20 June 2017

Dear Dr. James: Will there ever be a cure for pedophilia?

Dear Dr. James:

I have two questions I would like answers to. First question: Why is there no cure for pedophilia attraction?  Secondly, will there ever be a cure?  I have read that white matter is one of the problems causing the disorder.  So, why can’t we just add more white matter, for example?  If we, as humans, can solve so many problems, I don't see why we shouldn’t be able to solve this one in some way in the near future.

@fadelsadel via twitter

Hi, @fadelsadel.  Thanks again for letting me share your question: I think a lot of people are interested in knowing exactly the same things!

For your first question: I think it ultimately boils down there not being any funders—either public research agency or private philanthropist—who have taken this on as a goal.  Most people (very understandably) have strong emotions when it comes to this topic, and they fear and avoid any whiff of the stigma surrounding it. However, in my experience, only little education on the topic is needed before most people recognize how much we stand to gain, and how much suffering (nevermind financial expense) stands to be saved.  We need a public health official or a Bill Gates type to recognize what could be done if we (first) just faced down the stigma of discussing this rationally.

For your second question: I could never say never.  It’s amazing to think that it was only 10 years ago that we even established pedophilia to be a neurological phenomenon at all.  Currently, it still looks like pedophilia emerges from atypical connectivity among brain regions that identify/perceive social stimuli as sexy.  If governments and research funders made a serious effort to figure out how the sex response system of the brain worked, then we might be in a better position to know which of the ever-emerging tools from neuroscience could be applied.  Moreover, the more we know about how it develops, the earlier we might be able to detect it, and the earlier something is detected, the easier it is to influence.  I want to add, however, that these are fundamentally important questions of bioethics related to the science of this topic:  Many people have discussed these issues with regard to converting homosexuals to heterosexuals, but not with regard to converting pedophiles or others whose sexual interest pattern (unlike homosexuality) cannot be enacted without risk of harm.

Although it seems logical, just adding white matter isn’t as simple as it might sound.  Brain development starts very early after conception, and it undergoes very many phases ultimately leading to each point in the brain connecting to just the right other point of the brain.  Interestingly, the infant and childhood brain is quite “over-connected.” After childhood, substantial pruning of white matter occurs.  In adulthood, brain cells (the neurons) do not divide and make new brain cells like other types of cells.  The various signals that cells used to determine the direction to grow towards are no longer present in adulthood.  So, the great complication (I predict) will be how to get each of the brain cells to connect to all the corresponding brain cells, even though the rest of the brain is no longer undergoing the series of phases that originally led to its final structure. 

The best analogy I have is that, when it is still batter, we can add chocolate to make it a chocolate cake, but after it’s baked, adding the same ingredient gives us a vanilla cake drizzled with chocolate sauce.  That said, we are outside of my real field of expertise.  This step in figuring out a cure will have to come from a conversation between a real neuroscientist on top of developments in that field and a sex researcher who describes this situation until the neuroscientist says, “Hey, that sounds just like…”.

I don’t know who those people will be or what technology that will be, but I feel confident to saying that such conversations are most likely to happen in place that foster cross-pollination between fields and offer scientists some flexibility outside of a business model, and such places are becoming increasingly rare.

[FOOTNOTE: Just for the record, I’m using the colloquial sense of the word “cure” here, as the writer meant it.  I point this out to acknowledge that there are other people who would emphasize that (1) when someone sexually prefers children, but is neither distressed by it nor poses a risk of harm to anyone because of it, then the person would not receive a diagnosis in the DSM-5 system, and (2) without there being a diagnosis, it is not clear whether one should be referring to a “cure.”]

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