Thursday, May 02, 2013

A Conversation With: Psychiatrist Dinesh Bhugra, Expert on Deviant Sexual Behavior

Reports of rapes of very young girls continue to surface in India, appalling citizens and sparking protests. On Monday, a 4-year old girl died from injuries sustained after she was raped by a grown man and left near a crematorium in central India.

Ten percent of all rape cases in India in 2011 involved children below the age of 12, but “pedophilia,” defined by the American Psychological Association as a recurrent sexual interest in prepubescent children, is not even part of the discourse in India, social scientists and medical practitioners say.

Sexual molestation of children overall is vastly under-reported in India, they say, since much of child sexual abuse happens within the context of families. Little attention is given to studying the perpetrators of such crimes, often believed to be pedophiles, or men who experience persistent thoughts, fantasies, urges and sexual arousal involving children.

India Ink spoke to Dinesh Bhugra, a psychiatrist and professor of mental health and cultural diversity at the Institute of Psychiatry at King’s College London, to understand what research about such behavior in other countries has revealed, and his own experiences of working with people with pedophiliac tendencies.

Dr. Bhugra has authored a paper on sexual attitudes and practices in North India and has studied sexual behavior across several cultures. His clinic in London also handles patients referred by the courts who are charged with crimes involving pedophiliac acts.

Q.How can we explain sexual attraction to children in India?

A.Work done by an American sociologist, Vern Bullough, divides cultures into ‘sex positive’ and ‘sex negative’ cultures. Sex positive cultures are those where sex is seen as a positive activity where people enjoy sex, and procreation is seen as a byproduct rather than the main function. In sex negative societies it is the other way around: sex is purely for procreation and not for pleasure. What he said was that Indian culture was sex positive for centuries, but post-Mughal and post-British rule it became much more sex negative.

This indicates that sex is not about pleasure but about control and power. Particularly for men who come from poorer backgrounds, it could be the only way to demonstrate their power, by taking control of young girls, of women and of children.

But it is also true that there are people who are almost sort of biologically attracted to younger children. Nobody has come out and said that a brain lesion is what causes it, but there is some suggestion that there are neural networks in the brain which do not function properly in such cases.

Q.You have spoken about social control and power, what role does sexual pleasure have to play in such acts?

A.It is part of it, because there are people who do not force but still have sex with children — there is a whole child-sex industry in the Far East and in Thailand and also in Sri Lanka. Lots of people from the West go there.

Then again people have specific urges – there are templates of what turns people on – blond boy or dark-haired girl or dark skin or light skin. So there is that element, but in terms of rape it is more about control or power, so sexual pleasure becomes secondary under those circumstances.

Most people will have sexual fluidity, in that they can be interested in more than one outlet. But there will be others who will be exclusively attracted to children.

Q.What are the implications of suggesting that it is a medical condition?

A.Some people do argue that it is a biological impulse but it is a very sensitive issue – if you say it is biological then you can say that it is not in my control, I was born this way. That sort of puts it into an entirely different complexion. And in some ways society wants people to be responsible; they do not want any biological explanation.

Q.So if there was a biological explanation for it, the condition would be treated as an illness?

A.Yes it would. The patients that I see are quite often referred by the court and do not come to me voluntarily. I think in all the time I have been seeing such patients I remember only a few instances of people coming of their own will, one of whom said that he did not like the idea and wanted treatment. Another had these fantasies but had not acted on them, and did not want to, but just wanted somebody to talk to.

But mostly they come through the courts and police because they have got into some sort of legal trouble.

Q.What does treatment consist of?

A.There is a kind of hormonal treatment that is used to reduce their sex drive and then you work with them on the behavioral changes. But in the U.K. the law is that you need two psychiatrists to agree to give them hormonal treatment to suppress their sex drive. You need a second opinion about it, only then you can start them on biological treatment.

I cannot comment on individual cases, but in the case of a crime being committed we do usually look at circumstances like whether they were under the influence of alcohol or involved in substance abuse or there was peer pressure and what the specifics were that were spurring them on.

Q.Is the level of brutality seen in the recent rape of a 5-year-old in Delhi common?

A.Again there are two ways to look at it. There was a survey in America a few years ago which showed that somewhere between 2 to 4 percent men and women like sadomasochistic sex, so they get turned on by pain and inflicting pain. In that context we are talking about two consenting adults.

But in the case of the 5-year-old or where rape happens, violence can be sexual but it is more about power and control. Obviously there are issues related to personality traits of individuals, whether they are a psychopathic personality or anti-social or they are trying to dominate another person.

Q.What personality traits are associated with this behavior?

A.It is largely about psychopathic personality disorder, where basically there is no sense of shame or guilt and a need for instant gratification, to control people. Those kind of personality traits are seen quite early in childhood.

Data from the U.K. and U.S. certainly suggests that people who have conduct disorders during childhood, which can be seen in acts like plucking the wings of butterflies or burning insects with a magnifying glass or torturing them, develop personality disorders as they grow up.

Research shows that they are deficient in social skills, usually shy, unassertive, and passive and socially withdrawn. Many of them have troubled childhoods and may have been abused sexually as children themselves.

Q.Is this true of India as well?

A.It is hard to say. Data from India is not easily available because there are no official statistics or adequate research about the perpetrators, and people are not open to sharing information about what would be deemed as illegal acts. The U.K. has a database of sexual offenders and a sexual offender register.

India does not have that, or a large number of clinical psychiatrists working in this field. That is still in nascency in India.

My guess is the level of child sexual abuse is roughly about the same in countries like U.K., U.S. and India. But I find it ironic that in a way children are revered in India, and yet such incidents and violence against children also happen.