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Publications about men sexually abused as boys are infrequent, but rare indeed is the work that discusses this population, clinically and theoretically, in sound psychoanalytic terms. Here, in Richard Gartner's Betrayed as Boys, we have such a volume. Gartner writes with a clear psychoanalytic understanding of the conflicts and struggles of these men, and by presenting an array of vivid clinical examples, brings the reader to the experience of sitting in the consulting room, working with them to understand their pain. In great detail he explores the effects of victimization on masculinity and the role that societal myths—e.g., that “real” males are never victims—play in their gender development. Careful distinction is made between these myths and a more nuanced clinical reality: e.g., the myth that sexual abuse “turns” a boy gay is countered by the idea that it affects the quality of his sexual relationships, regardless of orientation; the myth that all sexually abused boys become abusers themselves gives way to the observation that a defensively heightened rigidity in an abused boy's masculine gender role (i.e., emotional constriction and deficits in empathy) increases the likelihood the boy will become abusive later in life. The chapter on dissociation and multiple self-states, which deals also with difficulties in affect regulation, is especially well presented.
Emphasis is placed on distinguishing the effects of sexual abuse on men from its effects on women, and Gartner's explication of its consequences for males is excellent. The book would have perhaps been improved, though, had the author said more about the similarities across the genders, in both subsequent psychopathology and complications in treatment; at times his overemphasis on gender differences strikes the reader as strained and unnecessarily dichotomizing. However, Gartner is to be congratulated for his thorough descriptions of psychoanalytic psychotherapy and psychoanalysis with this population,