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Every time the public hears that yet another convicted pedophile has been released to the community, the outrage is deafening and incredulous. The reaction grows more vicious and vengeful when the pedophile is found in a hotel room with a 13-year-old boy, mere weeks after release from a prison system that was able to contain the actions but not the sexual fantasies inherent in this psychiatric disorder.

People convicted of sexually abusing children are most always thrown in prison, a strategy that is exorbitantly costly and ridiculously ineffective in curbing the risk to society. The fact is that the vast majority of pedophiles -- adults that are sexually attracted to children -- are not violent or life-threatening. If they play out their sexual fantasies, the result is most often exhibitionism, masturbation or the fondling of a pre-pubescent child, disturbing events for a growing child. Penetration is relatively infrequent, as is violence and death at the hands of a pedophile, but when it happens, the crime deeply disturbs a society that fiercely covets the safety of its children.

Pedophilia is a psychiatric disorder that affects possibly 3 per cent of Canadians. It starts most commonly around age 13, in 10 boys for every one girl, when there is an emerging awareness of a sexual preference for pre-pubescent children. As the pedophile gets older, his sexual preference and fantasies remain squarely focused on young children.

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Within the pedophile population, the lowest risk to society for re-offence is the family member who preys on offspring or relatives, followed by the pedophile who molests young girls. The bisexual pedophile, though much less prevalent, presents the highest risk to his victims, and to society in general. Though mythic in our society, the liklihood of a stranger molesting a child is far less than an acquaintance or a family member.

There is no known cause of pedophilia but studies show that approximately 35 per cent of pedophiles were sexually molested at some point in their lives. We also know that often the age of the pedophile's victim is the same age at which the pedophile himself was abused. The causes are vague, but biological abnormalities, generally ascribed to genetics or a brain dysfunction, may play a role.

What remains clear is that pedophilia is not a deliberate choice made by an individual; it is the product of a disordered but inescapable sex drive that targets children. Unlike other psychiatric disorders, pedophiles are typically rational and competent, able to function productively on a day to day basis in everything but their compulsive urge to engage sexually with pre-pubescent children.

While we believe pedophilia is incurable, studies show that it can be successfully treated and that the risk to society can be minimized.

Between the 1930s and 1970s, for example, studies in Europe showed that surgical castration eliminates almost all risk of pedophile behaviour. Wanting to avoid such extreme treatment, we have seen similar effectiveness from a combination of psychotherapy and pharmacological castration.

The psychotherapy helps the patient "re-structure" his thoughts so that fantasies are more appropriate and healthy. This therapy can be effectively coupled with a medication regime that suppresses sex drive and fantasies about young children. Some medications may even help replace the inappropriate sexual orientation with normal interests in sexual relationships with consenting adults. For the more severe and high-risk cases, medication that blocks the production of testosterone, results in a form of pharmacological castration that greatly reduces the risk of re-offence.

The incidence of pedophilia may be more prevalent than schizophrenia, and many other major psychiatric disorders. Yet, we know that if schizophrenia is not treated, the patient becomes ill and very dysfunctional. The same is true for pedophilia. Would we deny a patient with diabetes his insulin? Should we deny pedophiles their appropriate treatment by warehousing them in jail?

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Pedophilia, whether we are prepared to accept this or not, is a major public health issue. The truth is that very little research has been done because governments and the pharmaceutical industry are opposed to any investment in this highly despised population. We are outraged at their crimes but unwilling to accept that this is an illness that can be treated in a caring, humane society.

It is time that we invested funds into good research so we can finally determine what pedophilia truly is; what causes it; and how it can best be treated. Surely after centuries of hysterical recrimination, of moral outrage and lynching, we as a civilized and reasonable society are prepared to accept this disorder as an inevitable part of human existence. If we can do this, then we can open the doors to greater understanding and most importantly, a much safer environment for our vulnerable children. Dr. John Bradford is clinical director of the Forensic program and the Sexual Behaviours Clinic at the Royal Ottawa Hospital, and the head of Forensic Psychiatry at the University of Ottawa.

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