Naf - A Street Kid in Israel (2004)

The shocking and revealing documentation of a homeless boy's life over a two and a half year period. Naf (Naftali), is an ultra-orthodox bot thrown out of his parents' home for being a "bad apple". From the age of 14 he wanders the Jerusalem streets, and is exposed to crime, violence, and sexual assault. Only fighting keeps him alive; fighting the city council as a representative of homeless youth; fighting the man who sexually abused him through the court system, fighting the radio stations to convince them to play his music. This is a child not only fighting for life, but for self respect and a future. This is the struggle for survival experienced by all our homeless children -- as seen through the eyes of NAF -- A street kid.

She Founded Resource for Sex Abuse Victims

By Bryna Zumer

Owings Mills Times

January 24, 2008

Vicki Polin, MA, LCPC, NCC, ATR-BC

Vicki Polin, a counselor specializing in sexual violence, noticed years ago that there seemed to be no Jewish resources for sex abuse victims, and she was uncomfortable referring them to Christian organizations, which she felt might proselytize them or be unable to speak to Jewish issues.

Before relocating to Israel in 2001, she attended Neve Yerushalayim, a women's college in Jerusalem, and saw that people who had been sexually abused had no place to turn.

"All these young women started telling me what happened to them," Polin said. "I started seeing what a problem it was."

A Chicago native, she moved to Baltimore in 2002 and, in 2003, launched the nonprofit International Jewish Coalition Against Sexual Abuse/Assault, now known as The Awareness Center.

The organization's goal is to provide resources to victims and educate the general community, but Polin, an incest survivor herself, has also drawn controversy for posting information on alleged offenders, including many prominent rabbis, on the center's Web site.

"Our goal is education. It's not just about, 'Get this guy, get that guy,'" she said, explaining that many in the Orthodox world do not watch TV or read secular news, but have gained information from the center's Web site.

After she, together with a volunteer board of directors, began posting information on offenders, "survivors started saying, 'Why don't you have my story?' The same (victims) were talking about the same (offenders), and we started putting the pieces together."

Although more than 250 rabbis worldwide support The Awareness Center, critics have accused Polin of "lashon ha'ra," derogatory or damaging speech against another person, which Jewish tradition condemns.

"In some places, we're seen as heroes and in some we're seen as crazy or vindictive," she said.

After Polin received allegations against rabbis by a group that turned out to be linked to al-Qaida and was anti-Semitic, she posted resources on abuse for Christians and Muslims as well.

She also works with groups like The Survivors Network of those Abused by Priests, or SNAP, and, in addition to running the non-profit almost single-handedly, regularly testifies in court on behalf of victims of sexual violence.

The goal is not just to educate and reach out to victims, Polin said, but also to help abusers.

"There's no proven treatment for offenders. We don't know what to do, how to stop them," she said.

"rabbi" Hershy Worch's Attempts at Sexual Harassment & Cyberbullying Vicki Polin

Been feeling like journaling lately
http://rebhershy.livejournal.com/40737.html

rebhershy (rebhershy) wrote
@ 2008-01-24 20:08:00 

By Rabbi Hershy Worch 

ALSO SEE: The Case of Rabbi Hershy Worch

Rabbi Hershy Worch - Alleged Sexual Predator

It's been so long since I felt safe I hardly recognize the feeling. 

Seriously, since my enemies tried their hardest to crucify me three years ago not a day went by but I dreaded some new infamy. 

Evil has many faces, but ugliest is the face of virtue triumphant. It matters not whether it triumphs like Rabbi Eichenstein who quietly calls my employer to have me fired, or like Vicki Polin who calls my ex-wife to say she's talking to 26 women who say I raped them in front of the children. There's no question in my mind that the worst sins are those we commit with the Yetzer Tov - Good Inclination. By the way, Eichenstein discovered I was working for XXXXXXXX XXXXXX Funerals Ltd as a Shomer - Guardian; someone who sits with the dead. He discovered it because one of the dead I happened to sit with (reciting the psalms at his side), was an uncle of his. When the good rabbi saw it was me, he called the funeral director and had me fired. He also stiffed me for the $15 an hour I'd earned sitting there all night.

Now I say that having a man fired because you think badly of him, doesn't make you less of a man. But stiffing the man who sits guarding the corpse of your uncle, finding an excuse to avoid paying him his fee after he's done the job, now that makes you a very small man indeed.

The thing is, the really important thing is that Eichenstein's Shabbes candles burned his house to the ground. Well, his wife put the tea lights on the plastic tablecloth which ignited when it heated up sufficiently, to be more precise, but you get the picture. I know which I prefer, having a mean prick try and burn my livliehood down or have the Sabbath burn my house down! Sometimes when I'm having sex I think of Victoria Polin, especially when I'm laughing. Or sometimes when my breath catches in my throat at the sheer beauty of woman skin or the perfume of her private places, I catch a glimpse of all the hot laughing sex Vicki doesn't have a hope of tasting, and I ask myself, who came out of all this enriched, and who impoverished? It's something to think about, isn't it?

You know, once a month like a fetish, on the 14th or 15th of the month, Luke Ford will visit all my web pages looking for only he knows what. 5 or 6 times in the last two years the 14th and 15th have fallen on the sabbath. So here's this convert to Judaism, to orthodox judaism no less, lives on a futon on the floor in a basement somehwere in Los Angeles, who can't hold back from firing up his computer to go snooping on the sabbath. Talk about being born again and getting a life!

I shouldn't crow, I suppose. But I feel like crowing, damnit.

____________________________________________ 

Holy Sister Vikele remove me
Live Journal  - October 21, 2004
By Hershy Worch
http://rebhershy.livejournal.com

I would have been satisfied to have Holy Sister Vikele remove me from her awareness website, I would have breathed a sigh of relief, but no longer. No. The website has to come down. Mostly it has to come down because it is a shaming thing, a shameless, shameful thing, an ERVA where vicki exposes her privates and plays with herself in our faces. But, equally important, it is time to celebrate the good things Reb Shlomo Carlebach gave us all. Next week will be his tenth Yahrzeit - Aniversary. Let's celebrate it with the joy it deserves.

Cases of Clergy Sexual Abuse Against Adults in the Jewish Community

Cases of Clergy Sexual Abuse Against Adults in the Jewish Community
© (2008) The Awareness Center

If you know of other cases of clergy sexual abuse involving adult survivors (both male and female), please forward the information to Vicki Polin, Executive Director - The Awareness Center.
vickipolin@ aol.com

Also see: Spiritual Abuse

Orthodox

1. Case of Rabbi Yoram Abergel
2. Case of Rabbi Shlomo Aviner
3. Case or Rabbi Ephraim Bryks
4. Case of Rabbi Shlomo Carlebach
5. Case of Rabbi Elior Chen 
6. Case of Rabbi Yitzchak Cohen
7. Case of Cantor Ami Edri
8. Case of Rabbi Moshe Eisemann (Baltimore, MDl)
9. Case of Rabbi Jacob Frank
10. Case of Rabbi Lewis Furman
11. Case of Rabbi Marc Gafni (AKA: Rabbi Mordecai Winiarz)  
12. Case of Rabbi Shimon Gerlick
    
13. Case of Rabbi Chaim Halpern
    
14. Rabbi Yochanan Hayout
15. Case of Rabbi David Kedmi 
16. Case of Rabbi Mahluf Aminadav Krispin
17. Case of Rabbi Pinchas Lew
18. Case of Rabbi/Psychologist Mordecai Magencey
19. Case of Rabbi Jacob A. Max
20. Case of Dr. Rabbi Samuel Mendelowitz
21. Case of Rabbi Yaakov Menken
22. Case of Rabbi Yona Metzger
23. Case of Rabbi Shalom Nager
24. Case of Gabriel Ohayon
25. Case of Dr. Rabbi Jack Nusan Porter
26. Case of Rabbi Haim Pardes
27. Case of Cantor Michael Segelstein
28. Case of Rabbi Zeev Sultanovitch
29. Case of Rabbi Mordecai Tendler
30. Case of Rabbi Isadore Trachtman
31. Case of Rabbi Hirsch Travis
32. Case of Rabbi Eliyahu Tzabari 
33. Case of Rabbi Ivan Wachmann
34. Case of Rabbi Matis Weinberg 
35. Case of Rabbi J. Hershy Worch
36. Case of the Unnamed Chasidic Rabbi in Quebec
37. Case of the Unnamed Chasidic Rabbi in a Yeshiva
38. Case of Sabbatai Zevi  
39. Case of the Rabbi Max Zucker 
40. Case of The Zwi Migdal Society

Conservative

1. Case of Rabbi Tobias Gabriel
2. Case of Rabbi Arnold Fink
3. Case of Cantor Philip Friedman
4. Case of Rabbi Jonathan Ginsburg
5. Case of Rabbi Mark A. Golub
6. Case of Cantor Mark Horowtiz
7. Case of Rabbi David Kedmi 
8. Case of Rabbi Robert Kirschner
9. Case of Rabbi Michael Mayersohn
10. Case of Rabbi Gabriel Ohayon
11. Case of Rabbi Joel Roth
12. Case of Rabbi Arthur Charles Shalman  
13. Case of Cantor Robert Shapiro

Reform

1. Case of Rabbi G. George Fox
2. Case of Cantor Joel Gordon (AKA Peter Gordon)
3. Case of Rabbi Mark Golub
4. Case of Rabbi Steven Kaplan
5. Case of Rabbi Marc Gafni (AKA: Rabbi Mordecai Winiarz) 
6. Case of Rabbi Sheldon Zimmerman

Jewish Renewal

1. Case of Rabbi Marc Gafni (AKA: Rabbi Mordecai Winiarz)
2. Case of Rabbi Hershy Worch 

Wisconsin: Bill Would Erase Sex Abuse Suit Deadlines

Associated Press

Madison, Wis. (AP) -- People who believe they were sexually abused as children would no longer face a deadline for filing a civil lawsuit under a bill a legislative committee considered Wednesday.

Critics told the Senate Judiciary, Corrections and Housing Committee the bipartisan measure would expose the Catholic church in Wisconsin to expensive lawsuits and is probably unconstitutional. Supporters countered the state's current deadline -- file by age 35 -- is arbitrary and doing away with it would expose more sexual predators.

"This bill is about protecting victims and giving them the ability to tell their story," said Rep. Scott Suder, R-Abbotsford, one of the bill's co-sponsors. "We truly believe it will make Wisconsin a sex predator's worst nightmare."

Democratic Gov. Jim Doyle signed a law in 2004 that increased the statute of limitations for adults who think they were sexually abused as children from five years after the incident to age 35. The change was triggered largely by the Roman Catholic church clergy sex abuse scandal.

The bill would erase that deadline going forward and create a 3-year window during which someone who had a lawsuit dismissed because they were too old could renew their actions.

Milwaukee Archbishop Timothy Dolan told the committee his diocese has paid more than $17 million in sex abuse mediation, therapy and outreach since 2002. The 3-year window would allow so many lawsuits his diocese could go bankrupt, he said.

"There is no Catholic 'Superfund' that can provide the monies this legislation will require of the church," he told the panel.

"We are at the limit of our ability to pay massive tort settlements "| plain and simple, a window is unjust."

James Friedman, a constitutional law expert at the Godfrey & Khan law firm in Madison, said the window likely violates the Wisconsin and U.S. constitutions. The statute of limitations clearly gives defendants the right not to be sued after it expires, Friedman said.

Sen. Julie Lassa, D-Stevens Point, stressed the bill isn't designed to single out any specific entity, such as the Catholic church.

She believes the bill is constitutional because it clearly reflects legislative intent and would protect people. She pointed out the state places no statute of limitations on murder and the age 35 deadline was picked at random.

"There is no statute of limitations on pain and suffering," Lassa said. "If they're 33, they can do it. At 36 they can't ... it's just an arbitrary line in the sand."

Vicki Polin, a 48-year-old counselor based in Baltimore, told the committee her mother and father sexually abused her when she was a child, including instances camping near Mukwonago. She confronted them in her 20s, and they cut off all contact. She learned last year her family was avoiding her until the statute of limitations had expired.

She said civil lawsuits would help victims pay for therapy. They also would compel the legal discovery process. That could uncover more information about possible victims, leading to identification of more abusers and, perhaps, criminal charges.

"It's validation," she said.

The bill got a cool reception from the committee. Sen. Jim Sullivan, a Wauwatosa Democrat and attorney, called the bill a "sweeping change of precedence." He questioned why the bill is needed since the state just increased the deadline to age 35 four years ago.

Sen. Glenn Grothman, R-West Bend, asked Suder and Lassa why they didn't address the criminal statute of limitations. He also asked how many predators would escape litigation because they have no money for lawyers to win.

Lassa said the civil process could lead to criminal charges. Suder said he didn't know how many would escape a lawsuit because they're poor.

The committee wasn't scheduled to vote on the bill.

Sexual Abuse in the Jewish Community: Panel Discussion After 'Narrow Bridge' Film - Baltimore, MD

 

The film above is of the panel discussion that went on after showing the movie 'Narrow Bridge' (see below).  The film is about clergy sexual abuse in the Jewish community. The showing was in the Baltimore, MD on January 2, 2008. The event was sponsored by The Awareness Center, Inc., which is the international Jewish Coalition Against Sexual Abuse/Assault.

Panel Members included:

• Mesa Leventhal Baker, MD - Medical Director of the Baltimore Child Abuse Center.
• Senator Jim Brochin
• Murray Levin, JD - Survivor of Rabbi Ephraim Shapiro
• Israel Moskovitz - Director/Writer/Composer and Plays "Daniel Schneider"
• Vicki Polin, MA, LCPC, NCC - Founder and Director of The Awareness Center, Inc.
• Bob Russell - Legislative coordinator of SNAP of Maryland
• Joy Silberg, PhD - Nationally renowned child psychologist, who specializes in sexual abuse.

Pedophile suspect extradited from Israel charged in NY

Pedophile suspect extradited from Israel charged in NY

by Michal Lando

Jerusalem Post - January 9, 2008

A suspected Brooklyn pedophile extradited from Israel to the US under a revised extradition treaty was arraigned and held on $10-million bail on Tuesday. 

Stefan Colmer was indicted by a Brooklyn grand jury on charges that he sodomized two 13-year-old boys from the haredi Jewish community in Brooklyn where he lived. 

To avoid arrest, Colmer, a computer technician and salesman, fled to Israel, where he has been hiding under the name David Cohen. 

A revamped extradition treaty between the United States and Israel, which went into effect January 10, 2007, allowed Colmer to be returned to Brooklyn. Prior to the newly amended treaty, Israel and the US had agreed to extradite suspected sex criminals only if they had been charged with rape. Since last January, at least two other sex offenders have been extradited, including Michael Leon Zeve and Kenneth Frank. 

"Until now, Israel has been a Mecca for sex offenders," said Vicki Polin, founder and executive director of The Awareness Center, the international Jewish Coalition Against Sexual Abuse/Assault. 

The indictment charges that between March and May 2006, Colmer sodomized two teenage boys on numerous occasions, after luring them to his home from a nearby yeshiva high school, according to the US extradition request. 

Colmer is charged with eight counts of criminal sexual acts in the second degree, eight counts of sexual misconduct, 19 counts of sexual abuse in the second degree and two counts of endangering the welfare of a child. 

In the Orthodox world, "the status quo has been to protect offenders' parnassa [income] and not shame family members, at the expense of shaming those who have been victimized," said Polin, who has been working in the sexual violence field for just under 25 years. 

The new treaty may also allow for the extradition of Avrohom Mondrowitz, who claimed to be a rabbi and posed as a school psychologist in Boro Park during the late 1970s and early 80s. He was indicted in 1984 for sodomizing young boys, and he fled to Israel after learning he was under investigation. Since then, Mondrowitz has remained in Israel, protected by the now-defunct treaty. He was recently arrested there, pursuant to the amended treaty, and extradition proceedings are pending. 

Michael Lesher, an Orthodox lawyer representing six of Mondrowitz's alleged victims and actively pursuing his extradition, has been facing intense pushback. 

"I continued to bang on the door about Mondrowitz, but I am operating against tremendous institutional logic," said Lesher. "He should have been first to be extradited years ago. When they arrested Colmer, I think they were testing the waters."

Case of Jeremy D. Goldberg

Jeremy D. Goldberg

(AKA: Jeremy Goldberg)

 

Highland Park, IL

Convicted on charges of possessing child pornography. 

Jeremy Goldberg is a 23 years old, is the son of a prosperous couple in the wealthy Chicago suburb of Highland Park.  He downloaded file-sharing software that gave him access to a web site called "PreTeenGirlPics." Over a period of some 18 months, he downloaded hundreds of pornographic photographic images, some depicting children as young as 2 or 3 being vaginally penetrated by adult males. He offered these images to other subscribers to the web site to induce them to send similar images in return.

____________________________________________________________________________________

Disclaimer: Inclusion in this website does not constitute a recommendation or endorsement. Individuals must decide for themselves if the resources meet their own personal needs.

Table of Contents:

1. USA v. Goldberg, Jeremy   (06/27/2007)
2. Illinois Sex Offender Registry  (01/05/2008)

____________________________________________________________________________________

Illinois Sex Offender Registry
January 5, 2008


Name: JEREMY D GOLDBERG  Sexual Predator

Date of Birth: 10/5/1983

Height: 5 ft. 07 in.      Weight: 145 lbs.      Sex: M      Race: W

Address: 1483 RIDGE RD, HIGHLAND PARK , IL 60035


Crime Information

Victim was 12 years of age

Offender was 23 at the time of the offense

Crimes:    CHILD PORNOGRAPHY/FILM/PHOTOS

             CHILD PORNOGRAPHY

County of Conviction: Cook

____________________________________________________________________________________

USA v. Goldberg, Jeremy
United States Court of Appeals for the Seventh Circuit
http://altlaw.org/v1/cases/181806

No. 07-1393

UNITED STATES OF AMERICA,

Plaintiff-Appellant,

v.

JEREMY GOLDBERG,

Defendant-Appellee.

____________

Appeal from the United States District Court for the Northern District of Illinois, Eastern Division.

No. 05 CR 922—Joan B. Gottschall, Judge.

____________

SUBMITTED MAY 29, 2007—DECIDED JUNE 27, 2007

____________

Before BAUER, POSNER, and WILLIAMS, Circuit Judges.

POSNER, Circuit Judge. The government appeals from the imposition of a sentence of one day in prison, time served, for a violation of the Child Pornography Prevention Act of 1996. The specific section of the Act that the defendant violated, 18 U.S.C. § 2252A(a)(5)(B), authorizes, so far as bears on this case, the imposition of a maximum prison sentence of 10 years on anyone who "knowingly possesses any book, magazine, periodical, film, videotape, computer disk, or any other material that contains an image of child pornography that has been mailed, or shipped or transported in interstate or foreign commerce

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No. 07-1393

by any means, including by computer." For the defendant's particular offense, the federal guidelines sentence range was at least 63 to 78 months—"at least" because, as noted at the end of this opinion, it appears to have been mis- calculated in the defendant's favor.

The judge imposed a nominal prison sentence, though her preference was to impose no prison sentence at all, because without imposing a prison sentence she could not have imposed supervised release. The statute that authorizes supervised release, 18 U.S.C. § 3583(a), states that "the court, in imposing a sentence to a term of imprisonment for a felony or a misdemeanor, may include as a part of the sentence a requirement that the defendant be placed on a term of supervised release after imprisonment." The Sentencing Commission understands supervised release to presuppose a prison sentence. See U.S.S.G. ch. 7, pt. A,§ 2(b); see also United States v. Sanchez-Estrada, 62 F.3d 981, 994 (7th Cir. 1995).

The defendant, who is now 23 years old, is the son of a prosperous couple in the wealthy Chicago suburb of Highland Park. He downloaded file-sharing software that gave him access to a web site called "PreTeenGirlPics." Over a period of some 18 months, he downloaded hundreds of pornographic photographic images, some depicting children as young as 2 or 3 being vaginally penetrated by adult males. He offered these images to other subscribers to the web site to induce them to send similar images in return. He masturbated while viewing the pornographic images. He has a history of drug abuse. His lawyers describe him as a "normal young adult."

The district judge justified the remarkably light sentence that she gave the defendant as follows:

No. 07-1393

3

It's a very, very difficult case, but I have concluded that I'm going to begin with a lengthy period of supervision rather than a period of incarceration, with the idea that it's going to be very intensive, and if there is a problem, Mr. Goldberg is going to go away for a very long time.

But the way I look at this case, . . . I think that if I sent Mr. Goldberg away for 63 months or anything close to it with the hope that he gets sex offender treatment in prison, we're pretty much guaranteeing his life will be ruined. And I think there's some possibility here that his life can go in a different way, and I'd like to try that, but I'm very worried, because what's gone on here is very, very difficult for me to deal with. I mean, these pictures, I can't even bear to look at them they're so horrible. And what spiraling downward does to you so that you can stand looking at pictures like that I don't know, but it's spiraling pretty far downward.

The guidelines allow me to place Mr. Goldberg,and I'm going to . . . I don't know what our current word is . . . deviate from the guidelines under 3553, and I'm going to impose a period . . . as I said, the supervised release can be any years up to life. I'm going to impose a ten-year period of supervised release.

It's more supervised release than I have ever imposed before, but I really think that given the psychiatric reports and given what transpired here, that the period of supervision has to be long enough to ensure that if Mr. Goldberg turns his life in a different direction he does it for a long time.

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No. 07-1393

I also want to make sure that if there is further . . . any evidence of further problem, that the Court retains a handle over Mr. Goldberg for a long time.

Now, during that period of supervision, I really need a little help in figuring out . . . and I have been trying to get the lawyers to give it to me, but I don't know that I've gotten it yet. Maybe it depends on what kind of financial commitment people are able to make, I don't know, but I need to have close supervision in both the drug area and in the therapy area to make sure that we're not having a problem here. And I know that . . . I think Ms. Cohen is the one who suggested some kind of periodic polygraph examinations, and I think that should be an important part of this.

.* * *

I think I better now talk about why under Section 3553 I deviated from the guidelines. My reason in this case is less . . . well, it's this: It's considering the history and characteristics of the defendant I think that there's a substantial likelihood . . . and also considering the psychiatric reports, that this offense was committed out of boredom and stupidity and not because Mr. Goldberg has a real problem with the kind of deviance that these cases usually suggest. I believe that if that is correct, and if he is sent to prison for a lengthy period, anything of any consequence at all, I think it's going to ruin his life in many ways. I think that sex offender treatment within the Bureau of Prisons is going to expose him to people who are dangerous to him. I think any substantial period of incarceration is going to ensure that he's not able to

No. 07-1393

5

take advantage of his education and get a good job, and I think all of this will reinforce whatever negative things he's done in the past rather than pushing him in a positive direction. I recognize that the viewing of child pornography over the Internet destroys the lives of young children, but I also recognize that the life that I'm concerned with here, the life that I can affect, is Mr. Goldberg's life, and I don't want to destroy his life in the hope that maybe in some very indirect way it's going to help somebody else's life. I don't think it is. And I would like, if I can, to support him in putting his life on a positive direction rather than in destroying it. The reason for the long period of supervision and the close supervision that I believe I've required is to make sure that if he indeed represents a threat, and if I'm wrong in my assessment of what went on here, that we are able to catch it before any damage is done. This is kind of an odd balancing of factors under 3553, but I think I do have the discretion in an unusual case like this one to choose not to incarcerate and to choose close supervision to see what transpires over the next few years. There is also a brief "statement of reasons" appended to the original judgment that the judge entered. But it is omitted from the amended judgment (entered because the original judgment was discovered to contain clerical errors) and is not in the appellate record, although the defendant's counsel quotes from it in his brief and the clerk of the district court has found a copy for us. In the oral statement, which we just quoted, the grounds on which the judge justified the sentence were that the defendant was not a real deviant because he had committed the crime out of

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No. 07-1393

"boredom and stupidity," that it would ruin his life to be imprisoned because he would be exposed to "people who are dangerous to him," and that his life, rather than the lives of the small children who had been raped in order to enable the creation of sadistic child pornography to assist the defendant in masturbating, was the only "life that I can affect." The written statement of reasons is similar. In it the judge attributes the defendant's porno- graphic activity to boredom resulting from his being confined at home as a result of being convicted of a drug offense and states that he "has normal sexual interests and is not a pedophile, internet or otherwise." She states that "no one argues that any actual children are at risk from any conduct of [the defendant] (other than the harm to children who are used to make images used on the internet)," but she assigns no weight to that harm—the harm to the children—consistent with her oral statement that the only life she can affect by her sentence is the defendant's. The written statement assigns weight to the fact that if the defendant is sent to prison, "his education will be interrupted."

These grounds, and the passages we quoted in which they appear, do not comply with the requirement that the sentencing judge conscientiously consider the factors set forth in 18 U.S.C. § 3553(a) to guide sentencing. Those factors, so far as pertain to this case, are

(1) the nature and circumstances of the offense and the history and characteristics of the defendant;

(2) the need for the sentence imposed—

(A) to reflect the seriousness of the offense, to promote respect for the law, and to provide just punishment for the offense;

No. 07-1393

7

(B) to afford adequate deterrence to criminal conduct;

(C) to protect the public from further crimes of the defendant; and

* * *

(6) the need to avoid unwarranted sentence disparities among defendants with similar records who have been found guilty of similar conduct.

A prison sentence of one day for a crime that Congress and the American public consider grave, in circumstances that enhance the gravity (we refer to the character of some of the images), committed by a convicted drug offender, does not give due weight to the "nature and circumstances of the offense" and the "history and characteristics of the defendant." It does not "reflect the seriousness of the offense," "promote respect for the law," or "provide just punishment for the offense." It does not "afford adequate deterrence to criminal conduct." And it creates an unwarranted sentence disparity, since similarly situated defendants are punished with substantial prison sentences. See, e.g., United States v. Lange, 445 F.3d 983

(7th Cir. 2006); United States v. Grigg, 442 F.3d 560 (7th Cir. 2006); United States v. Baker, 445 F.3d 987 (7th Cir. 2006); United States v. Perez, No. 06-50041, 2007 WL 1065784 (5th Cir. Apr. 11, 2007); United States v. Nikonova, 480 F.3d 371 (5th Cir. 2007); United States v. Rolfsema, 468 F.3d 75 (1st Cir. 2006); United States v. Branson, 463 F.3d 1110 (10th Cir. 2006). United States v. Grinbergs, 470 F.3d 758 (8th Cir. 2006), reversed a sentence of a year and a day (a sentence 366 times longer than the sentence imposed by the district judge in this case) imposed on a defendant who had pleaded guilty to one count of possessing child pornography and faced a guidelines sentence of 46 to 57 months in

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No. 07-1393

prison, lower than our defendant's guidelines sentencing range. It is true as the defendant points out that the statute under which he was convicted contains no mandatory minimum. But it does not follow that Congress envisaged no prison time for violators. The absence of a mandatory minimum sentence may signify no more than that the legislature did not want to take the time to try to determine what the minimum sentence should be or did not think it could anticipate unusual cases in which a light sentence might be appropriate. We can imagine a case, involving the downloading of a handful of images none showing any prepubescent child or depicting any sexual activity, yet still constituting child pornography (the statute de- fines "child" as any minor and "pornography" as including besides actual sexual activity "lascivious exhibition of the genitals or pubic area," 18 U.S.C. §§ 2256(1), (2)(A)(v)), in which a permissible sentence might be light. The hundreds of images in this case include as we have noted images of prepubescent children being penetrated by adults.

The district judge was influenced by the erroneous belief that a sentence affects only the life of the criminal and not the lives of his victims. Young children were raped in order to enable the production of the pornography that the defendant both downloaded and uploaded—both consumed himself and disseminated to others. The greater the customer demand for child pornography, the more that will be produced. E.g., Osborne v. Ohio, 495 U.S. 103, 109-11 (1990); United States v. Barevich, 445 F.3d 956, 959 (7th Cir. 2006); United States v. Richardson, 238 F.3d 837, 839 (7th Cir. 2001); United States v. Angle, 234 F.3d 326, 337-38 (7th Cir. 2000). Sentences influence behavior, or so at least Congress

No. 07-1393

9

thought when in 18 U.S.C. § 3553(a) it made deterrence a statutory sentencing factor. The logic of deterrence sug- gests that the lighter the punishment for downloading and uploading child pornography, the greater the customer demand for it and so the more will be produced. Why the fact that the defendant committed the offense out of "boredom and stupidity," if it were a fact, should be thought a mitigating factor escapes us and was not explained by the judge. Anyway it is not a fact; the defendant obtained sexual gratification from the pornographic images that he so sedulously collected. It is also inconsis- tent with the 10-year term of supervised release that the judge imposed, which includes conditions that require the defendant's participation in programs for the psychological treatment of sex offenders. The judge's suggestion that the defendant does not have "a real problem" could be interpreted to mean that she disparages Congress's decision to criminalize the consumption and distribution of child pornography, perhaps because she thinks that only people who actually molest children, rather than watching them being mo- lested, have "a real problem." This interpretation is reinforced by her statement elsewhere in the transcript of the sentencing hearing that the defendant's crime was just "a kind of mischief." This characterization cannot be reconciled with the judge's having fully credited (as she said she did) the report of a psychologist who stated that the defendant has been using pornography for more than a decade, that he "believed he was smart enough not to get caught and if he were caught he believed he would not have any consequences," that he has "little knowledge, understanding or empathy for the little girls depicted in the images," that "he began using pornography when he

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No. 07-1393

was 12-13 and continues to fantasize about the same age girls he looked at then," that he has "persistent sexual interest in adolescent males and females," that he is a "pedophile," that he "has admitted to other deviant behaviors, namely voyeurism, scatological phone calls and the stealing of a 14 year old girl's panties," that he has "sociopathic traits," that "he doesn't think of the consequences of his behavior," that "he has had two convictions within two years," and that "he has little respect for the law or social conventions." The district judge's assertion "that sex offender treatment within the Bureau of Prisons is going to expose [the defendant] to people who are dangerous to him" is ill informed. Sex-offender treatment in federal prisons is voluntary. Statement of Andres E. Hernandez, Director of the Sex Offender Treatment Program Federal Correctional Institution Butner, N.C., Concerning "Sexual Exploitation of Children Over the Internet: The Face of a Child Predator and Other Issues," Before the H. Subcomm. on Oversight and Investigations of the H. Comm. on Energy and Commerce, 152 Cong. Rec. D1035-01, D1038 (Sept. 26, 2006), http://projectsafechildhood.gov/ HernandezTestimonyCongress.pdf, p. 2 (visited June 1, 2007). And "the vast majority" of sex offenders in the program are individuals convicted of "Possession, Receipt, Distribution, and Transportation of Child Pornography," like the defendant. Id. at 3. The judge gave no explanation for why she thought a prison sentence would be more ruinous for the defendant than for any other imprisoned criminal other than her mistaken belief that he would be thrown in with violent sexual offenders. The judge's balancing of the section 3553(a) sentencing factors was indeed "odd," as she acknowledged, but, more

No. 07-1393

11

to the point, it was unreasonable. United States v. Roberson, 474 F.3d 432, 435 (7th Cir. 2007); United States v. Repking, 467 F.3d 1091, 1094 (7th Cir. 2006) (per curiam); UnitedStates v. Walker, 447 F.3d 999, 1007 (7th Cir. 2006). When the guidelines, drafted by a respected public body with access to the best knowledge and practices of penology, recommend that a defendant be sentenced to a number of years in prison, a sentence involving no (or, as in this case, nominal) imprisonment can be justified only by a careful, impartial weighing of the statutory sentencing factors. It may not be based on idiosyncratic penological views (such as that the severity of criminal punishment has no significance for the victims of crime, but only for the criminals), disagreement with congressional policy, or weighting criminals' interests more heavily than those of victims and potential victims. See, e.g., United States v.Grinbergs, supra, 470 F.3d at 759; United States v. Davis, 458 F.3d 491, 498-500 (6th Cir. 2006); United States v. Martin, 455 F.3d 1227, 1239-42 (11th Cir. 2006); United States v. Crisp, 454 F.3d 1285 (11th Cir. 2006); United States v. Robinson,  F.3d 839 (8th Cir. 2006); United States v. Cage, 451 F.3d 585, 595-96 (10th Cir. 2006). The judge neglected con- siderations of deterrence and desert, which dominate the federal criminal code, in favor of undue emphasis on rehabilitation, and seemed even to think that any prison sentence, however short, is inconsistent with rehabilitation. That is not the theory of either the criminal code or the Sentencing Reform Act, which actually downplays the significance of rehabilitation as a penological goal by rejecting imprisonment as a means of promoting it. 28

U.S.C. § 994(k); Mistretta v. United States, 488 U.S. 361, 367 (1989); Kerr v. Puckett, 138 F.3d 321, 324 (7th Cir. 1998). Finally, the guidelines sentencing range appears to have been miscalculated. The district judge did not make the

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upward adjustment required by U.S.S.G. § 2G2.2(b)(3) for sadistic images, even though at the sentencing hearing the government pointed out that some of the images on the defendant's computer involved "bondage of these young children" and "sadistic and masochistic sexual activity with these children," as well as girls "as young as two and three years old being vaginally penetrated with an adult male penis." We do not rule that a sentence below a properly calcu- lated guidelines range would have been improper in this case. The guidelines are merely advisory, and the statutory sentencing factors (a laundry list of incommensurables which guides consideration but does not dictate the sentence or even the sentencing range) leave plenty of discretion to the sentencing judge. But that discretion was abused in this case, and the judgment is therefore reversed and the case remanded for resentencing.

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FAIR USE NOTICE

 
Some of the information on The Awareness Center's web pages may contain copyrighted material the use of which has not always been specifically authorized by the copyright owner. I am making such material available in my efforts to advance understanding of environmental, political, human rights, economic, democracy, scientific, and social justice issues, etc.

I believe this constitutes a 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material on this site is distributed without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes.

For more information go to: http://www.law.cornell.edu/uscode/17/107.shtml . If you wish to use copyrighted material from this update for purposes of your own that go beyond 'fair use', you must obtain permission from the copyright owner.
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"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has." --Margaret Mead

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1,320,000 Jewish survivors of CSA living in the United States today!

© (2008) by Vicki Polin, MA, LCPC, NCC

1 out of every 4 adults have been sexually abused as a child

As a Jewish survivor of childhood sexual abuse it's easy to start to feel that I am alone and that I am very different then everyone else in the Jewish community. There are times I feel that I will never “fit in” because of what happened to me as a child.  The truth is that I am not the only one who feels this way -- it’s a common theme for most us who were emotionally, physically and or sexually abused as children.  It is also a fact that many adult survivors of child sexual abuse report that keeping secrets and remaining silent -- often leads to a severe depression.

We all have to remember that according to statistics (in just about every country), that one-fourth of the population has been sexually abused by the time they reach their eighteenth birthday. 

Considering there are just about 306,000,00 people in the United States, there are just about 76,500,000 survivors of child sexual abuse.  There are about 5,280,000 Jews living in the US -- meaning there at least 1,320,000 are survivors.  According to the Israeli Central Bureau of Statistics there are around 5,432,700 Jews living in Israel -- meaning there are around 1,358,700 Jewish survivors of child molestation.

It’s very difficult to deal with the denial in Jewish communities.  I have to admit that I get extremely frustrated when I hear how much time and money is spent making sure a cow is kosher, that an eruv is in place or the time, money and research put into the kiruv movement (Jewish outreach) -- yet when it comes to shining a light on child molestation, no one wants to hear about it nor fund organizations like The Awareness Center.

Over the last nine years I heard story after story coming from observant communities where parents are told if they report sex crimes to law enforcement -- their children will no longer be allowed to attend Jewish day schools or yeshivas . . . or that their children will not find a good shuddich (marriage partner).  In some orthodox communities parents are told if they tell anyone their child was molested the school would have no choice but to expel the child “for having sexual relations”.  Instead of getting the needed help and protecting other children from the same fate, parents and community members are bullied into silence.

I often think about the political strength survivors of sex crimes and non-offending family members would have if we all banded together and start speaking out.  I truly believe that a small group of people can make a difference.  The Awareness Center needs your help in doing this.  We need volunteers and your financial support.  We also need each and everyone of you to learn how to use your voices.  We all must organize and speak out against the injustices we have faced in our communities. 

Too many of our rabbis and other community leaders have a responsibility to stop this shame/blame game they have been using against our most vulnerable.  We must demand that they start allowing education programs in their congregations on all aspects of rape prevention and start to offer proper and appropriate help to those who have been victimized as children.  We must demand that our rabbis honor and respect those who have been abused -- just as they would any veteran of war.  Survivors of all forms of child abuse should be seen as hero’s -- especially after they start coming forward to report the crimes to law enforcement and or speak out.

As survivors we all have a responsibility to do our part to ensure our offenders are reported to law enforcement officials and hopefully brought to justice.  We gain power and control over our lives by these actions and also by using our voices.  Considering the fact that offenders have multiple victims, our silence can and does lead to more children becoming the next victim of a sex crime.

If you are a survivor of child abuse remember -- no matter what you are feeling remember you are not alone.  Things can and will change and get better.  I’ve seen it happen not only for myself -- but for other survivors too!  The pain you feel today is real and needs to be honored, respected and embraced. Your feelings are real -- but they will not always be so intense.  I know you will have many good days in the future and you have to believe that will happen.  One of the most important life lessons I’ve learned over the years is that when we are educated on the issues, have the right connections and determination -- each and everyone of us can help to make the world a better place for others who have been abused and also prevent one more child from being harmed.

Please keep The Awareness Center in mind this holiday season -- please help us continue to shine a light on a topic in which many want to keep hidden.

The Awareness Center, Inc

P.O. Box 4824

Skokie, IL 60076

The Awareness Center is a non-profit, certified 501 (c) (3) organization.  Our goals include reaching out to Jewish survivors of sexual violence, parents of sexually abused children, family members of alleged and convicted sex offenders, rabbis, cantors and other community leaders. We also serve as a clearinghouse of information, and offer advocacy for those in need and educational seminars.

Sources

2008 US Census Bureau

2007 Israeli Central Bureau of Statistics

The Awareness Center’s Brochure

Dissociative Disorders in Women: Long-Term Consequences of Violence Against Children

Dissociative Disorders in Women:
Long-Term Consequences of Violence Against Children

By KAREN HOPENWASSER, MD 


Dissociative disorders, diagnosed as much as nine times more frequently in women than men, are poorly under- stood. The mosaic symptomatology often leads to misdiagnosis or incom- plete assessment. Despite substantial research indicating the probable etiol- ogy as severe childhood abuse, many clinicians do not recognize the rela- tionship between violence and dissoci- ation. An emerging body of research indicates that post-traumatic memory can be distinguished neurobiologically from other forms of memory. While clinical research has given us tools for evaluating dissociative symptoms, neurobiological research is clarifying the relationship between brain devel- opment in children and adult dissocia- tive symptoms. Once the diagnosis is made, many patients report feeling understood for the first time in their lives. This allows for stronger thera- peutic alliances and the use of com- plex treatment techniques to manage pain and increase a sense of safety. 


Everyday physicians examine women who have experienced violence as an ordinary occurrence. The awareness that they have been physically beaten and/or sexually abused is silenced in some women by unbearable shame, while for others, the context of violence within the family camouflages their awareness altogether. As children these women used methods of coping that allowed them to manage the pain, maintain emotional connec- tions, and survive into adulthood, albeit with multiple physical and psychological problems. Few physicians have been trained to recognize the long-term conse- quences of early childhood abuse and Dr. Hopenwasser is a clinical assistant professor of psychiatry at Cornell University Medical College and is in practice in New York City. 

dissociative disorders, in particular. While the dissociative disorders are weighted with great controversy, this controversy has propelled much-needed research and scientific interest.

The concept of dissociation put forth within the medical community dates back to the late 19th century with the work of Jean-Martin Charcot and Pierre Janet.1 These Salpêtrière physicians had a major influence on Sigmund Freud, who more fully developed the concept of hysteria.2 As psychoanalytic thinking moved from a trauma theory of dissocia- tion to a seduction theory of hysteria, interest in dissociation faded. Although clinicians recognized the phenomenon of “battle fatigue”3 in soldiers during both World Wars, a renewed interest in disso- ciation did not emerge until the late 20th century. Currently, dissociation is recog- nized as a neurophysiological phenome- non that develops in response to envi- ronmental influences and manifests itself in distinct physical and psychological symptoms. Recent research on the neu- robiology of post-traumatic stress disor- der (PTSD) and dissociation4-8 has sup- ported the distinct categorization of dissociative disorders and chronic post- traumatic states. We are becoming increasingly aware that extreme stress, particularly in the form of interpersonal mistreatment, has a profound psycho- physiological impact on the developing child. As we understand more about these consequences, we need to reevaluate some fundamental theories about the structure of the mind, the phenomenology of psychiatric diagnosis, and the impact of environment on brain development after birth. 


Dissociation, though, remains an elu- sive concept. Frank Putnam defines it as:

a process that produces a discernible alteration in a person’s thoughts, feel- ings, or actions so that for a period of time certain information is not associated or integrated with other information as it normally or logically would be.9 

Bessel van der Kolk, et al subdivide dissociation into three categories: primary, secondary, and tertiary.10 Primary refers to sensory and emotional elements dur- ing a traumatic experience that may not be integrated into memory. Secondary refers to the separation of the experienc- ing and observing self, such as the feeling of floating above oneself and observing from a distance. Tertiary refers to the development of distinct identity states, characterized by particular thoughts, feel- ings, and behaviors. This tertiary form— the dissociative disorders—is the main subject of this paper. 


Dissociation will be seen in primary care practice as a symptom of other major psychiatric illness, such as major depressive disorder, bipolar disorders, and substance abuse or withdrawal; as a psychological defense; as a psychiatric ill- ness; and, at times, as a nonpathological experience, including its manifestation in certain non-Western rituals. It will also be seen in a variety of medical condi- tions, such as toxic reactions to chemi- cals, medication reactions, and metabolic disturbances. As a symptom of illness, there is no evidence of a sex difference in prevalence. As a Diagnostic and Statistical Manual (DSM-IV) diagnostic category, however, dissociative identity disorder (DID), formerly multiple personality dis- order, is diagnosed three to nine times more often in women.9,11,12


The dissociative disorders masquerade as a variety of illnesses and somatic disor- ders. A 1991 literature review found an average of seven years between a patient’s entry into treatment and a diagnosis of DID, and that each patient accumulated an average of three to four different diag- noses along the way. The author con- cluded that “clinicians’ general lack of familiarity, . . . skepticism, and low indices of suspicion play important roles in their failure to make the diagnosis in a timely manner.”13 The development of such research-based instruments as the Structured Clinical Interview for Dissociative Disorders,14 the Dissociative Disorders Interview Schedule,12 and the Dissociative Experiences Scale15,16 helps clinicians to make the diagnosis more quickly. 

With increased recognition of dissocia- tive disorders, clinicians find that patients feel better understood, sometimes for the first time in their lives. This enhances the sense of trust vital to the therapeutic relationship and increases the sense of safety essential for healing. 


Despite some methodological limita- tions, studies on long-term outcome indicate that symptoms and the cost of treatment are both reduced when patients are correctly diagnosed with DID.17,18 Ellason and Ross looked at 54 inpatients with DID over two years and found that with treatment, both Dissociative Expe- riences Scale and Dissociative Disorders Interview Scale scores decreased signifi- cantly, and other symptoms improved.17 The purpose of this review is to help clinicians understand the dissociative disorders in both individual and larger social contexts. The relationship between dissociation as a psychological defense and as a psychiatric illness affords us insight into what can be called a post- Cartesian neurophilosophy of mind/ body unity.19,20 This shift from dualism, the separation of physical and mental, to an appreciation of the material compo- nents of consciousness, helps us to understand dissociative disorders. The nexus of symptom presentation will begin to make sense as we understand the neurophysiology of consciousness and the developmental integration of physical and psychological self. 



Relationship Between Dissociation and Violence The dissociative disorders are:

a psychobiological response to a relatively specific set of experiences occurring within a circumscribed developmental window . . . the most compelling and clinically useful model [of the genesis of DID] is based on evidence that repeated childhood trauma enhances normative dissocia- tive capacities, which in turn provide the basis for the creation and elabora- tion of alter personality states over time.21 

Repeated childhood trauma can occur within the context of such large scale social violence as the holocaust or war, or within the individual family. The overwhelming majority of US women who suffer from chronic dissociative disorders were victims of childhood physical, emotional, and/or sexual abuse starting between the ages of 2 and 12 years old.22-25 This abuse includes the repetitive exposure to violence against a parent or sibling as well as that experi- enced directly. 


A recent epidemiological study in Ontario, Canada of nearly 10,000 resi- dents age 15 and older found that 31.2% of men and 21.1% of women reported a history of childhood physical abuse. Childhood sexual abuse was reported by 12.8% of women and 4.3% of men. Severe physical abuse (based on the Child Maltreatment History Self-Report) was reported nearly equally by men and women (about 10%), while nearly three times as many women as men reported severe sexual abuse (11.1% versus 3.9%).26 These findings support the national consensus that domestic violence against children is common, and that severe sexual abuse is more common in girls than boys and has a prevalence of more than 10%. 


While not all abused children develop dissociative disorders, studies have shown a high rate of dissociative disorders in women who identify themselves as sur- vivors of sexual abuse.24,27-29 One study of 98 female psychiatric inpatients found that 83% had dissociative symptom scores above what would be considered median for normal adults, and those with a history of childhood sexual abuse had the highest dissociative experience scale scores. In addition, a history of childhood sexual abuse seemed to double the risk of concurrent physical and sexual abuse in adult life.24 


Some clinicians have speculated that men with DID are found more often in the criminal justice system than the men- tal health system.21,30 An example can be found in the work of James Gilligan, a forensic psychiatrist, who noted case after case of severe early childhood maltreat- ment among male murderers in prison.31 In a review of records of 11 men and one woman who had committed murder, clinical researchers were able to establish a link between early severe abuse and DID. They were able to rule out malin- gering, while the evidence of early abuse was based upon corroborating informa- tion from family members, neighbors, court and hospital records. Most of the subjects had at least partial amnesia for the abuse.32 

Neurobiology of Dissociation

When abused children grow up, they often have fragmented memories of their childhood experience of violence. While physicians are aware that domestic violence is a nationwide “serious public health problem,”33 adults with inconsis- tent recall are often greeted with skepti- cism. A number of studies of “normal” college students and untraumatized children have demonstrated that children are suggestible, and that memory is unreliable.34,35 These studies have been used in a media campaign that has created excessive doubt in the minds of both clinicians and patients. 
  
The encoding of memories of trauma is subject to stress hormone influences that are different from those of nontrau- matic memory. Neurobiological research, as opposed to laboratory cognitive psy- chological research, has demonstrated that intense overstimulation of the amyg- dala (as a result of a terrifying stimulus) interferes with hippocampal function. As a result, registration of sensorimotor per- ception may occur without symbolic or semantic coding.36 The increased firing of hypothlamic-cortical pathways under stress may lead to increased facilitation of long-term memory. This could account for the eidetic (photographic) nature of flashbacks. Overstimulation may also lead to decreased sensitivity of receptors, leading to decreased registration, consoli- dation, and integration of memory. This accounts for both the “black holes”37 of dissociation as well as errors of recall. 


In a study looking at brain activity during flashbacks, positron emission tomography showed increased activity in right limbic, paralimbic areas and visual cortex, while activity was remarkably decreased in left inferior frontal (Broca’s area) and medial temporal cortex, the brain areas necessary for one to find words to describe these experiences.38 In

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addition, neuroendocrinological alter- ations lead to a failure in the develop- ment of a conventional linear sense of time. Instead of steady forward move- ment there are gaps in continuity.39 Fail- ure to experience time in a linear fashion can lead to a blurring together of memo- ries, not unlike what would happen if several transparencies were projected on top of one another.40 We would not be able to distinguish one from the other. Thus, the phenomenon of delayed recall will not be understood without further research in the neurobiology of traumatic stress and dissociative adaptation. 


While research is clarifying the mecha- nisms of PTSD, much less is understood specifically about the neurophysiology of dissociation. The thalamus plays a crucial role in dissociative states, serving as a sensory gate to modulate information between brain stem, cortex, amygdala, and hippocampus.41 One current theory of the biological basis of conscious awareness is that it is dependent on oscil- lating connections between the thalamus and cortex.42 The organization of con- sciousness is dependent on integrated corticocortical function. Certain drugs that produce dissociation interfere with cortical integration. Much laboratory research is now focused on various neuro- transmitters, including the excitatory transmitter glutamate and the NMDA (N-methyl-D-aspartate) receptor. There is hope that the study of these transmit- ters and receptors will someday give us insight into the pharmacologic manage- ment of severe dissociative states.41 



Clinical Picture of Dissociative Disorders
The DSM-IV divides dissociative disorders into five diagnostic categories: dissociative amnesia, dissociative fugue, dissociative identity disorder, depersonalization disorder, and dissociative disorder not otherwise specified (DDNOS). DDNOS includes many women who were severely abused as children but have not devel- oped distinct “alter” identities. The tran- sition from the old concept of multiple personality disorder to DID represents an attempt at conceptual advancement. Alter identities are not personalities at all, but could be thought of as uninte- grated or partially integrated pathways of neural networks regulated by neurotrans- mitters and neurohormones.40 As chroni- cally traumatized children mature, they may fail to integrate affectively charged memory with cognitive functioning, and as a result, dissociated alter states (or what Putnam calls “discrete behavioral states”)39 may emerge. This accounts for the classic symptom of “lost time” or memory lapses. In other words, DID is a disorder of consciousness and identity integration over time.40 One of the major tasks of psychotherapeutic treatment is the development of an integrated, sub- jective sense of past and present so as to distinguish between then and now. 

It is my belief that this failure to dis- tinguish between past and present is probably responsible for some of the range of psychiatric symptoms we see in dissociative patients, such as panic attacks, phobias, cycling mood changes, suicidal depression, paranoia, and even attention deficit type symptoms. The physical manifestation of this failure is seen in flashback states and somatic memory. Both somatic memory and somatic symptoms bring these patients into the primary care physician’s office. 


The multitude of symptoms associated with these disorders often leads to confusion about diagnosis. Many symptoms play together to create a unique picture, while individual symptoms overlap with those of other diagnoses: panic disorder, rapid cycling mood disorders, PTSD, and eating disorders.12 There is also a certain amount of co-morbidity, particularly with chemical dependency prob- lems, borderline personality disorder, PTSD, and mood disorders.28,43 Confu- sion between the Axis II diagnosis borderline personality disorder and Axis I diagnosis dissociative disorder is striking. The two can certainly coexist, while at times one is misdiagnosed for the other. Research on borderline personality disorder has shown an impressive correlation with early childhood abuse,44-46 and diagnostic criteria (identity disturbance, poor impulse control, self-mutilation) clearly overlap. One prospective study found that 38.6% of 44 children diagnosed with borderline personality disorder had abuse histories, compared to only 9%

of 100 controls with a range of other diagnoses.45 

Failure to recognize or appreciate a history of severe early trauma can hinder understanding of such extreme behaviors as self-mutilation, which is often a pain management technique used in the ser- vice of emotional survival rather than of self-destruction.47 When done in a state of post-traumatic numbness it can be particularly alienating for the helping professional to watch. Both clinician and patient are caught in the eddy of forgetting the function of this behavior. 



Dissociative Disorders in Medical Practice
Women with dissociative disorders fre- quently report somatic complaints;12,48-50 the list is lengthy, with headache, body pain, gastrointestinal and gynecological complaints particularly common. Miller found significant variability in visual functioning, with measurable changes in refraction between alter states in two studies comparing DID patients with simulated controls.51,52 Electromyographic studies indicate there may be marked changes in muscle tension as switches among conscious states are made.53 One recent example encountered personally was a woman who developed blisters on her feet wearing shoes that were already broken in and previously quite comfort- able. A switch into another conscious state (sometimes called a part) led to a shift in posture and manner of walking. 


Fluctuations in sensitivity to medica- tions and differential expression of allergic reactions, which can be problematic for the physician prescribing medication, have been found. Clinicians should not assume the patient is misleading if she gives a history of erratic reactions to medication or is confused about whether she has had allergic reactions. In the presence of a history of early trauma, this may be indicative of dissociative state changes.

Both electroencephalographic and thyroid studies can be inconsistent.54 In a prospective, longitudinal study of girls age 8 to 15 years, 14 sexually abused girls were compared with 13 control subjects. The sexually abused girls had twice the frequency of positive plasma antinuclear antibody titers when compared with matched controls, suggesting the possi- bility of alteration in immune function.55 

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It is a common clinical observation that the patient with severe dissociation seems different from visit to visit. The emotional tenor, quality of voice, body posture, and affect state may change markedly.9,12,21 The patient may well not report awareness of any difference, unless asked directly: Do you have clothing in your closet you don’t remember buying? Does your handwriting change dramati- cally? Do people seem to know you that you do not recall meeting? A rather sub- tle but serious problem is the change in cognitive ability across altered states.56

A highly educated, intellectually capable patient may on a specific occasion not understand directions for further medical treatment and use of medication, and she may not acknowledge it because she is either ashamed or too confused to

say that she does not understand. Cogni- tive changes will alter the relationship between doctor and patient. It can be bewildering to find that the trusting relationship one had developed with a patient is ruptured inexplicably. 


Women severely abused as children frequently develop chemical dependency problems.57 One study found that 73% of 55 women being treated for chemical dependency in an inpatient facility had been victims of sexual or physical assault, while those with concurrent PTSD were more likely to have been victims of childhood sexual abuse.58 



The Gap Between PTSD and Dissociative Disorders
Most clinicians have treated women victims of violence. PTSD syndromes are common following rape, battering, random crime, and accidents.59,60 Disso- ciation during a traumatic event increases the likelihood of ongoing post-traumatic symptoms.10 This observation has led to the development of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ),61 an instrument that has been used primarily to predict PTSD follow- ing natural disasters. While some trau- matized children develop chronic PTSD and others develop clear DID, there is a vast overlap of symptoms, and probably a majority do not strictly meet the crite- ria for either. Some have suggested com- plex post-traumatic stress disorder62 or disorders of extreme stress63 as diagnoses 

for adults who were victims of repeated violence in childhood. These are not yet DSM-IV diagnoses, although the criteria were used during some of the PTSD clinical field trials. These proposed diag- noses take into consideration that pro- longed, repeated trauma in childhood (what Lenore Terr has called Type II trauma)64 disrupts subsequent matura- tional processes and leads to a plethora of symptoms in adult life,65 including failure to self-regulate affect, inability to comfort oneself, impaired attachment (both clinging and fear of intimacy), impaired interpersonal functioning, and mistrustful attitude toward the world. 


Use of a diagnosis like disorders of extreme stress would allow us to identify a group of patients who are otherwise misdiagnosed and, consequently, some- times treated inappropriately. It would facilitate a view of the patient as a whole person with a disorder of adaptation, rather than fragmented diagnoses to match the fragmented sense of self. 



Treatment Considerations

No controlled studies have addressed the treatment of DID. Perhaps the greatest benefit of the controversy around DID has been the development of treatment guidelines. The International Society for the Study of Dissociation released Guidelines for Treating Dissociative Identity Disorder in Adults in May 1994. Revised in 1997 based on the available clinical and research literature, the guide- lines cover diagnostic procedures, treat- ment planning, and an outline for psychotherapy.66 While there are a vari- ety of treatment approaches, the many clinicians with extensive experience seem to agree that an emphasis on pain man- agement and creation of a sense of safety are necessary regardless of approach.67,68 Building the trust essential for a sense of safety starts with clearly defined bound- aries within the therapeutic relationship.69 


Because symptoms are broad and mul- tisystem, an informal treatment team— psychotherapist or psychiatrist, primary care physician and/or gynecologist, and adjunctive social supports—is most productive. Someone who is chemically dependent cannot learn to manage intense affect and integrate this with cognitive function, so the use of 12-step programs 

is essential to maintain sobriety. While numerous inpatient programs around the country treat adults with the dual diag- nosis of chemical dependency and disso- ciative problems, the majority of treat- ment occurs in an outpatient setting. Even severe symptoms can be managed on an outpatient basis with pharmaco- logical agents, within the context of psy- chotherapeutic support. Antidepressants relieve some depressive symptoms, though alter switching may create the impression that medication has stopped working.70 Flashbacks can often be man- aged with the long-acting benzodiazapine clonazapam. Anecdotal reports indicate that the alpha adrenergic agonists cloni- dine and guanfacine diminish flashbacks, while case reports have shown the efficacy of propanolol.39 Because propanolol can have substantial side effects and drug- drug interactions, I have tried the beta blocker pindolol, also useful in treating resistant depression, with some success. Carbamazepine, valproic acid, and low- dose new generation neuroleptics have also been helpful. As mentioned above, neurobiological research on dissociation suggests a theoretical role for anti-gluta- mate drugs, yet to be developed. 


Psychotherapeutic treatment requires flexibility and versatility. Cognitive restructuring, the modification of long- held beliefs,71 must be done within a care- ful exploratory context. This is usually facilitated through the use of such adjunc- tive therapeutic tools as journal writing, art work, poetry, yoga, meditation, and sometimes body work. In addition to traditional individual and group psycho- therapy, many adult victims of child- hood abuse benefit from nonverbal treatment approaches, such as art and movement therapy.72 


How much one has to remember in order to heal is a matter of debate, but it appears that one must remember enough to validate one’s experience and to mourn what was lost by or stolen from the trau- matized child.67,68 Speaking the unspeak- able and having others bear witness to it has allowed many women to move on
in their lives. The process is exquisitely painful, and we have few tools to amelio- rate that pain. I approach dissociative symptoms as a form of memory. Treat- ment needs to support the integration of

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these memories as long as they persist, especially since dissociation seems to increase the risk of revictimization, described by Kluft as a “sitting duck syndrome.”73 When dissociation dimin- ishes and no longer interferes with func- tioning, then remembering is determined by individual strengths and other subjec- tive traits. Many women find that spiri- tual connection is the only way to hold and tolerate their memories of utter helplessness and despair. 


One very new therapeutic tool for diminishing fear, enhancing safety, and decreasing pain is eye movement desensi- tization and reprocessing (EMDR).74 Originally developed to treat PTSD, it can be incorporated into the overall treatment of dissociative disorders.75,76 Clinical evidence indicates that EMDR allows the patient to downregulate the intensity of affect and process traumatic memories in clusters, rather than indi- vidually. It also allows for the processing of somatic memory in the absence of visual images. EMDR is not a hypnotic technique and does not involve sugges- tion. In the course of an EMDR session, the brain is stimulated through alternating left and right perception either through eye movement, auditory or tactile stimu- lation. Prior to the eye movements, the patient is encouraged to generate an authentic, positive cognition, even if it is difficult to believe in the thought. The alternating stimulation seems to allow for the rapid integration of cognitive and emotional information. While research has not yet explained the mechanism or efficacy of EMDR, “the absence of theory or a conceptual foundation is not suffi- cient to dismiss totally the preliminary findings of the technique.”77 In the hands of a skilled and competent thera- pist, EMDR can be an additional useful tool. The use of hypnosis in treatment and the risks of suggestibility have generated considerable controversy. 


In response to concerns about pseudo- memories, the American Society of Clinical Hypnosis released a 1995 task force report concluding that memories may be recovered later in life, that hyp- nosis may facilitate recovery of memo- ries, and that pseudo-memories may occur in and out of therapy, with or without hypnosis.78 Dissociation is a

form of auto-hypnosis, and it is impossible to avoid auto-hypnotic states in treating dissociative patients. The use of hypnosis allows for carefully controlled manage- ment of severe symptoms.79,80 

Conclusion

In summary, dissociative disorders are almost always a result of severe, repeated childhood maltreatment. They appear much more commonly in women, possi- bly because of the higher incidence of sexual abuse in girls than boys, and pos- sibly because they are recognized more in women than men. 

Many patients with dissociative disor- ders are misdiagnosed and mistreated by clinicians who misunderstand their dis- guised and multifarious symptoms. As Judith Herman says,

The ordinary response to atrocities is to banish them from consciousness. Certain violations of the social compact are too terrible to utter aloud: this is the meaning of the word unspeakable.67(p1) When we recognize and identify dissociative disorders in our patients we are forced to acknowledge the consequences of chronic violence on individuals and families. Clinicians who allow patients to speak about atrocities they have experi- enced are challenged to hold the aware- ness that this suffering was inflicted by other human beings and not a random act of nature. While dissociation helps children to survive, in adults it interferes with mature adaptation. 

The clinical presentation of dissocia- tive disorders needs to be taught to every medical student, every health profession- al in training, and every mental health trainee. While the fractured bones and the bruises of physical abuse in child- hood are no longer obvious in adult women, the symptoms of dissociation are carried into adulthood and seen by medical professionals routinely. 

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