What should we do with child sex offenders?BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d6908 (Published 26 October 2011) Cite this as: BMJ 2011;343:d6908
- Tony Delamothe, deputy editor, BMJ
The actor Chris Langham was talking of life after his conviction for downloading child pornography: “After I came out of prison I went to the Co-op, and it was like a really big event for me, and this little old lady tottered towards me as I was walking in, and she looked like she was going to say something really nice. Just a lovely old lady, you know? And she just leaned into me, and she said: ‘People like you should be killed at birth’” (www.guardian.co.uk/film/2011/sep/25/chris-langham-interview).
A week after this interview appeared, two prisoners were charged with murdering the paedophile Mitchell Harrison, who was in prison for raping a 13 year old girl. Harrison had been disembowelled and stabbed in the eye and had his throat cut, in what a criminologist described as a “ritualistic slaughter” (Daily Mail, 3 Oct, p 20).
What is to be done with such people if we accept that strangling them at birth or ritualistically slaughtering them once they’ve offended are not realistic options? There’s no doubt about the devastating psychological havoc they can wreak, as Iona Heath described in her Harveian Oration at the Royal College of Physicians last week. Anyone unconvinced should leaf through the recent Ryan report into child abuse in Ireland.
Given what we know now, it’s hard to believe that Lolita would be lauded as one of the world’s greatest novels if it had been published this year rather than in 1955. It’s harder still to accept sexually abusive Uncle Ernie in the Who’s rock opera, Tommy, as just a pantomime villain, knowing now that one of his creators, Pete Townshend, says he was sexually abused as a young boy. (This emerged after Townshend was arrested as part of Operation Ore, a police crackdown on internet child pornography.)
Part of the horror of sexual abuse of children is that its effects don’t automatically die with the perpetrator but, like some old testament punishment, reverberate down the generations. If sexually abused, a boy is about 10 times more likely to become a perpetrator himself. Up to half of child sex offenders have themselves been abused. You wonder how many paedophile priests had themselves been abused as boys by paedophile priests.
For these reasons and more, sex offenders have emerged as the ultimate monsters of our age. Yet the degree of vilification they suffer seems disproportionate. In prison, sex offenders have a tougher time even than multiple murderers and need segregating for their own protection. In “the community” we’re in the grip of the modern equivalent of a medieval witch hunt, with suspected transgressors being smoked out and hunted down. At the height of the News of the World’s campaign to “name and shame” alleged sex offenders, several families, wrongly identified as harbouring such offenders, were forced to flee their homes. A Newport paediatrician had “paedo” spray painted on her front door (http://news.bbc.co.uk/1/hi/magazine/4719364.stm).
The topic has many more unknowns than knowns. For example, how did the News of the World know that targeting child sex offenders would be more popular than, say, targeting perpetrators of domestic violence (who are more numerous and whose actions can be just as devastating)? Or what about anti-paedophile vigilantes: are they trying to exact revenge for the sexual abuse they suffered as children, or is it their way of dealing with their own troubling feelings towards children?
Some of the things that are known are surprising, given popular perceptions. Firstly, sexual offending against children is relatively common: the lifetime prevalence among men for such a conviction approaches 1%—about the same lifetime prevalence as schizophrenia. Around the world reconviction rates for sexual offending are low and falling (not explained by failed prosecutions). Child sex offences have the lowest reconviction rate of all violent crimes other than murder—overall about 13% after five years in the community. For those offenders judged at conviction to be at low risk of reoffending—the vast majority—the reconviction rate is 1% at five years.
The higher the risk of reoffending, the better is the evidence base for treatment. For those at highest risk of reoffending, robust cognitive behavioural therapy results in a substantial drop in reconviction rate: from 18% to around 12%. If anti-libidinal drugs are taken, rates of reoffending are very low.
What’s brought a new dimension to child sexual abuse is the internet. There have been enough studies of the characteristics of online sex offenders for a consistent picture to emerge. It seems that online offenders have greater self control and more psychological barriers to acting on their deviant sexual interests than might be assumed from their viewing behaviour. Studies indicate that just 1% of users of internet child pornography (as long as they do not already have a conviction for child sex offences) escalate into touching children. It’s been claimed that more individuals apprehended in Operation Ore have committed suicide than have gone on to sexually assault children.
A decade ago the psychiatrist Mary Cannon wrote that the outcry over paedophiles in the UK showed that there was little public desire to understand or explain such behaviour. “People who abuse children are viewed as beyond comprehension or redemption—they are ‘wicked, evil and perverted’ and should be ‘locked away’ forever.”
While this may be a marginally more enlightened position than that taken by Langham’s little old lady in the Co-op or Mitchell Harrison’s murderers in Frankland Prison, it’s not one that doctors should feel comfortable with. We need to do better than that.
Cite this as: BMJ 2011;343:d6908
Acknowledgment: Jackie Craissati provided invaluable assistance with the writing of this article.