Child pornography is produced at the psychological expense of the p h o - lographed child. Child pornography is defined as photographs, films, videotapes, magazines, and books thai depict children of either gender in sexually espiici! acts. Since 1978. federal and state statutes have been strengthened to protect children from this type ol exploitation, with 24 stales protecting children through their eighteenth birthday, four states through the seventeenth birthday and 21 stales through the sixteenth birthday.1
Clinical work with children involved in sex rings has provided insight into the negative impact of child sexual abuse on the cognitive, psychological, and social development of the child victim.2 In a study of child sex rings that operated between 1976 and 1978, 2 and of child pornography rings that operated between 1978 and 1981,' we defined the type of ring by the number of adulls involved and by their sexual use of the children.
A solo ring, consisting of one adult who is sexually involved wild small groups of children, has no transfer of the children or of photographs to other adults. A syndicated ring includes several adults who form a well-structured organization for the recruitment of children, the production of pornography, (he delivery oi direct sexual services, and the establishment of an extensive network of customers. In a transitional ring, there may be more than one adult involved with several children, but the organizational aspect of the syndicated ring is missing. However, the transitional rings move toward the organization of the syndicated ring; for example, pornographic photographs may be sold.
The close examination of one transitional sex ring reveals how group dynamics and individual participation in the ring combine to impact the ring's young victims. After pleading guilty Io 31 charges stemming from sexual assaults on boys whose ages ranged from 8 to 17, Mr. A. a retired, 71-year old electronics technician and scout leader, was sentenced to a 151-year prison sentence. Police had seized color photographs of the victims participating in various sex aets. Ten months later, 21year-old Mr. K was sentenced to 16 years in prison for his part in sexually abusing the boys. Mr. K testified during his own trial that after he had turned 18. Mr. A blackmailed him imo having sex with the boys at Mr. A's home. Mr. K testified that Mr. A had sexually explicit photographs taken of Mr. K at age II.
A civil suit was filed by the parents of the 15 boys. It alleged that the scouting organization knew or should have known that Mr. A had been molesting boys for several years and that when some oi' the parents had complained to officials at the school sponsoring the troop, no action was taken to correct the problem.
The data for this article were derived from several sources: interviews wilh the 15 victims anda series of drawings completed by each boy,4 results of the Nadcr & Pynoos Child Post-Traumatic Stress Parent Questionnaire (University ol Calilornial-os Angeles. School ol' Medicine. Department of Psychiatry) administered to parents, and clinical summaries of each boy, Elements of child sexual abuse, sex ring dynamics, acute symptoms, and adaptive behavioral responses and treatment issues are all discussed.
ELEMENTS OF CHILD SEXUAL ABUSE
Sexual encounters between adults and children usually fall into a predictable pattern and include the following elements: access to and sexual entrapment of the child by the adult; isolation and secrecy of the sexual activity; the sexual activity itself; encapsulation by the victim of the abuse; and disclosure of the victimization, which includes shorland long-term outcomes and the impact on the victim.
Access and Entrapment
The sexual abuse of a child is consciously planned, premeditated behavior. The adult offender is usually someone known to both the child and the parent and who generally has access to the child. After gaining this access, the offender lures the child into sexual activity, using the power and authority that adulthood conveys to the child as well as misrepresenting moral standards.
In the case of Mr. A, the offender was not only an authority figure (a scout leader) . but was also nationally recognized for his community service. So highly regarded was Mr. A that parents encouraged their sons to stay in scouting with him even when the boys might not want to continue.
Isolation and Secrecy
When offenders are successful in abusing children, they must conceal their deviate behavior from others. Usually they try to pledge their victims to secrecy as a way to strengthen power and control over the victims and to perpetuate the sexual activity. The victims usually keep the sexual activity secret; some children never tell anyone. They may fear that people will not believe such behavior, that people will blame them for the activity, that there will be parental punishment for disclosure, and that the offender will carry out the threats.
All of these elements were present in the case of Mr. A. Usually the victim was ordered not to tell anyone ("this is our secret"); it was clearly implied that telling would be disastrous ("we'll both be in big trouble."). For many of the boys, this message meant they too were responsible for the sexual activity, and thus the stage was set for tremendous feelings of guilt when the ring was disclosed. The power of the offender was tested when one boy told a parent; authorities who were notified by the parent discouraged any criminal action ("H is your boy's word against the word of an esteemed adult").
There is a wide range of sexual behaviors that may occur between adults and children, behaviors that may involve psychological pressure and/or physical force. There may be a slow progression of acts, perpetrated with the characteristics of sexual seduction, or the sex acts may be forceful and sudden.
Mr. A gained sexual access often on the first or second meeting by surprising the victim. In one instance, a boy described being asked if he was "body shy." The boy, wanting to be selected for a special dance troop and knowing he would have to change his clothes in front of other boys, replied that he was not. He then removed his clothes in front of Mr. A, assuming he was going to wear a costume as promised. Instead, Mr. A fondled the victim's genitals and orally copulated with him. The boy became immobile; his response was fright and confusion. His body tensed "like it does watching scary movies."
In other instances, the boys were intimidated into the sexual activity, as in the following account:
On my first visit to Mr. A's house, 1 saw boys sitting around in lhe bedroom smoking cigarettes and using a vibrator. I left to watch TV until the boys came out of the bedroom. The next day I was invited back and refused. Then one of the boys said thai if I didn't [go with them] I'd be beaten up and hurt, so I wrote a note to my mother that 1 was going Io Mr. A's. At his house, two of the boys picked me up and carried me into the bedroom. They started taking off my clothes. I struggled and told them to leave me alone. Mr. A came in. and 1 got really scared. Two hoys were holding me clown. Mr. A started unbuttoning my pants. 1 bit one of the boys, and he ran out. 1 locked myself in the bathroom. Then one of the boys said thai one of the parents was there to take us home. 1 sat in the back of the station wagon. I was scared, f didn't tell anyone. One of the boys said he would beat me up if I told. Later that day. I was riding my bike around, and one of the boys knocked me off and asked why I had bitten him. 1 said it was in selfdefense. He hit me on the arm and knocked me off my bike. Every other day Mr. A would stop to get me. 1 didn't know what to do. 1 didn't think my parents would be able to do anything. Three or four times later, the boys dragged me into Mr. A's room and used the vibrator ?p me. They held me down, look off my clothes, and then used their mouth on me. All the boys were doing it. They would get magazines and look at the sexy pictures and IaIk about [sex].
Interspersed in the description of the sexual activities, the young victims reported pictures being take of them. They were often puzzled and perplexed not on/y by the acts but by their awareness that they had been recorded on film.
As the sexual activity continues, the victim becomes isolated and trapped in the sexual activity. The child is forced to participate, yet also forced to be silent. Victims become confused over the use of power and authority. As the abuse continues, their beliefs about sex between adults and children shifts from wrong io right. Some think they can intervene and stop the abuse ("I thought once I got in the dance team, I could get him to stop the sex."). But the confusion continues ("he asked the other kids lo do it to me ... I just stopped thinking"). At this point, the use of photography further binds the victim by normalizing the acts and by blackmailing the child.
When child sexual abuse is discovered accidentally, a third party may have become suspicious or observed activities or symptoms and behaviors in the child. In purposeful disclosure, a child consciously decides to tell an outsider or parent about the abuse. More often than not, the victim's first attempts at disclosure include revealing only some of the abuse. When disclosure occurs, the child must deal with the reactions of people (ìe, parents, friends, authorities) ?? the abuse. It becomes important whether people believe the victim, understand the victim's confusion and fear, and take protective action on behalf of the child. The child may be pressured not to tell and attempts may be made to undermine the credibility of the child. If the case is prepared for legal action, the child's age and consent will become an issue.
In the case of Mr. A, police were notified after a victim told a parent. Subsequently, a father talking to his son about sex learned the boy already knew about sex from Mr. A. Gradually, parents heard about the abuse, and authorities could no longer ignore the complaints. The boys were terrified of disclosure and of people knowing about the abuse ("will I have to go to reform school for this?"). Thus, when some of the boys were interviewed by detectives, they initially denied any knowledge or participation in the sex ring. However, one father identified his son's participation in the ring through the photographs that had been discovered. This observation not only had an overwhelming impací on the father, but it was humiliating for the son when talking to his father.
SEX RING AND PORNOGRAPHY DYNAMICS
The organizational structure of the ring included the adult offender, Mr. A, and a secondary partner, Mr. K, who at age 1 1 was a victim of Mr. A. The victims were recruited from various scout troops as well as from a troop of handicapped boys led by Mr. A. Boys were encouraged to recruit their brothers into a special Indian dance troop. Photographs of older boys were used to solidify the neophytes' participation in the ring activities.
A critical element in the organization of the ring was the fact that many of the boys had characteristics that set them apart from other boys their age. Some of the characteristics were social (feeling lonely due to an absent father), cognitive (reading problem due to learning disabilities), and physiological (impaired motor coordination due to cerebral palsy or muscular dystrophy). Feeling thai they were "normal" was important to these boys. Exploiting this need, the offender verified that each victim's sexuality was intact. He especially commented on the boys' sexual organs, using such adjectives as "big" or "pretty" to describe the penis. One boy confined to a wheelchair was told how he would be able to impregnate a woman and have his own physically normal children. Although the sexual activity in the ring was homosexual, the offender avoided drawing attention to this. Instead, he focused on the boys as sexual beings initiating them into autoerotic acts as well as into peer sex and adult-child sexual activity.
The offender gained access to the boys because his presence wilh them was not questioned; he held legitimate power with the parents as well as within the community. Boys described Mr. A in positive terms: "He was nice and understanding; if you wanted something he would give it to you." Parents described Mr. Aas acting "like a second father" and "wonderful to the boys."
Mr. A befriended the fathers of his victims. The fathers of the handicapped boys reported that Mr. A cared about their children who were shunned and neglected by the mainstream. It is not surprising that he was held in high regard.
Victims were made aware instantly that sexual activity was part of the group membership. They observed boys having sex with each other, and they saw Mr. A having sex with the boys. Pornographic magazines and pictures of the groups were plentiful in the bedroom where the activity occurred and sexual aids (vibrators) were available. Sexual activity became the norm for the group; to participate was to guarantee membership; to refuse was to be isolated.
Ritual, in the form of the Indian theme, was a strong binding element in the ring. The boys were told they could be in a special order that had such privileges as going out at night, playing the Indian hunt game, and performing in pageants. Authentic leather Indian costumes and moccasins were used in combination with body paint and feathered headdresses. Several Indian dances were favored :
* The Big Brother Danee, in which a little brother defies his big brother's instruction to leave and hides under the big brother's Indian skirt;
* The Buffalo Dance; which involves a hunt and the killing of animals;
* The Death Dance, during which the old chief dies and the young warriors spear each other to death in a battle to become the new leader.
Mr. A used Indian story telling to glorify sexual acts, varying the stories to match the interest of the boy. He also told of his own experiences as a scout having sex with other boys, with an adolescent girl, and with various women. The message of these stories was that males could bond together sexually in brotherhood, but sex with females involved conquest, power, and procreation rather than tenderness and caring.
Bonding through brotherhood, which included fear and coercion, was a key factor in the continued operation of the ring. The eohesiveness of the boys guaranteed continuity in and submission to the sexual activity. Peer pressure contributed to developing group loyalty by providing lonely boys with a peer group and pressuring these boys to earn peer approval ("all the boys were doing it").
Mr. A used several means to keep the sex ring and pornography secrel. These include the following:
* Body response. Physical sensation and excitement was the dominant pleasure element that kept the boys in the ring. Its homosexual aspect made the boys fearful of exposure.
* Threat of retaliation. The boys believed they would be held accountable for the ring activities, especially as part of the group membership involved recruiting younger boys into the ring and having sex with other boys.
Symptoms Described by Parents and Victims of a Transitional Child Sex Ring
* Fear and intimidation. Several of the boys who were abused and controlled by older boys felt they were being watched wherever they were and believed they would be beaten if" they revealed the abuse. They were threatened with bodily harm and with their houses being burned.
* Blackmail. The boys were photographed in the nude, participating in sex acts and using alcohol and cigarettes. The photographs were used as blackmail.
Various covert indicators of attempts to break away from the ring were noted in some victims. Some acted up at home, which resulted in parents' restricting their activities in scouting. Some boys would attend large-group scout aclivities, but not activities involving Mr. A. Some boys told their parents; others were able to stop participating. One boy, observing Mr. A having sex with severely handicapped boys, thought to himself, "Mr. A is really sick to even think of doing that to a totally helpless kid," and abruptly left the troop.
ACUTE SYMPTOMS AND ADAPTIVE BEHAVIORAL RESPONSES
A two-year follow-up study of children exploited through child pornography and sex rings,3 and a sixro-eight year follow-up study of 34 of these former victims.' have provided the clinical observations that are the basis for an understanding of acute symptoms and adaptive behavior responses of sexually exploited children.
Because many of the symptoms and behaviors come to the clinician's attention without disclosure of childhood sexual abuse, it is important for clinicians to evalúale for unresolved sexual abuse. The report of an abuse history suggests that the victim's symptom complex may be best understood under the diagnosis of chronic or delayed post-traumatic stress, rather than under other psychiatric diagnoses. This differential diagnosis is particularly important in dealing with acute dissociative states that may be labeled as schizophrenia and in evaluating somaloform disorders, anxiely states, alcohol and substance abuse, and the categories of borderline and antisocial personalities and the paraphilias.
In the case of Mr. A, symptoms and behaviors of the severe distress experienced by the boys were exhibited both before and after public disclosure of the ring. Symptoms described by the boys and their parents are summarized in the Figure.
The repetitive, secret nature of the sex ring activities resulted in the victims' dissociation and compartmentalization of the event: "This isn't really happening . . . Fm not really there . . , Others do not know this is occurring." Inherent in such dissociation is cognitive confusion. At some level, the victims knew the activities were wrong because they had to be kept secret.
Further along in the victims' dissociation is the unconscious integration of the victimization, which leads to the mechanism of splitting. Splitting is manifested in components such as body states and cognitive states. In this case, splitting was noted in the sexual abuse; although the boys were humiliated by the rapes, they were bound to the activities. In addition, social relationships external to the group were disrupted. Rather than developing normal, trusting, social bonds with others, the boys bonded to the sex ring and to the homosexual activities. The boys were afraid of being socially ostracized by nongroup members if their secret activities were made public. Their bonding to the group was increased by the fear and anxiety over exposure. Within the group, they had to find means to cope with acts that compromised their sense of decency. Isolation from the large group increased the value of patterns of recognition and specialness within the group. Emphasis was placed on sexual expression regardless of its impact on others. The boys had a oua] iife, cut off from their sensitive and caring responses.
Splitting also occurred in the boys' control over themselves and their environment. Self-protection was inhibited, and adult protection was nonexistent. Because the victims could not assert themselves, their aggression became displaced. Thus, anger and aggression were noted in symbolic and/or inappropriate behaviors. These victims are now afraid of adult males because they initially could not protect themselves, and, lhey could not depend on the male social order (ie, fathers, teachers, police) to protect them, Rather, their view of adult males is that they sexually exploit young male children. Because human behavior tries to master fear, there is a risk for some of these victims ?? identify with Mr. A by acting out sexually with younger boys and girls. Mr. A fostered such behavior by having Mr. K be present for the ring activities and by encouraging peer sexual aggression, which added to the victims' confusion. At another psychological level, some of the boys exhibited rage against women, suggesting displacement of their anger that women (ie, mothers) do not protect men from one another.
The victims repeatedly reenacted rescue fantasies and their need to be protected through suicidal attempts and psychiatric hospitalizations. Their drawings were filled with failure and death themes. In the drawings, trees were diseased, dead, or dying; one drawing depicted a hanging noose; people were often absent.
The victims expressed the underlying fear and anxiety generated by the sexual exploitation by aggressive acting out and by avoidance and withdrawal. Both patterns were present. In the context of the sex ring the victim can project aggression by copying the aggressive behavior of the adult molester and of dominant, aggressive children in [he ring. The child also can project and act out passive, submissive behavior in response to aggressive behaviors from others in the ring. Because of the ring's social organization, some children will assume a passive role (but learn aggression) over a period of time, while others move more quickly into the aggressive roles and inhibit and suppress their submissiveness. They gain a sense of mastery and superiority by not being concerned about the fear, pain, humiliation, and degradation of another person. This denial of their victim role allows them to repeat the abusive behaviors to others.
The first treatment issue in assessing a troubled child or adolescent is, as mentioned earlier, the careful evaluation for unresolved childhood sexual abuse. Identifying sexual abuse trauma and ils relationship lo symptoms and behavioral pallerns is erilical to accurate diagnosis and treatment planning. If a diagnosis of chronic post-traumatic stress disorder is made, the next treatment issue is to evaluate the dominant character organization of the youth and to appreciate its cognitive defensive structure. The clinician, by working within the context of that defensive structure, can confront the behaviors aimed at blocking thoughts and reasoning that inhibit the individual's capacity to express vulnerability. This vulnerability is rooted in fhe abuse experience and documented in the pornography and is psychologically experienced through humiliation, betrayal, and powerlessness. In addition, the abuse is embedded with social responses of being blamed and being told that the activities were asked for or wanted.
For patients with unresolved sexual abuse who are in treatment, sexual acting out and sexual abuse of others must be evaluated for its defensive aims as well as its grounding in identification and modeling. In the latter, sexual and aggressive arousal dominate the behavior. Children who have been repeatedly sexually abused have adopted both passive and aggressive behaviors regarding sex, Treatment will require resolution of the unresolved trauma and integration of aggressive and avoidant patterns.
Treatment of the internalizing victim is complicated by the victim's unconscious identification with the aggression and the split from vulnerability, tn addition, lhcre is conflict in terms of right and wrong, assertiveness and aggressiveness, and sexuality and deviance. These young victims experience guilt, and it is important to help them review how they decided to survive the experience, their reasons for continuing the participation, and their recruitment or abuse of other victims (Nader & Pynoos Child PTSD. Parent Questionnaire. University of California-Los Angeles*). Clinicians need lo be u ware of the suicidal idealion, depression, and substance abuse.
Treatment of externalizing victims is complicated by having to deal with the aggressive manifestations of their experiences. In the case of Mr. A, five of the boys became involved with juvenile authorities b e f o r e the youths reached age 15. Clinical issues involve the youths minimizing the consequences of their victimization, their loyalty to the adult perpetrator, and their distrust of authority. As they manage the victim's process of working through the sense of victimization and exploitation, clinicians need to be aware of the potential for the acting out of sexual deviance both internal and external to the transference relationship.
A third treatment issue concerns the disclosure aspect of the abuse. Disclosure confronts males with issues of bisexuality. Gender identity, sexual preference, and sexual peformance are key clinical issues. The offender may have told male victims they would be able to function sexually with girls, but with disclosure they are confronted with their homosexual activities. Suicidal attempts may be seen as a way to gain relief from their confusion. In this group of 15 boys, four made overt suicidal attempts and six were psychiatrically hospitalized for extended periods. In one case, the youth was so frightened of any sexual assertiveness on the part of his girlfriend that he became impotent unless he was the initiator of sexual activity.
The treatment issue of parental protection is important, as the usual role of parents being able to protect has been disrupted. Parents did not know about the abuse, and thus could not stop what was occurring. Safety for the victim becomes critical tn the treatment relationship. Parents need to understand the symptoms of withdraw! and aggression toward them is predicated on the victim's disillusionment with the parents' ability to protect.
In summary, a treatment protocol focused on the abused child includes knowledge of:
* Measures for assessment of cognitive, psychological, and social functioning;
* The impact of the victimization experience in terms of the individual and his or her social network;
* Strategies tor confronting avoidant and actingout responses of the child and for addressing the sexualization of relationships and the acting out of the deviant patterns ;
* Techniques for establishing a strong alliance with the family or social network throughout a varied and often lengthy treatment contact.
1. Burgess AW (ed): Child Pornography and Sex Rings. Lcxington, Massachusetts. Lexington Hooks, 1984.
2. Burgess AW. Gruth AN. McGuislund MP: Child sex initiation rings. Am J Orthopsychiatry 1981: 51(1):110-119.
3. Burgess AW, Hartman CR. McCausland MP. et al; Response patterns in children and adolescents exploited through sex rings and pornography. Am J Psychiatry 1984; 141:5.
4. Burgess AW. Hartman CR. Wolhert WA. et al: Child molestation: Assessing impact in multiple victims (Part I). Archives of Psychiatric Nursing 1987; 1(1):33-39.
Symptoms Described by Parents and Victims of a Transitional Child Sex Ring