Psychiatrists, Criminal Justice Experts At Odds Over Handling of Pedophiles
It used to be that Americans convicted of pedophilia would get sentenced from one day to life in prison, and it was then up to the prison warden to decide whether and when they were safe enough to be released, Howard Zonana, M.D., explained in an interview. Zonana, a professor of psychiatry at Yale University, is a past chair of APA's Task Force on Sexual Offenders.
But today, Zonana continued, there is fixed prison sentencing for convicted pedophiles, and once pedophiles have served their sentences, they have to be released. Moreover, once they are released, they do not have to receive any treatment for their pedophilia unless they have a period of probation.“ So you can see why there is public concern,” he said.
So how might the American criminal justice system be altered so that convicted pedophiles pose less of a danger to children? Here are several possibilities, along with their pros and cons:
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Psychiatric commitment: Under increasing public pressure on elected officials to get tough with sexual predators, 16 states and the District of Columbia have enacted laws allowing the commitment of sexual predators to public psychiatric hospitals after their prison terms are up. The governor of New York has issued an executive order permitting the same. While such laws and orders are undoubtedly protecting children better than before, they do present other concerns, psychiatrists and mental health advocates recently told Psychiatric News (Psychiatric News, November 18, 2005). A primary concern is that psychiatric commitment laws may misuse psychiatry to detain people for whom confinement rather than treatment is the goal.
Another concern, Richard Rosner, M.D., chair of the New York State Psychiatric Association's Committee on Psychiatry and the Law, pointed out, is that placing pedophiles in public mental health facilities would overwhelm already tight state mental health system budgets. “To the extent that the mental hospital beds are filled by people for whom they were not intended, there are fewer of them available for people for whom they were intended,” he said.
Psychiatrists' opposition to civil commitment of pedophiles who have completed prison terms, in fact, is swaying elected officials on the issue. For instance, the Vermont legislature recently rejected a measure to establish a civil commitment program for convicted sex offenders at psychiatrists' urging (Psychiatric News, March 17).
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Life imprisonment: Another approach that might better protect children without burdening the public mental health system is to imprison all convicted pedophiles for life. Yet “vast sums of public money are [already] being targeted toward the containment of sexual predators,” Richard Krueger, M.D., medical director of the sexual behavior clinic at New York State Psychiatric Institute, pointed out. So imprisoning even more would undoubtedly be colossally expensive. Also, blanket imprisonment, Zonana asserted, would mean “incarcerating a lot of people for whom there wouldn't be trouble.”
The long-term recidivism rate for convicted pedophiles is not known. But in a five-year follow-up study of 400 convicted pedophiles treated in the community, less than 8 percent were accused of subsequent offense.
“That is a far cry from the common public misperception that most of these people will be back into trouble,” declared lead study investigator Fred Berlin, M.D. Berlin is an associate professor of psychiatry at Johns Hopkins University and director of the National Institute for the Study, Prevention, and Treatment of Sexual Trauma.
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Chemical castration: Still another possibility for better protecting children that would entail neither lifetime imprisonment nor commitment to a psychiatric facility would be to mandate that all convicted pedophiles, prior to their release from prison, receive a mandatory evaluation to determine as nearly as possible the underlying cause of their behavior. For those who are symptomatic (that is, present with pedophilic symptoms), there is robust evidence that medications that lower sex hormone production can be helpful by decreasing pedophilic symptoms and thus sexual recidivism, Fabian Saleh, M.D., told Psychiatric News. And such agents, he added, which are given by monthly injection, are just as effective as surgical castration in reducing pedophiles' re-offending. Saleh, an assistant professor of psychiatry at the University of Massachusetts, is also director of research at the National Institute for the Study, Prevention, and Treatment of Sexual Trauma.
But a drawback of chemical treatment, Saleh pointed out, is that it is not always effective in reducing recidivism rates among child molesters. Medications only treat those offenders whose behavior is motivated by an underlying paraphilic disorder, such as pedophilia. ▪
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Published online: 19 May 2006
Published in print: May 19, 2006
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Are there better ways to protect America's children from convicted pedophiles?
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