July 25, 2011 — B4U-ACT has sent an open letter to the Board of Trustees of the American Psychiatric Association (APA) notifying the organization of the inaccuracies and misleading information contained in the current draft of its Diagnostic and Statistical Manual of Mental Disorders (DSM), currently under revision.

The letter requests the establishment of a working relationship between B4U-ACT and the APA’s work group in charge of revising the diagnostic criteria for pedophilia. B4U-ACT is a 501(c)(3) organization that promotes dialog between mental health professionals and people with a sexual attraction to children or adolescents.

The Diagnostic and Statistical Manual is the authoritative publication of the psychological sciences that provides the profession’s descriptions of mental disorders and their symptoms.

“The current revision of the DSM is full of inaccurate and misleading information on people who are attracted to children or adolescents,” said Howard Kline, science director of B4U-ACT. “It is based on data from prison studies, which completely ignore the existence of those who are law-abiding. The proposed new diagnostic criteria specify ages and frequencies with no scientific basis whatsoever. The DSM should meet a higher standard than that. We can help them, because we are the people they are writing about.”

Co-founder and chair of the B4U-ACT board, Russell Dick, a licensed social worker with 38 years of experience working with people who are attracted to minors said, “People with this attraction struggle to lead lives consistent with society’s rules. If we want them to succeed, we need to give them a reasonable level of support by providing them with welcoming, informed, and empathetic mental health services. The current revision of the DSM hinders that goal.”

Richard Kramer, director of operations for B4U-ACT, added, “Inaccurate negative stereotypes perpetuated by the DSM force people into hiding, leave young adolescents who are attracted to children hopeless with nowhere to turn, and do nothing to protect children. We have tried every available avenue to get the work group to meet with us and begin addressing this problem. We had a conference call with them last June, where it was apparent that they did not understand the stigmatic effects of the DSM. They then reneged on their promise of follow-up communication. Consequently, our only recourse is to go over their heads to the Board of Trustees of the APA itself.”

B4U-ACT is holding a symposium on pedophilia and the DSM in Baltimore on August 17. One of the ways it suggests the APA work group could start working with them is to send a representative to speak at the symposium. The work group has ignored the invitation.

Read the full text of the letter to the APA trustees at https://www.b4uact.org/wp-content/uploads/2014/08/b4uact-20110713.pdf.

B4U-ACT sent the e-mail letter below to all members of the DSM Paraphilias Subworkgroup and leading officials of the DSM Task Force, inviting them to come and speak at its upcoming symposium. B4U-ACT suggested this as a way to restart the conversation begun the previous summer with a conference call between DSM officials and B4U-ACT, and thereby take steps “to ensure not only that the DSM is founded in sound science, but also that it does not engender stigma or diminish availability of care, and takes valid patient input into account.”

No reply was received.


Subject: B4U-ACT Symposium on Pedophilia and the DSM
From: Howard Kline
To: Ray Blanchard, Martin Kafka, Richard Krueger, Niklas Langstrom, Kenneth Zucker, David Kupfer, Darrel Regier, William Narrow
CC: Richard Kramer, Russell Dick, Irving M. Binik, Lori A. Brotto, Peggy T. Cohen-Kettenis, Jack Drescher, Cynthia Graham, Heino F. L. Meyer-Bahlburg, Friedemann Pfäfflin, Robert Taylor Segraves
Date: Tue, 03 May 2011 23:50:21

To Dr. Ray Blanchard, members of Paraphilias Subworkgroup, and APA DSM Task Force officials

Dear Gentlemen:

On August 17, B4U-ACT will hold a symposium on “Pedophilia, Minor-Attracted Persons, and the DSM: Issues and Controversies.” All of you have received the call for proposals for this event, which is also available at www.b4uact.org/callforproposals.htm. The purpose of this e-mail is to reach out to you with a special invitation to participate.

The symposium will be a collaborative exchange of ideas among researchers, scholars, clinicians, and minor-attracted people from a variety of disciplines and with a variety of views. We wish to have all views reflected as accurately and fairly as possible. As such, it would be beneficial to have Dr. Blanchard, other members of the Paraphilias Subworkgroup, and/or other representatives of the DSM Task Force present the perspective under review by the APA on these issues. We would like to have at least two DSM-5 representatives speaking at the symposium in order to ensure that your views are well and accurately represented and that the discussion is fair and meaningful. If none or only one of you is available on the date of the symposium, we’d be interested in your recommendation of others who could speak on your behalf.

There is an important reason for the APA to participate in this symposium. Seven of the recipients of this e-mail took part in a conference call with representatives of B4U-ACT in June 2010. Promises were made of specific follow-up by the APA after that call, however none of that follow-up took place despite numerous attempts by B4U-ACT to obtain it. We are reaching back out to you now in an attempt to restart the conversation. We know how busy you are and understand how various pressures on your time may have interrupted your follow-through last summer. However, we also trust that you are committed to “the best interests of patients and those actually or potentially making use of mental health services” [APA Bylaws] and to enabling care to be provided “with compassion and respect for human dignity and rights” [AMA Ethics]. Therefore, we trust that you want to take all reasonable steps to ensure not only that the DSM is founded in sound science, but also that it does not engender stigma or diminish availability of care, and takes valid patient input into account. These objectives are the key focus areas of the symposium.

If none of you is able to participate in the symposium, and if there is no one else to nominate to represent you, then we urge you to delegate one of you to speak with us about an alternative course of action to resume the conversation started with the conference call last summer.

While this is a matter of professionalism for you, for us it is a matter both of professionalism and of life and limb. Legions of minor-attracted people are suffering daily and reporting inability to find compassionate and respectful mental health services. Most are left to cope by themselves, and some fail. Too many, including many teenagers who find themselves attracted to younger children, take their own lives, or try to. We trust that such outcomes are as unsatisfactory to the APA as they are to us. Please work with us to find solutions that properly diagnose disorder and support its appropriate treatment. Please come and speak at our symposium or get back to us about other ways to get our conversation back on track.

Thank you.

Sincerely,
Howard Kline
Science Director
B4U-ACT, Inc.
www.b4uact.org

B4U-ACT joined with seven mental health professionals to object to an article recently published in the Harvard Mental Health Letter. The open letter sent in response follows:


April 25, 2011
The Editor
Harvard Mental Health Letter
Harvard University
Cambridge, MA

Dear Editor:

We wish to respond to the article “Pessimism About Pedophilia” published in your July 2010 issue.

A broader examination of the facts demonstrates that pessimism as a professional response to pedophilia and hebephilia is unjustified and leads to serious undesirable consequences.

People who are attracted to children or adolescents can and do contribute positively to their communities and to society. The non-profit organization B4U-ACT, based in Maryland, consists of such people working together with mental health professionals to promote dialog, the dissemination of accurate information, and the accessibility of compassionate mental health services. The people who are attracted to minors that we know deal with their sexuality in responsible ways and live within the law. They care about the well-being of children and adolescents as much as other people; many are parents themselves.

Most available information about minor-attracted people is inaccurate and incomplete. Most minor-attracted people do not come to the attention of the criminal justice or mental health systems, or when they do, their positive characteristics and contributions are not acknowledged. As a result, descriptions are based solely on non-representative forensic samples and inaccurate assumptions about their feelings and motives. Non-forensic research presents a more hopeful picture, finding that they may be similar to the general population in personality and psychological functioning (Okami & Goldberg, 1992; Wilson & Cox, 1983). In addition, there is strong evidence that their feelings of attraction may be similar to those of people attracted to adults: they may involve feelings of affection, tenderness, and romantic attraction (Blanchard, 2009; Li, 1990b; Sandfort, 1987; Wilson & Cox, 1983).

Treatment can be very effective. Some minor-attracted people connected to B4U-ACT have experienced therapy that helped them to find ways of coping with their sexuality and society’s response to it, and to develop fulfilling relationships while living within the law. Such treatment is only effective when the therapist has an accurate understanding of pedophilia or hebephilia, shows empathy and compassion for the patient, and works cooperatively with the patient to develop treatment goals and approaches.

Pessimism, inaccurate and negative characterizations, and a reliance on law-enforcement rather than therapeutic approaches by the mental health profession seriously discourage minor-attracted people from seeking services. Such responses strongly suggest to potential clients that mental health professionals will not understand them, will respond to them with suspicion or hostility, will ignore their mental health needs, or will report their feelings to authorities. In a recent survey of minor-attracted people conducted by B4U-ACT, one respondent said, “I have no way of knowing if they’ll call the cops just for telling them my attraction. I wouldn’t want to see a psychologist unless I can be truly open and honest. So that’s out.” Another said, “I can never reveal the fact that I am a pedophile. At least now, they do not know that they hate me, and that is the best that I can ever hope for.” Altogether, 54% of 166 respondents cited fears that therapists would report their feelings to authorities or others, 63% feared negative judgmental reactions, and 48% feared they would be treated unethically by therapists. Minor-attracted people learn that they must remain in hiding. This does not protect children.

In short, negative stereotypes and reliance on law-enforcement approaches by mental health professionals intensify stigma, causing serious negative consequences. The very same issue of the Harvard Mental Health Letter also contained an article on this topic: “The Evolving Understanding of Stigma.” The article noted that “the constant background noise of stereotyped or inaccurate information contributes to the persistent stigma about mental illness…stigma is important because it contributes to delays in seeking treatment for mental health disorders and problems in accessing care.” In B4U-ACT’s survey, 40% of respondents said at some point they had wanted services to deal with issues related to their sexuality, but never received them due to fear or stigma. In addition, 27% said they wanted services for other reasons but did not seek them because they could not be honest with a therapist about their sexuality. Sixteen percent also said they had received such services, but these services were inadequate for the same reason.

Adolescents and young adults just realizing they are attracted to minors are especially vulnerable to stigma. Feelings of hopelessness can lead them to depression, substance abuse, and suicidal thoughts. Some of the volunteers at B4U-ACT have experienced this in their youth. Others have been contacted by youth who abused alcohol, engaged in self-harming behavior, or were suicidal due to the stigma of their attraction to children. In the B4U-ACT survey, 44% of respondents had thought seriously about suicide due to their sexuality; the most common age for such thoughts was 16.

Inaccurate stereotypes lead to dehumanization. As the stigma article notes, “people who are stigmatized experience social death when others in society hold attitudes and behave in ways to turn the stigmatized person into an ‘other,’ or a non-person…This leads to dehumanizing treatment, such as making psychiatric patients in China wear outfits like those of prisoners, [or] prohibiting them from participating in family gatherings…If stigma is primarily psychological, then eradicating it may involve psychotherapy to help patients boost self-esteem. If it is more of a social construct, the way to fight it is through awareness campaigns to change public opinion and policies. And if stigma is a moral issue, then it may be necessary to advocate for basic human rights.”

We urge mental health professionals to reject pessimistic responses and to join in a hopeful effort both to protect children and to promote the well-being of people who are attracted to minors. Such an effort would involve reducing stigma, conducting non-forensic research on pedophilia and hebephilia, making accurate information available to professionals, the public, and minor-attracted people, and providing visible therapeutic services to minor-attracted people.

Sincerely,

Russell Dick, LCSW-C, Board Chair, B4U-ACT, Inc.
Richard Kramer, Director of Operations, B4U-ACT, Inc.
Tom Scott, MSW, LCSW-C, Executive Director of Clinical Services, National Center on Institutions and Alternatives
Kevin J. McCamant, Ph.D., Private Practitioner, Clinical and Forensic Psychology, Sex Offender Treatment Provider
Wayne Bowers, President of the Board, Sex Abuse Treatment Alliance
Eric Anderson, Sociologist and Professor, University of Winchester, U.K.
Lee Beckstead, PhD, Private practitioner
Marjorie Diehl, ACSW
Amy Craig-Van Grack, LCSW-C

References

Blanchard, R. (2009), Paraphilia scales from Kurt Freund’s Erotic Preferences Examination Scheme

Li, C.K. (1990b), Some case studies of adult sexual experiences with children Journal of Homosexuality, 20 (1-2), 129-144.

Okami, P. & Goldberg, A. (1992), Personality correlates of pedophilia: Are they reliable indicators?. Journal of Sex Research, 29, 297-328.

Sandfort, T. (1987), Boys on their contacts with men: A study of sexually expressed friendships. New York: Global Academic Publishers.

Wilson, G. & Cox, D. (1983), The Child-Lovers: A Study of Paedophiles in Society. London: Peter Owen Publishers.