pornography often have fewer prior sexual convictions. Research also shows that their psychological distress is more amenable to treatment and can be more successfully rehabilitated back into society with lower rates of recidivism. Conversely, contact offenses correlate with antisocial features—such as rule-breaking and diminished empathy—and this correlation increases with the number of victims (Webb, Craissati, & Keen, 2007). Child pornography offenders seem to be at the highest risk of recidivism primarily if they have had a prior criminal charge (including nonsexual charges) but especially if the prior charge was a contact sexual offense (Seto & Eke, 2005). It becomes clear that clinicians cannot simply lump child pornography offenders with contact offenders—all under the umbrella of pedophilia—when their clinical presentation, method of treatment, and prognosis differ significantly. Furthermore, the diagnosis becomes even more convoluted if one considers incestuous child molestation in which there may only be one victim, usually related to the individual. That individual may not show persistent and sustained sexual interest in prepubescent children at large yet still qualifies for the diagnosis (Ward, Polaschek, & Beech, 2006).
The criteria for this disorder seem to be over-inclusive, and Malón (2012) notes that the criteria become even more so with the pedophilic disorder for the fifth edition of the DSM, where the diagnosis will explicitly include all child pornography offenders (APA, 2013). It should be considered, however, that pornography is an extension of fantasy, and that pornography does not necessarily mean that the individual will act upon those fantasies. Furthermore, any clinician can attest to the difficulty in eradicating a client’s fantasies, yet this is the primary view of what treatment of pedophilia should entail as opposed to monitoring, interrupting, and dissipating the effects of the fantasy.
This is not to imply that those critics who argue against the inclusion of pedophilia in the DSM are condoning adult-prepubescent sexual relations. Malón (2012) highlights the necessity of treating pedophilia but raises the question of whether it is a psychiatric issue or a forensic one. Classifying pedophilia as a psychiatric disorder becomes more complicated when one considers that it (and other paraphilias) are listed in the DSM because they are primarily distressing, dangerous, criminal disorders affecting other individuals and not necessarily the perpetrator. This is unlike the majority of mental health disorders in which the primary criteria for inclusion are ego dystonia and/or maladaptive functioning. (Perhaps the only possible exception to these criteria are personality disorders, but, even still, there is long-term maladaptive functioning within the interpersonal and occupational arenas.) The psychiatric basis of pedophilia is also brought into question when one wonders why other criminal conduct—such as rape, incest, homicide, and so on—are not included in the DSM as mental disorders. The attempts and arguments to pathologize criminal behavior (particularly pedophilia) repeatedly lead to categorical problems. It is inadequate to understand pedophilia as a mental health disorder without any explanation of etiology.
Instead of thinking about pedophilia solely within DSM’s behavioral diagnostic model, it would be helpful to conceptualize pedophilic behaviors within the larger context of personality. Raymond et al. (1999) found that diagnoses of pedophilia largely correlates with personality disorders, noting that sixty percent of incarcerated pedophiles (and the authors do not specify if this includes child pornography offenders) meet the diagnostic criteria of a personality disorder; with twenty percent meeting the criteria for narcissism personality disorder and twenty-three percent meeting criteria for antisocial personality disorder. Additionally, over sixty percent of their pedophilic participants also met diagnostic criteria for an anxiety disorder and/or psychoactive substance abuse. The high rates of comorbidity should give clinicians pause in considering pedophilic behavior as a subset of a larger personality structure. If clinicians intend to treat pedophiles as a psychiatric issue rather than a forensic one, the definition should be expanded to include a more nuanced understanding of the personality types that correlate most likely with pedophilia. To better understand pedophilia, clinicians need a more developmental understanding of perversion.
Psychodynamic and psychoanalytic understandings of perversion
Stoller (as cited in Gabbard, 2005), a professor of psychiatry at UCLA and who characterized perversion an erotic form of hatred, argued against the change of the term perversion to paraphilia in the third edition of the DSM, stating that perversion properly connotes impressions of sin—specifically against God. Stoller’s religious jargon also connotes that a perverse individual feels shame and needs to make penance, which are also misleading traits by which to characterize perversion, as there are perverse individuals that do not feel any shame (and, consequently, no need to repent) for what they have done. Diagnosing or defining perversion as decontextualized behavioral acts ignores the cultural, historical, and political climate as does a definition that invokes moral grounds. Gabbard (2005) aptly notes that it is difficult to make any psychodynamic generalizations about perversion because of the wide variety of character dynamics that may be involved in any particular sexualized scenario.
The psychoanalytic tradition offers clinicians a more nuanced perspective for understanding perversion. Since Freud, many psychoanalytic and psychodynamic theorists have attempted to present a universal definition of perversion. Freud’s (1989/1905) original definition of perversion included those sexual acts that fall outside the aim of genital intercourse with an age-appropriate, opposite-sexed partner. Consequently, all nonstandard sexual practices include being aroused and achieving gratification with those body parts that are not intended for sexual use and/or reproduction, and this definition of perversion quickly becomes problematic when he considers that the simple act of a kiss qualifies as a perverse act. Furthermore, Gabbard (2005) notes that the sexual conventions inevitably changed over time. For instance, anal, oral, and homosexual intercourse are no longer pathologized and have been accepted into normal sexual practices. Thus, to accept Freud’s early notion that perversion includes any sexual acts performed for purposes other than reproduction is to claim that the vast majority sexual acts are perverse at their core (Fink, 1997). This observation alerts clinicians to the fact that perverse behaviors are continuously shifting in their meaning and that we must move beyond mere behavioral indicators when describing perversion.
There are ways to conceptualize perversion that accounts for the cultural, historical, and political horizons of the individual’s actions. Freud (1989/1905), himself, noted that the difference between perversion and neurosis was the primary defense mechanism mobilized by the individual; for neurotics, it is repression, while perverts engage in denial. Whereas the neurotic individual represses and desexualizes his/her perverse Oedipal fantasy, the perverse individual still retains some remnant of those fantasies in consciousness. In neurosis, those perverse fantasies emerge through symptoms that function to keep the material unconscious; conversely, for the perverse person, “the fantasies become conscious and are directly expressed as ego-syntonic, pleasurable activities” (Gabbard, 2005, p. 315), and those overt fantasies become displaced onto the external world—thus making the world appear sexually charged. Lacan’s notion of perversion as a structural organization of personality is extremely useful for clinicians.
Fink (1997) notes that those individuals who use denial as their primary defense eventually develop symptoms to—as Gabbard (2005) states—ward off castration anxiety. A perverse personality structure arises when the individual has experienced enough alienation to perceive him/herself as different and foreign to the mother, yet the paternal function was not strong enough to completely separate the individual from being the object of his/her mother. When Lacan refers to the paternal function, he is talking about the disciplinary actions that the father uses to separate the fusion of the child and mother in the Oedipal triangle. For perverse individuals, the child is differentiated enough from the mother (and, consequently, not psychotic) but the separation process was never completed and subsequently repressed (as it would be for the neurotic individual). Thus, the perverse individual stands in limbo between psychosis and neurosis.
Lacan understands the paternal function not as the literal actions of the father but as a structural placeholder (Fink, 1997). As said, the paternal function may not even be a father, but it can be anything outside the mother-child dyad that tells the child, “No, you are not a part of your mother, and you cannot have her,” to sever the dyad in through an action akin to castration. This statement could be issued by the father, but it could also be conveyed through siblings, extended family, school, work, and so on. This function in Lacanian psychoanalysis is understood as the Law, or the workings of the superego (and the cultural, historical, and political meanings conveyed to the child through it). In perversion, the child receives the threat of castration, but the threat is ineffective and allows the child to expose the meaninglessness of the Law while still remaining an object for the mother. Consequently, the child acknowledges that the Law exists but denies that it applies to him/her. This is an important difference between the perverse individual and the neurotic one: for the neurotic, sexuality is repressed, while for the pervert, the sexuality is ever present although its restrictions are disavowed.
At the level of personality organization, a perversely structured adult knows the rules and norms of society but continues to deny that they exist or that they apply to him/her. Because perversion is a structure of personality that first forms during time of the Oedipal drama, the conscious and compulsive attention of the perverse individual remains in the genital regions, for genital pleasure was never repressed during childhood (Fink, 1997). A perverse individual continuously attempts to flaunt his/her transgressions of the Law, exposing its inefficacy and impotency—positioning castration to be an empty threat and nothing more. Unconsciously, however, there is a drive towards the Law, to engage in those forbidden behaviors to prop up the paternal function—perhaps because there is an unconscious wish for the Law to enact the threat and follow through with castration, thereby finally separating the individual from the dyadic structure of personality. This, however, is an impossible proposition, as one cannot turn back the clock on missed developmental milestones, but it nevertheless appears within the individual’s repetition compulsion. As Gabbard (2005) notes, “[a] perverse act becomes a fixated and ritualized procedure that is the only route to genital orgasm” (p. 315). I would like to expand on Gabbard to identify that the perverse act is not necessarily what qualifies one as perversely structured—a perverse act could also be motivated by neurotic defenses. But the ongoing fixation, ritual, and sexual gratification of the perversely structured individual seeking castration are important factors that differentiates neurosis from perversion. While perverse behaviors may dissipate with neurotically organized offenders in psychoanalytic treatment, Lacan’s notion of perversion is useful in explaining why unlawful sexual conduct continues to be the primary means of achieving sexual gratification for repeat offenders despite the clinician’s best efforts to treat them.
Clinicians should keep in mind that a psychoanalytic understanding of perversity is not inherently stigmatizing, but perverse behaviors can be particularly dangerous when compounded with a perverse personality structure. Again, transgression characterizes most repressed sexual fantasies, and it is also possible for a person with a neurotic organization of personality to engage in perverse and/or pedophilic behaviors and consequently be plagued with guilt and/or shame. For neurotic pedophiles, the prognosis and receptivity to treatment is better than those with a perverse personality structure, who consciously act in defiance of the Law. The perverse individual’s relationship to the Law provides some conceptual foundation for understanding the subset of individuals diagnosed with pedophilia who go on to reoffend. Perverse pedophiles often fit the cultural stereotype of the pedophile who acts impulsively and compulsively on their fantasies—in short, being a predator with little thought of guilt or consequence.
While a concept of a perverse personality structure can elucidate an individual’s relationship to the Law, it also provides a nuanced psychological understanding of perversion. Gabbard (2005) notes the common thread between many theories of perversion is that the individual uses perverse acts to avoid any intimate, functional relationship with another adult. By definition in Lacan’s formulation of perversion, the other person is not viewed as a subject but as a person who exists for him/her (Fink, 1997) because the perversely structured individual is continuously attempting both to deny yet seek out castration from the Other. Intimacy thereby becomes impossible where others serve solely as a function of the Law that can never be realized.
1. Mary’s sexual misconduct with Precious was a prominent theme in the novel (Sapphire, 1996). It was only implied through one line of off-screen dialogue in the film in which Mary says, “Come take care of mommy, Precious” (Daniels, 2009).
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