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The Clash of Media, Politics, and
Sexual Science:
An examination of the controversy surrounding the
Psychological Bulletin meta-analysis on the assumed properties of child
sexual abuse
Abstract: Given the recent focus on child
sexual abuse (CSA), with significant implications for public policy and
therapy, a scientifically valid understanding of CSA is vital. Because
most prior reviews of the effects of CSA have been qualitative and based
primarily on biased samples, we focused instead on nonclinical samples
and the use of quantitative methods. Basic assumptions about CSA--that
it causes intense harm pervasively regardless of gender-- were found to
be unsupported. Nine months after publication in Psychological Bulletin,
our analysis of the college student data came under intense attack by
the radical right with assistance from traumatologists associated with
the left. This controversy recently culminated with the U.S. House of
Representatives condemning the article in a 355-0 vote. We will briefly
summarize the methods and findings of our analyses, then focus on
subsequent events. Time will be available for attendees to discuss
sexual science, the media, and politics.
Authors: Bruce Rind, Ph.D., Philip
Tromovitch, M.S., Robert Bauserman, Ph.D.
Presenter: Philip Tromovitch, M.S.
Talk presented at the 1999 Joint Annual
meeting of the Society for the Scientific Study of Sexuality (SSSS) and
the American Association of Sex Educators, Counselors, and Therapists (AASECT)
November 6th, 1999 (St. Louis, Missouri).
Correspondence concerning this presentation
should be sent to Philip Tromovitch via e-mail at: pmt@dolphin.upenn.edu
Introduction
On July 12th, this year, the United States
House of Representatives voted 355-0 (with 13 members voting
"present") to condemn our study entitled "A meta-analytic
examination of assumed properties of child sexual abuse using college
samples," published in Psychological Bulletin. The Senate quickly
followed suit. To our knowledge, never before in the history of this
country has a scientific publication been so treated. Over the next
half-hour we will describe the sequence of events and the forces behind
this unprecedented occurrence. But first, let's review the study itself.
The Logic Behind our Meta-Analyses and the
Results
A tremendous increase in concern over child
sexual abuse, or CSA, began in our society in the 1970s and has
continued ever since. While positive in that it brought attention to a
social problem often ignored in the past, the anxiety over CSA reached
such heights that it created new problems. From the early 1980s through
the early 1990s, day care workers at dozens of sites around the country
were arrested and prosecuted on charges of such crimes as sexually
assaulting dozens of children in their care, ritually sacrificing babies,
torturing children with weapons, and mutilating animals to scare the
children into silence. Almost all of these cases have now been
discredited, viewed as the result of a system gone haywire. During the
same period, thousands of patients across the country were "recovering"
so-called repressed memories of childhood sexual abuse and sometimes
satanic ritual abuse during therapy, resulting in numerous lawsuits
against parents and other adults. Diagnoses of multiple personality
disorder (MPD) were skyrocketing. The validity of these phenomena are
now in serious dispute, owing to extensive research demonstrating the
malleability of memory and the power of social influence in the
therapeutic setting.
What these cases had in common is the
belief that CSA is so traumatic that it produces severe psychopathology.
In brief, the thinking goes, memories of the event are repressed as a
coping mechanism, but nevertheless produce overt symptoms, which can
only be relieved by retrieving the memories. Critics have charged that
questionable retrieval methods have produced false memories, leading to
the problems just discussed. Because assumptions about CSA have been so
central to these phenomena, it follows that systematically and
comprehensively testing them is of paramount importance.
Several dozen literature reviews of CSA
have been conducted. Most, however, have been narrative reviews that
have qualitatively summarized the results of many studies based on
clinical or legal samples, concluding that CSA causes such diverse
problems as depression, anxiety, dissociation, suicidal ideation,
posttraumatic stress disorder (PTSD), and so on. Consistent with common
beliefs about the pathogenic nature of all early sexual contact, the
reviewers have frequently implied or stated that these symptoms are
pervasive in the general population of persons who have experienced CSA.
But there are several serious problems with this approach and
interpretation. First, we cannot assume that clinical findings
generalize; they may be a biased sample of CSA experiences in the
general population. Second, we cannot assume that the observed symptoms
were caused by CSA, particularly because CSA is frequently confounded
with other problems such as emotional neglect and physical abuse. Third,
narrative reviews are subjective, meaning that reviewers with an initial
belief in the conclusion may fall prey to confirmation bias emphasizing
findings that support their view and minimizing or ignoring unsupportive
findings.
To address these shortcomings, we conducted
two reviews of CSA. In the first, published in 1997 in The Journal of
Sex Research, we included only studies based on national probability
samples so as to avoid the all-too-common practice of focusing on
clinical samples and then inappropriately inferring to the general
population. We analyzed the data quantitatively rather than narratively,
to strive for greater objectivity. In particular, we used meta-analysis,
a technique that statistically summarizes data across studies and not
only tells us about statistical significance but also about the strength
or magnitude of association. We found that, although statistically
significant, the association between CSA and adjustment was small: a
Pearson correlation of r = .07 for males and r = .10 for females. This
contradicted the assumption that CSA produces lasting, intense symptoms.
We also found that CSA was confounded with family and social environment,
meaning that the assumption that CSA is the cause of maladjustment in
the typical case is questionable.
To extend this research, we conducted a
second review, the one published in Psychological Bulletin in July 1998,
on which the subsequent controversy centered. In this review, we focused
on studies based on college samples. The rationale was that these
studies comprise the largest body of nonclinical research on CSA, that
they are more representative of CSA experiences in the general
population than are clinical cases (because some 50% of the population
in the U.S. has college experience), and they are rich in family
environment data, which are relevant to examining whether CSA causes
symptoms. As in the first review, we used meta-analysis to increase
objectivity. Once again, we found a small association between CSA and
adjustment. This association was, in fact, exactly the same as in the
national samples, and associations were consistently small across 18
different symptoms. Further, prevalence rates for types of CSA,
frequency of occurrence, and the extent of incest were all very similar
in both types of samples. We found that CSA was confounded with family
environment, and that family environment better accounted for
differences in adjustment than CSA did by a factor of almost 10. We also
found that self-reported reactions to the CSA and self-reports of harm
from the CSA were highly variable, rather than always being negative.
For example, 37% of boys reacted positively, 29% neutrally, and 33%
negatively.
In sum, testing assumptions about CSA is
important. But this testing has to be methodologically sound. We
improved over previous reviews by focusing on more generalizable samples
and examining their data statistically that is, more objectively. We
found that common assumptions about CSA do not hold up well in the
general population. CSA-symptom associations are small, the causal
connection between these factors is far from certain, and negative
reactions are far from pervasive.
Chronology of the Controversy
NARTH
Our article appeared in print in July 1998.
Nearly half a year later, in December, an organization called the
National Association for Research and Therapy of Homosexuality (NARTH)
attacked our study on their website.
The home page of NARTH's website tells us
that the core of its membership consists of psychoanalysts and
psychoanalytically-informed psychologists, which describes well its
three founders: Charles Socarides, Benjamin Kaufman, and Joseph Nicolosi.
These men founded the organization in 1992 to combat what they claim to
be the erosion of the scientific study of homosexuality. NARTH states
that homosexuality is a mental disorder caused by conscious and
unconscious conflicts, is a "sign that deep emotional wounding has
occurred," and is the cause of intense suffering because it
"distorts the natural bond of friendship" between members of
the same sex and "works against . . . the all-important family
unit."
Socarides, NARTH's president, wrote in JAMA
in 1970 that "homosexuality is a dread dysfunction, malignant in
character, that has risen to epidemic proportions." More recently,
in 1995, he wrote that the removal of homosexuality as a mental disorder
from DSM was a "Trojan Horse which, once admitted into the gates of
the heterosexual world, has led to a sexual and social dementia."
He asserted that homosexuality "is a freedom that cannot be
given." Nicolosi, NARTH's executive director, has written that gay
sex is neurotically driven with an addictive dimension that is not about
sex itself, but instead about stabilizing the homosexual's "fragmented
personality structure." In support of these claims, NARTH cites
decades-old psychoanalytic studies based on highly unrepresentative
clinical samples (e.g., Bieber, 1962) to argue that homosexuality is
caused by factors such as poor family relationships, sexual seduction in
childhood or adolescence, a sense of inadequacy with same-sex peers, and
self-labeling. To argue that homosexuality is unnatural and therefore
pathological, they speak of the "essential male/female design"
and "immutable laws of nature." In short, although NARTH
claims to be "devoted to scientific inquiry," their approach
is patently moralistic and lacking in scientific rigor.
With this background in mind, let's now
consider NARTH's critique of our meta-analysis. At the beginning of our
article we criticized most previous literature reviews of CSA for
focusing on clinical samples and then extrapolating from these to the
general population, assuming that correlation was synonymous with
causation, and ignoring confounds between CSA and other problems such as
physical and emotional abuse. In criticizing our paper, NARTH repeated
these errors. They listed dire symptom after dire symptom based on
mostly clinical samples, asserted or implied that all persons in the
population with CSA experiences are so afflicted and that CSA is the
unambiguous causal agent, and ignored or dismissed research unsupportive
of their view. Their critique of our review was consistent with the poor
quality of their "scientific" analysis of homosexuality.
Despite its shortcomings, NARTH's critique
played a key role in a chain reaction that ended in congressional
condemnation of our review. In fact, it became a standard "refutation"
of our review for conservatives around the country.
The Wanderer
The next development occurred in early
March when a conservative Catholic newspaper named The Wanderer picked
up where NARTH left off. Basing its attac k entirely on information from
NARTH, The Wanderer article concluded that our review was a "pseudo-professional,
pseudo-academic analysis." It claimed that "a team of
academics from Temple University has endorsed the view that adult-child
sexual relations are beneficial . . . and recommends overhauling and
euphemizing the language of sexual abuse." It expressed regrets
that homosexuality was depathologized and feared the same would now
happen to pedophilia. In fact, they, as NARTH did, implied connections
between homosexuality and pedophilia a favorite conservative theme.
Next, a listener to a Philadelphia radio
talk show sent a copy of The Wanderer article to the show's host, who,
we were later told, had been criticizing Temple University for years.
The host invited one of us (Philip Tromovitch) to appear on air,
whereupon he used this opportunity to sensationalize the study and
attack Temple University. An outraged listener, of which there were many
as witnessed by the dozens upon dozens of listeners c alling Temple's
psychology department to air their outrage, sent a letter to
conservative radio talk-show host Dr. Laura Schlessinger, informing her
about this.
Dr. Laura
Dr. Laura runs a nationwide syndicated
radio talk show, broadcast daily by about 485 radio stations in the U.S.
and Canada, reaching about 20 million listeners. She also has a
syndicated newspaper column. Vanity Fair magazine dubbed her "the
poster girl of the Christian fundamentalists." Indeed, she espouses
conservative, family-values positions in an often caustic style, which
helps account for her huge following of both fans and detractors. Dr.
Laura has said that NARTH is an organization she respects and has stated
that homosexuality is "a biological developmental error biological
mistake."
In her attack on our article, which began
March 22nd, she denounced meta-analysis as putting a bunch of
meaningless findings together and stirring them up with mathematics. She
asserted that she had never heard of a real scientist using such
procedures revealing her ignorance of its widespread use not just in
psychology but in other disciplines, such as medicine. Her evidence that
our article was "junk science," as she repeatedly called it,
came from sources such as NARTH, whose verbatim comments she presented
without attribution in her mid-April syndicated newspaper column.
The World
The conservative attack on our article, or
more precisely, the straw-man version of it manufactured by NARTH and
Dr. Laura, continued to expand. Another conservative religious newspaper
called The World articulated more explicitly the homophobic concern
implied in prior conservative attacks. The author claimed that the
positive reactions reported by males were "abundant evidence that
child molesting turns its victims toward homosexuality." He
lamented the removal of homosexuality as a category of mental illness
from DSM, adding that:
"One can only marvel at how the 3
percent of the population that is homosexual exerts such an influence on
the culture, while the 80 percent that claims to be Christian and the 43
percent that goes to church every Sunday seem to exert no influence
whatsoever."
The Family Research Council
A conservative lobbying group, The Family
Research Council or FRC, soon entered the fray. On their website they
say their organization exists to "reaffirm and promote nationally .
. . the traditional family unit and the Judeo-Christian value system
upon which it is built." They produce newsletters such as the
weekly CultureFacts, which they say "keeps watch over political and
cultural forces that threaten the traditional family, with a special
focus on the homosexual agenda." Their website also features an
"in depth" examination of "homosexual culture,"
where they say that the "FRC believes that homosexuality is
unhealthy, immoral and destructive to individuals, families and
society."
In support of their beliefs about
homosexuality, the FRC has posted a series of articles, presented as
"scientific," attacking homosexuality. In one, NARTH executive
director Joseph Nicolosi claims that people cannot decide their sexual
identity until they are in their 20s. In another, written by Thomas
Landass entitled "The Evelyn Hooker Study and the Normalization of
Homosexuality," the author attempts to undermine the credibility of
Hooker's landmark 1957 study. To do so, he complains that Hooker says in
the text of her article that the subjects' IQ range was from 90 to 135,
but the table shows the lowest IQ as 91. He also notes that the average
education for the homosexual subjects was 14.0, not the 13.9 that Hooker
reported. He argued that, although minor in degree, these discrepancies
suggest that we cannot trust Hooker as a researcher, and elsewhere
repeatedly called her a "rat-runner," implying that we could
not trust her measurements of humans.
On May 12th the FRC held a press conference
in Washington, DC, to attack our study and demand that the American
Psychological Association (APA) repudiate it. Participants included Dr.
Laura, whom they have praised on their website for her defense of the
family; Judith Reisman, known for her unsupported claims that Kinsey and
his colleagues sexually abused hundreds of children in their research
and for her more recent attacks on Vern Bullough, historian of sexuality
and former president of SSSS, by falsely calling him "a
self-confessed pedophile;" a representative from NARTH; and three
conservative Republican congressmen. In their press release they
presented a straw-man version of our article by saying it was
"based on the premise that a child can actually consent to sex with
an adult."
Congress Attacks APA with Misinformation
From a New Group
Two days after this press conference, Dr.
Raymond Fowler, CEO of the APA, appeared on MSNBC with one of the
congressmen. The congressman said that our study was "a very, very
bad study . . . based on some very, very bad data" and that it
should never have been published. Fowler replied that, "Well, with
all due respect, it isn't a bad study. It's been peer-reviewed by the sa
me principles as any kind of scientific publication. It's been examined
by statistical experts. It's a good study." The congressman
disagreed, saying that our study was based on "what they call
meta-analysis, where they take a whole bunch of studies and put them
together. But a whole bunch of studies that they put in this study were
never peer-reviewed, and 60% of them were based on one study done over
40 years ago in 1946 [sic]."
After the show Dr. Fowler contacted us and
asked what was going on with this 60% figure, saying that members of
Congress were using it as "major data for discrediting" both
the APA and us. He also indicated that the source of this criticism was
Paul J. Fink, former president of the American Psychiatric Association
and current president of a new group called the Leadership Council for
Mental Health, Justice and the Media, for whom Fink was speaking. Fowler
said that Fink had sent a letter to Dr. Laura with these criticisms,
which eventually ended up in the hands of Congress. Fowler wrote to
Fink, asking him what his organization was all about and what were its
exact criticisms.
Fink claimed that, of the 59 studies we
used, over 60% of the data came from one single study conducted 40 years
ago by Landis (1956). He asserted that we "loaded" our
analysis with these data, implying that we intentionally tried to skew
the results to minimize negative outcomes. We pointed out to Fowler that
the Landis study was not used at all in our meta-analyses of symptoms,
the core of our article. We further noted that we had used the Landis
data in two secondary analyses, one on self-reported reactions to CSA
and the other on self-reported effects of CSA. Ironically, the Landis
data were the most negative of all studies in terms of reactions. His
sample was the largest, comprising a third not 60% of the data on
reactions. In our review we calculated the weighted means across
samples, so that completely contrary to Fink's claim we handled the
Landis data in a way that maximized the reporting of negative outcomes.
Dropping the Landis study would mean that positive reactions for boys
would go from 37% up to 50% and negatives would drop from 33% to 24%.
The trend is similar for females. In our analysis of self-reported
effects, in which there were very few studies and the Landis data were
the least negative and where they did account for about 60% of the data
we calculated unweighted means, which avoided any minimization of
negative outcomes, again, contrary to Fink's accusation.
The second criticism from Fink's group, and
one repeated by congressmen and by other critics in the media, was that
many of the studies we included were never peer reviewed. As premier
meta-analyst Robert Rosenthal has argued, unpublished data "should
indeed be cited and employed in meta-analytic computations as long as
the data were well collected" it is in fact standard practice for
reviewers conducting analyses to attempt to locate and include
unpublished data. The unpublished data we included came almost entirely
from doctoral dissertations, which, as most academics know, are
generally well supervised by a group of Ph.D.s from design, through data
collection, to presentation. Even more importantly, in our review we
actually compared the CSA-symptom association in the unpublished and
published studies a fact that has been completely ignored by our
critics. The mean associations were both small (unpublished data r =
.08; published data r = .11) and were not statistically significantly
different, and certainly not different in a practical sense. In short,
the unpublished and the published data were telling the same story.
Despite the erroneous nature of these
criticisms, Fink's group provided them to Dr. Laura, and eventually to
certain congressmen who then used them as a justification for attacking
the APA for publishing what almost all of the critics now routinely
referred to as "junk science."
More on the Leadership Council for Mental
Health, Justice, and the Media
Fink's group presents itself as a nonprofit
organization whose mission is "to disseminate accurate information
about the psychological sciences to the public." They claim to be
composed of national leaders in psychology, medicine, law, and
journalism, who are "committed to promoting the ethical application
of science to public welfare." However, their membership appears to
consist mainly of persons who practice or advocate what has been termed
"recovered memory therapy," which is typically centered on
psychoanalytic or psychodynamic assumptions, particularly the repression
of memories of CSA experiences. Many of their members have expressed
support for a belief in multiple personality disorder (MPD), and some
have even expressed belief in the reality of satanic ritual abuse (SRA)
presumably perpetrated by large and well-organized but completely hidden
cults (both of these areas have been fraught with controversy and
supporters of these beliefs have been strongly criticized by many other
therapists and researchers). Some of the Leadership Council's key
members have been sued by former patients who claimed they received
false diagnoses of MPD, causing severe iatrogenic harm in them and their
family members.
In correspondence to APA, Fink wrote that
his group's goals are to "preserve the integrity of dynamic
psychotherapy and the utilization of anemnesis [sic]." He wrote
that "we also want to protect GOOD psychotherapists from attack and
from financial ruin as a result of suits that are costly both
financially and emotionally." He complained about the
"destructive theories that justify a trivialization of sexual
abuse" and about the "effort to reduce and destroy
psychotherapy by undermining some of the basic principles by which we
conduct our work." These statements suggest that the Leadership
Council has a very clear agenda: to protect the practice of recovered
memory therapy and diagnoses of MPD from lawsuits and from ideas that
challenge the validity of these practices. Our finding that CSA is not
strongly associated with maladjustment in the general population, and
our conclusion that more focus is needed on other childhood problems
such as emotional neglect and physical abuse, call into question some
basic assumptions of recovered memory therapy: that early sexual
experience is typically very traumatic, often resulting in repressed
memories, which produce neuroses during adulthood, which will persist
unless and until these memories are recovered, permitting abreaction
(relief of symptoms). Thus, the Leadership Council has a strong motive
to attack, and even distort, our analyses.
Despite APA Concessions, Congress Condemns
our Study
Thanks to a coalition of right-wing
conservatives, two sorts of psychoanalysts anti-homosexual and repressed
memory advocates and conservative Republican congressmen, the APA found
itself in the middle of a storm. As Fowler commented to us on June 8th,
he was "in hand to hand combat with congressmen, talk show hosts,
the Christian Right and the American Psychiatric Association." This
pressure, especially from Congress with whom the APA must negotiate for
political support and funding for both clinical treatment and behavioral
research proved to be too great. On June 9th, Fowler wrote a letter to
Congressman Tom Delay, one of the conservative Republicans who appeared
at the FRC's May 12th press conference. He began by stating that he
commended Representative DeLay for his strong stand against sexual
abuse. Later he wrote that our article "included opinions of the
authors that are inconsistent with APA's stated and deeply held
positions" and that "sexual activity between children and
adults should never be considered or labeled harmless." Finally,
Fowler offered a series of unprecedented concessions, among them that
the APA would seek independent evaluation of the scientific quality of
our article thus overriding the independence of the peer-review process
and that its journal editors would be asked to "fully consider the
social policy implications of articles on controversial topics."
Despite these concessions, on July 12th the
U.S. House of Representatives voted 355-0 to condemn certain conclusions
of our article; the Senate quickly followed suit. The APA itself was not
attacked in the final version of the resolution, which stated, among
other things:
Whereas all credible studies in this area .
. . condemn child sexual abuse as criminal and harmful to children; . .
.
Whereas the Psychological Bulletin has
recently published a severely flawed study, entitled ''A Meta-Analytic
Examination of Assumed Properties of Child Sexual Abuse Using College
Samples'' . . .
That Congress . . . condemns and denounces
all suggestions in the article . . . that indicate that sexual
relationships between adults and "willing" children are less
harmful than believed and might be positive for "willing"
children . . . [and] any suggestion that sexual relations between
children and adults regardless of the child's frame of mind are anything
but abusive [and] destructive . . .
[and that Congress] encourages competent
investigations to continue to research the effects of child sexual abuse
using the best methodology, so that the public, and public policymakers,
may act upon accurate information.
Nicely capturing the essence of these
events, an anonymous attendee, unknown to us, at this year's APA
conference in Boston posted a sticker around the site that read,
"If the US Congress says that 'The sun revolves around the earth,'
then that fact will be given most careful consideration in all articles
published by the APA."
An Answer to Two Common Attacks
Throughout the controversy, two vehement
criticisms emerged repeatedly: that we wrote of some experiences labeled
as CSA as being willing or consenting, and that we suggested that
value-neutral terms such as adult-child sex or adult-adolescent sex
should be used in place of the term "child sexual abuse" under
certain circumstances. NARTH asserted that non-coerced sex is a misnomer
and that using value-neutral terms constitutes a "repetition of the
steps by which homosexuality was normalized." Dr. Laura agreed that
such contacts are never willing and that value-neutral terms were an
attempt to normalize pedophilia, which will further destroy the family.
The Family Research Council claimed that our study was "based on
the premise that children can actually consent to sex with an
adult." Their spokeswoman added that "children cannot consent
to sex and any study that does not accept this premise should be
dismissed," and also that "adult-child sex is always
reprehensible, always harmful and always forced." The Leadership
Council claimed that we made "an artificial distinction between
force and consent" and that "value-neutral terminology
normalizes child sexual abuse." Steven Mirin, Medical Director of
the American Psychiatric Association, in a letter written to the FRC,
similarly rejected the notion of consent and asserted that
"academic hair-splitting over whether the act should be considered
adult-child sex or child sexual abuse . . . is not in the public
interest and obfuscates the moral issue involved." Congress
enclosed the term willing in quotation marks in its resolution and
denounced the suggestion that "willing" children are less
harmed than believed. Fowler of the APA wrote in his letter to Tom DeLay
that:
Clearly, the article included opinions of
the authors that are inconsistent with APA's stated and deeply held
positions. . . . It is the position of the Association that sexual
activity between children and adults should never be considered or
labeled as harmless or acceptable. Furthermore, it is the position of
the Association that children cannot consent to sexual activity with
adults.
Terminology and Definition of CSA
In our original drafts, we did not suggest
the use of value-neutral terms. In fact, our lengthy section in the
Discussion entitled "Child sexual abuse as a construct
reconsidered" had not been written. In accepting our article for
publication, the action editor wrote that the "major and most
difficult issue to address is the central one raised by Reviewer A
concerning the conceptual and definitional issues . . . [that] might
need to be reconsidered in light of your findings." After noting
that 37% of males reacted positively to their CSA experience at the
time, and 42% in retrospect, he wrote:
Although these experiences might meet legal
and social definitions, the data suggest that the operationalizations
employed might not sufficiently contextualize the events in such a way
that adequately captures the essence of "abuse." Please note
that I am not condoning behaviors that meet current definitions of CSA
any more than I condone illicit substance use in minors. Indeed, both
types of behaviors are legally and socially proscribed. Both, however,
need to be contextualized in order to carefully assess their
pathogenicity. . . . [P]erhaps we need to be more thoughtful about how
we define CSA at a psychological level. That is, current definitions may
not be sufficiently probing. I base this conclusion on the data
regarding the extent that such experiences were positive, and the extent
that such experiences correlate with outcome in men if the CSA was
unwanted. . . . I'm not encouraging a conceptual definition that
requires harm as an effect . . . but one which captures the essence of
"abuse" . . . . With respect to the "big picture," I
think you need to . . . spend more time in your discussion elaborating
the conceptual and operational implications of your review. I believe
that, in doing this, you can make the substantive contribution
sufficient to warrant publication in Psychological Bulletin.
Reviewer A had noted that the definitions
for CSA have been too broad, such that the "result is poor
predictive utility." The idea is that differences in adjustment
would be better accounted for if the term CSA were restricted to a
subset of the very wide range of experiences that are currently labeled
CSA, and that this would advance understanding of CSA and prediction of
its effects. Hence, our assignment was to reconceptualize the term
"child sexual abuse." We carefully outlined the problems
caused in the past by the mixing of morality and science in other areas
of sexuality; we noted how several researchers came to question their
broad usage of the term "child sexual abuse" after gathering
empirical data; we provided the scientific rationale for reconsidering
terminology (to improve predictive validity); and finally, based on this
background, we made our suggestions. Our actions were a direct
consequence of the editorial process, and we believe they were well
grounded in science.
Consent
We were also attacked repeatedly for using
the construct of consent. The argument was that "children"
cannot consent, so our supposed premise was false. In Webster's 3rd New
International Dictionary, the first definition of consent is:
"compliance or approval especially of what is done or proposed by
another." This definition can be termed "simple consent,"
of which children and adolescents are certainly capable; in fact,
ethical guidelines for research with adolescents and children typically
require researchers to obtain the agreement or assent of the
participant. The second definition is: "capable, deliberate, and
voluntary agreement to or concurrence in some act or purpose implying
physical and mental power and free action." This second definition
is "informed consent," which the law takes into account and
which is also the typical ethical and social definition. Thus, the term
"consent" clearly does not always or inevitably imply informed
consent. More important from a scientific view is the value of simple
consent in discriminating reactions or outcomes. If simple consent
discriminates, then it is scientifically valid for use in research,
irrespective of moral or ethical objections.
Many studies in our review distinguished
between consenting and forced acts. We merely compiled the relevant data
and examined the value of consent as a predictor of outcomes. It had
utility, it did discriminate, and it was therefore scientifically valid
to use as a construct. The studies we reviewed generally defined CSA
either as a child or adolescent's sexual experience that was unwanted
regardless of partner's age, or as wanted or unwanted experiences with
someone older typically, at least 5 years older. We merely contrasted
study effects from these two groups to examine the value of
"consent" as a predictor of outcomes. This analysis clearly
demonstrated the utility of distinguishing unwanted from wanted (i.e.,
consenting) experiences in terms of predicting outcome.
The procedure that we used, however, was
not completely satisfactory, because the second category (which included
both wanted and unwanted experiences) overlapped with the first (which
only included unwanted experiences). Unfortunately, researchers almost
never analyzed outcome data as a function of consent. The first and only
study that we are aware of that has cleanly done this was published
earlier this year in BMJ (formerly The British Medical Journal). Coxell
and his colleagues, all abuse researchers, examined a nonclinical sample
of nearly 2,500 men in Great Britain, recruited from general medical
practices. They were interested in psychological correlates of
non-consenting sexual experiences, but also inquired about sexual things
the men had done prior to age 16 with someone at least 5 years older
that they had wanted to do, so as not to miss these "abusive"
experiences. Throughout their paper they distinguished repeatedly
between consensual sex and non-consensual sex their terms. They found
that 5.3% of the men had had non-consenting sex prior to age 16 (with
peers or persons significantly older), but that 7.7% had had consensual
sex prior to age 16 with persons significantly older. We examined the
findings reported for their key dependent measure, which was whether the
men had reported a psychological problem of at least two weeks duration
sometime in their life. We compared their results for three groups of
men on this measure: those with no CSA prior to age 16, those with
consensual CSA, and those with non-consenting CSA. The results were that
the consenting group had no more problems than the control group, with a
very small effect size (r = .02). However, the non-consenting group had
significantly more problems than either of these groups, with an effect
size of r = .10 when compared to the control group and a somewhat larger
effect size when compared to the consenting group (r = .15). These
results, obtained by abuse researchers using a huge nonclinical sample
where consent served as an explicit key moderating variable, provide
very strong support for the utility of the simple consent construct.
It should also be made clear that when
Congress, the Leadership Council, the Family Research Council, or even
the APA is talking about "children" in the context of sexual
relations with adults, they are not using biological definitions of
childhood, but instead are referring to minors under the age of consent,
which is generally from 16 to 18 in the U.S. Thus, they are talking not
only about prepubescent children, but also adolescents. It is thus
informative to review what the APA has had to say in the past about
adolescents' ability to provide informed consent in a different context.
In an October, 1989 amicus brief to the U.S. Supreme Court, the APA
argued, based on a review of the developmental literature, that pregnant
girls do not need parental consent to obtain abortions, because they are
capable, in an informed consent sense, to decide for themselves. They
wrote:
Psychological theory and research about
cognitive, social and moral development strongly supports the conclusion
that most adolescents are competent to make informed decisions about
important life situations. . . . In fact, by middle adolescence (age
14-15) young people develop abilities similar to adults in reasoning
about moral dilemmas, understanding social rules and laws, and reasoning
about interpersonal relationships and interpersonal problems. . . . By
middle adolescence most young people develop an adult-like identity and
understanding of self. . . . Thus, by age 14 most adolescents have
developed adult-like intellectual and social capacities including
specific abilities outlined in the law as necessary for understanding
treatment alternatives, considering risks and benefits, and giving
legally competent consent. . . . [Additionally,] there are some
11-to-13-year-olds who possess adult-like capabilities in these areas.
In view of these conclusions, which are
based on the developmental literature, it seems inconsistent to reject
even simple consent as a moderating variable in a rigorously
peer-reviewed article, given that many of the CSA episodes analyzed
involved adolescents. In short, the scientific data demonstrate the
utility of consent, in the sense of simple consent or willingness, as a
moderating variable. Thus, simple consent is a valid scientific
construct for predicting and understanding the outcomes associated with
CSA experiences.
Conclusion
AAAS Declines Independent Review;
Criticizes Politicization, Misrepresentation of Our Article
The most recent development of which we are
aware was the decision of the American Association for the Advancement
of Science (AAAS) regarding the APA's request that they perform an
independent review of our Psychological Bulletin article. On September
15th, the AAAS Committee on Scientific Freedom and Responsibility voted
not to conduct the evaluation. Their letter communicating this decision
to the APA is very important in terms of the rationale behind their
decision. The Committee reported that ". . . two independent
consultants were asked to assist the Committee in determining what
assessment criteria and effort would be involved in conducting a
full-scale evaluation of the underlying science and methodology,"
and that they made their decision "taking into account the views of
the two consultants and extensive background materials on reactions to
the published article." They stated that "We see no reason to
second-guess the process of peer review used by the APA journal in its
decision to publish" and went on to say that "we saw no clear
evidence of improper application of methodology or other questionable
practices on the part of the article's authors." In rebuke of our
critics, they went on to say that:
The Committee also wishes to express its
grave concerns with the politicization of the debate over the article's
methods and findings . . . we found it deeply disconcerting that so many
of the comments made by those in the political arena and in the media
indicate a lack of understanding of the analysis presented by the
authors or misrepresented the article's findings. All citizens,
especially those in a position of public trust, have a responsibility to
be accurate about the evidence that informs their public statements. We
see little indication of that from the most vocal on this matter,
behavior that the Committee finds very distressing.
Concluding Remarks
Our meta-analysis was accepted for
publication in APA's most prestigious journal after a rigorous
peer-review because it was seen as advancing the field. We believe it
did. It brought methodological rigor into an area that needed this.
Issues of generalizability, causation, and validity of constructs in
relation to CSA were systematically addressed issues that are at the
very center of sound science. But our research has been severely
attacked by a coalition of psychoanalysts and religious conservatives
who have succeeded in mischaracterizing our research as "junk
science," having it condemned by the U.S. government, and
pressuring the APA to act politically at the expense of scientific
integrity.
We see little evidence that our critics are
truly concerned with issues of generalizability, causation, statistical
precision, or rigorous assessment of assumptions. Their push is patently
not toward scientific advancement. We do not claim to have issued some
final truth on CSA, but we can confidently assert that we adhered to
true scientific methodology in its pursuit.
[end]
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