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Breast carcinomas diagnosed in the 1980s.

SIR,-Dr Andrew J Wiener,' in commenting on my editorial on the long term effects of child sexual abuse,2 first constructs a straw man of his own making by claiming that my argument against child sexual abuse depends entirely on its propensity to inflict long term harm, then demolishes this thesis to his own satisfaction. I agree that child sexual abuse is an evil irrespective of its long term consequences. In condemning a social evil there is no need to medicalise it by claiming that it causes illness. On the other hand, some social ills-for example, unemploymentprobably do contribute to morbidity and mortality and surely it is permissible to point this out. Dr Wiener rightly raises the possibility that the same social and family factors that predict adult psychopathology may also predict vulnerability to sexual abuse. We are preparing for publication data showing that the sexual abuse itself contributes to adult psychopathology independently of the disrupted and deprived background which enhances the risks of being abused. The law on sexual contact with children could be changed tomorrow and some moral convulsion could conceivably alter the public's attitude to the sexual use of children, but such contact would almost certainly go on producing immediate and long term psychological and emotional damage to those children. Child sexual abuse is in my opinion a medical problem as well as a moral and legal problem, and the clear recognition of this, far from "stunting" our view of the rights of children, as asserted by Dr Wiener, provides information essential for their protection.