On a Saturday afternoon last spring, Fred Berlin leads me into a room where he holds group therapy sessions in his private practice in midtown Baltimore. In this sparsely furnished space, with peeling wallpaper, Berlin and the team he oversees treat patients with sexual disorders and difficulties — everything from gender dysphoria to overpowering sadism to pedophilia.
On one wall are grotesque sculptures representing the seven deadly sins. Berlin, who is an associate professor of psychiatric and behavioral sciences and director of the Sex and Gender Clinic at the Johns Hopkins University, is fascinated by shifting perceptions of sin — gluttony, he observes, was once categorized with other cardinal vices, but is now understood as more of a medical issue than a personal failing. For Berlin, what a culture considers abhorrent says as much about the culture as it does about the vice. That’s why, next to the sin sculptures, in this chilly room where people share their most personal impulses, hangs a baby photo of Adolf Hitler.
“I put it there not because I have respect for the horrors of Hitler,” he says. It is unlikely that any patient recognizes the picture. But for Berlin, the photo raises eternal questions about the nature of evil. “I could just label Hitler as evil, and we could all say, ‘OK, he was evil.’ Where does that get us? But if the question is, what about his life experiences? What about his biology? Was there some sort of psychosis?”
Berlin possesses an ultra-rational, almost detached way of contemplating horrible deeds. As much as any other academic in the past 40 years, he has made arguably the most reviled type of person in our culture — the pedophile — into a legitimate subject of study and even empathy. “Fred needs tremendous recognition for making it clear to the general public that people don’t choose to become pedophiles, that it’s a neurobiological condition,” says John Bradford, a forensic psychiatrist at the University of Ottawa. While it’s unclear that the general public has, in fact, recognized this, it’s undeniable that, as Bradford says about Berlin, “he has been a pioneer.”
As one might imagine, Berlin’s views have made him enemies. He is a “pedophile apologist,” Judith Reisman, a law professor at Liberty University, has written (with Geoffrey B. Strickland), in the Ave Maria International Law Journal. “Dr. Berlin protected the predators in his care while ignoring their acknowledged ongoing child victims.”
Explosive charges like those are routine for Berlin. When he began his work, in the mid-1970s, few people paid attention to the scant research on child molestation and pedophilia. Since then, day-care abuse scandals in the mid-1980s, revelations of child rape in the Roman Catholic Church, and assaults on minors at Penn State and Michigan State, mean anyone doing his kind of work has to withstand public suspicion, even vilification. Now, as he nears retirement, he is having difficulty finding a successor to run his clinic. Will anyone else want to devote a career to studying and helping pedophiles?
A growing number of experts have arrived at something of a consensus on pedophilia and its origins. First, adults do not choose to be attracted to children. They are either born with these attractions or develop them through ways that are mysterious to us. Second, not all those with pedophilia act on their attractions — indeed, many such individuals are horrified by their impulses and suppress them successfully. Third, most people who abuse children are not pedophiles. They are not exclusively attracted to children but rather are sexual opportunists. Finally, for some people, pedophilia is something that can be treated with a combination of psychotherapy and medication. People with pedophilia usually cannot cease being attracted to children, but sometimes they can control their urges to the point of never acting on them.
None of this was known to Berlin at the outset of his career. He received his Ph.D. in psychology and M.D. from Canada’s Dalhousie University in the early 1970s. His dissertation examined the effects of hypnosis on patients trying to quit smoking. But when he arrived at Johns Hopkins as a resident in 1975, his focus shifted. He began working under John Money, a sexologist who pioneered research into gender fluidity and transgenderism. Money coined the now-common terms “gender identity” and “gender role.”
Money’s Johns Hopkins was an experimental environment. Given the paucity of research into sexuality — this was but a few years after the Mad Men era — it had to be. In the mid-1960s, he established the world’s first clinic devoted to transgender surgeries, the Johns Hopkins Gender Identity Clinic. Money himself engaged in nudism and group sex and advocated open marriages and the virtues of the porn flick Deep Throat. He was described by one writer as “suavely charismatic … with the long, elegantly cut features of a matinee idol.” He would regularly sprinkle expletives into conversations and make sexual remarks at unusual times. The New York Times called him “an agent provocateur of the sexual revolution.”
I’ve just tried to do a good job, to do what I feel is right, and trust that things will turn out well.
Money’s brilliance could morph into arrogance. Most notoriously, he persuaded the parents of a son who lost his penis during circumcision to undergo sex-reassignment surgery and be raised as a girl — but the girl later reverted to identifying as male, suffered from depression, and committed suicide. Money also studied pedophilia and child abuse. And, as with other sexual practices he studied, he was sometimes blasé about the harm that could result from child molestation. “If I were to see the case of a boy aged 10 or 11 who’s intensely erotically attracted toward a man in his 20s or 30s, if the relationship is totally mutual, and the bonding is genuinely totally mutual, … then I would not call it pathological in any way,” he once told Paidika, a Dutch-based pro- pedophilia journal.
This was the avant-garde setting Berlin entered. “I remember back then people asking me, Is it ‘pedophile’ or ‘peedophile’?” Berlin recalls. “People weren’t even familiar with the term. If you looked at the literature, there was very, very little out there.”
In 1963 the FDA approved a drug called Depo-Provera to be tested as a female contraceptive, but Money began experimenting with it on sex offenders. Combining the drug with therapy, he used it to suppress testosterone and diminish the brain’s erotic imagery, reducing sexual urges and functioning. Since Money wasn’t a medical doctor, the department asked Berlin to help write prescriptions for Depo-Provera.
Beginning in the early 1980s, hundreds of Maryland sex offenders were offered probation if they agreed to be injected with the drug under the supervision of Money and Berlin. (Money died in 2006; Berlin no longer works with the prison system.) This course has proved enticing to medical experts, government officials, and inmates alike as an alternative to prison, but civil libertarians and others have lambasted the process as essentially forcing people to take mind-altering drugs. “To me, it’s still kind of coercive because they are inmates. It’s a coerced choice,” says Daniel C. Tsang, librarian emeritus and an LGBT activist at the University of California at Irvine, who wrote about Money for the Journal of Homosexuality.
Others identify the limitations of Berlin’s advocacy of drugs and therapy for most pedophiles. “From a public-safety standpoint, my understanding is that it is only effective so long as the offender takes it,” says John Stinneford, a law professor and assistant director of the Criminal Justice Center at the University of Florida. Some patients may simply stop taking the medication and disappear.
Still others question the science behind Depo-Provera. “Dr. Berlin’s studies and those conducted by other psychiatrists and clinical psychologists have not provided any scientifically valid basis for assessing the safety and effectiveness of using Depo-Provera to treat sexual deviates and sex offenders,” writes William Green, a Morehead State University professor, in his 2017 book, Contraceptive Risk: The FDA, Depo-Provera, and the Politics of Experimental Medicine (NYU Press).
That hasn’t prevented many states from mandating what is often called “chemical castration” of sex offenders. And patients who benfit from the medication see it as vital. Jason (not his real name) is a 30-year-old married man living in West Texas. In 2011 he was charged with indecency with a child. As part of his plea deal, he received sexual counseling. But because his counselors doubled as his probation officers, he felt inhibited from being honest about his attraction to children. In addition, he couldn’t find anybody who specialized in sex-related treatment in his region. In 2014, the courts gave Jason permission to travel to Maryland to be treated by Berlin. He flies to Baltimore every other month. The drug he is on, Lupron, which reduces the amount of testosterone in men and is commonly used to treat symptoms of prostate cancer, has “absolutely, literally, been life-changing,” he says. “My addiction really controlled me.” The injections of the drug don’t make his attraction to children disappear, but they reduce the urge to a controllable level. “I shudder to think where I’d be without it.”
B erlin’s office is large and has a fireplace. Framed posters announcing the clinic’s early days hang on a wall. Beside them are stills of Berlin speaking on the Today show and on 20/20. A statue of Yoda stands in the corner (“I have to get wisdom from somewhere,” Berlin jokes).
He is friendly and candid. But he is also wary of talking with reporters. He asks me to explain my interest in him, although I’ve explained it to him previously, over the phone. He’s Googled me thoroughly.
Berlin is remarkably equanimous about the controversy he’s attracted, however. “I see on the internet sometimes the nasty statements that people make, but I felt very supported in this over the years [by] the people I work with,” he says. “I’ve just tried to do a good job, to do what I feel is right, and trust that things will turn out well if I continue to approach it that way.”
When Hopkins created a clinic for people with sexual disorders and problems, in 1980, the university was a pioneer. “There was a tremendous need,” he recalls. “If you had schizophrenia, substance-abuse problems, anorexia, you name it, there were places you could go to get help. But there was virtually no place you could go, even though pedophilia was listed as a mental-health condition, if you wanted to get help.”
Discussing sexual problems was so taboo that in the early years of the clinic, there were days when no patients showed up. But eventually they began showing up in droves. Few individuals in America have studied as many people with paraphilias — sexual abnormalities — as Berlin. One of his patients was a sadist who was afraid he was going to act on his violent fantasies. He was preparing to attack his wife with a weapon he had devised by attaching a club to a chain (Berlin still has the device).
By the early 1980s, Berlin’s clinic had gained national attention. “Sexual Deviancy: Clinic at Hopkins Fills a Need,” read the headline of a 1984 profile in The Baltimore Sun. The article’s language is revealing of the times: “They are child molesters, all of them. In the language of medicine, they are ‘pedophiles.’ " The next year, the Sun reported on a man under Berlin’s care who stopped by the downtown arcade to meet young boys before his visits to the Hopkins clinic. This validated criticism from child-advocacy groups, which charged that Hopkins was protecting predators at the expense of children. The man had previously been convicted of child molestation, compounding the blunder. Berlin admitted to the Sun that he and the staff at Hopkins had erred in allowing the man to go off Depo-Provera, but otherwise they stood their ground.
Berlin points to the decreased recidivism rates of his patients as evidence that the therapy-and-medication approach works. “Most child molesters are treatable,” says the sociologist David Finkelhor, director of the Crimes Against Children Research Center at the University of New Hampshire. Of course, much of the public thinks otherwise. Many believe any punishment short of execution is too lenient to pedophiles. “This clinic was founded by John Money to give judges ‘leeway’ in sentencing sex offenders — that is, a place where they could send child molesters other than jail,” writes Liberty University’s Reisman, a leading figure in conservative efforts to roll back the sexual revolution. “Dr. Berlin was his disciple.”
In 1987 the Maryland legislature introduced a bill requiring physicians and therapists to notify authorities if an adult patient told them he had abused a child. But Berlin told lawmakers that such legislation would prevent sex criminals — or those struggling with urges to commit sex crimes — from voluntarily pursuing psychiatric treatment. “I didn’t want to deter undetected people from coming forward and getting help that might, in effect, make the community safer,” he says. “We weren’t trying to give anybody a pass — if somebody was in trouble, we weren’t saying they shouldn’t be prosecuted, we weren’t saying if children are seen, they shouldn’t be reported. But we didn’t want to enable anybody who might want to get help, to be safer, not to be able to get it.”
Initially, Maryland policy makers compromised with Berlin. If abuse was happening and the clinic knew about it, the law said, it had to be reported. But if the abuse had been committed in the past, it didn’t. Critics nicknamed it “the Berlin exemption.” It proved deeply unpopular — local critics worried Johns Hopkins would attract pedophiles from across the country — and soon the exemption was revoked.
But Berlin and Hopkins found something of a loophole. “The Sexual Disorders Clinic adopted a policy of advising prospective patients that offenses against children would not be reported if their cases were referred to the clinic by an attorney, since such information could be protected by the attorney-client privilege,” the clinical psychologist Douglas Peddicord wrote in the Sun. He said the clinic was trying “to hide behind lawyers to shield knowledge that the legislature has specifically refused to exempt.” A different, front-page article in the Sun accused the clinic of “skirting the law” when it came to reporting sexual abuse. “Johns Hopkins Hospital Has a Sex Problem” was the headline in Baltimore magazine. Only after the state’s then-attorney general, J. Joseph Curran Jr., spoke out against Berlin did he grudgingly agree to cease the practice, though he said that “an attorney general’s opinion is not legally binding.”
Then, in March 1988, a sexual-assault victim being treated for depression at Johns Hopkins Hospital said she had been sexually assaulted for a second time — by a fellow patient who broke into her room. They were on the same floor of the hospital, although he was in the Sexual Disorders Clinic and had raped teenage girls. The woman filed a lawsuit against Berlin and the hospital; her lawyer said they were responsible for “housing sexual deviants and sexual offenders including pedophiles with unsuspecting general psychiatric patients.” The woman eventually dropped the complaint against Berlin and sued only the hospital.
Hopkins settled with the woman for an undisclosed amount, but the incident permanently altered the relationship between the hospital and Berlin. In 1992 the university distanced itself from the Sexual Disorders Clinic. Berlin moved the clinic into a private office and changed its name to the National Institute for the Study, Prevention and Treatment of Sexual Trauma. The Sun reported the news by saying, “Over the years, Dr. Berlin earned the scorn of many with his position that therapists specializing in the treatment of pedophiles — child molesters — should not have to report sexual offenses to law-enforcement authorities. … Child advocates have frequently pointed to patients and former patients who returned to deviant behavior after brief periods of good behavior.”
“I didn’t by any means agree with the decision, but I understood it, and I’ve tried to work to find common ground,” Berlin says. He remains director of the Johns Hopkins Sex and Gender Clinic, and the university has repeatedly been forced to defend its relationship with him. The most notorious incident came in August 2011 at a conference on pedophilia and the Diagnostic and Statistical Manual of Mental Disorders, where Berlin was to deliver the keynote speech. The symposium was hosted by B4U-ACT, a support group that aims to help people attracted to children receive treatment before they act on their impulses. In his remarks, Berlin argued that “we need to have both a criminal-justice involvement and a public-health perspective. I would make an analogy to alcoholism. We have to have laws against drunk driving — society has a right to protect itself — but it would be naïve to think that you are going to solve the problems of alcoholism simply by putting drunk drivers on a registry, and to think that we can punish and legislate the problem away.” Cued up by a Daily Caller article before the event, the media response, particularly from the right, was immediate and vicious. The Washington Times, First Things, and Fox News accused Berlin of trying to normalize child rape.
Hopkins released a statement decrying the “significant misinformation circulating about Fred Berlin … and his recent participation at a conference in Baltimore.” It continued: “As an international expert in sexual disorders, Dr. Berlin speaks routinely at conferences in his role as an individual and as an expert in these matters. In this role, Dr. Berlin speaks for himself, and not as a representative of Johns Hopkins.”
B erlin doesn’t seem to comprehend how unpopular his views are in the wider culture. “There are very few who have come and talked to me who have left, you know, wanting to say bad things about me,” he says. With his thinning hair and grandfatherly demeanor, it is easy to forget how contentious his work can be. But the B4U-ACT incident illustrated why his institution has few peers. “I’ve been trying to reproduce what he’s done: a university-based sexual-disorders clinic,” says Renee Sorrentino, an assistant professor of psychiatry at Harvard. “Most institutions are concerned with the stigma of having this kind of patient population at their university.” Though administrators understand that the work is important, “getting the money and the resources” is next to impossible, she says. “Because of its history with John Money, Berlin was able to go make Hopkins” into a rare place.
A clinic attached to a university has several advantages over a private practice. It prioritizes research. It also can treat the indigent. (Research shows that individuals on the sex-offender registry have difficulty getting jobs.) As a result of her difficulties with Boston-area universities, Sorrentino established a private practice, the Institute for Sexual Wellness. She treats her patients with Lupron and psychotherapy, but laments that not everyone can afford private therapy. “Everyone agrees that someone has to do it, but nobody wants it in their facility,” she says.
Some of the most cutting-edge research into pedophilia is taking place in Canada. An Ottawa hospital is claiming that its Sexual Behaviours Clinic can actually cure pedophilia, turning a man who was attracted to children into someone attracted to adults. The clinic won a 2015 award from the American Psychiatric Association, but most experts are deeply skeptical of claims that pedophilia can be eliminated, any more than straight men can cease being attracted to women. However, all agree that more research is beneficial — it’s just hard to come by.
“There’s no obvious reason why money should be spent directed toward learning more about pedophilia,” Berlin concedes. “It probably is harder to do research — to get the funding to do research — because there’s not this sense that it’s deserving of research.” He continues: “If I had to say there’s one big thing holding back more research, more availability in clinical health and so on, often people don’t have the sense that these are deserving human beings.”
Berlin’s empathy is almost limitless. He worked with the first person to be executed in New England since 1960, the serial killer and rapist Michael Ross. He put Ross on medication while he was incarcerated, so he wouldn’t assault guards or obsess about sexual violence. Berlin doesn’t think people like Ross could be rehabilitated or safely released, but he does think their condition could be improved. Similarly, Berlin visited the serial killer and cannibal Jeffrey Dahmer in prison in Milwaukee, and testified for the defense, saying that Dahmer had no control over himself. “There’s a lot there showing a guy who really was struggling not to do this, but who eventually lost the battle,” he says. “I couldn’t help wonder if we had had a society where we encouraged somebody who was having these thoughts to come forward in the beginning, might these people who have all died been alive?”
Through all of this, Hopkins has maintained ties with Berlin, who remains grateful to the university. But now in his mid-70s, he is slowing down his pace, and having trouble finding a successor for his clinic. He can’t offer a big salary, and anyone carrying on his role will have to be comfortable being vilified. Matthew Taylor, a former student of Berlin’s and now a psychiatrist at Hopkins, admits that many of his colleagues hated having to work at Berlin’s Hopkins clinic. “He can do this kind of work that is so distasteful for others,” Taylor says of Berlin. “Many find it too difficult.”
Berlin is often asked why he’d want to spend his life studying and helping people who are attracted to children. To him, the answer is easy. “I don’t think the general public today has the sense that, if a person is sexually attracted to children, and certainly if they’ve acted on it, that there’s any chance at all this could be a decent person struggling, deserving of help,” Berlin says.
“I believe that’s the case. I believe that, in time, society will see it that way.”
Jordan Michael Smith is the author of the Kindle Single Humanity: How Jimmy Carter Lost an Election and Transformed the Post-Presidency. He last wrote for The Chronicle Review about Stephen F. Cohen.
