Taming the Beast Within
Can chemical castration help pedophiles control their desires?
The Institute for Sexual Wellness is located on the backside of a luxury apartment building in Quincy Center, facing the T stop and a municipal parking lot. There’s no sign out front, and the discreet location is difficult to find. The center’s founder, Renee Sorrentino, says this is by design. Sorrentino is a Boston University- and Harvard-trained forensic psychiatrist who treats chronically disturbed men—convicted pedophiles, rapists, exhibitionists, and voyeurs—for their deviant compulsions.
Many people doubt that convicted sex offenders can ever truly be cured, which has prompted states from Virginia to Oregon to pass laws making it even more difficult for them to get out of jail. But Sorrentino says deviant sexual disorders are like other mental diagnoses and can often be managed with meds and therapy. And she claims that she has a treatment for even the direst cases: chemical castration. Sorrentino believes that the procedure—a monthly injection of the drug Lupron—can radically curb men’s harmful desires, allowing them to return to quasi-normal lives. Widespread use of chemical castration could also protect potential victims, she says, because it would effectively neutralize the insidious compulsions that prompt men to act on their fantasies. Right now, she is one of only three doctors in Massachusetts who provide this treatment.
Sorrentino’s caseload of 100 patients is just a fraction of those who might benefit from chemical castration. In Massachusetts alone, there are more than 11,000 state-registered sex offenders, plus about 1,350 inmates serving time for sex crimes, and several hundred more sex offenders who have served out their sentences but are being held indefinitely in civil commitment facilities until they are deemed fit for release. Few ever are. It’s this last group—especially those convicted of abusing children—that is most problematic, and most dangerous. Yet with 30 patients currently on the experimental drug, Sorrentino has high hopes for Lupron, and for her patients, whom she casually refers to as “my guys.” Gaining public support for the treatment, however, is another matter.
Since opening her practice a decade ago, Sorrentino has become increasingly comfortable speaking about topics that make people squirm—deeply disturbing sexual fantasies, child molestation, prison. The petite brunette sits in her office, which is decorated with aboriginal art and burgundy tufted leather chairs. Thirteen framed diplomas and certificates crowd the pale-blue wall behind her. She says that her decision to treat patients with deviant sexual disorders—clinically known as paraphiliacs—was likely influenced by her father, a neuroendocrinologist who wrote his Ph.D. thesis on how the deprivation of hormones can influence behavior. She points to a photo on the file cabinet to her right: It’s a black-and-white shot of her father at work in his laboratory. A closer look reveals that he is, in fact, castrating a rat.
References to male castration date back to Greek mythology, but castration as a treatment for sexual disorders has roots in the late 19th century, when Swiss doctors first began performing the surgery. This method was used throughout the U.S. and Europe until the introduction of oral hormonal treatments, such as estrogen pills, in the 1940s and anti-libido medications in the 1960s. Deemed more humane than surgery, these medications were never considered a cure-all, and most had significant physical side effects, including feminization in men. Today, American doctors often prescribe antidepressants to paraphiliacs to help them suppress their compulsive tendencies. Paraphiliacs also commonly participate in a rehabilitation program called the Good Lives Model, which can include one-on-one and group-therapy sessions that involve training in personal responsibility, sexual-impulse control, and empathy. The program also offers biofeedback methods that measure their reaction to sexual stimuli.
Lupron is still a relatively new treatment, but psychiatric journals have deemed it promising—though not without significant risks. Sorrentino first witnessed the power of hormone therapies like Lupron when she took a forensic psychiatry clerkship at the Sexual Behaviours Clinic in Ottawa. The patients she saw in Canada were high-risk, which she says “tends to translate to people that have some sexual sadism, some arousal to violence and interest in kids, and have recidivated.” For men with seemingly incurable urges, Lupron has been shown to lower their testosterone, reduce their sex drive, and mitigate deviant desires. The urges are still there; they’re just not a 24/7 obsession.
To explain how it operates, Fabian Saleh, director of the Sexual Violence Prevention & Risk Management Program at Beth Israel Deaconess Medical Center, compares the drug to appetite suppressants. He says Lupron enables “carefully selected patients [to] gain control over their lives so they are not consumed day in and day out with wanting to have sex with a child.” Each doctor has his or her own analogy; Sorrentino suggests Lupron’s mechanism is akin to the volume being lowered on a radio. Either way, they both contend that Lupron’s effects are impressive. “In this field, you don’t often see profound changes. But when you do, it’s memorable,” Sorrentino says. “People get better with psychology, but it’s different than people getting better with an antibiotic.”
There are side effects, however. Patients on Lupron often experience hair loss, weight gain, and the development of breasts. Sorrentino regularly measures their sexual arousal levels and administers bone density scans, because suppression of testosterone can lead to osteoporosis in men. Yet they tell Sorrentino this is better than feeling unwanted urges.
Lupron is also expensive. On top of an $800 fee for the monthly dose, which in some cases is covered by MassHealth, treatment requires a daylong assessment by a doctor like Sorrentino or Saleh to determine whether a patient is eligible. Patients must often pay for the balance of the assessment themselves, which can run between $1,500 and $2,500. They are also required to cover the cost of all follow-up tests. Sorrentino’s Lupron patients need constant monitoring: Blood tests, for instance, check their testosterone levels to ensure they’re not secretly taking Viagra to counteract Lupron’s effects. Other men who are compulsively promiscuous may tell her they’re not sexually active when, in fact, they are. These instances are rare, Sorrentino says, but they’re also when a polygraph machine can come in handy.
When it comes to paraphiliacs and the law, however, treatment takes a back seat to keeping potential victims out of harm’s way. Those who have been arrested face incarceration, mandatory counseling, and entry onto the Sex Offender Registry Board, which designates an offender’s risk level on a three-tiered scale—the highest, Level 3, being the most likely to act again. (Sorrentino and Saleh point out that not all sex offenders are paraphiliacs and not all paraphiliacs are sex offenders: Some people’s deviant urges do not constitute crimes, while others may have already acted on their urges but have not yet been apprehended.) A person’s status limits where he can live and work, and offenders’ names are sometimes made available to the public. Advocates who work with this population point to the low recidivism rates among sex offenders—about 15 percent—to make the case that such restrictions further ostracize and isolate paraphiliacs, potentially increasing an offender’s likelihood to act out. But victims’ rights groups contend that it’s that same 15 percent that will forever muddle any discussion about treatment and release.
The recent case of John Burbine—the Wakefield man charged with abusing children at his wife’s at-home daycare center—showed how tragic it can be when an offender is mishandled. After being found guilty of molesting three boys in the late ’80s, Burbine was deemed a Level 1 offender. He received a six-month suspended sentence and two years’ probation, during which he was told to undergo court-mandated psychological counseling. Three years after his arrest, his case was essentially closed. Two decades later, the Department of Children and Families began receiving complaints about him fondling children at the daycare, but because those allegations failed to result in charges, they were never reported to the registry board. In 2012, Burbine was finally charged with more than 100 alleged incidences of rape or abuse, some on children just a few days old.
After Burbine was apprehended, legislators were quick to change the state’s registry board laws. This past August, they gave the public access to the complete list of Level 2 and 3 offenders. As a Level 1 offender, Burbine’s name would still not have been made public, so a new sex-offender recidivism commission has been proposed to reexamine the state’s outdated leveling process.
Burbine, who pleaded not guilty to the charges, faces a potential life sentence if convicted. During pretrial proceedings in November, however, he offered the court a Faustian bargain: Allow him to be surgically castrated, but reduce his sentence. As regressive as castration sounds, consider the fact that eight states, including California, Florida, and Texas, have instituted court-mandated chemical-castration treatments for high-risk sex offenders. In Texas, offenders can also opt for surgical castration. (The ACLU in California opposes these treatments, saying that it’s impossible to get informed consent—an acknowledgment that an offender understands and wants the treatment—while he’s under court order.) The judge refused Burbine’s proposal. His trial is scheduled to begin this May.
The glaring problem in cases like Burbine’s, according to advocates who work with the paraphiliac population, has little to do with sentencing, jail time, or registries. Instead, they argue that the real problem lies in the fact that chronically disturbed men lack easy access to relief from their demons. “They have these intense urges to be sexually involved with a child,” Saleh explains. “They fantasize about the child, and want to have sex with the child, but they know doing so will get them in serious trouble and would certainly cause harm to the child. So it’s an internal battle that they are dealing with day in and day out where they struggle for and against the impulse for sex with the child.”
Occasionally, when she answers her office phone, Sorrentino can immediately hear the desperation in the caller’s voice. Most people on the phone don’t reveal that they’re about to abuse a child, she explains: “If someone tells me that they’re planning on sexually abusing an identifiable kid, then I have to do something.” Keeping quiet is a form of self-protection—mandatory reporting laws in Massachusetts stipulate that any person who learns that a child is in danger must report the threat to the Department of Children and Families. So instead, these men often tell Sorrentino that they’re “worried about themselves” or about the intensity of their fantasies and are concerned they might someday commit a crime.
Only a small percentage of Sorrentino’s clients come to see her voluntarily, a fact that she attributes to their shame, societal stigmas, the high cost of treatments, and the lack of awareness about the fact that such treatments exist. Of the very few men who do find her, not all are treatable. Some men who call Sorrentino’s office live out of state—too far to travel to see her for regular treatments. Some want Lupron injections but can’t afford the follow-up visits.
For men who are “worried,” there are limited resources in the U.S. One of the few places in this country where paraphiliacs can receive guidance is the help center run by the Northampton-based child-advocacy group Stop It Now, which responds to inquiries from people who suspect abuse or may be committing it themselves. But just 8 percent of the 704 inquiries the group received last year were from adults who called about their own deviant desires. “For most of these folks, it’s, ‘Please help. I don’t want to be this person. I have attractions to children, but I’ll kill myself before I hurt anyone,’” says Jenny Coleman, who runs the help center. She typically offers callers names of specialists and suggests ways to avoid acting on their urges. But she doesn’t have a way to ensure they’re getting the help they need. “I don’t hear back from a lot of people,” she says, and acknowledges the hardest part of her job is “the not knowing.”
Not knowing is familiar territory for those who work with paraphiliacs. An estimated 85 percent or more of sexual-abuse incidents go unreported, says Jetta Bernier, the executive director of the child-advocacy group Massachusetts Citizens for Children. Of those cases that are reported, she says, a very small percentage lead to criminal charges. “It’s easy to think about people who offend as living in some kind of vacuum, and we tend to turn them into monsters and bogeymen in our head,” says Maia Christopher, executive director of the Association for the Treatment of Sexual Abusers. “But when you think about it, if the majority of sexual offending happens by somebody who is known to the victim—and we know for a fact that that is true—then the majority of offenders are people in the community on a day-to-day basis. So there are people who are aware of their behaviors or can become aware of their behaviors.” She hopes that strong prevention strategies can lead to better policy.
Sorrentino also frequently gets letters from men being held under civil commitment at the Massachusetts Treatment Center within the Bridgewater Correctional Complex, a holding facility where such “sexually dangerous persons” undergo various therapy programs until they are deemed fit to re-enter society. Many of these men seek out Sorrentino for chemical castration as a possible conduit to their release. Enter the ethical juggernaut. In order to legally administer the treatment, Sorrentino needs to get informed consent from the subject. But, the state asks, can a man being held against his will produce such a thing? How does a doctor know if a patient truly wants to get treatment and better himself…or if he’s simply looking for a way out?
Last year, this quandary played out in the courts when Jeffrey Healey and Edward Given—two men held at the treatment center—filed a lawsuit against the Massachusetts Department of Corrections. Both had been deemed sexually dangerous after serving time for their crimes: Healey had been held at the center for four decades after being convicted of indecent assault and battery of a minor; Given had been at the treatment center for more than a decade for indecent assault and battery of a retarded person and the unnatural rape of a child. In their suit, they argued that the center’s therapies were inadequate, and that they wanted to be tested to see if they could receive Lupron. In April, U.S. District Court Chief Judge Patti Saris ruled in the men’s favor, finding that the department’s failure to rehabilitate people deemed sexually dangerous violated state law and the inmates’ constitutional rights.
Sorrentino did both men’s assessments. “In my eyes that is the absolute patient population that we want to be working on,” she says, and believes that ultimately, a person’s reasons for wanting treatment matter less than the fact that they’re willing to receive it. “As long as the person is willing to take it, I don’t really care what the reason is,” she says. “The bottom line is it decreases recidivism.” The case is currently under appeal, and representatives from the treatment center declined to comment, citing pending litigation and privacy laws surrounding the inmates’ care.
Whether Lupron is effective or not, many argue that convicted sex offenders have no right to treatment, particularly when it could result in their release from prison. “The thing with biological treatments, especially with chemical castration, is you’re relying on an offender to take their medication,” says Laurie Myers, the executive director of Community Voices, a victims’ rights organization based in Chelmsford. She says that both providers and offenders acknowledge there’s no way to tell for certain whether someone will reoffend while on these medications. “If they make a decision that they don’t want to molest kids or victimize someone, that’s wonderful. But you’re relying on someone, especially a pedophile, to make decisions as to whether or not they want to be sexually attracted to a child that day…. To say chemical castration will change what’s going on in these people’s heads is grasping at straws,” she says. “I don’t want them testing it on my kids.” To Myers, these treatments are too new, and too risky. She’d prefer to keep sex offenders under lock and key. Myers is also quick to note that putting more patients on Lupron therapies will help line doctors’ pockets.
For those who believe that providing Lupron to offenders is too merciful, treatment providers say that denying a patient a viable therapy is bad medicine. Saleh reasons that we should administer medication to those who have been diagnosed with treatable disorders, just as we give heroin addicts access to methadone to keep them—and the public—safe from harm. He says it’s a matter of public health. “If you compare the cost that goes into the assessment and management of the identified pedophilic sex offender…to the cost of creating a victim by their hands,” Saleh reasons, citing the distress caused not only to victims, but also to their families and the community, “…it’s ultimately less expensive to provide the treatment and management rather than just containment. On top of that, the most important part, in my judgment, is you potentially have a treatable condition. And if I can treat pedophilia or manage pedophilia with the right treatment, the number of victims is going to go down significantly.”
“Obviously there are those individuals who have the ‘Every sex offender needs a bullet in the head’ kind of view, which is a great way to stop recidivism, but is not really an ethical or justifiable way to conduct a criminal justice system,” says Kelly Socia, a criminal justice professor who studies the efficacy of sex-offender laws at UMass Lowell. He says the same logic can be applied to civil commitment. “You can have 100 percent reduction in sex-crime recidivism if you’re willing to lock up everybody for the rest of their life. But when you’re talking $50,000 to $100,000 to keep somebody in a secure mental-hospital-type environment, it’s just economically infeasible. And ethically there are some tricky issues that come with locking somebody up for that long.”
Sorrentino believes she has the tools to greatly curtail sexual abuse, but says she often finds herself hamstrung by the law, by a patient’s inability to pay, or both. And because so few doctors provide these treatments, she sometimes encounters ethically treacherous situations that leave her with little recourse.
One day, several years ago, a pediatrician came to Sorrentino seeking chemical castration. A self-described pedophile, the practicing doctor had been harboring sexual fantasies about prepubescent children for years, but told her that he had not acted upon them. He had been turned away for Lupron treatment by another Massachusetts physician, and Sorrentino knew that if she denied the pediatrician care, there was no other provider he could turn to. So she agreed to offer him treatment, but only under the condition that he suspend his license while he was her patient, thereby limiting his access to kids.
The pediatrician refused her terms. “I felt like I was going to be an impaired physician,” Sorrentino says. “I wasn’t sure if he was being honest about his access to children.” Because of the strict confidentiality agreement between doctors and patients, Sorrentino was powerless to warn the authorities or the parents who send their children to his practice. “I have people that are now calling me saying, ‘I have trouble managing my pedophilic desires, I don’t want to touch kids, I need help,’” she says, shaking her head. “And one of the difficult things is I’ve actually had to turn down a fair amount of these people.”
Source URL: http://www.bostonmagazine.com/news/article/2014/02/25/chemical-castration/