Circumcision and Psychological Harm
Last updated on 5th September 1998
Circumcision is a euphemism for genital reduction surgery or genital mutilation, performed by medically-licensed or unqualified practitioners for various reasons. It is important to define it honestly, for that is how the mind interprets it, with or without superimposed denials, explanations and intellectualisations.
Many circumcisions are performed on children, who, by definition are not able to give informed consent of the kind available to adults. They are vulnerable to coercion and manipulation and generally have little say in what happens to their bodies medically & surgically. They are not usually allowed to say no to medical procedures because it is deemed that parents & doctors "know best". However, it is unlikely that any child, asked if they would like a person with a knife to cut off part of their penis, would agree to such an action. This would be a normal psychological reaction to the threat of attack and is overruled at some psychological cost.
When one's own natural tendency to protect oneself is rendered ineffective, one loses a sense of one's own power over one's destiny & survival, and a feeling of helplessness ensues. This occurs in situations of rape, torture and sexual abuse. In a situation where a person feels he or she cannot escape physical attack, the mind will "escape" by a process of "dissociation" - it is as if the mind leaves the body temporarily, so that the body can endure the attack, but the mind does not have to. On returning to the body, the mind may then be subject to unconscious repetitions of the traumatic memories in flashbacks or nightmares. These recurring images may be triggered by any situation which reminds the sufferer of the original traumatic event; a child who has been subjected to a painful surgical procedure in hospital may develop a phobia of hospitals or doctors or people in white coats. The child, or later the adult he grows into, may sweat, have palpitations, feel breathless, nauseated, panicky or dizzy at the thought of the trauma situation and try to avoid it happening again. This may lead to difficulty when medical attention is genuinely needed for a subsequent illness.
One man, who had been subjected to circumcision at the age of three years old, vividly recalled at the age of thirty, how he had been undressed and his penis manipulated by a man in a mask pre-operatively, without his consent. The child had experienced an erection about which he was embarrassed, and then, post-operatively found himself with a bleeding, painful penis from which the foreskin had been amputated without his permission. This event had changed his life. He was angry that this had been done to him and humiliated by his powerlessness to protect himself from what felt like sexual manipulation. He felt that he had been sexually abused. In any other context than the medical one, the same sequence of events would be open to an interpretation of sexual abuse. To the child, the psychological impact is the same, whether it is illegal rape or legalised medical activity.
Another man, who was circumcised at the age of seven, asked what was going to happen to him in hospital. He was told that it was "nothing" and he didn't need to worry his head about it. After the operation he was devastated to find that part of his penis was missing and that his trust in his parents' words had been misplaced. It was as if his experience of losing part of his body was not worth a mention or an explanation.
The process of psychological dissociation from trauma, and the subsequent re-experiencing of frightening images, plus avoidance of situations which symbolise the trauma, is called Post-traumatic Stress Disorder, or PTSD for short. It is a collection of symptoms recognised in some soldiers after combat and in victims of extreme terror. It has been shown to occur in women after gynaecological procedures and after circumcision in children of both sexes.
Some of the factors which contribute to the experience being traumatic are:
A child subjected to amputation of part of his body, whatever the reason given, is likely to experience all of these factors. In addition, if the child perceives that the parents have failed to protect him from surgical "attack", whatever their reasons, there is a loss of trust in the carers, and, perhaps, in all authority. This difficulty in trusting others can lead to avoidance of relationships, sometimes lifelong, and conflict with authority. Shame of the damaged penis and embarrassment about being mutilated can lead to avoidance of sexual relationships, again, sometimes lifelong.
The child may grow up in ignorance of his circumcision, particularly if it has been done shortly after birth and if his peers are also circumcised. However, when it is discovered that part of his genitalia has been removed without his permission, often for no good reason, there is a loss reaction amounting to grief. The loss may be minimised and trivialised so as not to expose the mind to too much psychic pain; the pain of loss is profound. There may be a denial of its significance and, in order to maintain the image of the parent as "good", it may be idealised as a "good thing" which parents should do to their children if they care about them. Hence, the transgenerational passage of circumcision practice from father to son. For the cycle of mutilation to be broken, at least one generation would need to face the true nature of the activity and acknowledge the harm and the pain caused. This is a courageous act, since it brings into play feelings of betrayal and abandonment by one's own parents; that instead of protecting one's body from harm, they have given their child into the hands of a stranger to remove part of his body.
The intellectualisation of a harmful act is a way of turning "bad" into "good" - the thought process may run thus: "my parents cut off part of my body and despite the fact that I didn't like it, my parents are good - so cutting off part of my body was good - therefore, to be a good parent myself, I must do the same to my son...". And so the cycle of abuse continues. Similarly within the medical profession- "I was circumcised/have done circumcisions - I was not harmed/have not harmed my patients - therefore to circumcise is trivial, harmless and necessary..." If the doctor is in a process of trying to deny that he has been harmed by his own circumcision, he may be psychologically compelled to repeat the act on his patients to "prove" that circumcision is "harmless". In addition, when a circumcision victim becomes a circumciser, he is no longer powerless to attack - he is now the powerful attacker, thus redressing some of the balance in relation to his own fear of repetition of his own trauma.
We all try to repeat traumatic situations in order to resolve the original anxiety: battered women marry violent husbands; the children of alcoholics may marry drinkers; and foreskin amputees sometimes become compulsive circumcisers. Freud called it, "the compulsion to repeat"; Alice Miller described how people who are dissociated from, and deny the significance of, the original cause of their own pain, will often find expression in destructive acts against others.
In order to heal losses of any kind and to avoid perpetuating harm on the next generation, it is therefore psychologically necessary to acknowledge the harm done by circumcision and to grieve its effect. This involves a painful and protracted process, including initial denial, followed by anger & blame, then anxiety & searching, sadness & depression, and, ultimately, acceptance and reinvestment of energy into the future.
Most important of all, is to enter the child's world and see circumcision for what it is from the child's perspective. It is a forced robbery of a treasured part of his body and nobody except he, as an adult, can legitimately give permission for its removal.
Bibliography & useful reading