How Do Doctors Treat Pedophiles?

With drugs, psychotherapy, or scalpels.

Cardinal Joseph Ratzinger, before becoming Pope Benedict XVI, was informed of a decision to send a pedophile priest back to work only days after beginning therapy, according to a memo reported on in Wednesday’s New York Times. How do doctors treat pedophiles?

Hormone suppressors, group therapy, and sometimes castration. Doctors do not attempt to permanently rid pedophiles of their fantasies, which are remarkably persistent. Instead, they use techniques to decrease the likelihood that the patient will act on his urges. Studies have suggested that testosterone-reducing drugs, called anti-androgens, are the most reliable option. Patients receive a monthly shot, and doctors monitor their testosterone levels to make sure the drug is working. Prozac, which is known to decrease libido as a side effect of its intended anti-depressant use, is a somewhat common but less effective alternative.

Group therapy is a part of almost all treatment regimens. Participants discuss the nature and frequency of their sexual fantasies, as well as everyday life stresses that increase their chances of falling off the wagon. They are taught to empathize with past and potential victims. In cases where a pedophile abused his own children, doctors ask the patient’s wife—and his judge—to weigh in on whether a reunion may be possible in the future. If so, doctors often recommend family therapy as a prelude to heavily supervised father-child visits. Some patients eventually get to see their children alone.

Most patients attend 90-minute, 10-member group sessions every week for a couple of years before treatment tapers off. Still, doctors usually require pedophiles to check back in every few months for the rest of their lives. Patients who suffer from overwhelming cravings or demonstrate particularly poor self-control are occasionally hospitalized during periods of acute urges or high stress, when the chances of recidivism are highest.

Castration remains a controversial option. Many state justice systems view it as the ultimate cure—Texas pays for castration of criminal pedophiles but will not spring for anti-androgen therapy. Yet even castrated men are often still able to maintain an erection, and some castrated men have managed to reoffend. For this reason, most doctors prefer medical hormone suppression, since they can monitor this treatment over time.

Treatment for pedophilia has changed dramatically since the disorder began appearing in American diagnostic manuals in the 1950s. Early treatment regimes, based on Freud-inspired psychoanalysis, emphasized seeking out the traumatic event that occurred during the patient’s sexual maturation and resolving it. Midcentury psychoanalysts often claimed to have succeeded in curing their patients of urges altogether. Beginning in the 1960s, the Catholic Church itself treated pedophiles at a facility in Jemez Springs, N.M. Afflicted clergy engaged in role-playing and were asked to dramatize their own emotions. At the time, doctors likely told church officials that they had “cured” certain priests and that the offenders could safely return to work. (Of course, it’s unlikely that a doctor would have declared a patient completely healed only a few days after treatment began.)

Other old-fashioned treatments with limited evidence of effectiveness are still hanging around. A few therapists use covert sensitization, in which a patient is shown a picture of a nude child, then asked to imagine a traumatic event such as being humiliated in front of his family or getting his penis caught in a zipper. Aversive conditioning involves the use of actual, rather than imagined, negative stimuli. While showing the pedophile pictures of a nude child, doctors pump stinky ammonia into a room or apply an electrical shock to the patient. Laboratory studies, in which the doctor places a ring around the patient’s penis to measure arousal subsequent to the therapy, initially provided evidence in support of these practices. But large-scale studies of recidivism suggest that they have little effect on a pedophile’s behavior in the real world.

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Explainer thanks Fred Berlin of Johns Hopkins and Richard Krueger of the Columbia University School of Medicine.

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