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6. PAEDOPHILIA AS A BIOLOGICAL QUIRK
The simplistic hope that such complex sexual and social issues as homosexuality can be accounted for by a genetic or constitutional characteristic is attractive to many people. While paedophilia is often considered solvable by physical castration, research has not been extensive on possible biological abnormalities in paedophiles. One obvious possibility is that the sex hormones of paedophiles are in some way peculiar -- they have too many, too few, too much or too much at the wrong stage in their lifecycle.
Lang, Flor-Henry and Frenzel (1990) reviewed research on the sex hormone profiles of paedophiles and incestuous men. Summarizing previous findings, they concluded:
To gain better understanding, Lang, Flor-Henry and Frenzel took substantial samples of incest offenders, paedophiles and community controls. Details of the men's arousal to various slides using the penis volume measure were used to validate aspects of their sexuality. The hormones in blood samples taken early in the morning following fasting were analysed; there were differences in the mean amounts of the hormones prolactin, cortisol and androstenedione. Between 20 and 44% of incest offenders and between 9 and 20% of paedophiles , showed clinically abnormal levels of these hormones; the order was always (from lowest to highest) controls, paedophiles, incest offenders. The researchers were somewhat reserved in their conclusions. For example, differences in levels of the hormones prolactin and cortisol may simply be due to the effects of different
levels of stress present prior to the stressing life experiences of arrest and prosecution. Furthermore, psychological events and hormonal patterns do not exist in isolation from each other; they mutually interact and influence each other.
This theme of hormonal problems in paedophilia was dealt with more practically by Harrison et al. (1989) in a case study. Hyperprolactinaemia is a sex hormone abnormality involving prolactin which results in difficulties in sexual libido, arousal and ejaculation. Their patient, a 29-year-old storeman, had admitted indecent assault of a six-year-old, offences that continued for a further four years. The crimes:
He was a poorly educated, shy and solitary person whose adult sexual experience involved just one woman, a relationship which ended two years before the offending began. Sexual problems contributed to the failure of the relationship. Low sex drive and difficulties in erection and ejaculation had disrupted sexual intercourse.
The drug bromocriptine was given and his prolactin levels achieved normal levels within six weeks. Simultaneously, there was a renewal
of his libido, his erections and his ability to ejaculate. He claimed that his sexual fantasies were now solely about women and he was not
No relationships had been formed with adult women and it is an open question quite what his sexual proclivities actually were. The authors theorize how sexual dysfunction forced him towards children. On the other hand, this man was apparently capable of masturbating to thoughts of women but chose to masturbate over a young girl. Put in another way, what really drove him to offend against the child?
Other researchers have looked at the neuro-psychological characteristics of paedophiles.
Scott et at. (1984) compared-sexual assaulters with paedophiles in a secure ward of a Nebraskan state psychiatric facility. All had been ordered to undergo evaluation for possible categorization of "mentally disordered sex offender". Men with signs of neurological impairment (e.g. a history of seizures,
mental retardation or head trauma) were excluded. The control group consisted largely of non-hospitalized people:
Neuro-psychological information correctly classified 58& of normals, 50% of forcible sexual assaulters and 64% of paedophiles.
While seemingly impressive, the misclassification of individuals is actually quite large; a third of normal men would be misclassified as either sexual assaulters or paedoghiles. The authors claim that
This particular sample of offenders had been referred to the hospital for assessment for mental disorder, thus they may have been pre-selected by the system in a way that ensured more neurological abnormalities than is generally the case.
A similar approach measures brainwave activity using the electro-encephalograph (EEG). Flor-Henry et al. (1991) compared a large sample of court-referred paedophiles at forensic services at an Alberta Hospital, Canada, with a community sample recruited by newspaper advertisements. Phallometry and interviews were used to categorize men as paedophiles, hebephiles and incest offenders, Although the offenders were much the same as the controls in general, paedophiles differed in terms of the power and coherence of their EEG traces:
The authors hold that sexual deviation ma e the result of abnormal ideas that are the consequence of changes in the functions of the dominant cerebral hemisphere. Pathology of the dominant
hemisphere encourages abnormal sexual ideas and is involved in problems in the communication between the two halves of the brain (the non-dominant hemisphere being involved in the orgasmic response):
Considerable reservations ought to be expressed about this theory. It suggests that offenders have problems with the organiation of thoughts within and between the different halves of the brain. For ssome reason this results in deviant sexual thoughts. Since the cerebral organization of men is more susceptible to problems, this might explain paedophilia's relative absence in women. But there are difficulties with this.
First of all, it is not a finding that has received
Indeed, paedophiles tend to be psychologically similar to men in general.
The man was horrified by his actions and was intensely remorseful. For two years he had nightmares of the death of the child during the offence. Other bad dreams included wolves "tearing people apart" with heads and arms being bloodily ripped off. He was born with defects to his chest, foot and hand on the left side of his body and had received head injuries at the ages of 9 and 13; the resulting seizures were controlled by drugs.
The lack of systematic data of the association between this type of neurological problem and paedophilia makes such a single case study difficult to interpret.
Brain symmetry has been studied by some, including Wright et al., (1990), who examined the brain scans of a variety of sex offenders and non-violent non-sex offender controls. It is notable that the left brain hemispheres of offenders tend to be smaller than those of normal controls, although paedophiles were more like controls than sexual aggressors against adult women or incest offenders. Paedophiles differed from controls and incest offenders and sexual aggressors against women -- a far greater proportion of them had smaller left brain hemispheres than right hemispheres. This possibility suggests that abnormalities are commoner in the brains of sexual offenders.
Castration and Other Biological Remedies
Castration as a treatment for paedophiles has an emotive appeal for some. One cannot escape the odium that sterilization engenders and the considerable ethical and moral imperatives associated with it. Nevertheless, it is generally held to be a successful treatment for sex offenders by reviewers. For example, Crawford (1981) suggested:
Some argue that castration is extremely effective in reducing recidivism rates (Bradford, 1988). He mentions four studies indicating that, following surgery, the recidivism rates are under 4%. This contrasts markedly with recidivism rates of 60% or more prior to castration.
Judicial castration has a fairly distasteful pedigree (Sturup, 1972). For example, it was introduced in Kansas in 1855 to deal with black men who raped or attempted to rape white women. Similarly, Nazi Germany in 1933 allowed castration for men who murdered to satisfy their sex drives and for men who were evaluated as being dangerous sex criminals who had previously offended or had received a sentence of a year or more. Between 1899 and 1921, therapeutic castration was employed in the United States although it was finally abolished as unconstitutional. Some countries (Denmark and Germany) have legislated to help doctors to carry out therapeutic castration rather than for its judicial use.
Recidivism rates in studies in Denmark, Germany, Sweden, Norway, Holland and Switzerland for mixed groups of offenders are substantially under 10%, with a range from about 1 to 7% (Sturup, 1972).
These are not out of line with his own study of 900 men castrated between 1929 and 1959. At the time of surgery 44% were at institutions for mental defectives; only 18% were not institutionalized. Forty per cent were castrated following just one offence. The follow-up period varied, but over 60% were followed up for more than six years. A small percentage retained their sexual drive for lengthy periods after the operation. When crimes followed castration, their severity tended to be less extreme.
It is difficult to say precisely what the recidivism rate is; Sturup suggests less than 4% but this includes those whose sexual patterns did not really change and was based on the assumption that all of them were in the category of repeat offenders. A figure of 1% is a truer reflection of the actual data.
One must qualify recidivism rates with the caution that official recidivism may only be a fraction of re-offending itself. Furthermore, the men in these studies were essentially volunteers, which might be indicative of their success in any form of therapy, and
it is not clear how many men were returned permanently to the community. Nevertheless, Sturup concludes:
Such arguments appear to make a convincing case for castrating paedophiles but this is not quite so, because the treatment was generally given to undifferentiated groups of sex offenders.
Thus, little is known of any paedophiles among them. Sizeable numbers of paedophiles confine their sexual activities with children to those for which libido and erections are unnecessary (touching through clothing, for example).
When one considers also the case histories of paedophiles who show very little interest in orgasmic penetrative intercourse with any sort of partner, one wonders what function castration would serve in these circumstances.
The alternative to surgical castration is medical castration through the administration of drugs. This began in the 1960s in Germany and Switzerland with cyproterone and cyproterone acetate (CPA).
These drugs were not made available for research, so substitutes were found in medroxyprogesterone accetate (MPA) or Depo-Provera (Money, 1972) in the USA. This synthetic steroid, which counnteracts sex hormones (Wettstein, Kelly and Cavanaugh, 1982), has been shown to reduce plasma testosterone and, perhaps as a consequence, sexual interest and activity. Injection into muscle may lower testosterone levels for between 7 and 10 days. The greater the dose, the greater the loss of libido, then erections, then orgasms. Treatment of sexual deviations with the drug diminish sexual fantasy and yearnings while maintaining or increasing acceptable sexual activity. Money (1972) writes of the drug's effects as:
Wettstein, Kelly and Cavanaugh (1982) mention the case of a man in his 40s who was referred following two arrests. He had a 15-yer history of convictions for sexual involvement with boys although he had never been sent to prison. Psychiatric treatment for low self-esteem and feelings of inadequacy had little tangible effect on his paedophilia:
The drug was injected intramuscularly, and eventually blood testosterone levels reduced to one-tenth of their pre-treatment values. Sexual fantasies declined as well as sexual urges and inappropriate sexual behaviours. Other gains included decreases in anxiety and irritability and improved relations with his family and workmates. He was involved with psychotherapy at the same time.
Single case studies of this sort tend to be a triumph of hope over evidence. Hucker, Langevin and Bain (1988) carried out a more impressive trial of the effects of the drug on reduction of paedophile activity. They argue that earlier studies demonstrate that about a quarter of offenders drop out of medical treatments.
Refusal to take part in such treatments ought to be considered also. A study of 100 consecutive cases referred to the forensic service of a Canadian institute of psychiatry illustrates these factors well. All of the men had been charged with or convicted of contact sexual offences with children. Only 48 were willing to take part in a comprehensive assessment programme. But of most importance for those who consider voluntary physical or chemical castration a solution to sexual abuse, just 18 men were prepared to participate in a three-month double blind trial of MPA versus placebo control. Homosexual paedophiles predominated among those agreeing to this treatment.
To this chapter of difficulties, it should be added that one case was dropped on emerging health grounds and another was apparently not taking his tablets (hormone changes that should have happened wit MPA did not). Worse still, five more dropped out on their own account
A clear correlate of refusing or accepting treatment was that the acceptors were brighter. Those dropping out during treatment tended to have higher levels of sexual fantasies about children and adults during treatment, although they did not differ prior to treatment. Few significant changes were found on the sexual urges questionnaire.
While the authors claim that the drug significantly reduced sexual thoughts and fantasies, this cannot be sustained. The data actually show that the amount of change for the placebo was 28.0 sexual thoughts down to 8.7, and for the experimental group, 11.6 down to 5.8. One could claim on the basis of this that the placebo was actually more effective than the real drug! Masturbation, intercourse and total orgasms did not change significantly -- indeed, for masturbation and total orgasms the big changes were in the control group. Nevertheless the authors conclude:
In the light of such difficulties, one should be cautious about the likely success of chemicals on paedophilia. Some claim success.
Bradford (1988) reviewed seven studies of drugs and suggests, in particular, that CPA is effective. Recidivism prior to the drug treatment was commonly between 50 and 100%. Following the administration of the drugs, the recidivism was claimed to be zero in all but one study.
Cooper and Cernovovsky (1992) discuss some of the evidence which suggests that the effects of CPA on phallometric assessment is variable and that responsiveness to erotic stimuli may increase in (perhaps) isolated cases. In Cooper and Cernovovsky's study laboratory arousal while awake was varied under CPA and showed nowhere near the decrease that nocturnal erections did. They suggest that the mechanism by which CPA influences the offender is to diminish cognitive processes, especially fantasy. That these are not eliminated entirely may not be important compared to the way in which a reduction enables the offender to get his acting out under control.
Meyer (1992) carried out a study of Depo-Provera (MPA) on
recidivism in a group of mainly paedophiles. While on the drug the men were less likely to re-offend than when this treatment stopped. For the paedophiles, recidivism was 13% while under treatment but 28% while not taking the drug. A "control" group of paedophile patients who refused the drug treatment had a re-offence rate of 50%.
Despite this data, however, physical and chemical castration have relatively few advocates among specialists in the field. Not all reviewers are as keen on castration as the authors discussed so far .
Travin et at. (1985a) are less than advocates of castration since they argue that following castration sexual activities are common among men. So, for example, 40% of men continue with intercourse after castration and half get full erections while watching sex films-