The Anatomy of Violence (49 page)

That was interesting, but something else piqued our interest even more, which you can see in
Figure 9.2
. You’ll recall that pediatricians had assessed the children for signs of malnutrition at age three—
before
the intervention had begun. On the left-hand side of the figure, kids with normal levels of nutrition at age three who went into the enrichment showed only a small and statistically nonsignificant reduction in conduct disorder. In contrast, when we looked just at those kids who entered the study with poor nutrition, we found that the enrichment showed a 52.6 percent reduction in conduct disorder at age seventeen compared with controls.
²⁵
You can see that on the right-hand side of the figure. Early nutrition status
moderates
the relationship between the prevention program and the antisocial outcome. It works in one group—but not in another. Recall that the prevention program had a lot of ingredients. If nutrition was the active ingredient, you’d expect
the program to work more in kids who had poor
nutrition at the get-go—and that’s exactly what we found.

Figure 9.2
   Reductions in age seventeen
conduct disorder are greater
in children who had poor nutrition when they entered the
enrichment

It might be that better nutrition makes the difference—but could it be something else? This was the first study to show that early environmental enrichment increases physiological attention and arousal in the long term in humans. That gives us a clue to the mechanism of action—brain
change. The prevention program had more physical
exercise and outdoor play, and exercise by itself could account for some of the observed effects.
Exercise in animals is known to have beneficial effects on brain structure and function.
²⁶
For example, we know that in mice environmental enrichment produces
neurogenesis—new brain cells growing in the dentate gyrus of the
hippocampus—that is entirely attributable to running.
²⁷
So it could be something as simple as the daily walks and running around in free play that the children in the enrichment group got that improved hippocampal functioning and reduced adult crime.

Another hypothesis is that the increased social interaction with
positive, educated preschool teachers in the experimental enrichment may in part account for the beneficial effects. On the other hand, it may be unreasonable to focus on
any
single component of the intervention. Instead, the multimodal nature of the prevention program, which combined social and cognitive components alongside nutrition and exercise, may have facilitated biosocial interactions that
affected later development. Just as we saw in the model, the biosocial interaction is central to the explanation of crime. Similarly, with prevention it’s a question of covering all the bases to block
bullying behavior in children and violence in adults.

More intriguingly, perhaps the crime reduction can be chalked up to the young children eating fish. In Mauritius, I met with three of the original interventionists to reconstruct the typical week’s food intake for the enriched group, comparing it to that of the controls. The enriched group had more than two portions of fish extra per week. We’ve discussed in
chapter 7
evidence that increased fish consumption is associated with reduced violent crime, and we’ll see later in this chapter more substantive evidence for this alternative explanation.

It’s important to emphasize that our results could not be attributed to pre-prevention group differences in temperament, cognitive ability, nutritional status, autonomic reactivity, or social adversity, which were carefully controlled for.
²⁸
The fact that the prevention program reduced crime twenty years later using two different measures of outcome—both self-reporting and objective measures—indicates the robustness of the effects. It’s unusual in the field to get results that last. Something in the enrichment is really working to reduce adult crime and violence.

Let’s also be careful about the claim. The early enrichment did not eradicate crime. It reduced it by about 35 percent—so that leaves a lot. Obviously, we need more than two years of intensive enrichment to abolish adult crime. And maybe the Mauritius miracle crime cure would not apply to other countries that have a different culture and standard of living. Yet many kids don’t get good nutrition, even in the affluent United States, and we think our findings from Mauritius may be particularly relevant to poor rural areas of the United States such as the Mississippi delta region and also to inner cities, where rates of both malnutrition and behavioral problems in children are relatively high.
²⁹

We were pleased with what was achieved and how early efforts paid off in reducing crime. At the time the study began there were no government preschools on the island at all. One lasting infrastructure
contribution made by the research team, which included
Peter Venables, Sarnoff Mednick,
Cyril Dalais, and staff at the
Mauritius Child Health Project, was embodied in the 1984
Pre-School Trust Fund Act, which established government preschools based on the two model nursery schools the group had set up in 1972.
³⁰
Currently, 183 such schools are running in five educational zones in Mauritius—and making a difference in turning Mauritius into a model African country.

The authoritarian
Queen of Hearts in
Lewis Carroll’s
Alice’s Adventures in Wonderland
was a wayward woman with a radical way of dealing with even the smallest of difficulties. “Off with their heads” was her simple solution to every misdemeanor.
³¹
Although quite heartless, the Queen of Hearts was on the anatomical road to addressing one of the most difficult to treat classes of violent criminals—
pedophiles and
sex offenders.
Surgical
castration is the simple, radical, and highly controversial solution some authorities resorted to in order to reduce recidivism rates of sex offenders. Is this a mindless and unethical policy that should be halted? Or does it get to the heart of the matter and provide a workable solution to an intractable problem?

Surgical castration still continues in Germany, ever since a law was passed in 1970 allowing it. It’s a voluntary procedure, and only a few are performed every year. Because it sounds barbaric and is so easy to condemn, the German government has put several safeguards in place to regulate it. The offender has to be over twenty-five, and approval is needed from a panel of experts.
³²
Nevertheless, it remains a controversial practice in Europe. The
Council of Europe’s anti-torture committee in Strasbourg, for instance, views it as a degrading treatment that should be halted. But let’s reserve judgment until we hear all sides.

It’s not only Germany that conducts castration. The
Czech Republic has put over ninety inmates under the knife in the past ten years.
Pavel is a case in hand. He was imprisoned at the age of eighteen after he gave in to uncontrollable sexual desires for a twelve-year-old that resulted in the boy’s death. But even before the crime he knew he had a serious problem. After waking up in the middle of the night in a sweat just two days before the
murder, he sought help from his doctor. He was told that the urges would go away. But they didn’t, and apparently they became magnified as he watched a Bruce Lee
movie, which
stimulated his compulsion to use violence to heighten his sexual appetite. He took a knife to the boy and killed him.

After eleven years in prison and psychiatric institutions in the Czech Republic, and just one year before he was due to be released, Pavel asked to be surgically castrated. “I can finally live knowing that I am no harm to anybody,” he reported after the procedure. “I am living a productive life. I want to tell people that there is help.”
³³
Pavel now loves his life in Prague, working as a gardener for a Catholic charity.

For Pavel, removal of his testicles was the price he paid for peace of mind, even if it meant being alone, with neither sex nor romance. It’s a tough life, but nevertheless a life that gives him meaning and some degree of dignity. Isn’t that better than rotting away in prison, or living every day being torn apart by the wild horses inside that are urging you to desecrate the body of an innocent child?

Debates over the ethics of castration are heated and inevitably revolve around
prisoners’ rights and the benefits to the individual and society. Let’s leave aside the ethics for now, which can be debated at length. Here we’ll take a cold, calculated look at the empirical evidence for and against the efficacy of this drastic intervention. Does it work? If it does not make a difference, that would be a compelling argument for eradication of this drastic—and some would say draconian—form of treatment.

We saw earlier how high levels of
testosterone are associated with increased aggression, yet these data are correlational, not causal. The etiological assumption behind castration is that lowering testosterone and thus sex drive would lower reconviction rates
in sex offenders. But does it?

Good studies of the effects of castration in human prisoners are few and far between. Ethically, you cannot randomly assign one sex offender to castration and one to an alternative treatment. The study that comes the closest to the impossibly ideal experiment was conducted by the medical researchers
Reinhard Wille and
Klaus M. Beier in Germany in the 1980s.
³⁴
Wille and Beier followed up ninety-nine castrated sex offenders and thirty-five non-castrated sex offenders for, on average, eleven years after release from prison. Such a sample covers about 25 percent of all castrations in the period from 1970 to 1980, and is therefore reasonably representative of this population. Subjects could not be randomly assigned to experimental and control conditions as would be demanded by a rigorous randomized controlled trial. Nevertheless,
the thirty-five controls had all requested castration—but ended up changing their minds. As such they constitute as close a control group as can be ethically achieved.

Recidivism rates for sexual offenses over the eleven-year post-release period were 3 percent in castrated offenders compared with 46 percent in the non-castrated offenders—a dramatic fifteenfold difference. The 3 percent reconviction rate in castrated sex offenders is consistent with rates found in other studies that have not been as rigorous as that of Wille and Beier. Rates of reconviction in castrated sex offenders from these ten other castration studies range from 0 percent to 11 percent, with a median of 3.5 percent. These data provide further support for considerably lower reconviction rates in castrated sex offenders. Bear in mind that 70 percent of castrates in Wille and Beier’s study were satisfied with their treatment. It’s certainly not a panacea for pedophilia and other sexual offences, but should it be entirely ruled out if appropriate safeguards can be guaranteed?

What about the wider literature? One review of 2,055 castrated European sex offenders showed recidivism rates ranging from 0 percent to 7.4 percent over a period of twenty years,
³⁵
results very similar to those in the Wille and Beier study. Yet another review, by
Linda Weinberger, a professor of clinical psychiatry at USC, documents the low incidence of sexual recidivism following physical castration in many different countries, commenting that “the studies of bilateral orchiectomy are compelling in the very low rates of sexual recidivism demonstrated among released sex offenders.”
³⁶
At the same time she cautions that it is hard to generalize to present-day high-risk offenders, and recognizes the ethical difficulties. However, a commentary on this review cautions that it is important not to
underestimate
the potential importance of castration when considering the release of an offender.
³⁷

It sounds grotesque, doesn’t it? The holier-than-thou among you will be wringing your hands in horror at the barbarity of this surgical intervention. But
you
don’t have to live your life as a pedophile in a top-security
prison, do you?
You
don’t have to face the daily taunts—and danger of being raped—that these men face.
You
don’t have your mug shot on the Web for all to see after your release so that people know exactly where you live.
You
don’t have to be responsible for controlling sexual urges that are very difficult to contain. Shouldn’t people like Pavel at least be given the
option
of castration under conditions guaranteed to have no external coercion?

Fortunately—or perhaps unfortunately, depending on your perspective—there are less drastic methods of dealing with sexual offenders:
chemical
castration. Here anti-androgen medication is given to reduce
testosterone—and hence lower both sexual interest and performance. In the United States
medroxyprogesterone—or
Depo-Provera—is used to increase circulating progesterone. In the United Kingdom and Europe,
cyproterone acetate is used, which competes with testosterone at androgen receptors in the brain. Other medications include
leuprolide,
goserelin, and tryptorelin. In all cases, they reduce testosterone to prepubertal levels.