Is Chemical Castration A Humane Punishment?
The Ethics Of An Unsettling Procedure
By Professor Thomas Wells (University of Groningen)
December 31, 2014 Picture: Drinks machine/Flickr.
This article is part of the Critique’s exclusive series on the Alan Turing Biopic The Imitation Game
For some people sex is a big problem. These are the people with unconventional – or unacceptable – sexual desires, such as those attracted to children or animals or sadism, as well as those with conventional but excessive drives, such as those addicted to pornography. In either case these men – and it is overwhelmingly men – are in a constant struggle to control urges that most people do not experience. Properly understood, such sexual ‘deviants’ are not more wicked than the rest of us, but more in need of help. In some cases the best help we can offer them is ‘chemical castration’ – anti-androgens that reduce testosterone levels and hence the sexual drive at the root of their problems. In some cases the state should go further and require deviants to submit to such treatment.
Sexual deviance presents two different kinds of problems. First, at least some deviants present a real if unquantifiable risk to other people – ticking bombs living amongst us that might go off if their self-control over their wrongful desires ever falters – whether by exposing themselves on the subway or grooming a child on the internet or much worse. In the social imagination this risk is translated into a sense of vulnerability, inspiring in reaction a generalised fear, loathing, and suspicion of sexual deviants, such as was made particularly vivid by the mob that vandalised the house of a British paediatrician a few years ago. This sense of vulnerability is generally addressed, rather inadequately, solely through the criminal justice system, by punishing deviants’ losses of control with jail terms.
Second, there is the under-recognised suffering of those unfortunate enough to suffer from such deviant urges. Rather than being a positive and joyful part of their life, their sexuality must feel like a burden. It cannot even be expressed without shame and social stigma, even to those who should be closest to them, while acting upon it may result in social and criminal penalties from loss of employment to prison sentences. Society’s contempt – and even rage and fear – for their deviant urges requires a life-long strategy of containment and hiding, rather like being Christian in North Korea, or being gay in Nigeria.
Living such a closeted life is itself cognitively and emotionally demanding, requiring the ingenuity of a con-artist and the self-vigilance of a deep undercover policeman. It demands near constant awareness of what it is one is trying to hide, making one’s sexuality, the very thing one is trying to escape, far more central to one’s identity than it is for those lucky enough to have more conventional urges. Thus, even if the pretence of normality can be achieved and maintained it will not shield the actor entirely from the moral judgements of others, since it is the constant imagination of their contempt that motivates his behaviour from moment to moment. Besides the mental resources this diverts from getting on with one’s own life, over the long term the psychological harms of living a lie this big add up. As a result even the deviants most successful in escaping society’s judgement may well struggle to function very effectively, to hold down mentally demanding jobs or to sustain meaningful personal – non-sexual – relationships.
The way self-professed liberal societies presently address sexual deviance moralises certain conventional sexual norms and then uses the criminal justice system to punish those discovered to have broken them. Chemical castration has so far been mainly employed in this context, as a rather effective technique to reduce recidivism for particularly atrocious sex crimes, especially against children. As reported in The Guardian, several US states and an increasing number of countries, including Britain, Poland, Russia, Gemany and Sweden, now incorporate chemical castration into their criminal justice systems. Sometimes it is compulsory and an explicit part of the judicial punishment; sometimes it is voluntary, part of in-prison psychological treatment programmes. But the dominant approach is to make chemical castration a ‘voluntary’ condition for release from prison. Such demands are reminiscent of the famous case of Alan Turing, who was offered a choice between imprisonment and injections of a synthetic oestrogen upon his criminal conviction in 1952 for the “gross indecency” of a sexual relationship with another man. Turing’s treatment is held responsible for his suicide and is widely seen as a classic example of injustice. His case, for which the British government formally apologised in 2009, is an important landmark in the moral history of governments’ treatment of sexual deviants. After Turing, can chemical castration, voluntary or otherwise, ever be justified?
I think so, but only if we go beyond the crude goals and methods of the criminal justice framework and consider a broader, but also more demanding public health justification. The goal of criminal justice is to punish and deter bad behaviour. This assumes, wrongly, that people are all equally capable of behaving within the rules and merely vary in their moral character. The world is thereby divided into innocent victims and wicked criminals, into goodies and baddies. The logic of retribution further requires that the well-being of potential victims and potential perpetrators be considered differently. In a reversal of the usual humanitarian duty of governments, inflicting suffering on the latter is supposed to be a good thing, because suffering is just what bad people deserve. In addition, the kinds of sexual deviance the state sets itself to punish often relate more to what society considers disgusting than to defensible moral principles such as Mill’s ‘harm principle’, as in Turing’s own case.
By contrast, a public health approach takes a more utilitarian than moralistic approach, and one that is more consistent, principled, and humane – in the end, more liberal. In particular, a public health approach takes positive account of the well-being of those with unconventional sexualities. Its goal is not the moralistic one of punishing and repressing wickedness but the general reduction of unnecessary suffering. As a result, it requires evidence of harm to justify the suppression of certain behaviours. The mere popularity of belief in witchcraft does not justify the burning of witches. Likewise, while the state has a duty to prevent the sexual mistreatment of vulnerable members of society, such as children, it does not have the right to persecute some groups of people merely for being disgusting in the eyes of the majority.
My main claim is that chemical castration could be an appropriate treatment for sexual deviance. In many cases it is more appropriate than punishment. This is because the defining characteristic of sexual deviants is not the immorality of their actions, the dramatic events that draw our attention, but the despicable urges to which they are invisibly subject. If we judge their moral character by their actions we may well be mistaken. Their will, the immediate conscious reflection of their self-chosen and affirmed principles and values, is generally engaged – though admittedly not always – in strenuous efforts to suppress those urges from determining their behaviour. When deviants are discovered by society this is often because of a failure of their self-control, i.e. a failure of their will rather than an expression of it. It is not necessarily the case that such individuals have deliberately misused their liberty and the trust placed in them by society as a whole by choosing to do evil to others.
This point relates to the complicated relationship between two aspects of freedom, discussed so eloquently by Isaiah Berlin in ‘Two Concepts of Liberty’: liberty to act without external constraint, and autonomy to be the master of oneself. Liberty is at the heart of the modern project of political liberalism. It requires that people should be left alone to do what they want, unless that turns out to reduce the equal liberty of others or otherwise harm them. But the concept of liberty itself depends upon a prior richer conception of individuals as masters of ourselves. If we did not hold this belief, liberty would not be worth having. Yet there are cases where people do not seem to be properly the masters of themselves, such as anorexia, suicidal ideation, or heroine addiction. Likewise, if some people’s brains are so wired that they are prone to what society sees as despicable urges, is it ethical to presume that they have sufficient autonomy to choose and act on their own conception of the good, and to be held accountable for their actions?
Autonomy is about self-governance, which can be analysed into two components, self-control and self-command. The first is the traditional obsession of philosophers, the general public and psychologists (the marshmallow test and all that): strength of will. In this picture, the way we deal with inappropriate desires is a test of character. Good people are defined as those able to resist temptations, whether for fattening junk food or unwise sexual relationships with co-workers. Yet the will is exactly the wrong way to analyze moral character or autonomy since it takes no account of the strength of the urges that must be overcome. Some people face much greater challenges than others because of the nature of the desires they were born into, not because they are too lazy to try hard enough.
Self-command, by contrast, works through planning, by abstracting oneself from the moments when one is struggling with temptation and in a more cool and collected state of mind to develop strategies for evading those temptations in the first place. Thus recovering addicts are trained in how to identify and avoid potential triggers in their life, such as certain people, places, and moods. As that case suggests, self-command is something that others can help you with. Given the effectiveness of anti-androgens in reducing sexual drive, and of SSRIs in reducing mental rumination on deviant sexual fantasies, we seem to have an obvious medical tool available with which to help these people take command of themselves.
Chemical castration can thus be understood as an aid to autonomy, since it provides people burdened by the struggle to suppress an unacceptable sexuality with a device for directly removing the problematic desires themselves, rather than relying on the effortful and unreliable exercise of their will. Of course, taking these drugs removes (temporarily) one’s whole sexuality, and there can be unpleasant side-effects, but for at least some people the exchange would still be worth making. They would not only be freed of the burden of their sexuality, they would also be able to redirect their energies to flourishing in the various other dimensions of a worthwhile life.
In my view the state has a responsibility not only to leave us alone to get on with things, but also to provide the conditions that support our flourishing and autonomy. There is therefore a strong case for making voluntary chemical castration available, together with psychological counselling as appropriate, to individuals for whom it would be useful. Perhaps governments should launch a publicly funded publicity and treatment campaign with promises of extreme discretion, rather as they do for STDs. Such a programme might even be taken up by individuals whom society doesn’t consider deviants, especially if it were given a more attractive name than ‘chemical castration’, such as those who have come to see their sexuality as a distraction to their lives or work, or as demeaning in its “animality” (as religious and philosophical sages have long complained).
Yet the state may also be said to have a responsibility to remove some people’s deviant urges even without their consent. Individuals who seriously struggle to suppress sexual desires that involve harming others arguably have a duty to submit to treatment even if they do not recognize that duty. The right of the rest of us to be safe from just what they feel driven to do produces a corresponding duty on their part to take all reasonable measures to make themselves safe, to defuse the ticking bomb.
This logic seems particularly obvious in cases where someone has in fact already lost control and been convicted of a serious crime as a result. Whether or not people who repeatedly commit sex crimes are particularly unlucky in the temptations they have to struggle with is irrelevant to their duty not to put others at risk of being harmed. And if they don’t see it that way then trained and objective judges and psychiatrists seem appropriate proxies to determine and act on that duty on their behalf.
Alan Turing was famously offered an unsavoury choice, similar to that now being offered to many convicted sex offenders around the world: chemical castration or prison. To some, this choice is odious because from the prisoner’s perspective it isn’t so much a choice as extortion, demanding that people give up their sexuality under the threat of the severe punishment that is imprisonment. Yet from the perspective of the state it does not seem so unreasonable or inhumane.
The freedom of individuals with dangerous sexual desires they cannot reliably control to live amongst us puts the rest of us at risk of sexual assault and other harms. It seems quite reasonable for society to demand that the state reduce that danger. That goal can be achieved either by restricting the liberty of sexual deviants by external constraint (incarceration, perhaps indefinitely) or by enhancing their autonomy by freeing them from the internal urges that are the root of the problem and their danger. Of these, the latter seems the more humane option, since it is better fitted to the responsibility the sexual deviant bears, and it allows him a much greater freedom to live a flourishing life despite his disability.
Yet there was something disagreeable about how Turing was treated, and which we should bear in mind in considering the revival of chemical castration in the 21st century. The flimsiness of the moral justification for criminalizing homosexuality reflects a general tendency to invest mere popular prejudice and disgust – whether that be against incest between consenting adults, miscegenation, S&M, bestiality, or whatever – with the full power and authority of the state. Homosexuality was banned for being disgusting. It was a more humane but hardly more enlightened step in the mid-20th century to convert it from a moral crime to a mental illness and claim that anyone who had such irrational, awful desires must need saving from themselves whether or not they realised it.
Whatever laws we have against sexual deviancy, chemical castration may often be a more humane way of achieving compliance with them than imprisonment. But we should be much more demanding about the moral justification for the laws themselves, and more critical of the underlying social norms which also directly cause so much psychological harm to those who don’t fit in. The mere defence of public decency does not justify draconian criminal sanctions. Society has no more right to be defended from the imaginary harms of sexual non-conformists than from witches.