Research has found small reductions of recidivism among convicted sex offenders when they request chemical castration in conjunction with other therapeutic measures. Small studies have found that recidivism decreased when offenders received antidepressant medications, not anti-testosterone medications.
These findings largely leave the question of whether the technique should be used to the realms of ethics and legality, not medicine. Some legal scholars believe mandatory chemical castration violates the Eighth Amendment, which bans cruel and unusual punishment. The University of Florida law professor John Stinneford has called the practice “maiming” and “impermissibly cruel.” (Hurst, the Alabama bill’s sponsor, did not respond to a request for comment.)
Even when chemical castration is voluntary—which other legal scholars argue can never be the case, due to the coercive subtext of lessening prison sentencing for seeking the procedure—treatment of “hypersexuality” has a loaded history in the United States and elsewhere. The medical establishment and government have long erred on the side of narrowly defining normalcy and punishing “deviancy,” as they have with homosexuality, which was removed from psychiatry’s Diagnostic and Statistical Manual of Mental Disorders only in 1973.
This change came after researchers began documenting in mainstream journals the wide variations in human sexuality. The range of what was “normal” began to separate from morality and expand to show that the idea of what constitutes sexuality is vast and complex. Today, the psychiatric establishment still uses a diagnosis of hypersexual disorder, but the concept has shifted from a more rigid imposition of norms to an idea about how a person relates to sex. There is no cutoff for what is too much sexuality. Some people have sex multiple times a day; others rarely have sex. Hypersexual disorder is currently defined only insofar as it causes distress: When you lose your job because you need to keep having sex, or when your relationship falls apart because you lose all interest in sex, you may have reason to seek care.
If there is a role for the medical community in preventing assault, it is to help equip willing patients relate to people in healthy ways—to treat whatever psychological element precludes healthful, pro-social behavior. If such people find themselves in court, they could be offered the same option. This has been the suggestion of some physicians in South Korea, for example, who argue that chemical castration can be an effective tool for offenders who want and consent to the treatment “within the context of simultaneous comprehensive psychotherapeutic treatment.” Denmark has implemented options for “sexological treatment” of some sex offenders that includes therapy and androgen-blocking medications.
In every case, though, the suggestion is that this would be consensual, voluntary care. It would heed the words of Berlin, the Johns Hopkins psychiatrist, who writes that chemical castration cannot “effectively assist” a person “who lacks a sense of conscience and moral responsibility by somehow instilling appropriate values.”
To have the state impose mandatory standards of behavior toward other people is one thing; to forcibly regulate someone’s internal sex drive is another.