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Fantasizing about sexual activity with children is the first step, said Judith Becker, a University of Arizona psychologist who has evaluated more than 1,000 men convicted of sexual offenses against children.

“They’re the same as us in the sense they’re discovering, rather than deciding, the nature of their sexuality,” said Dr. Fred Berlin, director of the Sexual Behavior Consultation Unit at Johns Hopkins University. “It’s not someone’s fault in any way they have pedophilia. I can’t imagine anyone would choose to be that way. But it’s their responsibility to do something about it.”

Incremental steps toward abuse can follow. They work to access children, often grooming families as well as potential victims. Boys without father figures or mentors are particularly vulnerable, Ms. Becker said, lured by the desire to spend time with older men.

A well-worn pattern

Victim 9’s story, detailed in the second grand jury presentment, follows a well-worn pattern. Like others, he met Mr. Sandusky through Second Mile when he was 11 or 12 years old. Chats about hobbies followed, then Mr. Sandusky requested his phone number, chatted with his mother, brought him to Penn State football games and gave him gifts and money. Soon, Mr. Sandusky picked up Victim 9 from school and hosted him for overnight stays.

Pedophiles test boundaries. Not every child is a target. Sex offenders told Ms. Becker that they didn’t pursue some children because they were assertive or they feared the child would tell.

At first, Victim 9 thought Mr. Sandusky’s “very affectionate” and “touchy-feely” cuddling, hugging, rubbing and tickling were normal. After all, Mr. Sandusky attended church each week, usually bringing along a pile of Second Mile children. Second Mile’s name was inspired by a Bible verse, Matthew 5:41.

But, according to the presentment, Mr. Sandusky’s contact with Victim 9 escalated to repeated oral sex and 16 instances of attempted anal penetration.

Pedophiles may tell themselves they’re not doing harm or the victim likes it, said Maia Christopher, director of the Association for the Treatment of Sexual Abusers. Self-deceptive thoughts are a hallmark, said Dr. Berlin, oftentimes mixed with genuine care for children and an inability to understand the consequences of their behavior.

On one such occasion, Victim 9 testified, he said he screamed for help in Mr. Sandusky’s basement knowing that Mrs. Sandusky was upstairs. No help arrived.

“They know how to identify vulnerable individuals and exploit those vulnerabilities,” Mr. Lisak said of pedophiles. Victims wonder, “Did the fact I didn’t protest mean I wasn’t a real man or I was weak? They find it very difficult to remember they were young kids or teenagers. These people had incredible control over them. … They groomed you to trust them. After that, how do you trust anybody?”

In an extensive statement last week, Mrs. Sandusky denied the claim that a boy called for help from the basement. Mr. Sandusky maintained his innocence in interviews with NBC and the New York Times.

That didn’t stop the ex-wife of Mr. Sandusky’s son, Matt, from being granted a restraining order preventing her three children from unsupervised or overnight visits at Mr. Sandusky’s home. Court filings said Mrs. Sandusky called the ex-wife, Jill Jones, and insisted that the children were safe around Mr. Sandusky.

Actions get bolder

Some of Mr. Sandusky’s reported sexual encounters with children were said to occur in quasi-public settings, a telling sign to those studying the field. The grand jury presentments are filled with the details: the Lasch Football Building’s locker room showers and sauna, the pool of a local hotel, the weight room of a Clinton County high school.

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