Wednesday, June 5, 2019

Ruth Krall, Prolegomena: An Act of Re-Thinking

Ebola Virus Isolation Unit — A Visual Metaphor to Ponder (i)

I'm very pleased to be able to share once again an outstanding essay by Ruth Krall. In this essay about re-thinking how we've come to view the phenomenon of sexual abuse of minors and vulnerable people in religious contexts, Ruth urges us to consider applying terms and concepts from the realm of public health. Is this abuse an epidemic in religious contexts today? Is it endemic in religious structures? Is it pandemic? Because Ruth's essay is dense and long, I've broken the essay into two parts. The second part will follow in a day or so, and will link to this first half. Here's Ruth's essay:

Prolegomena: An Act of Re-Thinking

Ruth Elizabeth Krall, MSN, PhD

In 2015, I spoke at SNAP’s national conference and I raised the issue of the clergy and religious leader sexual abuse phenomenon not as a mental health pathology problem (which it is), nor as a spiritual perversion (which it is), nor as an institutional corruption problem (which it is), but as a long-standing and poorly addressed public health issue. It was in that context that I raised the issue of the sexual violence advocacy movement's need to involve the Surgeon General of the United States, the nation's academic Public Health Community, the National Institute of Mental Health, and the United States Center for Disease Control and Prevention. (ii)

This public health agency help is urgently needed because these governmental agencies have the personnel and financial resources to do population-specific demographic studies. These kinds of studies are essential to our understanding of the specific issues contained within the clergy and religious leader sexual abuse narrative and to our finding a collective way forward that both can and will protect vulnerable individuals inside a wide variety of religious and spiritual traditions.

The very first book about rape demography that I read was in the late 1960s or early 1970s.  I was just beginning to be clinically sensitized to the need to understand sexual violence and its sequellae as a clinical issue. I no longer remember the author's name or the book's title. But I do remember its content. The author was a mid-career psychotherapist in private practice and she did an ethnographic analysis of her case load. She extrapolated the figure that one in eight women in her clinical case load had been raped. She proposed, therefore, that this figure most likely represented a reliable demographic estimate or variable that needed to be considered in everyone's clinical practice with women. All women and girls seeking clinical assistance needed, in her opinion, to be asked about the presence of sexual violence in their life history. This information needed to be sought out as a routine part of girls' and women's medical and psychiatric history.

The book drew disdain from the male scientific, clinical, and criminology communities. The author's data could not possibly be accurate and, therefore, had no predictive value, critics maintained. In addition, her data and analysis had to be skewed by her feminist ideology. (iii) The one-in-eight data byte could not possibly be accurate or even predictive on a nationwide scale. The book was, therefore, in the minds of the author's critics, not at all useful.

I, on the other hand, found the book to be riveting and life-changing. After reading it, I began to talk differently with women clients and, I, too, found that when asked, many women told stories of their personal encounters with a wide range of affinity sexual violence behaviors. It became self-evident to me that most women in my clinical practice had never been asked and that most women, therefore, never volunteered this information.

I thought about her book when I read reviews of Richard Sipe’s ethnographic work about the incidence of clergy sexual abuse inside the Roman Catholic Church. I thought about the various ways in which his ethnographic work had been savaged and criticized as "non-scientific." (iv)

In both situations, later demographic studies provided vindication of these early ethnographic studies and hinted at even more inclusive statistics, i.e., a larger incidence than clinical ethnography alone could determine. The prophetic voices of these two clinicians could finally be heard. Their work could finally be honored as the precedent-setting clinical-diagnostic work it really was.

After decades of clinical and political work by feminist women on the topic of rape among USA women, we now have much more accurate demographics: one in five women and one in seventy-one men will be raped during their lifetime. One in three women and one in six men will have experienced some form of contact with sexual violence in their lifetime. 49.5% of multiracial women and 45% of first nation women have been subjected to some form of sexual violence in their lifetime. (v)

The predominant interpretive clinical paradigm of "victim-responsibility" for rape began to shift by the mid-1970s although remnants remain in the popular imagination and this idea of the victim's responsibility for being sexually assaulted periodically resurfaces in America's political culture wars about the controversial topic of date rape. (vi)

By January 6, 2012, the United States Department of Justice updated its legal definition of rape. The new definition: the penetration, no matter how slight, of the vagina or anus with any body part, or object, or oral penetration by a sex organ of another person, without the consent of the victim. (vii) This is the current definition by which national crime statistics are organized in the annual Uniform Crime Reports. (viii)

This rape definition work creates a standardized definition of the crime of rape and it provides the structure in which nationwide crime data are collected, analyzed, and published. The presence of such a uniform definition enables law enforcement agencies to compare data from state to state. It provides a platform upon which public health programs can be launched — for example publication efforts. It enables other statistics to be clustered around a common definition of rape — for example, sexual victims' health care costs across the lifetime compared with the health care costs of non-victimized individuals. In addition, it enables an examination of cross-cultural variables in demographic research protocols.  

Yet, despite persuasive anecdotal evidence, the question of religion as a specific variable to be examined seems non-existent on the sexual violence research horizon. This needs to change. In light of the nightly news during the past five years (2014-2018), it seems self-evident to me that the question of religious professionals who sexually abuse their spiritual dependents is an essential sub-component to the national sexual violence demographic research, for which recognition and investigation are needed.

Past and Present Public Health Crises

My internal model of a public health crisis is Typhoid Mary (1869-1938). Showing no visible symptoms of typhoid, she was a carrier of the deadly disease. A public health sanitarian followed the clues and she was identified as the carrier of disease and death. She was eventually quarantined and forcibly prohibited from having any contact with public food preparation. The underlying cause of a deadly epidemic had been identified, forcible containment procedures were implemented by the state, and the epidemic ended. (ix)

A second, more recently emerging public health model of assessment, diagnosis, containment, and treatment is today's Ebola virus crisis in the Democratic Republic of the Congo.

If one seeks to manage (identify, diagnose, contain, and treat) Ebola outbreaks in the context of world health as well as individual and communal well-being, several things are essential:

One must recognize the presence of and, to some degree understand, the pathogen (Ebola Virus) 
One must understand how a pathogenic organism transmits itself from the environment to specific human beings and from human being to human being 
One must understand the complex relationship between guerilla warfare, political terrorism, political refugees, and community "apathy" in proximity to the Ebola Virus 
One must understand the nature of war-terrorized and war-impoverished individuals and communities 
One must understand the matrix of nature and culture in which the Ebola virus lives and multiplies — for example, the community's  need to ritually bathe the dead as a sign of respect is believed to be a contributing factor in Ebola virus transmission 
One must understand the role of malnourishment and unsafe water supplies 
One must preventively vaccinate those who are at risk — this involves community education and outreach programs 
One must recognize early symptoms of the disease's emergence inside a given community 
One must take immediate precautionary actions to isolate the disease-bearing human being from other human beings — isolation here is used in a medical sense not in a social sense 
One must begin aggressive treatment as soon as the disease is diagnosed 
One must properly and promptly bury or cremate the dead 
Caregivers must protect themselves and their colleagues to avoid becoming ill; with the Ebola virus this includes body-covering protective gear, transportable isolation units for patients. access to vaccines, etc. (x)

In addition to these elements of diagnosis and treatment, demographic data about incidence are also needed. Where has the Ebola virus been located and among what vulnerable populations has an epidemic of full-blown illness occurred? How many people are currently affected? What predictions about future cases exist? What is the diagnostic baseline for knowing that public health safety measures are being effective in isolating the disease and limiting its spread? (xi)

In Cross-Disciplinary Conversations, a Shared Vocabulary Matters

As a pastoral theologian-clinician who was also a psychiatric-community mental health practitioner, let me look slant at these issues of public health case studies as a model for our understanding. The world-wide public health phenomenon under our imaginary microscope is not a virus or bacteria. Rather, it is the sexual abuse of children, adolescents, and vulnerable adults by religious and spiritual leaders. These leaders abuse inside institutionalized religious or spiritual organizations such as ashrams, churches, synagogues, mosques, parishes, zendos, and temples.  

Medically speaking, the word epidemic refers to the widespread occurrence of a disease in a given community at a particular time. Epidemics refer to diseases which are actively spreading. For example, from January to May, 2019, the USA has been experiencing a rapidly expanding epidemic of measles. (xii) As of June, 1, 2019, this current outbreak of measles has now spread to twenty-four states.

One factor in this current epidemic is parental refusal to vaccinate their children. The ideologies behind such refusals vary from religious beliefs to culturally inculcated fears of vaccine-induced pathology such as autism. In this ongoing debate, parental rights are visibly competing with community rights. At this moment in time, there is no comprehensive resolution of these conflicting rights. Consequently, the epidemic continues to spread. Given the predictive reality that 1-2 per 1000 individuals with measles will die, politicians and public health officials are faced with a dilemma: do they legislatively mandate measles vaccinations for every child when many parents disagree? Do they back these legislative mandates with criminal sanctions for parents who refuse to get their children vaccinated?

This debate inside a democratic society about mandatory vaccination of all children is but one debate among many that involve the rights of the individual to make individual health care decisions and the rights of the collective whole to live disease-free in safety.

Culturally, the word epidemic may also be used colloquially to mean any problem that has grown out of control. (xiii)

The term pandemic is used to describe a disease or pathological disorder which affects an entire country or the entire world. For example, the Black Plague (1345-1353 CE) which spread across Asia and Europe was a pandemic reality. It is estimated that 75-200 million people died of the Black Death or Black Plague in that era. (xiv) Pandemic is, therefore, the more comprehensive term.  It is used to describe a disease or disorders which have grown (or are growing) out of control and which affect an entire region of the world or the global world as a whole.

Is clergy and religious sexual abuse of vulnerable members of the laity a pandemic reality? What definitions can we use to hold this discussion? By what demographic criterion can we begin discussions of clergy sexual abuse as a pandemic public health concern?  Is that the correct word to use in our discussions about these matters?

The term endemic is also useful. It refers to the constant presence and/or usual prevalence of a disease or disorder in a specified population. For example, malaria is endemic in swampy Atlantic Ocean coastal areas in parts of Central America. Living in these areas, it is likely one will develop malaria. There are, however, prevention measures one can take that definitely lessen the likelihood of getting the disease. While there is no vaccine to prevent malaria, there are oral anti-malarial medications which can be taken as a prophylactic measure.  

The term hyper-endemic refers to persistent high levels of a disease or pathological condition well above that which is seen in other populations. For example, radiation belts or radiation accidents may cause various pathologies in excess of that which might be expected inside comparative populations outside of high radiation exposure areas.

One might suggest, for example, that clergy sexual abuse of vulnerable members of the laity is not a pandemic crisis but rather is an endemic reality in twenty-first century Roman Catholicism. Its prevalence reaches around the Roman Catholic world, which consists of 1.2 billion baptized Catholic individuals. Historically, church historians reveal the presence of clergy sexual abuse in the centuries which have proceeded today's documentation of clergy sexual abuse incidence.  

We must, however, note that no accurate demographic data exist in the public realm today to verify or to refute this claim. Thus, the baseline data for measuring changes across time simply do not exist.

Nevertheless, Doyle, Sipe and Wall suggested in 2007 that the clergy sexual abuse phenomenon — especially of post-pubescent boys — inside the boundaries of thee Roman Catholic priesthood has been present for millennia. (xv) These kinds of sexual abuse are not, therefore, an acute crisis but a long-standing problem. It may or may not be a rapidly expanding problem. This we simply do not know. There are no graphs or charts accurately describing incidence over a specified period of time.

Thus, this is the basic public health question: is clergy sexual abuse endemic to the profession of the Roman Catholic priesthood? Is there something inside institutionalized Roman Catholic religious faith and praxis which creates the milieu for this kind of abuse to perpetuate itself across generations of priests and within or across cultural and linguistic differences in any given generation of priests?

Or, is clergy sexual abuse a pandemic reality — a rapidly expanding pathology located inside today's Roman Catholic priesthood and inside the church's various religious orders? We need to be careful in this kind of analysis because the situation may be one of better reporting and not one of an increasing incidence. Until scientifically-gathered demographic data are routinely gathered and made public, it seems to me these remain unanswerable questions.

This question of endemic versus epidemic can be asked of any world or regional religious group in which clergy sexual abuse is uncovered.  While all religious groups have codes of expected moral behavior, none other than the Roman Catholic tradition have an elaborate centuries-old legal code. Most world religions do not have international repositories of historical case study information about clergy sexual offenses and their perpetrators. Perhaps no world religion systematically collects demographic data on a continuing basis.  At best, therefore, what we know about the demography of clergy and religious leader abuse is a hypothesis.

This is the first part of two-part posting of Ruth Krall's essay "Prolegomena: An Act of Re-Thinking." The second half of the essay will follow in a day or so.


i. Charlie Allday. "Ebola Outbreak: Emory University Isolation Unit To Treat Kent Brantly And Nancy Writebol." International Business Times, August 2, 2014. The photo is a Reuters photo.

ii. Krall, R. E. (August 6, 2015).  "Sexual Violence Activism in a Mennonite Voice: A Presentation to the 2015 SNAP Conference." Bilgrimage, August 6, 2015.

iii.  As the 1970s and 1980s rolled forward, I took to making a personal gesture based on Victorian Era female behaviors. Hearing men criticize feminist scholarship on sexual violence, I clutched my forehead, sighed deeply, grabbed the nearest chair or table, and made as if I were about to faint, all the while speaking something like this: "Gasp! Another deadly feminist analysis. I think I am having the vapors. Get me a glass of water." In part, my feigned histrionics were based on the emerging scholarship about Freud's politically-motivated abandonment of the idea that his women clients with the vapors were, in fact, telling him the truth about the presence of sexual violence in their life histories.

iv. Berry, J. (August 13, 2018).  "For Richard Sipe, Pattern of Deceit in Clerical Culture Was His Wittenberg." National Catholic Reporter Online.

v. National Sexual Violence Research Center. "Statistics About Sexual Violence." For additional information regarding college-aged women, see Rape, Abuse, and Incest National Network (RAINN). "Statistics."

vi. Amir, M. "Victim-Precipitated Forcible Rape." Journal of Criminal Law and Criminology 58 (4), pp. 493-502; and Amir, M (1971). Patterns in Forcible Rape. Chicago: Chicago University Press.

vii. United States Department of Justice. "An Updated Definition of Rape." January 6, 2012.

viii. Federal Bureau of Investigation, Criminal Justice Information Services. "Uniform Crime Reporting (UCR) Program."

ix. Filio Marineli, Gregory Tsoucalas, Marianna Karamanou, and George Androutsos. "Mary Mallon and the History of Typhoid Fever." Annals of Gastroenterology Online 26 (2), 2013.  Pp. 132-134.

x. For a short article and picture of a transportable isolation unit, see Jennifer H. Svan. "Mobile isolation unit for highly contagious fits Air Force cargo planes." Stars and Stripes, March 17, 2016. The picture at the top of this essay is another version of an isolation unit designed to be used on the ground.

xi. Appreciation to D. J. McFadden, MD, MPH for his close reading of my description/analysis of the Ebola Virus crisis in the Democratic Republic of Congo. Dr. McFadden is not, however, responsible for my subsequent re-wording of our electronic conversation.

xii. See e.g. the number of recommended articles and documents Google returns for a search of the question, "How many states have measles?"

xiii. Trisha Torrey. "Difference Between an Epidemic and a Pandemic." Mayo Clinic Verywellhealth site. Retrieved May 25, 2019 from

xiv. "Black Death." Wikipedia.

xv. Doyle, T.P, Sipe, A. W. R. and Wall, P. (2006).  Sex, Priests, and Secret Codes: The Catholic Church's 2000 Year Paper Trail of Sexual Abuse. Los Angeles: Volt Press.

For a continuation of this essay, please see this subsequent posting.

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