Leslie M Lothstein. Studies in Gender and Sexuality. Volume 5, Issue 2. 2004.

I argue that if change is to take place in the Roman Catholic Church, it must be systemic and Catholic moral theology needs to develop a more developmentally and scientifically sound narrative of human sexuality for parishioners and clergy.

The view of clergymen as being weak and vulnerable, filled with doubt and cynicism, is antithetical to the typical conceptualization of clergymen as models of perfection. When parishioners seek out clergymen for help during periods of suffering, they often assume that their priests are immune from ordinary suffering and that the priests’ special relationship with God insulates them from doubt, imperfection, melancholia, and all forms of mental illness. As indicated by the current crisis in faith communities throughout our country, especially in the Catholic Church, nothing could be further from the truth (Beintema, 1990; Gonsiorek, 1995). Indeed, it appears that being a clergyman may be a risk factor for a number of psychological vulnerabilities, including boundary violations, burnout, emotional exhaustion and mental illness (Rossetti, 1990; Plante, 1999).

While religion has been a vital source of community strength and integrity, it also has been a source of disintegration, social strife, and disunion in which promiscuous sexuality, debauchery, and violence have played a role for priests and members of religious orders (Manchester, 1992). Although no single religion or denomination dominates in displaying boundary violations and the sexual abuse of minors (Bradshaw, 1977; Editors, 1988; Blanchard, 1991; Francis and Baldo, 1998) the popular press has focused on the behavior of Roman Catholic priests as particularly egregious in the area of the sexual abuse of minors. The media may appear sensationalistic and suggestive of “Catholic bashing,” but the data overwhelmingly imply that sexual abuse of children among Catholic clergy is a serious phenomenon. It may, in fact, represent a public health crisis that is causing a schism within the Church (Rossetti, 1990; Sipe, 1995; Plante, 1999). Indeed, of the approximately 45,000 Catholic priests in the United States, between three and six percent have been identified as having serious sexual pathology with minors. It is this group that is the focus of this paper.

Catholic priests are particularly stressed in their work, a situation correlated with a variety of psychological and somatic disorders (Labier, 1986; Kilburg, Nathan, and Thoreson, 1986). Moreover, with an aging priesthood (the average age of priests is 57) and fewer men entering the priesthood, there are enormous demands on priests to cover more than one parish and to be available to everyone at all times. As a group, therefore, priests are overworked, overburdened, lonely, isolated, and socially stigmatized, factors that may lead to sexually inappropriate behaviors. These priests are at high risk for stress-related somatic and mental disorders and alcohol and drug abuse.

Recent changes in the selection process for seminarians have led to increased numbers of homosexual men entering the priesthood (Cozzens, 2000). According to Cozzens, this has changed the face of the priesthood. While there is a secret history of same-sex relationships in the Church (see Boswell, 1980), and current estimates are that the Roman Catholic priesthood is 40-60% homosexual (as reported anecdotally and by Jordan, 2000), the Catholic theology of sexuality is antihomosexual. For homosexual priests to survive in their Church, they may have to adopt a “don’t tell” attitude and maintain a secret self at the expense of their mental health. We know from clinical practice that maintaining a false self and keeping secrets can only lead to emotional trouble, especially in the Catholic priesthood, which depends on a virtuous and celibate priesthood.

One compelling facet of the recent Catholic abuse crisis is that, at times, hierarchical elements of the institutional Church have appeared to support sexual violence toward children. The current plethora of grand juries investigating the possibility of racketeering among members of the Catholic hierarchy (Donovan, 2003) are attempting to see if bishops and cardinals, to protect their priests and avoid a scandal, colluded to break civil laws by moving sexually abusive priests to new parishes once their crimes surfaced. As an example of the complex legal issues involved, consider the case of Bishop O’Brien of Phoenix, who admitted to moving sexually abusive priests to other parishes without informing anyone or following Arizona law. He agreed to a plea bargain with the prosecutor, who, in exchange for not prosecuting him, allowed the Bishop to transfer all responsibilities for sex abuse in the future to an appointed vicar over whom he would have no authority.

A recent case in Connecticut (Byron and Leukhardt, 2002) points to the role parishioners sometimes have in supporting sexually errant priests at the expense of victims. In that case, a visiting Polish priest allegedly raped a teenage girl while he counseled her at her home. He confessed the rape to a Polish speaking police officer. A segment of the Polish community, however, responded by raising a few hundred thousand dollars for the priest’s defense while the pastor rallied support and called the victim “a tramp.”

The Institute of Living

The treatment of impaired and distressed clergy has a long history at The Institute of Living, which was founded in 1822 in Hartford, CT (Braceland, 1972). Enoch Badger (1834), writing for The Retreat Gazette, The Institute of Living newspaper, noted, “We have in our snug Retreat all sorts of characters and conditions of men: priests and priestesses, elders and deacons.” As Director of Psychology at The Institute, I helped to develop a specialty program to treat professionals and clergy who were impaired and distressed. The program began in 1986 and was named the Retreat. It is a name that incorporates one of the original names of the Institute of Living (The Hartford Retreat) and suggests to clergy a place of safety to explore personal crises (Braceland, 1972; Goodheart, 2003).

Although we see clergy of all faiths, we particularly focused on Catholic clergy because of a unique combination of factors. James Gill, a psychiatrist, was also a Jesuit priest and a respected spiritual leader who referred Catholic clergy to the Institute of Living for treatment. He also edited the Jesuit Journal Human Development from the IOL grounds and founded a Christian Institute for the Study of Sexuality. The unit chief for the Retreat was an active Catholic deacon who wanted to reach out to Catholic clergy who had been identified as having sexual disorders. In addition, Fr. Kiely, the head of pastoral counseling at the Institute, had an advanced degree in Family Therapy and combined a deep spiritual compassion with expert clinical skills. These three professionals put together a specialized spirituality component to the program so that we could address the priests’ spiritual as well as their psychological needs. When we began the program, we had no idea that, eventually, we would evaluate and treat over 500 Catholic clergy, participate with the United States Conference of Catholic Bishops in formulating policies about abusing priests, and associate with other leading centers that also treated impaired and distressed clergy. In so doing, we accumulated an enormous depth and breadth of experience with this population. Some aspects of this work was reported (not entirely accurately) in The New Yorker (Werth, 2003).

Werth explored an important dimension of the conflict between the church institution that needed what he called a “cover” for errant priests and a “cash cow business” that he believed may have led our institution (among many) and some professionals to cave into the church’s need to have these priests both protected and then returned to work. While this was an oversimplification of a complex problem, it underscored some of the difficulties that may exist in those institutional affiliations, which often had diverse needs apart from evaluating and treating errant clergy.

Some of these areas of conflict involve professionals confusing a risk assessment and psychiatric evaluation with a fitness-for-duty assessment; writing letters supporting a priest’s ability to return to work; and not using a forensic model of evaluation in which the referring institution (the church) is held to the same standard as any attorney requesting an evaluation for his or her client. That is, the church is not held to the standards of full disclosure. We cannot expect a psychiatric center to conduct a police investigation, which means that we have to trust the referral source, in this case a bishop of the Catholic church to provide full disclosure, which rarely happens even between dioceses. Consider the suit brought by the Archdiocese of San Diego against the Archdiocese of Boston alleging failure to disclose fully the background of an errant priest who had been transferred to their diocese under false pretexts. He went on to molest children (proving our point at The Institute of Living that many of our reports were based on inadequate and manipulated information by the church hierarchy).

In the last analysis, while mental health professionals are not trained detectives and do not do well at detecting lying and malingering, it is quite another thing to find one deceived by the church itself, as did the Diocese of San Diego. These issues were best summarized in a deposition of a bishop in Connecticut as told to me by the attorney for the plaintiffs. He said that he had withheld from The Institute of Living crucial information about a priest’s long history of molesting minors because the bishop did not want to spoil the reputation of the priest (the priest had been sent to The Institute for psychiatric evaluation and treatment, see Lothstein, 2004).

In my work with hundreds of priests, it has become apparent that, in many cases, a man who had begun as a holy man, a “Man of the Cloth,” ironically and sadly turned into a “Man of the Flesh” who acted out perversely while rationalizing his errant behavior as actually protecting his celibacy and priesthood. I was also struck by how the defensive use of denial, rationalization, minimization, and disavowal by priests led to a split in their egos that allowed the behavior to occur despite their idealized self-image, vows of celibacy, and conscious desires to lead a virtuous life.

Many of the men I evaluated who had had sex with teenage boys identified themselves as heterosexual, but they consciously felt that having sex with a woman would violate their vows of celibacy and threaten their priesthood (e.g., if the woman got pregnant she might force the priest to marry her). For this subset of priests, having sex with a male, or a boy, was sinful but did not violate their priesthood or threaten their celibacy. It was this rationalization, or what Goldberg (1999) calls the defense of disavowal, that seemed to lead to a vertical split in the priest’s ego that allowed them to see themselves as celibate while engaging in perverse and illegal behavior with young men. In what seemed to be the most extreme form of abuse, a subgroup of priests I evaluated used the confessional as a place to recruit victims. I found some research on this practice (Valenti and diMeglio, 1974; Haliczer, 1996).

A large subset of sexually errant priests treated at The Institute of Living had had successful psychotherapeutic outcomes. They were able to control their sexual impulses, increase their self-knowledge, and develop the capacity for self-observation and empathy. In some cases, the priests were returned to some form of productive ministry and were able to be celibate (Lothstein, 1991).

For many clergy, however, vows of chastity and celibacy were no easier to keep than were vows of faithfulness and loyalty among married people (Lothstein, 1990; Lothstein and Rossetti, 1990; Thoburn and Balswick, 1994; Young et al., 2000). Indeed, Sipe (1990) claims that only 2% of his cohort of about 1300 Catholic clergy were genuinely celibate, another 20% desperately tried to maintain celibacy, and about 80% of his sample were not celibate (some never even took the vow seriously). He views the crisis in the priesthood as related to abuses of power, outmoded patriarchal systems, and the Church’s collusion in protecting priests and blaming the victims of clergy abuse (Sipe, 1995).

Psychological Problems of the Clergy

Those priests and religious who came to The Institute of Living for evaluation and treatment after being accused of sexual abuse represented a wide diagnostic spectrum. They presented with psychiatric problems including major depressive disorder, anxiety disorders, psychotic disorders, bipolar disorders, sexual and gender disorders, cognitive problems, including dementias, severe alcohol and drug abuse, and dependency. They were also likely to experience adjustment disorders related to being charged with sexual abuse, being taken out of their rectories, and being brought, sometimes across long distances, to a hospital-based mental health network.1

It is rare for a priest to have a diagnosis of only a sexual disorder. Sexual disorders, however, represent the full range of paraphilias and gender identity disorders. In addition, these men often exhibit nonparaphilic compulsive and addictive sexual disorders that have not yet been categorized in DSM-IV. These include compulsive masturbation, cruising, use of prostitutes, womanizing, engaging in illegal sex with adolescent minors, and using the Internet to download a variety of pornography including child pornography. With the increasing availability of erotic images on the Internet, we also began to see more priests who used Internet chat rooms to meet minors for sex. They sometimes engaged minors in inappropriate or illegal sexual activities. Some of these men were arrested and sent to jail.

A subgroup of priests acted out sexually in an impulsive, sadistic, and cruel manner. These men were sexually disinhibited and impulsive and revealed no evidence of being able to anticipate the consequences of their actions, and they had no empathy for their victims (see Goldberg’s, 1995, 1999, and 2000 work on perversion, the use of disavowal in perversion, and case histories).

With few exceptions, the overwhelming majority of priests and religious had both Axis I and Axis II pathologies. Using the Million Personality Test (Millon Clinical Multiaxial Inventory-MCMI-III), a large subgroup of priests had Cluster C personality disorders (dependent, avoidant, obsessive compulsive personalities) marked by a need for desirability and acceptance. This group of clergy were typically naïve and psychosexually immature. They had gravitated to the priesthood because they needed to be idealized, admired, and loved. They could not function autonomously and used the Church to obtain housing and health benefits. At times their dependency was so pathological that they obeyed authority without any sense of themselves as separate individuals. Often they feared their bishops and engaged in secretive sexual liaisons as a form of pseudoindependence. When this group of priests and religious became involved in sexual activity, it was likely to be limited to a few individuals and tended to involve kissing, hugging, wrestling and fondling, masturbation, and the use of alcohol to lower inhibitions.

A second subgroup of personality disorders involved Cluster B disorders (antisocial, narcissistic, borderline and histrionic). A small subgroup of these priests and religious were frankly psychopathic (as measured by the Hare Psychopathic Check List-R, the PCL-R, 1991). They were manipulative con men who were charismatic and loved by many of their parishioners. They combined a sense of grandiosity and high energy with a pathological need for love and admiration. Some of these priests were sought after for retreats and workshops. They were often idealized and were the envy of other priests. Few parishioners understood the dangers these men posed to their faith and religious communities. While the majority of the men fell along the higher end of personality functioning (Kernberg, 1975), some were cognitively disorganized, emotional wrecks, or frankly psychotic.

When priests who were psychopathic, narcissistic, grandiose, antisocial, or any combination of these became involved in compulsive or addictive patterns of sexual acting out, they were likely to engage in high-risk, dangerous sexual activity with little remorse or empathy for their victims. The impulsive, charismatic priests were able to engage in higher volume sexual acting out with little chance of being caught because they were clever psychopaths who were “loved” by their communities and their bishops.

A small group of priests and religious had Cluster A personality disorders (paranoid, schizoid, and schizotypal). Many of the priests in this group were older, were involved in scholarly teaching activities, administrative work, or canon law, and had histories of being chronically unable to relate successfully to anyone. They could not function as pastors in parish ministry as they feared closeness, avoided relationships, and were dreaded by their parishioners. Their social skills were so poor that even simple interactions were awkward and difficult. Some of these priests were also sadists who acted out bizarre sexual fantasies in a paranoid way. All were very negativistic and compulsive and had angry, irritable depressions. When this group became involved in inappropriate sex, their actions were often bizarre and unpredictable.

In some cases priests exhibited personality traits consistent with different clusters from DSM IV. A priest could be dependent and obsessional while also being borderline and narcissistic. The divisions I am making are over simplifications but do have heuristic value.

A majority of the Catholic clergy that we saw also had an array of Axis III medical disorders that complicated the clinical presentation. Of particular concern were obesity, diabetes, hypertension, and cardiac and pulmonary disorders. A subgroup of our Catholic clergy was HIV positive, and a few of those evaluated and treated eventually died of their illness. At least one of the priests had an AIDS dementia. Head injuries suffered as a result of childhood physical abuse or accidents also ranked high for many of these patients who came from dysfunctional homes in which physical abuse and trauma were the norm. Many of our patients showed frontal-temporal abnormalities on computerized EEG and neuropsychological testing (Lothstein et al., 1993; Lothstein, 1999a). The finding of executive dysfunction syndrome was common in clinical interviews and neuropsychological testing. These men were impulsive and had poor judgment and limited insight. They were disorganized and had problems planning, could not anticipate the consequences of their actions, and were disinhibited and concrete in their thinking.

About 20%-25% of the priests and religious had been sexually, emotionally, or physically abused as children. A subgroup of them had been abused by priests or religious when they were children. Priests in this group often had serious alcohol or drug problems, were nicotine dependent, or had all these problems. About one third of our priest patients had a comorbid alcohol or substance-abuse disorder. As a group, many of our patients were psychologically, spiritually, and medically compromised. The majority of priests we treated who sexually abused minors victimized male adolescents. While homosexuality may be a risk factor for some priests abusing male teenagers, it is not the cause of that abuse. It is my opinion that male teenagers are at the highest risk for being victims of clergy sexual abuse. The next highest risk group involves adult females.

Case Vignettes

The following case vignettes represent a cross-section of the kinds of sexual behavior disorders that I evaluated over the past 16 years. None of the behavior reported here reflects or typifies the interests or behaviors of the vast number of priests who practice their vocation safely and professionally. Moreover, despite the serious sexual pathology of those priests reported here most of them benefited from psychotherapeutic treatment and a few even returned to active ministry.

The Priest as Sexual Victim

Fr. A had been sexually assaulted by a group of religious brothers when he was in elementary school. This abuse went on for several years. As a child, he shared an efficiency apartment with his mother and witnessed the parish priest sneak into her bed and have sex with his mother on a weekly basis over a period of years. He later entered the priesthood and soon began sexually assaulting a number of teenage males. This abuse went on for a long period of time and probably involved close to 20 teenage boys. Alcoholism was also involved. Eventually, one of Fr. A’s victims went on to abuse a child under his care. When that case was reported, the man committed suicide. The horrific cycle of abuse in this case was intergenerational.

Exhibitionism

Fr. E paraded around the rectory naked. When the weather was warm, he went outside and sunbathed in the nude. The rectory was adjacent to private homes located in a suburban environment. Occasionally, some of the neighborhood children saw him naked, and he would walk up to them and talk to them without any sense of humiliation, shame, modesty, or embarrassment. He had no clue to the effect he was having on the children. He viewed his behavior as his fundamental right of freedom of expression and did not want to be told what to do. Occasionally he stood nude at the rectory window. He was shocked when he was arrested for many counts of indecent exposure and risk of injury to a minor. He was angry that his rights were being violated. He had no empathy for the neighbors, the children, or the authorities and, in fact, had major problems with authority. He was narcissistic and had a sense of entitlement, lacked empathy, and revealed a psychopathic core to his personality.

Foot Fetishism

Fr. F was a psychosexually immature and nervous young priest. He was extremely anxious and had difficulty establishing relationships. Unable to engage in healthy adult relationships, he developed a foot fetish and was sexually attracted to women’s legs, feet, and hosiery. He enticed a group of teenage girls to allow him to play a game with them in which he pretended he was a shoe salesman and they would come into the store to buy a pair of shoes. He rationalized the game as allowing the girls, onto whom he projected his own anxiety, to feel less anxious in his presence. He enticed many girls to play the “shoe salesman” game with him.

In the game he would sit in front of each girl and ask her to put her legs in his lap. He then took off her shoes and massaged her feet while pretending to talk about buying a new pair of shoes. Excited by the girl’s stockings and feet, he would become aroused. At first, he tried to conceal his erection. Ultimately he put the girl’s stockinged feet on his crotch and rubbed back and forth until he ejaculated inside his pants. He pretended to the girls that nothing had happened. After ejaculating, he would congratulate the girls on being less anxious with him.

This game was repeated many times until two girls became frightened and reported him to their parents. Fr. F knew what he was doing was wrong but believed that the charade of the “shoe salesman game” somehow legitimized his needs. A very dependent, anxious man with a paraphilia, he lacked common sense, was psychosexually immature, and chose not to think about the consequences of his actions.

Cross-Dressing’ and Fetishism

Fr. CD came for an evaluation for suspected exhibitionism. During our interview, he admitted that he cross-dressed in women’s lingerie and had about 10 couples in his parish engage in a “sacred ritual” in which he would lie down on the altar, wear women’s lingerie, and have the couple engage in sex with him on the altar. At times there was some bondage involved. Although it seems incredible that he could have enlisted so many couples to participate in this “ritual,” he apparently did so quite successfully. He convinced the couples that, as an emissary of God, he could bring them closer to God’s love through this bizarre, fetishistic, ritualistic sexual behavior. Khan (1979) noted that perversion always involves an accomplice, and the cooperation of the parishioners suggests such was the case with Fr. CD. After engaging in these sexual practices, which clearly violated the Sacrament of Marriage and the use of the altar, each of the couples received Communion from him during the regular mass.

Spontaneous Emissions

Fr. SE was an immature and histrionic priest. When he was eight years old, his father had hit him with a baseball bat and fractured his skull. As a priest he became so excited in the presence of women that, whenever a woman came close to him, he had a spontaneous ejaculation, which both pleased and frightened him. A woman reported him to the bishop when she noticed that he had become aroused and ejaculated in his pants while he was talking to her. He did not have an integrated concept of sexuality and intimacy, and his only source of excitement was a brief, rapid ejaculation with all his clothes on. This case could involve disinhibition secondary to cerebral abnormality (a possible consequence of his father’s having hit him with the baseball bat). Unfortunately, the case was presented in an era when sophisticated neuroimaging was not available. He was, however, noted to have serious cognitive deficits on neuropsychological testing.

Transsexual Priest

Fr. TP had been struggling with his gender identity since childhood. He entered the priesthood to conceal his feminine longings and to wear priestly garb, which resembled dresses. He viewed his vestments and robes as courtly dresses. Over time he experienced intense longings to become a real woman, left his parish work, and underwent sex reassignment surgery. He is currently living as a female.

The issue of wearing cassocks and robes and other garments associated with female dress is occasionally brought up in the therapy of priests who have difficulty with their masculinity and are attracted to wearing these garments because of their association with the female gender.

Child Molester

Fr. CM was celibate until just after ordination. In his first parish, he was assigned to a youth ministry where he was surrounded by teenagers who were excited, joyous, overly emotional, highly sexual, and intensely involved with each other. The overall mood excited him and aroused him. He was jealous of the teens’ excitement, an experience he had missed out on his adolescence, having gone directly into junior seminary at age 14. He regressed to a teenage state: went to the movies with them, played video games, had pizza parties, and did everything he had longed for during his own adolescence. Although attracted to the girls, he feared having sex with them because “it would threaten my ministry.” That is, he feared falling in love, getting a girl pregnant, or being forced into marriage. Eventually he had sex, consisting of mutual masturbation while drinking beer with a few of the boys. He was arrested for violating sex statutes and risking injury to a minor. He rationalized that having sex with boys would not threaten his priesthood since women were not involved.

Other cases of child molestation involve a more aggressive, psychopathic pattern of behavior. In these cases, the minors are physically harmed and threatened and often sustain physical as well as emotional injuries.

Psychopathic Predator

Fr. PP’s case received a lot of newspaper publicity as his case was eventually brought back to court after a 20-year lapse and resolved with a long probation period after lengthy residential treatment. He was accused of having sex with a 13-year-old boy who then disappeared (Mason, 2003). The boy’s body was found, and the priest was questioned about his possible involvement in the murder. Because of the climate of the times, no one could believe that a priest would molest, much less murder, a child. Some 25 years later, the case was reopened and a criminal investigation was instigated to see what role Fr. PP might have had in the child’s death.

The priest’s demeanor frightened those around him. He seemed cold, calculating, paranoid, and self-protective. He had no feeling for the boy or his family. Clinically, Fr. PP presented as a cold, calculating, paranoid-schizoid individual who could dazzle parishioners with his wit and artistry but whose underlying personality structure appeared to be psychopathic.

Sexual Sadism

Fr. SS was excited by teens (16-19 years old) and young adults. He would befriend young men who were in the military and drink with them. Once drunk, he would challenge them to see how brave they were. He would have them take off their shirt, tie them up to a stake, and beat them with a whip on their backs. During the beatings, he would masturbate. A shy, withdrawn, troubled man, Fr. SS had no clue to the impact of his behavior on others. While he knew that what he was doing was wrong, he compulsively and ritualistically repeated his enactments until he was arrested.

Gay Cruiser

By the time he was 45 years old, Fr. GC had anonymous sex with more than 5000 men. He would travel from his parish to major US cities and cruise gay men. Eventually he would go to bath houses and group sex parties to participate. Fr. GC never contracted a venereal disease, despite having totally unprotected sex, both anal and oral, in which he was the recipient as well as the donor. He never had a genuinely intimate relationship and demanded sex while avoiding intimacy. During group therapy sessions, he sat stiffly and argued with other patients and once got into a swearing match with another priest who, in a paranoid narcissistic rage, had attacked him for not recognizing him and having dinner with him.

Child Pornography

Fr. CP used the Internet to secure images of young teenagers and prepubescent children who were naked or engaged in sex with peers or adults. Spending about eight hours a night on the Internet he would masturbate compulsively, often more than five times a night. Eventually, he used the chat rooms to arrange a meeting with a 14-year-old boy who turned out to be a 45-year-old male FBI agent. Fr. CP was arrested.

While these vignettes illustrate the broad range of sexually offending priests, the following case material offers a different perspective. The title of each case history points to the major cluster of personality traits that formed the basis of the priest’s offending behavior.

The Impulsive, Narcissistic Psychopath: “His Majesty, the Bahy”

Justus was adopted by parents whose reproductive failures had led them to adopt a child to prove that they were normal and apparently not barren. An only child, Justus was treated as an extension of his parents’ egos. He was overstimulated, overindulged, and emotionally abused by both parents, especially mother, who apparently used him to meet her own needs.

Justus was attracted to the priesthood because of the power associated with the role. He loved the pageantry, the garments, and the royalty of being called a priest. He loved the Roman Empire associations of the Roman Church and all the power, secrecy, and flair that went along with his ego ideal of a “priestemperor.” He viewed his vocation as one in which he could indulge all his unmet narcissistic needs to be admired as royalty. These beliefs also fed into his family romance fantasy that provided defensive compensation for his childhood family situation. Unconsciously understanding that he had been rejected, his assumption of the regal and powerful role of a priest allowed him to keep at bay the underlying experiences of inadequacy and being unwanted.

Becoming a Catholic priest never had sacramental meaning for Justus. It was a way of getting a job and a role that would enable him to receive the admiration and power that he longed for and lusted over (these were his words, not my interpretation). For him as priest, his consummate need was to entertain others socially in a lavish manner, to have money, dine out, and buy expensive bottles of wine. He viewed all this as part of his priestly entitlement. His daily work as a priest was drudgery. He was known by his superiors as someone who was “lazy” and could not be relied on either to begin or to finish a job. When he appeared in public, he looked more like a Roman emperor than a Catholic priest. All of his garments and symbols of priesthood were of the highest quality. He spared no expense to dress up like a priest.

In his personal relationships, Justus was demanding, exploitative, and impulsive. To avoid detection, he engaged in highly erotic sexual relationships with non-Catholic men. He was unable to achieve any genuine intimacy with men because he detested and feared any emotional closeness. He was in it for the sex and any favors, including money, that his lovers gave him. But because of his need to be seen and admired, he was very indiscreet in all his social liaisons, for instance, when dining and drinking. Over the course of his priesthood, Justus entered into a series of promiscuous, impulsive relationships that put him at risk for sexually transmitted diseases, and put the Church at risk for potential scandal if his relationships were made public.

Justus’s early object relations were organized along sadomasochistic lines in which women were viewed as treacherous and dangerous. As a priest, he was unable to minister effectively to women because he detested them. He said, “I can’t stand their odor.” Even during the Sacrament of Reconciliation, he was unable to function positively and affirmatively with women. He avoided women at all costs, except if they would cook or provide him with money. Most of the parishioners were women.

While in treatment, Justus behaved impulsively, stealing clothing and driving under the influence of alcohol. However, he was always rescued by the Diocese or a sympathetic Catholic policeman who tried to protect the Church and avoid scandal. Despite therapeutic interventions, his superiors never imposed on him any consequences for his actions. None of Justus’s behaviors were viewed by the diocesan officials as indicating serious enough flaws in character to warrant removing him from the priesthood. In fact, he had considerable support from his bishop and the Vicar for Priests, which allowed him to get out of some very difficult legal situations throughout his priesthood. This protective aura was viewed by Justus as expectable because of his assumption of “royalty and power.”

Treating Justus’s promiscuous sexuality entailed treating his narcissistic and psychopathic personality disorders and his use of narcissistic defenses. Any confrontation or clarification was interpreted by Justus as blame or criticism and led to battles in his individual psychotherapy. The therapist always had to be careful to support his fragile self-structure and provide him with mirroring and admiration as precursors to helping him repair his damaged self-structures. Justus was unable to use group psychotherapy because he felt superior to the other men. Moreover, he did not want to share the extent to which his psychopathic behavior revealed him to be a brittle, emotionally immature individual whom others saw as a “demanding child.” His treatment was abruptly terminated when Justus was transferred to another area of the country.

Justus’s belief system was highly skewed away from traditional Catholic moral doctrine. While Justus represents a minority of Catholic priests who sexually act out, he also represents a subclass of psychopathic priests who, owing to early object relational impairments, become priests in order to act out their narcissistic wishes. These men act out sexually in highly dangerous liaisons with total disregard for the safety of themselves or their religious communities.

The Frontal Dysexecutive Syndrome in the Impulsive, Disorganized “TBI” Patient

Another subgroup of Catholic priests who have sexually addictive or compulsive disorders, and are impulsive and disorganized in their relationships, resemble patients diagnosed with a Traumatic Brain Injury (TBI) or brain abnormality and act as if they are experiencing an executive dysfunction involving frontal disinhibition (Lothstein, 1999a). These patients may not necessarily have a diagnosable brain injury. They need a good deal of support and cognitive rehabilitation focused on stabilizing their emotions and modulating their impulsivity. This subgroup of priests is highly unstable and very likely to act out sexually. Clergy in this group are at the highest risk for relapse and recidivism. In many cases, these men are charming, highly verbal, engaging, but also extremely needy, emotionally dependent, anxious, and compulsive. Their neediness and dependency are core character traits to which others respond by trying to connect emotionally to them. Their typical style of acting out is impulsive, chaotic, and disorganized, and, even with much therapy, the risk for future acting out cannot be underestimated.

Claudius, a highly energetic and personable person, was very dependent and quickly developed attachments to everyone in his treatment program. He was the center of attention. Everyone loved him. Claudius exhibited instability and irrepressibility, which caused others to want to help him, and even coach him, on a daily basis. Very verbal and engaging, he often knew exactly what to say to another person to attract him or her, but he would quickly lose his ability to maintain effortful and sustained attention. So he would just move on to someone else.

He was impatient, erratic, impulsive, and inattentive. Whenever he was confronted by staff or patients, he assured everybody that he was safe, that he had learned a lot, that the program was extremely beneficial to him, and that he would never act out again. However, his acting out was always predictable and occurred when he was most needy and emotionally hungry for relationships. He acted out with minors and adults of either gender. He had no regard for the Sacrament of Marriage when he acted out with married women. He was so bold and fearless that he even had sex with some minors while their parents were in the next room.

Claudius’s immature personality often was rewarded by his victims who felt the need to rescue him and help him with his underlying deficits. At times, he was so behaviorally disorganized that parishioners would anonymously report him to his superiors about his engaging in behaviors that were inappropriate, high risk, and potentially damaging to others. His “victims” were highly vulnerable and often easy targets for the massaging, wrestling, and gross physical intimacies that frequently led to overt sexual encounters.

Claudius’s psychotherapy focused on crisis stabilization, emotional regulation through prescribed antiseizure medicine, and dialectical behavior therapies. Additionally, supportive individual and group psychotherapies were employed. He was helped to understand how his chaotic and disorganized sexual behaviors were part of his enduring personality and unlikely to change without structure, medication, and integrative, multimodal forms of treatment. In many ways, Claudius’s treatment was similar to the treatment of patients with TBI’s or those who were acutely brain damaged and had become impulsive and disorganized in their lives on all levels.

The “Groomer” and the Need, tor Immature Attachments

Another subgroup of priests who abuse minors engage in a pattern of grooming. They may spend long periods of time with the youngsters. They give them gifts, take them on vacations, buy them food, watch TV, play video games, and cater to the children’s interests. Eventually, the children become thoroughly “groomed” psychological partners who are vulnerable to being the priest’s sexual target. In most cases, the children go along with the priest since they have come to trust him, and they are unable to say no to the priest’s authority.

The grooming relationship involves an insidious, slowbuilding, and burning excitement in the priest and a delight in the child that an adult is finally listening to him or her and taking care of his or her needs. As time goes on, the child becomes an extension of the priest’s fantasy and acts as if he or she is in a hypnotic trance-state in which the sexual activity with the priest appears to be a natural outcome of the relationship. When the priest is arrested, he may turn the tables and blame the child for initiating the relationship and being seductive or a “tramp.” The grooming pattern is probably the most common form of child molestation among the nonpriest population.

In the majority of cases of priest-minor sex the abuse occurs with a teenager, typically a teenage boy who is distressed and highly vulnerable and who comes from a single-parent family or with no father psychologically present. Poverty and emotional and school problems frequently are evident. Often the mother or the parenting person is relieved to have the priest become involved with the child because she sees herself as unable to provide a male role for the boy. She views the priest as a life saver for her child; he performs the functions of a surrogate father and provides a role model for the boy to develop his masculinity. Relieved to have the priest take over some parenting functions, the mother does not question his motives when he invites the boy on a camping trip, takes him on an overnight to see a ball game, has a pizza party for him, or watches videos with him in the rectory on the weekends.

In the most notorious public case of a priest groomer Fr. Porter had sex with at least 125 unsuspecting children (Boston Globe, 2002). He was able to insinuate himself into the lives of children whose parents adored him because he rescued the parents from the enormous ongoing stresses of parenting.

Fr. JD-”Please stop me!”: A Plea to Help from a Sexual Abuser or Minors

Fr. JD turned himself into the police to put a stop to his cravings for prepubescent boys (usually of a specific background). He voluntarily entered treatment to curb his sexual impulses for latency-age boys. Although he had limited sexual contact with about three boys, he feared that his cravings were getting out of control. He entered treatment in a state of self-loathing for the harm he feared he had caused these boys.

In therapy, Fr. JD recalled a childhood of abuse and cruelty. He had been forced to work long hours on the family farm and was restricted from any playful contact with peers. Before and after school, Fr. JD was expected to work the fields and help his father with any chores. When his father decided to clear 10 acres of land, Fr. JD had to work until 10:00 at night cutting down trees by hand. Although his father had access to a bulldozer, he wanted to teach his son a hard lesson of life. Essentially, Fr. JD worked from 4:30 A.M. to 9 A.M. then went to school until 3 P.M. and returned to work the fields until 10 P.M. Some of his memories were particularly gruesome. He remembered witnessing his father slaughtering animals and castrating them.

In therapy, Fr. JD began to understand how his repressed rage at his father and his suppressed childhood had led to his acting out with boys. He realized he was linking his confused homoerotic impulses to his suppressed hatred toward his father and identification with the aggressor (although now the aggression was disguised as imagined “love” for the boys). After three years of intensive psychoanalytically oriented therapy, Fr. JD resumed an administrative form of ministry while he continued his treatment. He had no contact with children and his ministry focused on the poor and the homeless. Eight years into treatment he was safely practicing ministry as observed in close follow-up. Unfortunately, during the 2002 purges his name appeared on a list and he was summarily dismissed from ministry, although his last errant sexual act had occurred more than 15 years earlier, and he was sexually celibate and an effective minister. There are many men like Fr. JD who have benefited from treatment, but under a “zero tolerance” policy there is no room for exceptions.

“Men of the Flesh”: An Overview of the Problems

As is clear from these vignettes, there is no single profile of the so-called pedophile priest. Indeed, there are no reliable statistics on the number of priests who act out inappropriately with minors or with people under their care. There are only estimates suggesting that between three and eight percent of Catholic clergy act out with minors. Only a solid research methodology can address the incidence, prevalence, and phenomenology of pedophilia/ephebophilia among Catholic and non-Catholic clergy (Dornalas et al., 1966). I was among those initiating such a research proposal to the United States Conference of Catholic Bishops in 1991, but the Conference eventually withdrew its support in 1996 because of fears that anything we would learn about priests’ sexual acting out might be subject to disclosure in court. Their unwillingness to define and characterize the sexual abuse of priests through professional studies was unfortunate and deprived the Church, victims, and researchers of potentially valuable information.

In 2002, the American Council of Catholic Bishops, under pressure from many sectors of the church, appointed a lay board (the National Review Board for the Protection of Children and Youth) and appointed former governor of Oklahoma Frank Keating as board chairman. The board consisted of 14 prominent Catholics (six of whom were women) with the mission of studying the causes of the sex abuse crisis and assisting the church in implementing policies (Donovan, 2003). Just prior to the convening of the June 2003 meeting of the bishops, Cardinal Mahony asked for Keating’s resignation after he accused Cardinals Mahony and Egan (among many but not all the bishops) of engaging in stalling tactics, refusing to respond to their inquiries, and sabotaging the work product by engaging in secrecy and the equivalent of conspiracy.

Using the definition of pedophilia in its strictest sense-having recurrent, intense, sexually arousing fantasies, sexual urges or behaviors involving sexual activity with a prepubescent child or children, generally age 13 or younger-I agree with Jenkins (1996) that the incidence of actual pedophilia is probably no greater in the Roman Catholic priesthood than in other religions. However, the incidence and prevalence of ephebophilia-having recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving sexual activity with pubescent teens-does appear to be extremely high among a subgroup of Roman Catholic priests.

The majority of Catholic priests who act out with underage males do so with teenage boys (Lothstein, 2002). Only a small percentage of priests and religious (about two to five percent) who act out with minors act out with prepubescent children. There are about 45,000 priests in the United States of whom between three to eight percent (1350 to 3600) have been involved with minors, usually males. Another group of priests, whose numbers are unknown, have been involved with female parishioners. I treated three priests who fathered children.

Conclusion

As can be seen from some of the clinical vignettes, the treatment of sexually offending Catholic clergy cannot follow a unitary course. The problems even within a group are heterogeneous, and treatment needs to be tailored for each individual patient. Some treatment issues in cases of sexual offenders resemble those associated with cognitive distortions and thinking errors in the addiction disorders; denial, minimization, and rationalization of one’s actions are major aspects of the priest’s selfpresentation. Other issues for treatment include focusing on the priest’s history of chronic social maladjustment and lack of appropriate social skills in dealing with adults; problems with affect regulation, and, more specifically, anger management and the expression and experience of appropriate levels of anger.

Treatment of a sex offender begins with a cognitive behavioral and psychoeducational approach involving group treatment in which the offending priest can develop new skills including victim empathy (Schwartz and Cellini, 1995). First, cognitive distortions regarding the inappropriate sexual behavior are brought to an awareness, and empathy for the victim is taught and integrated into the self and appropriate social skills are noted (Twerski, 1977). Then the priest can enter into a more dynamic psychotherapy, often taking a group format in which the multiple layers of self are analyzed and worked through so that a more complete relapse prevention program can be maintained (Laws, 1989; Lothstein, 2001), thereby guaranteeing the safety of both the clergy and society. This type of treatment often takes at least five years (Lothstein, 2001).

In the next decade we will have additional tools to measure and investigate sexually offending behavior. The development of sophisticated quantitative EEG, computerized brain imaging, and, more recently, functional MRI are enabling us to understand better some of the more important neurological underpinnings for sexually offending behavior. We are moving away from such primitive methods as the penile plethysmograph into the more sophisticated world of functional neuroimaging of the biggest and most important sex organ, the brain. We are just beginning to understand the neurological underpinnings of addiction, such as denial. And we are only now beginning to recognize the role that cerebral abnormality may play in many of the sexual deviations involving compulsive and addictive sexual acting out. Future assessments of sexually abusing clergy and priests may include functional magnetic resonance imaging to explore how cerebral abnormality may contribute to errant sexual behavior. While we know that many priests need to be treated with mood-stabilizing medication to help to control the “brainstorms” that often lead to erratic and chaotic sexual behavior, we are still at a primitive level of understanding the exact relationship between brain and behavior.

Elsewhere I have argued for an integrative approach to treatment for sexually addicted and compulsive persons, including clergy (Lothstein, 2001; Lothstein and LeFleur, 2002). The approach is a multimodal one focusing on group therapy but also employing individual and family treatment, and, when necessary, a complex array of psychopharmacological and medical agents; close supervision of the clergy’s medical disorders; and intensive interpersonal and psychodynamic group psychotherapy following a successful course of treatment using the cognitive behavioral and psychoeducational techniques I have described. While the issue of whether or not a priest who has sexually abused a minor or has a sexually addictive/ compulsive disorder can be returned to the ministry is a complex one (Lothstein, 1991), under no conditions should a priest who abused a minor ever work in a parish, community, or hospital setting with minors. As reported in one of the case vignettes, while psychotherapy may be effective in resolving underlying conflicts that led to the acting out in the first place, it has become a de facto church policy to seek laicization for any priests accused of sexual misconduct.

One can well imagine the enormous psychological investment of the priest clergy and the financial investment necessary to carry out the treatment recommendations I have outlined. However, when one views the potential cost to society and to the victim when somebody acts out in a sexually inappropriate way against minors, the cost of treatment is negligible. We must hope, though, that one day these “Men of the Flesh” will be helped with therapy to truly become “Men of the Cloth.” I have had the opportunity both to treat and to supervise the successful treatment of errant clergy and hope that a more reasoned approach to the problem will replace the current practice of church officials to employ one standard for all clergy, despite clinical material suggesting that such an approach may be too harsh.

It is my opinion that, if real change is to take place, it must be systemic. Catholic moral theologians need to develop a developmentally and scientifically appropriate narrative of human sexuality for parishioners and clergy. Unless this support is forthcoming, we will continue to see perverse sexual enactments among a subgroup of clergy and a policy of coverup by those bishops who are more concerned with preventing scandal than with reaching out to the traumatized parishioners and their families. Until a healthy sexual narrative is established, we will continue to see faith communities become devastated by a combination of a clergy’s sexual mayhem (the enactment of a perverse scenario) and the coverup by the church hierarchy (Sipe, 2004).