A few days ago a Briton living in the US was sentenced to serve 27 years in prison before being deported back to the UK, after plotting to kidnap, rape, kill and eat children. Authorities last year found a dungeon, homemade child-sized coffin, a child-sized cage with exterior locks, butchering kit and torture tools at the Massachusetts home of Geoffrey Portway, who had engaged in online discussions with others about a mutual interest in abducting and murdering children.

Castration tools were among the equipment found. In view of that grisly detail, there are some who might feel castration would be poetically appropriate as a precondition of Portway being considered for parole. Personally, I would prefer he were never released. His plans went far beyond S/M fantasy: even surgical castration – as opposed to the reversible chemical sort – would leave the more grotesque aspects of his criminal motivation untouched.

There are many other cases, though, in which offenders who have sexually assaulted children in a coercive or forceful way, or even those who have not so offended but have good grounds for fearing they are in imminent danger of doing so, could be considered appropriate candidates for treatment aimed at eliminating or greatly reducing their sex drive. B4U-ACT was castigated by a commentator here at Heretic TOC recently for failing to distance itself from such treatment. This was Jeff, who asked how could it be right for such an organisation to promote a treatment that would inevitably be harmful to a MAP’s mental health when it had been set up to improve standards of mental health provision?

Decca Aitkenhead, writing in the Guardian, visited some of the relevant issues in an informative and thoughtful article last year which makes a useful starting point for me to take the matter a bit further. She introduced her piece through the story of “Barry” (not the Barry who was responding here to Jeff!), who was sentenced to life in prison in 1976 for murdering a random stranger who had refused him a light for his cigarette. He had never been convicted as a sex offender but was put on a sex offender treatment programme (SOTP) in prison. This was because he committed an offence of common assault after being let out on licence: he had lured a girl behind some bushes and the assault occurred following a sexual advance, when she tried to escape. During the course of the SOTP he admitted to being a serial voyeur in constant danger of attacking young females.

So when a prison doctor offered him a pill that might take away his sex drive, “I didn’t think twice,” he reportedly said. “I jumped at it. And I haven’t looked back.”

For patients with obsessive sexual fantasies, Aitkenhead continues, antidepressants from the family of SSRIs that includes Prozac, often prescribed to treat obsessive compulsive disorder, can help them control their sexual thoughts. The second and more radical approach is an anti-androgen drug, such as leuprorelin, which reduces testosterone levels and makes the patient impotent. Research from Scandinavia, she writes, has reported a drop in reoffending rates from 40% to between zero and 5%. Barry was among those who advanced beyond SSRIs to anti-androgen treatment – which one would have thought would stand him in good stead with the Parole Board in order to secure a further release from prison. Herein, though, lies a tale to which I will return.

For the moment, let’s just review Barry’s situation as reported so far. He wants to be free; he does not wish to harm anyone (unlike Geoffrey Portway); he professes to be happy with the treatment, which he feels is a success; I imagine his supervisors on the SOTP feel he has made progress, judging by his attitude as it comes across in what he reportedly told Aitkenhead. So, if he can go back into society with a good prospect of making a success of it, what’s not to like?

Let us now turn to a very specific objection raised by Jeff: how could something as drastic as chemically blasting a man’s sex drive away (with side effects including growing breasts that may need to be surgically removed) be considered a voluntary treatment, as is usually claimed? In prison, especially, if castration appears to be the only way of getting released, it is surely a totally coerced choice, isn’t it, and therefore ethically dubious?

This is where I am going to bring in Mike Bailey. As I said in a previous comment, Prof. J. Michael Bailey once wrote a paper in favour of castration but more recently declared that “persuasive evidence for the harmfulness of pedophilic relationships does not yet exist”. These two positions at first blush may seem poles apart, as though Bailey’s views must have changed very radically. But it is not necessarily so. Among several possible interpretations of his position, he may believe that non-coerced adult-child sexual contacts are intrinsically harmless, and that castration, whether castration “lite” (chemical/reversible) or the real thing (surgical removal of the testes) cannot be justified in such cases, and maybe not prison sentences either, or indeed any kind of punishment. My point here is not to pin down Bailey’s position exactly but just to show that even belief in such a drastic treatment as surgical castration does not necessarily make the holder of such a belief an ogre of anti-sexuality and illiberal dogma. Indeed, I think Bailey’s unusual combination of views indicates that he is a thoughtful guy who is not afraid to go where evidence and logic take him, even when that makes him look a complete bastard to conservatives and liberals of the more emotional, knee-jerk, type for totally opposite reasons.

What more specifically is of interest to us here is the fact that his paper on castration, co-written with fellow psychologist Aaron Greenberg, addresses Jeff’s point about coerced “consent” to castration in detail and, I would say, with considerable care in around 1,250 words which I have posted online here.

In a nutshell, their argument goes something like this. Everything we do in life involves weighing up alternatives, and we are often forced to choose between the lesser of two evils. Whether a particular choice offered in the penal system is coerced to an improper degree is something that might possibly be defined [TOC: constitutional or human rights grounds come to mind] but the criteria would probably be very hard to agree upon. Instead of puzzling over what is or is not voluntary, a more productive approach is instead to ask simply whether it is morally acceptable to put the offender in the position of being subjected to one of the alternatives offered. If the prison sentence is fair [TOC: but at Heretic-TOC many of us believe sentences in this field are often appallingly unfair], why would a less disagreeable alternative chosen by the prisoner not be fair? If the prison sentence is unfair, that is a different issue. Far from decreasing the offender’s freedom, all adding castration (or anything else) as an option does is increase his freedom. If he prefers the full prison sentence to castration, he will refuse castration and will be in exactly the same position as if it were never offered. His position with the castration alternative will be better than or the same as, but never worse than, his position without the alternative. In addition, it is by no means clear that castration is a morally unfair punishment for certain sex crimes, even if imposed without the offender’s consent: in the case of very serious crimes, a punishment that may greatly reduce the chance of recidivism seems particularly appropriate.

So far as it goes, I think the reasoning here is quite strong (please point out flaws I have missed) but rather limited in the scope of its moral vision. It seems to me that true castration, like capital punishment, is one of those extreme ways of dealing with offenders that not only violates fundamental human rights but which also endorses violence: these punishments make the state look as vicious as the offender, or worse, and underpin, rather than undermine, a social climate in which violence is seen as a solution rather than a problem.

The point about the effectiveness of surgical castration in stopping further offences, is worth dwelling upon. Elsewhere in their paper, Bailey and Greenberg quote a 1970s German study, by Wille and Beier, indicating a very impressive postoperative recidivism rate of only 3%, whereas a comparison group of uncastrated offenders reoffended at a rate of 46% over 11 years. However, the also extremely good results reported above from Swedish research in relation to chemical castration do not appear to find support in the latest major study of the effectiveness of all types of sex offender treatment (or possibly all types in the UK: surgical castration does not seem to have been covered) published as recently as last month in the British Medical Journal by Långström et al. Well over a thousand studies were considered in this systematic review of the literature.

Embarrassingly for science, none of them were deemed good enough to demonstrate that any particular treatment is truly effective, including chemical castration. The paper notes: “The lack of credible studies of antiandrogen drugs is particularly striking given the prominence of ‘chemical castration’ in public debates concerning the treatment of known perpetrators.”

In that case, we might think, the ethical arguments reviewed above become redundant. What possible justification can there be for B4U-ACT, or anyone else, to promote a treatment that could be held to violate human rights, and which certainly has the humiliating and degrading (for a man) side effect of breast enlargement, if it may well be utterly ineffective? Isn’t it all a bit of a sham?

In practice, it is often a sham in other ways, too. Prisoners sometimes undergo castration on the basis of false hopes, as Bailey and Greenberg’s paper shows in the case of an offender called Jeffrey Morse in America. A particularly egregious injustice occurred in that case because Morse ended up being surgically, and hence irreversibly, castrated but then found himself given an increase over the expected sentence (from 25 years to 26), not a reduction.

There are false hopes and pervasive bad faith in the British penal system too. As Aitkenhead reveals, prisoners are in effect being led up the garden path: they are encouraged to undergo chemical interventions in the belief that their cooperation with suggested treatments will help secure their release. What they are not told, it seems, is that under existing rules the Parole Board is not even allowed to know whether prisoners have been on a course of SSRIs or had chemical castration! It is thus impossible for treatment to help secure their release but they are left with totally the opposite impression. This strikes me as utterly unjust and even fraudulent.

So where does all this leave us? Conscious of the rather heated clash in Heretic-TOC’s comment space over B4U-ACT’s apparently pro-chemical castration (in certain circumstances) stance, I have tried to approach the issues in a balanced and reflective way. It was not always so. As a young man, back in the 1970s, I delivered a fiery speech against chemical castration at a conference of the National Council for Civil Liberties (now Liberty). It was later written up as an article in Gay Left after being attacked by Patricia Hewitt, who was later a cabinet minister in Tony Blair’s government. Reading that article again online, for the first time in over thirty years, I must ruefully note that it achieved nothing: chemical castration is still with us. Hewitt scoffed at my rather amateurish efforts – factual research by the unfunded non-professional was much tougher in the pre-internet era – and I now find my moral certainty at the time more than a touch simplistic.

The whole of the Gay Left issue in question is online as a PDF, and there is a Table of Contents. I might just mention in passing that the same issue includes a discussion of paedophilia by the Gay Left Collective, to which I replied in the following issue. Those who are interested in the changing attitude of the gay movement over time towards paedophilia might thus find these particular issues of Gay Left to be revealing. One of the leading lights of Gay Left was Jeff Weeks, then a radical young historian but sadly now – as I remarked in Tromovitch sets a poser on prevalence  – a rather bland and boringly PC emeritus professor.

What has not changed much, though, after all this time, is my opinion of chemical castration. Jeff (not Jeff Weeks!) is basically right, I think: chemical castration is an extreme form of intervention which is very hard to justify, especially as its efficacy is still in doubt after so many years. But that does not mean B4U-ACT is in some sort of conspiracy with the authorities or is anti-sexual.

This story related by Barry is worth recalling:

 …one young man … recently came to us seeking help. He had been on probation after he was released from prison for sexually assaulting boys, and during that time the state paid for him to receive anti-androgen medication. Now that probation was ending, he could not afford to continue the treatment and he was desperately asking for help to continue as he felt very strong urges to go out and assault another boy… What in actuality would be punitive is the 10- or 20- (or more) year sentence the MAP could receive if he were to act out on his urges. That would also certainly be more deleterious to the mental health of a MAP than a reversible course of medication…

These are strong points. It is not easy to know the right course to take when faced with responsibility for a case like this, which may be about self-coercion as a result of state brain-washing but is a very different situation to the hard choices faced by MAPs in prison or still under tight control during probation. If Jeff or anyone else can put forward a coherent and compelling policy for an organisation such as B4U-ACT in these circumstances, Heretic TOC would be pleased to hear it. Indeed, this blog would be interested to hear from B4U-ACT itself, in either its American or British manifestations.

MAIN REFERENCES

Aitkenhead, D., Chemical castration: the soft option? The Guardian, Friday 18 January 2013

Bailey, J.M. & Greenberg, A.S., “The science and ethics of castration: Lessons from the Morse case”, Northwestern University Law Review. 1998;92(4):1225-1245.

Långström, N. et al., Preventing sexual abusers of children from reoffending: systematic review of medical and psychological interventions, BMJ 2013;347:f4630 (9 August 2013)

Wille, R. & Beier, K.M., Castration in Germany, Annals of Sex Research 2, 105-9 (1989)