A good deal of what we define as mental illness lacks objective validating criteria. This is, psychiatric critics admit, probably an unresolvable quandary.

This issue has burst into public consciousness in the case of pedophilia.

Pedophilia is illegal, and our culture also considers it morally wrong--but some clinicians say an attraction to children can't be considered a mental illness.

In fact, a prestigious psychiatric journal, the Archives of Sexual Behavior, will debate that very question in a soon-to-be-published issue....with at least one prominent psychiatrist arguing against the idea of pedophilia as a psychiatric pathology.

Recent changes in the APA's own diagnostic manual may have encouraged this controversial new discussion.

In an earlier version of the diagnostic manual (DSM-III) , the American Psychiatric Association contended that merely acting upon one's urges toward children was considered sufficient to generate a diagnosis of pedophilia.

But then a few years later, in the DSM-IV, the APA changed its criteria in a way that made room for the psychologically normal type of pedophile. A person who molested children was considered to have a psychiatric disorder only if his actions "caused clinically significant distress or impairment in social, occupational or other important areas of functioning." In other words, a man who molested children without remorse, and without experiencing significant impairment in his social and work relationships, could be diagnosed--at least theoretically--as a "psychologically normal" type of pedophile. NARTH brought the DSM shift to public attention.

The APA stated categorically that it had, in fact, no intention of normalizing pedophilia. However, "man-boy love" advocates cheered the DSM shift as good news, and a door appeared to be opened, because soon afterward, a major journal published a pedophile-friendly meta-analysis of the evidence surrounding the effects of, in particular, homosexual pedophilia.

After that version of the DSM was issued and before the next one appeared, an event occurred which may have encouraged the psychiatric association to rethink its change in the diagnostic criteria. "The political storm of the century" hit the field of psychology. According to the March 2002 issue of the Psychological Association's official journal, the American Psychologist, that storm hit "with gale-force winds raging from the media, congressional leaders, states legislatures, and conservative grassroots organizations."

The fiasco APA was referring to had followed the psychological association's publication of a controversial study by Rind, et al which concluded that man-boy, "consensual" sexual relationships were not necessarily harmful and might even be positive. The Rind study marked the first time, the APA said, that it had been called into the public arena to defend publication of a study.

After a public apology of sorts--followed later by another statement which sounded a bit like backpedaling (insisting that researchers had a right to scientific freedom) the Psychological Association issued a new and quite surprising official statement.

APA said that no matter what the research showed either way about the psychological effects of pedophile relationships--pedophilia remained, in its opinion, "morally" wrong.

Morally wrong? This was an odd statement indeed from a scientific organization. What, then, was the APA's moral position on, say...adultery or abortion? What about the morality of sexually open relationships? Would APA have an official position on the morality of polygamy?

The very fact that APA admitted to holding a moral viewpoint on a psychological issue ought to have opened up a broad new challenge to psychology's authority and its presumptions as our culture's new secular priesthood.

Indeed, the time would was then ripe for layman to issue a fruitful challenge to the entire concept of psychological health--its inherent limitations, its value-laden nature, and its utter meaningless without dependence on an underlying social-moral philosophy.

Most of all, the discussion could have addressed psychology's inability to scientifically answer the essential, basic questions upon which any meaningful psychology must be based. Questions such as, "What is good?" "What is the meaning and purpose of sexuality?" "How does one define 'self-actualization'?" "What is our distinctively human nature, and how does our nature require that we live?

In an age when even our culture's moral leaders feel obligated to look to science to defend their positions, such a discussion could clarify to the public what psychologists already know but tend to be loathe to publicly admit: that science alone has a limited capacity to either define or resolve our social-moral problems.

The Psychological Association must have been aware of the larger implications of its own moral pronouncement about pedophilia, because the March 2002 issue of the American Psychologist carried an official article stating that what the association had learned from the Rind fiasco was--among other lessons--that

1) APA must build bridges to conservatives, and
2) in the future, psychology must be prepared to defend its validity as a science.

Public outrage from the psychological association's fiasco must have touched the American Psychiatric Association as well, because psychiatry just instituted a change in its most recent diagnostic manual--the Text Revision of the DSM-IV--regarding the definition of pedophilia. Now, merely acting upon one's pedophilic urges is sufficient for a diagnosis of disorder.

But still, the old, thorny questions remain--how do we define the "harm" in pedophilia? Do we regularly see this harm? Is this harm not only seen in the victim of adult-child sex, but in the perpetrator himself, as a result of the pedophile act he has committed? Is there such a thing as harm resulting to the integrity of the person's character? And what can psychology know about character, anyway?

Catholic moral philosophy, to use one example, recognizes pedophilia as an affront to the integrity of the person--but such a characterological and spiritual concept may be difficult to conceptualize, and even more difficult to assess, in narrowly psychological terms.

Perhaps the harm will be difficult to measure because it is subtle and values-laden. Maybe the molested boy will grow up to routinely sexualize his same-sex relationships. Maybe he'll have difficulty with marriage and mature intimacy. Maybe he'll not only have a distorted concept of gender differences, but a distorted understanding of generational distinctions as well--which could lead to the later sexualizing of his own mentoring relationships with children.

In fact, the molested child who has been hurt the most, in a moral and characterological sense, may actually be the boy or girl who grows up as an adult who truly believes--and who reports to researchers (as many of those found by the Rind study did, in fact, state) that they "remember the sexual relationship positively."

The man whom these psychological studies trumpet as being "unharmed" by their childhood molestation may, therefore, have been the most harmed by the experience--and the most likely to repeat it.

But harms to character are difficult for psychology to define and to measure. Perhaps, indeed, many of the deepest harms to the child, and to the perpetrator, are largely outside of scientific psychology's understanding. So, in a curious twist, maybe the APA--in throwing up its hands and saying pedophilia was "morally wrong"--was right.

Psychologist Gerard van den Aardweg has observed that the Rind study didn't find significant harm to some molested children because Rind "was looking through the wrong glasses."

But perhaps the day may come when psychology recognizes and openly incorporates the missing moral dimension--recognizing our human natures in all their intertwined psychological, moral and spiritual complexity.

--by Linda Ames Nicolosi