Chemical interventions and ethical side-effects: from pedophilia to depression. Where are the ethical boundaries of treating mental illness by neuro-chemical means?

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Pedophilia, Chemical Treatments, and Deviant Behaviour

Increasing biochemical knowledge of sexual functionality and attraction has allowed researchers to tentatively deduce a chemical cause for pedophilia and initiate various biochemical treatments for this condition. The availability of such knowledge, along with the development of new pharmaceutical treatment options, opens up new legal and ethical questions regarding how to chemically treat sexual criminality and how we, as a society, should reflect upon the use of chemicals in the treatment for other forms of deviant behaviour.

Evidence of the Neuro-chemical Basis to Pedophilia and Treatment Options

Several factors have been postulated as to the neuro-chemical basis of pedophilia. Research has indicated that pedophiles may have a serotonergic dysfunction, most likely caused by the decreased activity of the presynaptic serotonergic neuron and hypersensitivity of the serotonin-2 postsynaptic receptors. Some studies have reported that disorders in serotonin metabolism and increased sympathoadrenal system activity are also related to aggression or violence and impulse control disorder. It has also been hypothesized that disorders in the serotonergic neuron and increased catecholaminergic turnover in pedophilia may lead to aggression or sexual violence.

The potential link between pedophilia and serotonin dysfunction has resulted in the use of selective serotonin re-uptake inhibitors (SSRIs) to treat pedophiles as SSRIs are primarily used for the treatment of depression and anxiety disorders. SSRIs such as fluoxetine, paroxetine, sertraline, and fluvoxamine have also been associated with the induction of sexual dysfunction.

However, despite the early evidence of effectiveness in treatment, it is unclear how SSRIs work in relation to the treatment of pedophilia. They are thought to work by reducing compulsive behaviour, reducing general sexual function, or even reducing depression of the patient. This raises the potential of unpredictable neurological and physiological side effects.

Despite this, SSRIs may be the best available form of treatment as they appear to have fewer known adverse side effects than anti-androgens or other hormonal treatments which cause chemical castration. Even though this population group is alienated from society at large, the issue of adverse physiological side-effects that go beyond the treatment objective will still need to be explored within the context of medical practice, medical ethics, and legal rights.

The Promise of a Cure

A further dilemma raised by the chemical treatment of pedophilia is the expectation of a permanent cure for this form of sexuality. Studies have demonstrated that pharmacological interventions do not change the pedophile's basic sexual orientation toward children. This has led researchers to speculate that pedophilia is an independent sexual orientation from heterosexuality or homosexuality.

While the combination of pharmacological and psycho-behavioral treatment united with close supervision show a reduction in the probability of re-offending, the interventions do not change the pedophile's basic sexual orientation toward children.

Other interventions, like physical castration, seem definitive in preventing repeated sexual offenses, but, some physically castrated pedophiles have restored their potency by taking exogenous testosterone, allowing them to engage in abusive behavior again.

This appears to indicate that pedophilia is a distinct incarnated sexual attraction since pedophiles' core attraction survives in the absence of neuro-chemical function. It is therefore imperative that the use of SSRIs and other forms of chemical treatment for pedophilia are applied with the knowledge that their use acts to inhibit sexual behaviour rather than cure it. This also may provide insight into the temporary or limited nature of chemical treatments of other forms of sexually deviant behaviour.

Ethical Questions Relating to Neuro-chemical Technology and Deviant Behaviours

The evidence of a chemical impact on our daily lives is no longer under dispute. Antidepressants, methylphenidate for ADHD-treatment, and sildenafil citrate for sexual dysfunction treatment are rapidly becoming part of daily life for much of the population. At present, the use of such drugs is restricted by the need for a medical prescription.

However, there is strong empirical evidence of an illegal growing market for such drugs to serve a wide variety of educational, occupational, and more general purposes including improving memory, staying up late and improving concentration during exams. A large body of literature explores this market of neurological enhancement.

Among other issues including equal access to drugs, authenticity of experiences, and concepts of naturalness, the literature also raises concerns that neuro-chemical interventions may be reflective of a tendency to be more intolerant to human imperfections and increasingly willing to treat these by chemical means. The literature also raises questions concerning possible legislation against the use of neuro-technologies to enhance cognitive and other abilities above the normal range.

Recently, ethical questions have been raised concerning the diagnosis and neuro-chemical treatment of attention deficit hyperactivity disorder.

• Is this the unacceptable face of normalising children for social control, or a legitimate ethical attempt at addressing inequalities both genetic and environmental by raising the ability of an individual to concentrate above their natural abilities?
• If it is the latter, why shouldn't it be legal to use such chemicals to raise the cognitive abilities of other individuals not diagnosed with ADHD?

The socio-legal line currently being taken is that using such drugs to treat an illness is acceptable, whereas to enhance a healthy person neuro-chemically is neither acceptable nor legal.

While such enhancements appear socially and legally distinct from chemical treatments of pedophilia, they open up questions about how we treat deviant behaviours by neuro-chemical means. The possibility of enhancement also opens up possibilities of dis-enhancement or chemical normalisation, where an existing deviant behaviour is removed through chemical treatment.

However, caution is required to make sure that we do not find ourselves dis-enhancing or normalising traits that are simply the tail ends of a normal range of personality traits. Although pedophilia is arguably a crime that society-at-large and potentially the pedophile say justifies the use of chemical dis-enhancment or normalisation, there are other forms of behaviour that are being found to have a neuro-chemical component such as propensity to commit violent crime, that are more difficult to distinguish from the normal range.

Furthermore, as the case of ADHD-treatment for deviant school-behaviour indicates, it is becoming the norm to search for a neuro-chemical cure before reflecting back upon why such deviance occurs. While this commentary has primarily focused upon one area of criminal behaviour that is subject to potential chemical treatment, such treatment opens up a whole range of questions concerning our abilities to change people on a permanent or temporary basis chemically and how this challenges us to define what we might want to protect from chemical enhancement and dis-enhancement.

Acknowledgement:
The research for this paper was funded in part by a grant from the Canadian Institutes of Health Research.

• Frederic Gilbert and Simon Outram are postdoctoral researchers at Novel Tech Ethics, Dalhousie University.