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Other studies that look back over longer periods--five to 10 years--find higher percentages of pedophiles who strike again, as high as 58% for those who refuse treatment. Such disparities highlight how uncertain the study of pedophilia is, but even the higher figure belies the popular notion that if a pedophile is allowed to go free, he will almost always molest again. "It's very easy to say, 'Throw away the key,'" says Berlin. "But many of these people are tortured by these temptations, and they are relieved that we can do something for them."
Few pedophiles get this help, as Berlin is one of only a dozen or so doctors who run such clinics in North America. "We don't have Betty Ford centers for people with sexual disorders," he says. Instead, a 1996 federal law requires sex offenders to register with state authorities. When an offender is released from prison, the state can (and often does) notify neighbors. It's unclear whether the legislation is preventing abuse.
One difficulty in treating pedophiles is that we know little about their condition. Could people become pedophiles because they were sexually victimized as kids? That theory makes common sense, but only one-third of pedophiles say they were abused. Could pedophilia be a brain disease? Bradford of the University of Ottawa says studies of pedophiles' brains have shown differences in the way they react to changes in hormone levels, but he says the research is in its earliest stages. Other scientists have posited several risk factors that can lead to pedophilia, including chromosomal abnormalities, psychological problems during puberty and even being brothers: The Journal of Psychology in 2000 reported that "a gap of several years between brothers might deprive the pedophile of companionship in formative years of sexual behavior development."
But such ideas are still guesswork. "If we really want to understand these people and develop good ways to prevent pedophilia, we need a national demographic survey," says Berlin. "The funding is minuscule, so the research is incomplete." And politically fraught. Everyone who works in the field constantly negotiates America's discomfort with children and sex. Yet understanding child sexual abuse means not only exploring its prevalence, causes and treatments--issues that focus on the abuser--but finding the best way to help victims cope as well. And that research is positively radioactive.
Consider the most basic question of such inquiry: What constitutes a victim of child sexual abuse? By definition, pedophiles prey on the prepubescent. No one would seriously argue that a 6- or even 10-year-old can meaningfully consent to sex. But what about those 12 and older, who make up nearly half of all juvenile sex-abuse victims? The states define the age of consent for sex differently. Most say it is 16, but some say 18. In Hawaii, it's 14. So are teenagers from the onset of puberty (usually about 13) to the age of sexual majority (usually 16) always victims when they have sex with someone older?
Legally speaking, as the differences in legal adulthood indicate, the younger partners are not always treated as victims. Even in states where the age of consent is 18, prosecutors rarely go after, say, a 23-year-old for sleeping with a 17-year-old. Given that up to half of teens say they have had sex while a minor, "millions of statutory-rape cases occur every day," says Michelle Oberman, a DePaul University rape-law specialist.
Different cultures have different views on whether adult-adolescent sex is always wrong. In the Netherlands, the law allows children ages 12 to 16 to make their own decision about sex, though if Mom and Dad feel a relationship is exploitative, they can ask the authorities to investigate. Most Americans would find such a law abhorrent. Recently, the University of Minnesota initiated an unusual review of its university press after it published a book that calls the Dutch law "a good model." Judith Levine's Harmful to Minors: The Perils of Protecting Children from Sex, scheduled to arrive in bookstores this month, asserts that "teens often seek out sex with older people ... For some teens, a romance with an older person can feel more like salvation than victimization."