CHARLOTTESVILLE, VA -- He was a
schoolteacher, a husband, a father. Then he became a pedophile
preoccupied with sex.
Doctors who treated him at the University of Virginia
hospital in 2000 believe that the man's powerful sex addiction
was caused by an egg-sized tumor in his brain.
"It turned out he was a guy who had made it into his 40s
without having any problem with this," said Dr. Russell
Swerdlow, a UVa associate professor of neurology. "He had a
brain tumor that was damaging the part of the brain that
Once the tumor was removed, the man's sexual obsession
disappeared. Swerdlow believes this is the first known case to
link damage of the frontal lobe with pedophilia.
Swerdlow and Dr. Jeffrey Burns, a former UVa physician,
have written an article on the case. It was published in the
March edition of Archives of Neurology.
"The most interesting part of this is getting into the
hardwiring of morality and free will," Swerdlow said. "It
raises the question, how free is free will?"
This philosophical question is being investigated by
doctors across the country. And the answers they find through
their research could have serious implications - not just for
individual treatment but for the criminal justice system as
Brain scans conducted on murderers, for example, show that
there is sometimes damage or poor function of the prefrontal
cortex, a part of the brain that lies just behind the forehead
Such scans and other scientific studies of the mind may one
day be widely used in courts as evidence for the defense, as
it was for Swerdlow's patient.
"This guy was going to go to prison and what he needed was
an operation, not incarceration," Swerdlow said.
Dr. Burns first met the man after he showed up at UVa
hospital complaining of headaches and saying he feared he
would rape his landlady.
Burns described his behavior as impulsive and
"He was propositioning the nurses and the female
residents," Burns recalled. "He had no concern that he
urinated on himself or how he was perceived by other people.
He would stop the conversation between the doctor and himself
and ask women to get into bed with him."
Neurological exams showed the man was unable to write or
copy drawings normally. An MRI was ordered.
"We found a very large brain tumor replacing the entire
orbitofrontal lobe," Swerdlow said.
Swerdlow said the man was relieved that the tumor provided
an explanation for his sociopathic behavior.
"He's grateful that he was properly diagnosed and properly
treated," Swerdlow said. "He's relieved to know that he isn't
the 'evil' person that he thought he was destined to be."
According to Swerdlow's paper on the case, the man secretly
visited child pornography Web sites and solicited prostitutes
during 2000. The patient said that he had never participated
in these activities before.
"It started with a fascination of pornography, including
child pornography, and as the tumor grew the symptoms
worsened," Swerdlow said.
When the man's wife found out he had made subtle sexual
advances toward a young girl, she kicked him out of the house.
He was found guilty of child molestation and medicated with
drugs intended to produce chemical castration.
A judge ruled that he had to pass a 12-step sexual
addiction program or go to jail. But the man was thrown out of
the class after he solicited sexual favors from staff and
Coincidentally, he showed up at UVa's emergency room the
night before his sentencing.
"There was some concern he was malingering in an effort to
avoid his court date," Burns recalled.
But then the tumor was found. It was located in the right
lobe of his orbitofrontal cortex, which is known to be tied to
judgment, impulse control and social behavior.
"The brain tumor was resected and the symptoms were
resolved," Swerdlow said. "He was given a second chance at a
program for sex offenders. He successfully completed the
But seven months after the tumor was removed, the headaches
began anew. And the man again started viewing porn.
An MRI revealed tumor regrowth. In 2002, a tumor was
removed for the second time. And for the second time, the
"He's doing great, but there is always the possibility that
it could grow back," Swerdlow said. "It's a really bizarre,
Swerdlow argues that the case legitimizes the question of
whether some sociopathic behavior is caused by brain
"Will we one day find that people perform criminal acts
because they have some kind of damage or abnormality to this
part of the brain?" Swerdlow asked. "I think that we are just
beginning to scratch the surface of how personality is
"Researchers are investigating whether there are certain
groups of people born this way," he said. "Maybe that part of
their brain has developed differently. Maybe that's just the
way they came wired from the store."
George Thomas, a UVa professor emeritus of philosophy, said
this idea goes back at least to the 1920s.
"A lawyer named Clarence Darrow argued that all criminal
behavior was caused by mental or physical illness," Thomas
said. "He said we should think of criminal behavior as a
disease that could be treated mentally or physically."
Thomas said if the man truly was unable to control his
actions, he should not be held morally responsible for
"If the conditions that produce the behavior are
independent of that person's values, you shouldn't hold that
person accountable," Thomas argued. "You should try to treat
An example of this would be someone with Tourette syndrome
who shouts out obscenities.
The problem is that it's often difficult - if not
impossible - to judge whether a person is unable to suppress
"You certainly can't generalize from this one case to say
that all pedophiles can't control their behavior," Thomas
And Thomas isn't convinced that Swerdlow's patient is
"The tumor wasn't completely the cause of the behavior,"
Thomas said. "He had to have the impulse somewhere within him.
The tumor simply made it difficult for him to act against that
"Sexual impulses are common to everyone, of course," he
said, "but I don't believe the impulse to molest children is
common in everyone."
Swerdlow emphasized that he is not suggesting that every
pedophile has a brain tumor and should escape
"The difference in this case was that the patient had a
normal history until he developed the tumor," Swerdlow said.
"Most pedophiles develop problems early in life."
It's known that deviant behavior can be caused by several
kinds of brain damage, including tumors, trauma and infections
such as encephalitis. Swerdlow hypothesized that abnormalities
could be caused on biochemical levels that scientists aren't
even aware of.
"Studies suggest that when damage is done to the frontal
lobe before 18 months, people never learn right from wrong,"
Swerdlow said. "When damage is done after that time, people
can learn right from wrong but they can't control their
impulses. There is no longer regard for long-term
consequences, only short-term gratification."
"Nothing puts the brakes on their behavior. They are always
in trouble," he said. "If their brain wants something, they
Swerdlow said this was the case with his patient. The man
knew his actions were wrong "but the pleasure principle
overrode his restraint."
There are many documented cases of behavioral changes
caused by damage to the frontal lobe. The most famous probably
is that of railroad worker Phineas Gage.
In 1848, an explosion sent a railroad spike through the
front of Gage's skull. He survived, but after the accident the
once passive man was prone to rage.
Some of the most compelling modern visual evidence for the
link between brain damage and violence is the work of Dr.
Monte Buchsbaum, a professor of psychiatry and director of the
neuroscience PET laboratory at Mount Sinai School of Medicine
in New York. In 1997, Buchsbaum conducted the largest
brain-imaging study of murderers ever.
Buchsbaum performed PET scans on 22 people on trial for
murder and 22 other people of similar age who had no history
of violence. The accused murderers, as a group, had lower
glucose metabolism in the prefrontal cortex, showing
diminished activity in brain areas which normally function to
inhibit aggressive impulses.
"I think that people can become murderers as a result of
brain damage, but they are not predestined to become
murderers," Buchsbaum said. "There is not a murder center in
the frontal lobe. These areas in the frontal lobe are involved
in motivation, mood regulation and impulse control. And these
personality features are applied across a wide range of
Buchsbaum doubts that brain scans will ever be used as a
technique to identify potential murderers or even less violent
"They will never find a brain center that makes people
commit murder," he said. "The brain is just not wired that
Brain damage, Buchsbaum argues, can have a range of
unpredictable effects. It could cause something as minor as
antisocial behavior or something as severe as murder.
Scientists can provide information about the link between
deviant behavior and brain damage. But ultimately, it will be
up to the legal justice system and juries to make sense of new
scientific discoveries and decide how accountable people are
for their actions.
"The goal of the legal system is to cure criminal behavior.
This is often done through incarceration," Swerdlow said.
"Perhaps, in the future, there will be others ways to manage
sociopathic behavior - maybe prescription drugs or
He concluded: "We're dealing with the neurology of morality
Claudia Pinto, a staff writer for The (Charlottesville)
Daily Progress, at (434) 978-7266 or