Should We Cure Bad Behavior?

Tough questions about crime and neuro-rehabilitation

The "Ludovico Technique," a revolutionary treatment for violent criminal behavior, is supposed to make criminals sick. But for decades, it's been readers of Anthony Burgess' A Clockwork Orange and viewers of Stanley Kubrick's film adaptation of the novel who have been made queasy by the chilling scene in which the imprisoned teenaged murderer and rapist Alex undergoes the fictional treatment. Ludovico is an aversive treatment in which prisoner-patients are forced to watch violent scenes while being made severely nauseated by means of injections. Eager to get out of prison at any cost, Alex lies to the prison chaplain that he is volunteering for the Ludovico Technique because, "I just want to be good." The chaplain tries to talk him out of it, arguing, "The question is whether or not this technique really makes a man good. Goodness comes from within. Goodness is chosen. When a man cannot choose, he ceases to be a man."

Nevertheless, Alex agrees to the treatments so that he can get out of prison in two weeks rather than serving out his 14 year sentence. The treatments work. Once he's out of prison, whenever Alex—as vicious a sociopath as you'll find in anywhere in print or on screen—contemplates committing "ultraviolence," he instantly becomes incapacitated by nausea.

Modern advances in neuroscience and psychopharmacology are bringing the day closer when real Ludovico therapies become available. Currently, a lot of effort is being devoted to developing various medications and treatments to prevent or control recreational drug use. Researchers are testing an anti-cocaine vaccine, an anti-nicotine vaccine, Topamax for alcoholism, and GVG for methamphetamine dependence, among other treatments. Vaccines aim to prevent drug molecules from getting into peoples brains. Pharmaceuticals target various neurotransmitters to prevent drug molecules from producing the pleasurable effects people taking them seek.

Brain and genetic research is also beginning to illuminate some of the neurochemical sources of violence. For example, elevated levels of dopamine and norepinephrine are associated with impulsivity and violence. The gene for catechol-O-methyltransferase (COMT) comes in two varieties, one of which is four times slower in breaking down dopamine and norepinephrine. Studies indicate that people with the slow COMT variation are more prone to violence. Monoamine oxidase-A (MAOA) is another brain enzyme that inactivates dopamine, norepinephrine and serotonin. It too comes in two versions. A study in New Zealand found that men who carry the low activity version and who had been reared in abusive households are much more likely to commit crimes and be violent. The researchers explicitly noted that "these findings could inform the development of future pharmacological treatments."

Given that effective neuropharmaceutical interventions will one day be available to control drug dependence and prevent criminal violence, what role should the government have in administering such treatments? In the case of anti-drug treatments, if a person decides that she wants to break her dependence, she, of course, should be allowed to take such treatments. Similarly, a person who worries that his genetic makeup might cause him to behave violently should be able to choose to take pharmaceuticals to calm his impulses.

But setting aside the stupidity of prosecuting the drug war against non-violent users, what should be done about people who have been incarcerated for crimes committed while using drugs or alcohol—say, drunk driving that kills someone? Like Alex in A Clockwork Orange, why shouldn't courts offer to let prisoners out if they agree to anti-drug vaccinations or other treatments? In the future, violent offenders could agree to take pharmaceuticals to boost their COMT and MAOA enzyme activity in exchange for their freedom. After all, some states already offer to reduce the sentences of repeat pedophiles and rapists who agree to a fairly drastic procedure designed to alter their behavior—castration. Taking a simple shot to prevent cocaine use or a tablet to calm violent impulses seems tame by comparison.

But then comes the next hard question: Why should the state patiently wait for a prisoner to agree to treatment when the means to rehabilitate and restore him as a productive member of society is at hand? Drug users who have proven themselves dangerous to others could be required to take anti-drug vaccinations and violent offenders could be compelled to take pharmaceuticals to boost their COMT and MAOA activity. After all, they are criminals who have presumably been justly deprived of their liberty. Does the state have the right to invade the last privacy of a person, the privacy of his or her own mind?

And what about people who have not yet dangerously abused drugs or committed crimes? In Britain, some government officials are already eager to launch vaccination campaigns to inoculate children against future cocaine and nicotine use. To justify anti-drug vaccination campaigns, officials offer a public health rationale. Even though the vast majority of children would survive a bout of measles, we vaccinate them all against the disease. Similarly, even though the vast majority of people who use cocaine or smoke tobacco will cause society no appreciable problems, we should vaccinate the whole population to protect those who might succumb to the deleterious effects of drug use. And people will not necessarily need to be coerced into taking anti-drug vaccinations. One can also easily imagine parents eager to protect their children from the scourges of drug abuse demanding that their children be inoculated. With regard to people whose genetic tests reveal that they carry genes that predispose them to violence, why not require them to use neuropharmaceuticals to control those impulses?

In A Clockwork Orange, the chaplain argues, "Goodness comes from within. Goodness is chosen." But could Alex the sociopath really choose goodness? As neuroscience advances it will increasingly appear that goodness is the proper balance of neurochemicals acting on appropriate neural circuits. Right now the balance of neurochemicals that makes it possible for one to choose goodness is generally brought about by good parenting, schooling and proper socialization. The question that will soon confront us is whether or not effective neuropharmaceuticals are just another way to enable us to choose goodness.