Psychological and neurological impacts of circumcision

Psychological impacts of male circumcision

This menu page indexes and links articles relevant to an understanding of the psychological, neurological, and sociological sequelae and effects of male circumcision. The material within each category is arranged in order of publication.

Introduction

In medical circles, neonatal male circumcision was long assumed to be psychologically and emotionally benign. It was believed that newborn infants had poorly developed neurologic systems; that newborns could not feel pain; or, if they did feel the pain, they would not remember it. According to that orthodoxy, the experience of neonatal circumcision could never have any lasting effect on a child and could not traumatize a child.

• The belief that infants cannot feel pain is now outmoded and discredited.
• Pain of circumcision and pain control

It was also a common belief that the foreskin had no particular structure and no useful function; and that the patient would never later regret its loss.

• The idea that the foreskin is a useless flap of skin is contradicted by a modern understanding of anatomy.
• The penis and foreskin: Penile anatomy and sexual function
• The assumption that no patient would ever regret being circumcised was not justified.
•  Awakenings (link to  NOHARMM website)

Enough evidence now exists to say with confidence that male circumcision causes psychological changes. The trauma of the experience is injurious.^24,47 It can have long-term deleterious effects later in life.^{24,47,48,51,56,57} However, the specific neurological, psychological, and behavioural changes resulting from early genital trauma have never been carefully investigated. Much more study is needed to further elaborate these changes.

The study of the psychology of circumcision can be divided into several interrelated areas:

1. The effects of pain and perinatal trauma on the child;
2. Grieving the loss of a body part;
3. Effects of early trauma and loss in the adult;
4. The effects on the parent (parental-infant bonding);
5. The effects on society;
6. Factors influencing parents and doctors to request or perform circumcisions.

Although the literature on the psychological impacts of circumcision is far from complete, some information is available. New material is gradually appearing and will be added to these pages as it becomes available.

Perinatal trauma. Circumcision is a form of perinatal (birth) trauma.³⁵ Cansever tested boys before and after circumcision and found that the trauma causes severe disturbance of normal function.⁶ Taddio and others have documented behavioral changes at six months of age, suggestive of PTSD in circumcised boys.³⁷ Yilmaz et al. have demonstrated PTSD in boys in the phallic period who are undergoing circumcision for phimosis.⁵⁶ Rhinehart has documented posttraumatic stress disorder resulting from the perinatal trauma of circumcision in middle-aged males.⁴⁸ substantial evidence that perinatal trauma^{16,33,45,46,47,49,52,57} and/or deprivation of pleasure^8,19 contribute to later aggressive, violent, and/or suicidal behaviour. Anand and Scalzo suggest that early trauma predisposes to altered pain sensitivity, stress disorders, ADD/hyperactivity, and self-destructive disorders.⁶⁵ Van der Kolk identified a compulsion in traumatized persons to repeat the trauma.¹⁸ Goldman reports that the performance of circumcision by a circumcised male doctor may be a reenactment of one's own circumcision trauma.⁴⁷

Denial of loss. Persons who have lost body parts must grieve their loss.^41-43,45 The first stage of grief is denial of the loss.²⁵  Fitzgerald and Parkes state that Anything that seriously impairs sensory or cognitive function is bound to have profound psychological effects, not only on the person who is affected but also on family, friends, workmates, and caregivers.⁴² The thought of permanent loss of sensory function is so painful that persons deny their loss in order to avoid facing the painful feelings.⁴² Denial of loss causes a flight from reality.  Parkes et al. state that persons in denial may minimize their loss.^41-43 Circumcision causes the loss of a body part and all of its functions including a drastic loss of erogenous sensory function, so denial of loss is not uncommon in circumcised males. Circumcised males may experience the full range of distress and emotional dysfunction resulting from loss. This frequently results in circumcised fathers adamantly insisting that a son be circumcised.^25,29,57

Fathers are frequently unable to vocalize their feelings. They will say that I want my son to look like me, even though the child may be different in eye color, hair color, and other aspects. In fact, what the father really may be feeling is, I don't want a son with an intact penis to remind me of what I have lost.

Effects of denial on medical doctors. Goldman states that some circumcised male medical doctors misuse the medical literature to support, rationalize, and justify their own loss; and to defend the practice of circumcision.⁴⁷  Denniston reports that doctors who have been cut themselves may be unable to stop cutting others.²⁹ LeBourdais reports that the likelihood of a baby being circumcised is determined by the circumcision status of the a father; the sex, age, and circumcision status of the physician; amongst other factors. Goldman reports that doctors who are older, male, and circumcised are more likely to condone circumcision.⁴⁷ Members of medical societies may have emotional issues that may preclude the objective formulation of policy concerning non-therapeutic male circumcision.⁵⁵

Summary

Parents need to be aware that circumcision is dangerous. It involves traumatic loss of a body part. There is a definite potential for long-lasting psychologic injury. However, children differ unpredictably in their resilience to pain, trauma, and loss. Some individuals will be affected more seriously than others. Much more research is needed before we can fully understand the psychologic and social consequences of this traumatic life event.

Highlights

• In the late 19th and early 20th Century, Sigmund Freud identified castration anxiety resulting from fear of operations on the genitals.¹
• Cole (1927) reported a fearful reaction that may have been the first reported case of a posttraumatic stress disorder (PTSD) flashback in which the stressor was circumcision, although he could not have known what he was reporting because PTSD was not recognized as a disorder until years later.²
• As early as 1929, British analyst Edward Glover reported a case of impotence secondary to castration anxiety caused by a particularly brutal circumcision. Glover also reported the behaviour of a medical doctor with an apparent obsessive-compulsive need to perform circumcisions.³
• In 1945, David M. Levy, M.D., reported a study of many children who had undergone various surgical operations, including circumcisions. He found that many suffered from combat neurosis, an early name for what is now known as posttraumatic stress disorder.⁴
• Child psychiatrist Anna Freud discussed the role of bodily illness in the mental life of children in 1952. Freud stated that the combination of pain and anxiety can have devastasting effects on children.⁵
• Child psychologist Gocke Cansever (1965) assessed 12 Turkish boys before and after they were circumcised. Cansever reported severe disturbances with functioning after the circumcision as measured by psychological testing.⁶
•  James Prescott (1975) reports on the origins of violence. Prescott believes that the deprivation of body pleasure contributes to the development of violent behaviour. ⁸ Circumcision removes the pleasure sensors in the foreskin and so deprives the individual of body pleasure.
• Richards et al (1976) observed behaviour differences in male children in the US that were not found in male children in Europe. The US male children were circumcised while the European children were not circumcised. Richards suggested that the changes were due to circumcision.⁹
• Grimes, apparently unaware of the work of Freud, Cansever, or Richards, wrote in 1978 that [t]he application of crushing clamps and excision of penile tissue... probably do little to engender a trusting, congenial relationship with the infant's new surroundings.¹⁰
• Kennedy reported the case of an adolescent boy traumatized by circumcision.¹² Yorke subsequently reported on the need for additional study of psychic trauma. He cited the trauma of circumcision as an example.¹³
• The Diagnostic Manual of the American Psychiatric Association (DSM III) first identified the conditions that contribute to the development of post-traumatic stress disorder (PTSD) in 1980. The 1987 DSM-III-R reports the conditions described for the pathogenesis of PTSD. These are exactly similar to those experienced by the helpless infant undergoing circumcision.¹⁵
• Perinatal psychologist David Chamberlain (1989) demonstrated that people under hypnosis can remember their birth and traumatic events associated with it.¹⁷
• Van der Kolk (1989) reported that victims of trauma tend to reenact the trauma.¹⁸ These findings apply to many kinds of child abuse, and may help to explain why men and women who were victims of circumcision violence are more likely to perpetuate male and female circumcision violence.
• Prescott (1989) contrasts the pain and trauma of circumcision with the pleasure and peace of avoided circumcision. He identifies the pain and lack of pleasure associated with circumcision with changes in brain development and behaviour. Prescott argues that the early genital pain of circumcision encodes the brain for later sadomasochistic tendencies, including violent destructive behaviours.¹⁹
• Alice Miller (1991) discusses the effects of early child abuse and trauma on later violent and self-destructive behaviour.²⁰
• Walter and Streimer have reported a case of body dysmorphic disorder secondary to circumcision.²¹ Maguire and Parkes confirm that grief is common in persons who have lost body parts⁴⁰.
• Bigelow (1992,1995) reported that circumcised men who have become fathers in circumcising cultures often exhibit a behaviour described as adamant father syndrome. The adamant father insists that his son be circumcised, even after a rational discussion is provided.²⁵
• Menage (1993) found post-traumatic stress disorder in women who have undergone genital procedures.²⁶
• Williams and Kapila surveyed the complications of circumcision in 1993. This is believed to be the first medical journal article of this type to discuss psychologic complications of circumcision in any detail.²⁷
•  George C. Denniston, MD, MPH, (1994) discusses the psychological effects and behavior changes in adult men resulting from of denial of loss by penile circumcision.²⁹
•  David Chamberlain, Ph.D. (1995) discusses the perinatal origin of later violent behaviour.³³ Dr. Chamberlain argues that babies should not be circumcised.
• Hepper (1996) reviews the literature that shows that fetal memory commences to operate well prior to birth and continues across the birth experience into the newborn period.³⁴
• Diamond provides a psychosexual follow-up report on the case of John/Joan, who was sexually reassigned and raised as a girl following the total loss of his penis to a circumcision disaster. John was circumcised to treat a fused foreskin---even though this is a normal developmental condition in newborn boys.³⁵ John (David Reimer of Winnipeg, Canada) was the subject of a book, As Nature Made Him, by journalist John Colapinto.
• Taddio (1997) demonstrated that the pain of neonatal circumcision remembered at six months of age. The observed behaviour is suggestive of an infant analogue of post traumatic stress disorder.³⁶
• Psychologist Ronald Goldman reports the effects of the trauma of circumcision on the individual and society in a recent book.³⁷
• Hill (1997) reports the tendency of circumcised doctors and religious officials to cite false medical or religious grounds to justify circumcision.³⁹
• British child psychiatrist McFadyen (1998) reported the psychologic trauma experienced by her son following a circumcision operation.⁴⁰ McFayden's description of her son's trauma is consistent with the early reports of Anna Freud⁴ and Cansever.⁵
• British psychiatrists Maguire and Parkes (1998) reported on the need to grieve the loss of body parts.⁴¹ Failure to grieve the loss leaves the individual in a state of denial of loss and disconnected from the reality of the loss and injury.
• Bradley et al. report on the failure of sex reassignment surgery in the management of penile ablation secondary to non-therapeutic circumcision.⁴⁴
•  Menage (1998) reports on the psychological harm of male circumcision.⁴⁵
•  Jacobsen and Bygdeman (1998) report that traumatic and/or painful procedures in the perinatal period seem to cause a greater propensity to suicide. The effect is markedly greater in males.⁴⁶
• Ronald Goldman, Ph. D. (1999) discusses the impact of circumcision on the child, on parents, on adults, on medical doctors, and on society.⁴⁷
• Psychiatrist John Rhinehart, MD, (1999) documents four cases of PTSD from his psychiatric practice.⁴⁸
• Boyle & Bensley report a survey of the psychological and sexual effects of male circumcision on men.⁵⁰
• Boyle and colleagues survey the psychological and sexual effects of infant circumcision.⁵²
• Yilmaz et al. administered psychological test to boys before and after circumcision. They found evidence that circumcision causes anxiety similar to post-traumatic stress disorder.⁵⁴
• Goldman discusses psychological, cultural, and religious factors that influence medical doctors who determine circumcision policy.⁵⁵

See also  The Birth Scene, a site having an excellent discussion of circumcision in four articles by leading writers.

Therapists

NOHARMM maintains a  webpage listing therapists in various parts of the United States who are knowledgeable in helping men who have issues resulting from their circumcision.

Organizations

•  Circumcision Resource Center, Boston, USA
•  Society for the Psychological Study of Men and Masculinity (SPSMM)
  (A Division of the American Psychological Association)

[See also The Anthropology and Sociology of Circumcision.]

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