Moralistic psychiatry, Procrustes’ bed, and the science of child sexual abuse:
A response to Spiegel

Bruce Rind, Department of Psychology, Temple University, Philadelphia, PA

Robert Bauserman, Department of Health and Mental Hygiene, State of Maryland

Philip Tromovich, Graduate School of Education, University of Pennsylvania, Philadelphia, PA

Sexuality & Culture, Vol. 5, No. 1, pp. 79-89.

SUMMARY

Rind et al. begin by agreeing with Spiegel that it is up to the reader to decide who is distorting and misrepresenting in the debate between them. They believe that their extensive analyses of Spiegel’s criticisms in their two previous articles demonstrated that his criticisms consisted of misrepresentations, false speculations, and selective criticisms of methods, results, and conclusions. Their sense is that Spiegel and his associates were trying to discredit their study rather than to help advance objective knowledge. They say this because of the biases in the criticisms, and because of the fact that “every conceivable criticism was thrown our way, irrespective of relevance or importance, in an apparent attempt to persuade by volume rather than substance.” They dispute Spiegel’s charge that they cannot conceive of legitimate disagreement with their methods and conclusions, and write that his criticisms were mostly illegitimate.

Rind et al. summarize the objections raised by Spiegel and his associates and their own evaluation of these objections in the following table:

Spiegel & associates’ criticism	Rind et al.’s evaluation
“Loaded” analysis with Landis data—a “serious misreporting of data”	False claim about what we wrote; Ignored what we wrote when it countered their criticism
Sample bias (using college samples)	Ignored what we wrote when it countered their criticism
Inclusion of non-contact CSA in meta-analysis	False claim about what we wrote; Ignored what we wrote when it countered their criticism
Poor measurement (studies varied in purpose, questions asked, and definitions)	Criticism was applied only to our research, but not to research supporting their position
“Divide and conquer” (reporting different outcomes separately)	Criticism was applied only to our research, but not to research supporting their position
Misleading and “ill responsible” coding	False claim about what we wrote; Ignored what we wrote when it countered their criticism; Ad hominem; Speculated a result which was disproved by our data
Poor choice and interpretation of effect sizes (the small rs would be large ds)	Ignored what we wrote when it countered their criticism; Speculated a result which was disproved by our data
Deck stacked against CSA compared to family environment (CSA measures dichotomous, unreliable)	Ignored what we wrote when it countered their criticism
No way to infer causality or lack of it	Criticism was applied only to our research, but not to research supporting their position; Falsely attributing bias to us, then exhibiting same bias
Double standard of interpretation	False claim about what we wrote; Falsely attributing bias to us, then exhibiting same bias
Lacked disclaimers	Selective citation—citing author without including part that confirmed our position
Flawed conclusions not well supported by data	Falsely attributing bias to us, then exhibiting same bias; Selective citation—citing author without including part that confirmed our position
Minimized harm despite having found significant correlations	False claim about what we wrote

Rind et al. agree with Thomas Szasz who wrote in 1990 that moralistic psychiatry has dominated modern perceptions of human sexuality, adding new terms to religious beliefs (“sickness” instead of “sin”) rather than studying sexuality scientifically and advancing knowledge in this area. The most important advances toward the understanding of human sexuality came with Kinsey’s and Ford & Beach’s work which explicitly eschewed moral judgments at a time when professional discourse on sexuality was guided by moral bias. These researchers advanced sexual science by basing conclusions on broad-based observations rather than on narrow clinical studies, and by conducting cross-cultural studies rather than only examining American sexual practices. This approach, rather than moralistic psychiatry, will promote better understanding of sexuality even (and especially) when the topic is adult-minor sex.

Rind et al. then address Spiegel’s specific criticisms once again. First, Spiegel claims that their selection bias resulting from using only college samples “cannot be explained away,” but he and his associates never notice the selection bias of the numerous reviews that focus on clinical and forensic samples. Far from explaining away their use, Rind et al. provided a careful rationale for using college samples rather than clinical ones: the pervasive bias resulting from the latter, the lack of consideration they gave to third variables, the inattention they gave to males (but the generalization of findings that were made to them anyway), the relevance of college samples to the general population (moreso than clinical samples), the richness of the data in college studies, and the large number of males in such studies.

Furthermore, Rind et al. showed that the college data were very similar to the national representative data in prevalence, severity, and consequences of CSA. Spiegel continued to deny this, in spite of the data, and without evidence stated his opinion that CSA causes individuals to become incapable of attending college. In fact, studies familiar to Spiegel have found some of the worst sufferers from CSA and MPD have been middle class college-educated students. He also speculated that college students were more privileged and able to cope with CSA, and claimed Rind et al. failed to consider this. In fact, they did acknowledge this potential limitation, investigated it, and found (based on evidence rather than speculation) that it was not a threat to their methodology.

Once again, Spiegel claimed that the inclusion of the Landis data minimized negative effects of CSA, even though Rind et al. had clearly refuted this. The Landis data was not even used for the major analysis of the study, and when it was used, statistical calculations were performed in such a way that they minimized its effects. Again, he assumed that non-contact sex has less negative effects than contact sex, but the Landis data itself, and studies by Fromuth & Burkhart and West & Woodhouse, showed that this is not so.

Spiegel again attacked Rind et al. for not studying PTSD, this time claiming that the problem resulted from using college samples. However, in two other meta-analyses of non-college samples, meta-analyzable PTSD results were rare. And once again, Spiegel criticized Rind et al.’s method of controlling for family dysfunction, even though they had addressed his points several times. Spiegel ignored these technical explanations, and resorted to hand-waving by saying that even though Rind et al. might be satisfied with their defense, others weren’t.

Spiegel’s fiercest attacks concerned the issue of consent, which was addressed carefully in the first Sexuality & Culture article. Rind et al. justified the concept of “simple consent” on the basis of its use by almost all of the researchers whose studies they reviewed, by its use in many other studies of CSA, and by its ability to account for the effects of CSA in other studies as well as their own. Spiegel again ignored these points and responded moralistically, attacking the idea of “informed consent” rather than “simple consent.”

Rind et al. conclude:

The study of psychological correlates of adult-minor sex is just as important a topic as any other in sexology or psychology, in our view, and its study should be approached following the Kinsey et al. and Ford and Beach models. The alternative approach, moralistic psychiatry, should be avoided, as its tendency is to force all information into a single, narrow perspective. Moralistic psychiatry is a Procrustean bed, in our view, and Spiegel’s biases and errors in evaluating our thoroughly peer-reviewed and competent meta-analysis serve as a case in point.

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