How
many psychiatrists does it take to change a light bulb?
One, but only if the light bulb wants to change.

Money,
either the love of it or the lack of it, is the modern explanation for evil.
Eliminating poverty will solve both terrorism and muggings. But sex crimes defy
a materialist’s universal financial fix. Even Marx couldn’t argue that men who
molest children are simply trying to feed their family.

It
was Sigmund Freud who provided the beginning of a “scientific” solution for
evil. He argued that all of human behaviour ultimately had a sexual
explanation. Alfred Kinsey’s popular -- but later discredited --work was an
application of this insight which developed into a “scientific” discipline of
sexology. The correct kind of sex therapy, he contended, could amend deviant
and criminal sexual behaviour.

There
are few crimes which are more evil than rape. But now the American Psychiatric
Association (APA) is trying to decide whether rapists are evil or sick. The
upcoming Diagnostic
and Statistical Manual (DSM-5), psychiatry’s lexicon of mental disorders, may
list a compulsive desire to rape as a mental illness. It would be called Paraphilic Coercive Disorder.

Is
giving rape a fancy label the best way for society to deal with the problem of
sexual violence? I would say No, for several reasons.

First
of all, even though the number of sexual illnesses in the
psychiatric handbooks has grown, therapy has proven unsuccessful. For several
decades, until the 1990s, therapists used Freudian, psychoanalytic or
behavioral techniques. Doctors pronounced that criminals were cured and encouraged
them to return to their communities.

Unhappily,
when researchers got around to evaluating these therapies, no one could
demonstrate that they had succeeded. The same doctors who had proclaimed that
sex offenders could be cured then announced that sex offenders couldn’t be
cured. Dr Fred Berlin, the founder of the Sexual Disorders Clinic at John
Hopkins University, even made a public apology for claiming cures. Berlin went
on to write a letter to the American Psychiatric Association arguing that an
offender’s proclivities, including pedophilia, were simply sexual orientations
which cannot be changed.

Second,
treating rape (and other sexual crimes) as medical problems means that you have
to place the patients in hospitals. Except that they have to be special
hospitals, jail-lite institutions called civil commitment. This is an
alternative in about 20 US states. Offenders who are unable to control their
impulses live in a pleasant environment with paintings and pool tables and TV
where they can get “relapse prevention treatment” -- training offenders to
recognize triggers which cause the behavior and how to avoid bad thoughts and
habits. Since 1990, 3,000 sex offenders have been committed for treatment in
the US.

The
problem is that only a few of the offenders have ever been released. Since
1994, sex offenders can be treated
for life under civil commitment statutes. In 1994, the Supreme Court ruled that
indefinite commitment for sex offenders was constitutional. Three years ago,
the New York Times reviewed the policy of civil commitment for sexual
predators. It found that it was expensive and ineffective. Civil commitment
programs cost about four times (US$100,000 annually) as much as incarceration
($25,000 annually).

Octogenarian
sex offenders rolling in wheelchairs on oxygen are kept in civil commitment or
prison well beyond the time that they pose a threat or danger to anyone.

The
programs are a bizarre combination of prison, psychiatric hospital and nursing
home. The Times illustrated a chaotic environment at some centers, where
custodians ignore rule-breaking prisoners and female employees are merely quietly
dismissed after having had sex with inmates.

Legal
risks are a barrier to treatment. Most of the patients under civil commitment
refuse to attend therapy groups under the advice of their attorneys who are
concerned that any revelations in therapy may result in longer jail time.

Furthermore,
even an A+ student can flunk the exam outside of prison. The New York Times
reviewed treatment for sex crimes and reported on the disturbing case of Michael Renaud Jackson,
a felon who had spent 12 years in prison and 5 years in civil commitment.
Jackson, who had reached the highest level of the relapse prevention program,
raped and killed a young woman 2 years after his release.

Third,
a taste for sexual crimes is not like a disease. People want to be cured of
diseases. This is not necessarily true of sex offenders. Often therapists are
only assuming that the patient (aka the criminal) believes that he is ill and
wants treatment. Their tragic patient is like the mythical wolf-man, dangerous
and passion-driven but tortured. His deep guilt has made him ready make any
sacrifice, even death for a cure. “Who in their right mind would be sexually
attracted to young children?” asks Fred Berlin in USA Today.

Well,
the numbers of such people are not high, but they are sane enough to form
groups like the North
American Man Boy Love Association.

While
Dr. Berlin believes that child molesters are obviously sick, the pedophile may
not agree. When I was starting my career, I consulted for a program which
treated recently released drug addicts and sex offenders. One parolee looked
like a very ordinary guy. Jim (not his real name) was a slender middle-aged
Caucasian with a few brown strands of hair covering his bald dome. He lacked
the usual adornment of five tattoos and earrings. Jim could have easily been
the checker at my local grocery store or a shoe salesman.

Most
child molesters are not paedophiles (adults sexually attracted to prepubescent
children) but older men seeking teenagers. Jim was a paedophile and defended
paedophilia to me very cogently. In professorial tones he contended that unlike
Europeans, Americans were unenlightened. Children were better treated by the
molesters than by their parents. The trauma was entirely due to the legal
system. He even told me that 5-year-old children could consent to sexual
activity.

Can
self-deception be treated with medication? With counselling? With discussion
groups?

Finally,
there’s a practical problem with a diagnosis of Paraphilic Coercive Disorder.
To demonstrate that he has it, a patient must have committed three acts of
rape. Being sick may keep him out of jail for ten years but it could put him in
a civil commitment facility for life. It is the psychiatric equivalent of the
Three Strike laws common in many states for habitual criminals. Writing
in the Psychiatric Times, Dr Allen Frances, the architect behind the last DSM,
doubts that any rapist would be crazy enough to admit to more rapes and subject
themselves to the limbo of civil commitment.

It’s
about time that the psychiatric profession recognizes that ultimately evil is
beyond its powers to treat. Evil may co-exist with treatable mental illness but
only spiritual remedies are capable of redeeming people from a will with
unspeakable cravings. Dr Matthew Carroll, a
psychiatrist who evaluated John Gardner, the recently confessed killer of
17-year-old California girl Chelsea King, several years ago reported that the
felon “would not be amenable to treatment.”

Carroll’s
assessment was not based on sophisticated medical technology or preternatural
psychiatric insights. Instead, he pointed out what is blindingly obvious,
“There is no known treatment for a person who sexually assaults girls and does
not admit to it.” Gardner, he said, was “simply a bad guy who is inordinately
interested in young girls.”

Sexual
predators are like other criminals. They are responsible for their actions.
They can’t be cured but they can change. Medicine will never have the silver
bullet to change a soul. Hopefully, the APA will recognize the limits of
psychiatry and not misdiagnose another crime as a disease.

Theron
Bowers MD is a Texas psychiatrist.