The two recent articles, “Head case puzzle” (7/15/2012) by Robert M. Sapolsky (a professor of neuroscience at Stanford University) and “Do pedophiles deserve sympathy?” (6/21/2012) by James Cantor ( of the Department of Psychiatry at the University of Toronto) point the way toward what will undoubtedly become an increasingly well understood science of the way in which brain wiring, injuries to the nervous system both before and after birth, childhood factors affecting brain development and genetics are all interwoven in such a way as to produce a human being who is predisposed to particular sexual acts.
But for those who want to see sex addicts and/or sex offenders as responsible for making the right choices no matter how they are wired, Sapolsky’s Op-Ed piece in the L.A. Times is a shot across the bow.
As Sapolsky points out, “Self-discipline, impulse control, gratification postponement and emotional regulation are all just as much products of biology as anything else that emanates from the brain. The same types of evidence that allowed us to understand the role for biology in such things as abnormal sexual urges have also demonstrated a role for biology in giving in to those urges.”
Where are we with understanding sexual compulsion?
Some sex offenders and sex addicts seem to have wiring that is so messed up that they are incapable of ever gaining any connection with or empathy for another human being. And yet we used to claim that people with “character disorders” such as borderline personality disorder were incurable too. But we now know that these “disorders of the self” as they are sometimes called are most often related to neurophysiological issues that may be a result of early trauma and attachment issues and that they can be treated with a great deal of success.
So is sexual compulsion a disability permanently etched in the brain?
At present I believe we operate on the basis of a kind of implicitly understood continuum of biological permanence, which goes something like this:
sexual orientation – paraphilia – arousal template – trauma reaction
In this continuum sexual orientation (gay, straight etc.) is accepted by most if not all people as hard wired in the brain if not the genome. At the most fluid end of the scale, a trauma reaction or behavior that is in reaction to (or a repetition of) specific traumatic experiences which are often quite amenable to change through treatment.
The middle two categories are where the sex offenders and sex addicts are usually located. Pedophilia, attraction to children, is a paraphilia like other types of sexual fixations. It is the object of sexual attraction that is the most or only really sexually arousing person or thing. These are seen as learned rather than innate for the most part but have been viewed as resistant to treatment.
“Arousal template” is the word used in most sex addiction therapy to refer to the sexual preferences such as dominance and submission, voyeurism and so on, which are the result of childhood experiences, early trauma and conditioning. They are closer to trauma reactions in that with proper treatment they can be worked through and in many cases the person’s sexual behavior can come to be more “normal.”
If there is a neurophysiologically identifiable cause of the problem, we tend to see the person as less responsible for their behavior regardless of how effectively it can be treated. Actually, the question should be not how much or little people have control over a given behavior, but how far we have come in being able to treat it. The question of responsibility is one that the legal and philosophical systems rely on but ultimately it has little to do with the scientific reality of the prospects for treatment and recovery.