Pedophile fix: Did the tumor cause it?

There was something wrong with the schoolteacher with the headache– doctors could see that from the start.

Though charming and intelligent, the 40-year-old man couldn't stop leering at the female nurses in the emergency room. He had been in trouble with the law for making sexual advances toward his stepdaughter, and now he was talking about raping his landlady.

Neurologists Russell Swerdlow and Jeffrey Burns have treated all kinds of mental disorders at the University of Virginia Medical Center. But the case of the lustful schoolteacher, whom they declined to identify, still makes them scratch their heads.

The man had an egg-sized brain tumor swelling just underneath his right eye socket. When surgeons removed it, the lewd behavior and pedophilia faded away. So far, Swerdlow says, the man has kept out of trouble.

"It's possible the tumor released some pre-existing urges,'' Burns says. "But that's a tough debate, we just don't know.''

Why people make the choices they do, especially if those choices are considered immoral, is a question that brain scientists have long debated.

Deviant behavior can have little to do with upbringing or personal values, as the schoolteacher's case shows, says Dr. Stuart C. Yudofsky, a psychiatrist at the Baylor College of Medicine who specializes in behavioral changes associated with brain disorders.

In the case of the schoolteacher, the tumor was pushing on the orbital portion of the man's right frontal lobe– the part of the brain that keeps people out of trouble by controlling their urges for danger or sex or some other behavior that would be considered inappropriate. Alcohol, for example, puts this region to sleep.

"This tells us something about being human, doesn't it?'' Yudofsky says. If one's actions are governed by the relative health of the brain, "does it mean we have less free will than we think?''

It's a question that has vast implications in the criminal justice system, says Chris Adams, a death penalty specialist for the National Association of Criminal Defense Lawyers.

Already, the U.S. Supreme Court has ruled that executing mentally retarded murderers is unconstitutionally cruel because of their diminished ability to reason and control their urges. The next logical step, Adams says, would be to extend that protection for people with damaged or undeveloped frontal lobes.

"Some people simply don't have the frontal lobe capacity to stop what they're doing,'' Adams says.

The Virginia schoolteacher didn't grant The Associated Press' requests for interviews, passed along to him by his doctors. But according to his case report, which Swerdlow and Burns published in the March issue of Archives of Neurology, the man had not had any abnormal sexual problems or urges for most of his life.

In 2000, however, he began collecting sex magazines and visiting pornographic websites, focusing much of his attention on images of children and adolescents.

He couldn't stop himself, telling doctors "the pleasure principle overrode'' everything else.

When he started making subtle advances on his young stepdaughter, his wife called police. He was arrested for child molestation. The man was convicted and failed a 12-step rehabilitation program for sexual addiction because he couldn't stop asking for sex favors, according to the case report.

The day before he was to be sentenced to prison, the man walked into the emergency room complaining of a headache. He became distraught, Swerdlow says, and told the hospital staff he was contemplating suicide.

"He was totally unable to control his impulses,'' Burns says. "He'd proposition nurses; he'd ask them to get into bed with him.''

The next day, the schoolteacher was showing signs of brain damage: He complained of having trouble walking and had repeatedly urinated on himself.

An MRI revealed the brain tumor. After it was cut out days later, the man began to improve. He completed a Sexaholics Anonymous program and eventually moved back home with his wife and stepdaughter.

About a year later, Swerdlow says, the tumor partially grew back and the man started to collect pornography again. He had another operation to remove the tumor last year, and the lustfulness again subsided.

"That's one of the interesting things about frontal lobe damage,'' Swerdlow says. "This guy knew what he was doing was wrong, but he thought there wasn't anything wrong with him, and he didn't stop.''