Soon after I joined the faculty of the Department of Psychiatry at Dartmouth, the Chairman announced that he needed someone to teach a course in sexuality. My resume included a paper I had written at the University of Illinois where I had seen a few students who were too anxious to urinate in public restrooms. It was pedantically entitled "Psychophysiologic Disorders of Micturition." The Chairman thought that was close enough, so I got the job as sex expert. My wife and I did take the appropriate training, receive the appropriate supervision, and became the Masters and Johnson of New Hampshire.

When I later went to work for the New Hampshire Department of Corrections, the Director had a number of sex offenders in custody. With "sex" as the common denominator, that was again close enough and I became the sex offender expert as well. We went on to start New Hampshire's first sex offender program.

Having worked with both victims and abusers, I gathered the available data in Understanding Child Sexual Abuse, which was published by the University Press of Mississippi in March 2006.

For me, the most worrisome aspect of the child sexual abuse debate is the "one size fits all" characterization of both victims and abusers. To expect that every child who is abused will be scarred for life, or that every perpetrator should be locked up forever, does a great disservice to those who do not fit that stereotype.

There are four important points to consider in understanding the dynamics of abuse. First, true pedophiles believe that children are sexual objects, and they are sexually aroused only by those objects of their desire. Secondly, they identify emotionally with children. It should come as no surprise that most abusive priests are of a generation that went into minor seminaries when they were about twelve years old, and their sexual development stopped at that age level. Third, pedophiles usually fail to develop satisfying sexual relationships with other adults, and fourth, they are unable to control their sexual impulses or are somehow prevented or protected from doing so. Such true pedophiles should indeed be locked up or monitored closely in the community because their orientation will not change, and they present a significant risk of re-offending.

Other abusers are not true pedophiles and have many different dynamics. Consider, for example, a man in the process of divorce, depressed and drinking heavily, who touches a babysitter inappropriately. He has clearly done wrong, but he stands an excellent chance of rehabilitation once circumstances change, and a long incarceration would serve no useful purpose.

The vast majority of identified sex offenders are men. Female offenders tend to be controlled by dominant male offenders; however, female teachers who have sexual relationships with adolescent male students need to be studied in greater detail.

Each offender must be assessed individually, and a treatment plan developed that will balance society's need to punish the offender, with the potential ability to return a productive person to the community.

The same individual attention must be given to children who are sexually abused. One common stereotype is that such abuse invariably results in post-traumatic stress disorder. This constellation of symptoms includes re-experience of the traumatic event, avoidance of stimuli associated with the trauma, and an increase in agitation. Shattered trust, guilt, and feelings of worthlessness are also common. These symptoms can respond to appropriate early intervention and long-term therapy. Recovery can be achieved. While potentially devastating to those affected, such traumatic responses actually occur in only a minority of cases.

Resilience is different from recovery. Individuals with a strong sense of self may essentially say that bad things happen to good people, and then be able to go on with life. For family or community to expect that these individuals will act like victims is counterproductive. Granted, some of those who are abused may repress the trauma and push it out of conscious memory. Such hidden memories may remain inaccessible, be triggered by another trauma, or emerge when the person is more able to address them appropriately.

A real tragedy that has evolved from the concept of repression has been the phenomenon called "recovered memory" by advocates and "false memory" by detractors. It must be tempting for therapists to attribute any and all psychopathology to "you must have been sexually abused as a child." Such a powerful suggestion and "guided discovery" of such "memories" of abuse created "victims" and "abusers" where none exist. This can have devastating effects on a family.

Currently, a great deal of work is being done to clarify the true incidence and prevalence of abuse, and to understand the neurochemical changes that occur after trauma or that predispose an individual to a particular response to that trauma. These studies may lead to more effective interventions and a better understanding of resilience.

In an ideal world, child sexual abuse would be preventable. Unfortunately, stereotypes again come into play. "Stranger danger" is overemphasized, as the vast majority of abusers are known to their victims. A sex offender registry may help a community to feel safer; however, a register that fails to differentiate behaviors can lead to tragic results. A good example of this was the young man on the Maine register who was killed by a vigilante. His crime had been that, as a teenager, he had sex with his underage girlfriend. Background checks for any adult participating in a youth-oriented organization may provide some security; however, a greater emphasis on implanting the mantra to "resist and report" or "say 'no' and tell someone" as part of a comprehensive sex education program in schools remains an ideal by elusive goal.

One might think that a book that is published by a university press, includes a list of every state agency to which one should report suspected cases of child sexual abuse, and was reviewed positively by Publisher's Weekly would never be considered as offender-friendly. However, if one is running for even a minor public office, any published words can be taken out of context. "The Committee to Protect Children Against Abuse", actually the Republican Town Committee, had a field day quoting my comments about false memory as applying to all offenders and defining those comments as immoral. Unfortunately, the voters didn't buy the book to check the context, and I lost in a close race. The socially conservative position that "my mind's made up; don't confuse me with the facts" had one small victory here, but the Democrats swept New Hampshire anyway. There really is hope for the future.

(Ed's email address is ejrowan@comcast.net.)