[back] Male Circumcision

Circumcision: The Hidden Trauma .
How an American Cultural Practice Affects Infants and Ultimately Us All

by Ronald Goldman, Ph.D

1997


TABLE OF CONTENTS
Foreword by Ashley Montagu, Ph.D. xiii
Prefacexv
Introduction: Controversial Questions  1
1. Infant Development and Response to Circumcision 6
Changing Views of Infants; Sensory Response; Other Abilities and Qualities; Pain Response During Circumcision; Behavioral Response Following Circumcision; Comments from Professionals
2. Why Parents and Physicians Choose to Circumcise Infants 29
Mental Factors; Emotional Factors; Male Attitudes Toward Choosing Circumcision; Behavioral Factors; Communication Factors; Language Factors; Defense Mechanisms
3. Social and Cultural Factors Perpetuating Circumcision in America  57
Historical Context; Circumcision in Other Countries; Sexuality, Denial, and Normality; Conformity; Female Genital Mutilation; Science, Medicine, and Cultural Values
4. Long-Term Psychological Effects of Circumcision: 
     I. Early Trauma and Memory  82
Reasons for Lack of Investigation; Birth as Trauma in Psychoanalysis; Infant Neurological Development and Memory Capability; Clinical Experience with Body-Oriented Therapies and Research on Birth Impact; More Reports of Perinatal Memories; Circumcision Memories; Circumcision as Trauma; Circumcision of Older Children
5. Long-Term Psychological Effects of Circumcision: 
     II. Adult Emotional Impact  103
Menís Attitudes Toward Their Own Circumcision; Psychological Impact of Circumcision on Men; Body Image, Self-Esteem, and Shame; Neurological Effects; Discovering Circumcision; Symptoms of Post-Traumatic Stress Disorder Related to Circumcision; Sex-Related Effects of Circumcision
6. Circumcision and the Mother-Child Relationship  124
Maternal Anxiety; Mother-Infant Interaction; Loss of Trust; Mothers Who Observed Circumcision
7. The Impact of Circumcision on American Society  139
Effects of Low Male Self-Esteem; Avoidance of Intimacy in Male-Female Relationships; Unnecessary Surgery; Control of Female Sexuality; Attitudes Toward Pain and Stimulation; Passivity; Reduced Empathy; Antisocial Behaviors; Interrelationships of Social Problems; Warfare
8. The Lessons of Circumcision  176
Infants Are Real People; Circumcision Trauma and Effects on Adults; Circumcision and Disrupted Bonding; American Motivation to Circumcise; Science and Medicine; Ethics and Medicine; Cultural and Social Perspectives; Hope for Healing
Appendix A   Sample Hospital Circumcision Information  205
Appendix B   Questionnaire  215
Appendix C   Personal Account of FGM  216
Appendix D   Jews and Circumcision  220
Appendix E   Research Considerations  222
Glossary 227
Resources 229
Notes 231
Bibliography 267
Index

From the Author
Nothing is so firmly believed as what we least know.
The American public generally assumes that our cultural practice of circumcision is a trivial and benign procedure, hardly worthy of serious consideration and discussion. We believe that such a widespread practice must be grounded in a consensus that it is safe and effective, that it benefits the child or at least does no harm.

In fact, there is considerable disagreement about the advisability of circumcision. According to one national survey, 33 percent of American obstetricians and pediatricians are personally opposed to circumcision, though some of them may not disclose this to their patients. Some doctors and nurses have refused to participate in circumcisions. In addition, some circumcised men are revealing long-standing opposition to circumcision or are adopting such a stance after learning more about the practice. Parents' views and choices are changing, too. According to the National Center for Health Statistics, the circumcision rate has dropped from a peak of about 85 percent to about 60 percent nationally and to only about 35 percent in some areas of the country.

What do these people know? What motivates their opposition? Is it wise to continue subjecting our children to a practice that has provoked growing criticism and questioning? Does it matter that about 3,500 circumcisions are still performed every day, one every twenty-five seconds?

From a global perspective, most of the world rejects circumcision: over 80 percent of the world's males are intact (not circumcised). Most circumcised men are Muslim or Jewish. The United States is the only country in the world that circumcises most of its male infants for nonreligious reasons.

The public perception is that there are valid health reasons to circumcise associated with cleanliness and protection from various diseases. However, the American Academy of Pediatrics, the country's largest organization of physicians who care for infants, has not found any proven medical benefit from circumcision. In fact, no national medical organization in the world recommends routine circumcision of male infants. Furthermore, the results of the latest research are arousing some concern about this often misunderstood surgical procedure, and critics are charging that circumcision causes serious harm.

How can a common, routine procedure cause harm? How could this alleged harm have escaped the notice of doctors, parents, men-the whole society-for so long? How would people react, and what would it say about us if circumcision were found to have a negative impact?

The public is generally unaware of the controversy about circumcision, because circumcision has never had the full and open debate that many believe it deserves. However, that is changing. Increasingly, newspaper and magazine articles, radio and television shows, and a growing network of committed people are focusing attention on the subject. Some media stories on circumcision have elicited a surprising amount of mail and comment requesting better and more extensive reporting on this issue.

New information about circumcision often conflicts with previous teachings and long-held beliefs. Many people, including doctors, are confused by what they learn. If our world makes sense, then there must be a coherent explanation for all the apparently contradictory information. The conflicting conclusions, beliefs, and opinions surrounding circumcision, together with the tenacity with which advocates and opponents of circumcision hold on to their viewpoints, suggest that deep psychological factors are involved. I believe that the heart of the circumcision issue lies beyond the field of medicine.

This book addresses two main questions: (a) Why are circumcisions really being done? and (b) What effect does circumcision have on us? More specific questions include

1. What motivates doctors and parents to circumcise? Is this a rational or an emotional decision?

2. Why is the United States the only country in the world that circumcises most of its male infants for nonreligious reasons? Do we know something other countries don't, or do they know something we don't want to know?

3. What, exactly, happens during a circumcision? Is it "just a little snip" or much more, as some claim?

4. Does the infant feel "discomfort" or extreme pain and possibly trauma? If circumcision is traumatic, psychological effects could be long-term.

5. Can infants remember their experience? Any evidence that a male retains such memories would support possible long-term effects.

6. What are the possible long-term psychological effects of circumcision? Could something that happened that long ago make any difference now?

7. What is the sexual impact of circumcision? Does sex feel the same without a foreskin as with one?

8. How does circumcision affect the mother-child relationship? Any negative effect that results from the procedure could also have long-term implications.

9. Does circumcision affect the male-female relationship? If there are effects, women cannot avoid them.

10. How does circumcision affect our society? Is there any possible connection to either common or extreme forms of social behavior?

Amazingly, some of these questions have never been studied, perhaps because they are too disturbing. Close examination could threaten personal and cultural beliefs and challenge current mainstream assumptions about medical and mental health practice. Despite our possible discomfort, we need to know if we are harming ourselves and our children.

Since circumcision touches on so many aspects of life-physical, sexual, psychological, social, historical, and religious, to name a few-many find learning about the practice both engaging and challenging. Indeed, examining the subject of circumcision is a surprisingly rewarding path to learning more about ourselves.

If this book challenges any of your most firmly held assumptions and beliefs about circumcision and society, I urge you to allow yourself to question them.

It is not so important that all agree about the ideas presented in this book, but it is critical that an open discussion take place. I hope this work serves to stimulate and expand the dialogue. Whatever you think and feel about what you read, I would welcome your response.