The new California law that forces repeat child molesters to undergo "chemical castration" may be a popular strategy, but to many physicians, it's bad medicine.
The urge to punish people who sexually abuse children is understandable. So is the desire to prevent repeat abuses by sex offenders. In recent years the nation has been horrified by the sexual abuse of children -- and then after the headlines, we learn that the perpetrator had been quietly released from prison into the community after serving time for a similar offense.
To crack down on child molesters, California now requires that repeat offenders choose between surgical castration and chemical castration, which involves regular injections of a drug that reduces sex drive. The goal is to prevent offenders from committing more crimes of sexual abuse once they are leave prison.
It sounds so simple. Get to the root of the problem. If a child molester is chemically castrated, how can he -- it's usually a he -- hurt anyone anymore?
But the treatment doesn't fit the crime, according to those in the medical community who treat people with sexual disorders. "It makes no sense," says Fred S. Berlin, associate professor at the Johns Hopkins School of Medicine and founder of the school's sexual disorders clinic. "The law is saying, Let's in effect castrate the bastards.' " Not only is it improper to use a medical treatment as punishment, he continues, but drug therapy by itself is not going to solve the problem of child molestation. The law is a "formula for disillusionment," he says. "It's naive to think this is a panacea," he says.
Proponents argue that European studies have shown a low recidivism rate among child molesters when they are treated with surgery or drugs. But as Berlin points out, in many of these studies, treatment was voluntary and people were closely followed for decades. Simply forcing all offenders to receive medications won't accomplish what the public wants, he says.
For starters, the drug intervention does not "castrate" a man. The drug most often used, Depo-Provera, lowers levels of the male hormone, testosterone, in the body. While the drug lowers a man's sex drive, it does not render him impotent. Men on the drug can still have intercourse.
More important, the one-size-fits-all strategy will not be successful in most cases because there are many reasons why people commit such crimes. The problem is more likely to be in the brain than in the genitals.
Perhaps the perpetrators were drunk or on drugs at the time. Or as Berlin explains it, they have "poor judgment and psychological immaturity" or "diminished intellect." They may have some form of psychosis. Getting weekly injections of Depo-Provera doesn't do anything to control these root causes of criminal behavior. Certainly it doesn't force offenders to confront the magnitude of their crime, the first step to getting someone to change behavior.
"If people don't recognize they have a problem -- if they say I was just drunk' or it was a mistake,' there's no medication that can change that thinking," explains clinical psychologist A. Nicholas Groth of Orlando, who has worked in correction institutions for more than 30 years.
Sometimes people who victimize children are simply evil -- what psychiatrists call an antisocial personality. Depo-Provera can't stop the Bad Guy from being bad. As Berlin says: "There's no drug in the world that is going to instill a conscience and sense of morals."
Still, medication has a place in the treatment in a proportion of offenders -- those who suffer from the specific sexual disorder of pedophilia, the obsessive erotic craving of children. These represent the minority of offenders -- perhaps a third, estimates Groth.
But even for this minority, medication is not the only treatment. The primary strategy is group therapy in which offenders are forced to deal with their aberrant behavior and break through their denial of the harm they have caused. California psychiatrists argued unsuccessfully that counseling be included in the law.
Those who suffer from pedophilia aren't usually aggressive or violent. They generally wish no harm to the children they have victimized. The drug is helpful to them because it reduces their erotic cravings; the group therapy is essential because it instructs them on how to change their attitude and behavior toward children.
Physicians point out that treatment can be successful. In a survey of more than 400 men treated for pedophilia at the Johns Hopkins clinic, more than 92 percent were able to control their behavior in the five-year period after treatment. The treatment of choice was group therapy, combined in some cases with medication. As Berlin notes, most sex offenders return to the community so it's in the public's interest to provide treatment as a way to prevent future crimes.
But first the offender has to be properly diagnosed to see if treatment is appropriate. The positive fallout of California's controversial law is that it highlights the role of medicine in treating some conditions that can lead to crimes. But to many physicians, its mandatory, generalized approach to child molesters is doomed to fail.