This week's issue of the New Yorker has an article by Rachel Aviv on the medicalization of sex abuse crimes. It is well researched, well written and worth reading. She focuses the piece around the story of a man named John, who was drawn to child pornography on the internet, then to a chat room and finally to a rendezvous with undercover police officers. She describes his time in prison and on probation, his relapse, and his re-incarceration. The heart of the article is about the use of civil commitment to keep John "in treatment" after finishing his prison sentence. She describes civil court hearings, psychiatric testimony and life in the treatment facility where John winds up. Aviv is particularly interested in the fact that while John has not harmed anyone [other than indirectly through his support for the child pornography industry], the judicial system seems almost unable to release him for fear that he might assault a child. She discusses the psychological tests and psychotherapy which contribute to the view that John is a risk. Since the advent of the internet and the emergence of internet child pornography there has been a virtual epidemic of cases like that of John. As yet, however, as I read Aviv, we don't have a way to distinguish those men who will assault children from those who won't, nor do we have effective means of stopping such men from indulging in pedophile fantasies. As she describes it this creates a catch 22 situation that leaves men like John to spend years in involuntary treatment. Aviv quotes psychiatrists who deplore the profession being used to medicalize what they regard as a criminal issue. But, of course, there are also those psychiatrists who make a living testifying in civil court and running involuntary treatment programs.