COURSTEY MIRROR MARCH6
The roots of sexual misconduct

Altaf Patel

The good doctor on modern medicine and age-old common sense

Damage to the brain’s temporal lobes, such as occurs in herpes or stroke patients, may cause peculiar conditions like hypersexuality, and is called Klüver-Bucy Syndrome

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Inappropriate sexual behaviour may soon be classified as a disease. Its sufferers, not necessarily perverts, need treatment
As a young physician, I was often called aside by nursing staff who told me that some patient had been behaving badly with them. This often pertained to sexual advances, some verbal, some involving touching the nursing staff inappropriately, or, worse still, groping. Many of the nursing staff was from Kerala, efficient to the last, and lived away from their homes; most of them found employment abroad.

I found their harassment disgusting, and often told off the patient, sometimes threatening dire action if it was repeated. In today’s times, such crimes against women are not tolerated anywhere. It is demeaning in every way to treat a woman purely as an object of lust. At times, hospital administrators have told me that even senior doctors behave this way. It surprised me then and still does that a man past his sexual prime, often late into his seventies, would behave in such a manner. Could these patients’ behaviour have been due to some illness; could the predatory doctors’ behaviour be because of dementia? If so, these must be looked at as diseases, and dealt with differently.

A number of international celebrities have made the front pages of newspapers recently for their inappropriate sexual behaviour. Matt Lauer of NBC News was even fired for sexual misconduct at the workplace. The term ‘inappropriate sexual behaviour’ encompasses a host of things, such as sexual conversation and innuendo, jokes about sex, inappropriate touching or groping, sexual propositioning, exposure, sexual assault, or masturbation in public places.

An article by Greg A Hood about inappropriate sexual behaviour in the elderly is enlightening. It says such behaviour in the elderly is not uncommon, and is estimated to occur in 7.8 per cent of Alzheimer’s patients. It must be understood that some of the behaviour might be willful and voluntary in a coherent geriatric patient, because he feels he can get away by citing infirmity and age. On the other hand, there are also several situations that cause damage to the brain and its nerve connections, which may be responsible for such sexual behaviour. Such situations, when the patient suffers from tumours or a stroke, may predispose him to aggressive hypersexuality. In fact, damage to the temporal lobes of the brain, such as occurs in herpes or stroke patients, may cause peculiar conditions like compulsive eating, or putting objects into the mouth, or hypersexuality, and is called Klüver-Bucy Syndrome. Thus, a physician should look at the patient’s medication list, e.g. for drugs for Parkinson’s disease. Even excess testosterone may encourage such behaviour. In fact, using antidepressants (selective serotonin reuptake inhibitors) may help treat such conditions.

I think we need to determine if the patient is a rogue, or his illness is making him behave this way. Naturally, a rogue must be treated firmly and set right under the law. In some clinical cases, medication may be used, such as anticonvulsants — like Gabapentin — antiandrogenic drugs, oestrogen, or Finasteride, which is used to shrink an enlarged prostate, and may prove helpful.

In the elderly, it would be best to consider non-drug therapy, and simply assigning a male nurse to the patient may sort the problem out. Encouraging social activity, taking snack breaks, and engaging in conversations and exercise also help relieve boredom and can direct the patient’s mind away from sex. An interesting article by Tune in The American Journal of Geriatric Psychiatry tells of a patient who touched nurses inappropriately when agitated. The problem was overcome by giving the patient a toy to fondle, after which he left the staff alone. Cognitive behavioural therapy can also help in treatment.

To conclude, one must remember that inappropriate sexual behaviour (ISB) is on its way to being classified as a disease, and one needs to differentiate its sufferers from criminals, because their disease may be responsible for their behaviour, and may be treatable.