Jewish circumcision: an alternative perspective

Introduction

As a Jew, I used to take ritual circumcision completely for granted. I watched the procedure many times, when a son was born to family or friends. It is unusual for a woman to watch, but I was a young medical student, unafraid, curious and, eventually horrified. My concern about this issue has arisenslowly, simply from what I have seen.

In the first section, I examine the reasons for circumcision, and compare some of the physiological and clinical findings about the procedure with popular Jewish beliefs about its nature and consequences. I consider the effect of the procedure on the mother as well as the child, and discuss the ethical implications. In the second section, I discuss some Jewish texts and traditions that could surprisingly, lend support to challenging the established practice ofcircumcision.

In the third section, I describe the historical and psychosocial factors that make challenging Jewish circumcision so problematic, and that sometimes lead to intensely negative responses to new information about it. I also discuss the vexed question of whether challenging Jewish circumcision is necessarily anti-Semitic.

In the penultimate section, I examine the received view that Jewish people practise circumcision because of Gods commandment to Abraham (in Genesis 17:11–14). I show that for most Jewish people, the reasons have more to do with a sense of belonging than with a sense of being divinely commanded. I then argue that circumcision is, nevertheless, not as essential to our Jewish identity as most of us have assumed. Finally, I consider the possibility of cultural evolution, providing examples from within and outside the Jewish community of how, despite the difficulties, customs can and do change.

Reasons for questioning religious circumcision

There are several reasons to reconsider the practice of religious circumcision, including the pain, trauma and complications associated with the procedure, the lack of previously supposed medical benefits, and the effect of circumcision upon the mother of the circumcised child.

Pain and trauma

Jewish boys are circumcised at 8 days of age, i.e. well within the neonatal period; no anaesthetic is used. The level of pain associated with the operation, whether judged by the babies screams or by objective physiologically indices such as heart rate and plasma cortisol levels, is severe. Even using a lignocaine injection for neonatal circumcision, Stang et al.¹ showed plasma cortisol levels of 331 nmol/L. whereas the normal level is 28-138 nmol/L. Similarly Benini et al.² found heart rates of 180 bpm in recently circumcised babies, which were only slightly reduced (to 160) by anaesthetic. Paediatrician Paul Fleiss, writing in Lancet, considers these cortisol levels and heart rates to be consistent with torture³.

Other researchers have found comparable physiological responses indicative of severe stress during circumcision, including dramatic rises in respiratory rate and trancutaneous oxygen, as well as plasma cortisol level and heart rate^4-6. Circumcision is so painful that it has now, according to Stang et al. become a model for the analysis of pain and stress responses in the newborn¹.

These findings contrast starkly with the beliefs commonly expressed in the Jewish community that its only a little snip that doesnt hurt, and its just like changing their nappy or cutting their fingernails. Even though most babies scream, tremble and go pale or ever blue, many Jewish people will describe a circumcision they attended at which the baby didnt cry, in fact he just went to sleep. This is taken to mean that the baby felt no pain. However, studies suggest that rother than feeling fine, these babies may actually be lapsing into a lethargic, semicomatose state as a reaction to overwhelming stress^7-9.

Another popular belief, perpetuated even by those Mohelim (ritual circumcisers) who are also doctors, is that there are no nerve endings in the foreskin, so it cant possibly hurt. However, it has been clearly show that the foreskin is a complex and important sensory organ, containing many nerve endings, including the specialized Meissners corpuscles, similar to those found in the fingertips and lips¹⁰.

In conversations about circumcision, many Jewish people claim that Jewish circumcision is less traumatic than, say, Muslim circumcision, precisely because it is performed at such an early age. The underlying myth, common until recently in the wider community, is that newborn babies simply do not feel pain. But medical research contradicts the wishful thinking of folk beliefs. Not only do newborn babies feel pain, they feel it more intensely, for longor and over a wider area of the body than do older children or adults subjected to the same stimulus. Fitzgerald and her team at University College London, have shown clearly that the nervous system of a newborn baby differs from that of an older child or adult, bouth anatomically and physiologically, so that what would constitute a light or harmless stimulus to the older child or adult actually produces pain in the newborn. Furthermore, newborns lack the inhibitory or damping down mechanisms of the more mature nervous system, so they cannot protect themselves from the experience of pain in the way they could at a later stage¹¹.

The developmental anatomy of the penis also suggests that the earlier circumcision is performed the more painful it will be. In the neonatal period, only 4% of children have a retractable foreskin. For 96% of Jewish babies therefore, circumcision will involve the forcible tearing of the foreskin from its attachment to the glans, as well as the cutting of its attachment to the sulcus. However, at the age of 3 years, 90% of boys have a retractable foreskin and this trauma would only apply to 10% of them¹².

Closely following (and contradicting) the no pain story, one frequently encounters the following statement: Alright, maybe it hurts, but it only lasts a moment and they forget about it the minute its over. Theyre too young to have any memory of it. In fact, the raw surface of the glans may bleed and be painful for several days after the circumcision, so the pain is far from momentary. Further, there is ample evidence that newborns do have some memory of the event, which takes the form, not of conscious remembering, but of a permanent restructuring of the nervous system. The result is an intensification of the behavioural response to subsequent painful stimuli, as though the nervous system has been sensitized. Thus, for example, Taddio et al.¹³ found that pain responses in children being vaccinated were significantly greater in those who had been circumcised (several months previously) than in those who had not. Other studies show that pain experienced in early infancy can disrupt breast-feeding, mother-infant bonding¹⁴ and sleeping patterns¹⁵.

In addition to pain, circumcision is traumatic because it constitutes an experience of utter helplessness¹⁶. Not only is the child in great pain, but nothing he does can help to avoid or reduce the pain. His cries have no effect and movement to escape is impossible, because he is held down; he learns that he is powerless.

Complications

Many serious complications of ritual circumcision have been reported¹⁷, including haemorrhage, infection, meatal stenosis¹⁸, amputation of the penis^19,20, trapped penis²¹, urinary retention (frequently from tight bandaging) and renal impairment (rarely²²), UTI²³, septicaemia²⁴, and four cases of acute heart failure²⁵, Williams and Kapila²⁶ reported a horrifying list of surgical disasters leading to permanent severe damage to the penis.

I have listened to several Jewish women describe how their sons hemorrhaged severely after circumcision, requiring hospital admission and blood transfusion. In one case, an orthodox Jewish woman, whose only child had bled nearly to death, felt so traumatized that she chose to have no more children although deeply wanting them. She said if I had another boy, I couldnt bear to have him circumcised. But I also could not bear not to have him circumcised. Her son is 16 years old now and has no siblings.

While haemorrhage, infection and the occasional tragic accident may be acceptable risks in surgery performed to treat disease, and to save life and limb, i.e. where the risks clearly outweigh the risks, they are unacceptable risks in surgery that has no such healing function. As far as I have been able to ascertain, neither the Jewish nor the Muslim community in Britain keep any statistical records of the complications of circumcision performed by their practitioners.

Lack of presumed medical benefits

According to the Jewish religion, circumcision should be carried out purely for reasons of faith, not for any real or imagined medical benefits. Nevertheless, in conversations with secular and non-orthodox Jewish people, hygiene and preventive medicine are frequently given as reasons for continuing the practice. Most Jewish people seem unaware that claims for the prevention of cervical cancer, penile cancer, UTI, etc., have been thoroughly discredited²⁷, as were the claims for prevention of asthma, epilepsy and masturbatory insanity which preceded them. In any case, preventive medicine is normally about choices that a free adult can make, relating to diet, lifestyle, screening programmes, etc. It is not usuallyabout removing healthy body parts from infants.

Effects on the mother

The strongest instinct of the new mother is to hold, cherish and protect her baby. In the Jewish world, this natural and vital desire is brought into immediate and painful conflict with the demands of tradition. In gatherings of Jewish women over the past several years, I have listened to scores of Jewish mothers and grandmothers describing how they felt torn between loyalty to their child and loyalty to their tradition, at what should have been a time of resting and rejoicing. I have heard African and Muslim mothers describe the same agonizing dilemma. Usually, the circumcision goes ahead and the mother feels impotent, guilty, and full of regret, even many decades later. Many mothers say they only consented because they had been told it was a painless, minor procedure. Had they realized the degree of blood and trauma involved, they would never have agreed; they felt betrayed.

In Jewish law, it is the father not the mother, who is commanded to circumcise the boy. It is a rite of male bonding, designed (unconsciously), as are all such rites worldwide, to separate the baby boy from his mother and to claim him as one of the men of the tribe. It was Abraham, not Sarah, who was commanded to circumcise. It is Jewish men, not the woman or children, who have defined circumcision as sacred. As Pollack points out²⁸, Jewish women now need to redefine what is sacred, and every mother knows in her heart that there is nothing sacred about taking a knife to a childs genitals. There is nothing sacred about shattering a childs inborn trust, his basic assumption that his parents will do their utmost to protect him from harm. Pollack states, Circumision is fundamental to patricarchy, but it is not holy²⁹.

Ethical implications

Anyone subjecting an adult to what is permitted in regard to an 8-day-old baby would be charged with assault. If children and babies are to be regarded as fully human beings, then it must surely be unethical for them to be held down forcibly while a healthy functional part of their body is excised. It is not only that babies are helpless, or that they are too young to give consent. Their reactions, their screams, and that they have to be held down at all, are best and only way of indicating that they are actuallywithholding their consent.

Judaism, like all religious traditions, has many layers and many strands. In the next section, I show that despite the Biblical injunction to circumcise, support can be found from many Jewish sources for the view that circumcision of infants is unethical and should therefore be abandoned.

Textual support for change within Judaism

In Judaism, and in Islam, the human being is considered to be made in the image of God, and God is conceptualized as perfect. So one could not argue that interfering with Gods perfect creation is a form of blasphemy. In Judaism there is a law of Shmirat Ha Guf, the guarding or protecting of the body. Body-piercing, tattooing and amputation are all forbidden for this reason. Further, there is the Talmudic concept of Tsaar baalei chayyim, compassion for all living creatures. If compassion in all its fullness were applied to 8-day-old babies, circumcision would become impossible.

The literal commandment to circumcise that is found in Genesis appears in the later books of Deuteronomy and Isaiah with a metaphorical meaning. The prophet Isaiah urges people to circumcise the foreskin of your hearts, i.e. to melt the hard shell of defensive insensitivity with which each of us armours our innermost selves. This is highly inapplicable today; as we circumcise the foreskins of our hearts, we become able to hear the anguished cries of our babies.

The Shulchan Aruch, the authoritative Code of Jewish Law, says: Extreme care should be taken not to circumcise an infant who is ailing, as the fulfilment of all ordinances is suspended if there is danger to human life. Moreover, the circumcision can be performed at a later date, but the life of a human being can never be restored.³⁰ (emphasis added bypresent author).

The Talmud discusses at length the imperative of Pikuach Nefesh, the obligation to save human life in any situation in which it is endangered, whether the danger is immediate or only potential, as in the case of a condition which is not dangerous now but could suddenly deteriorate³¹. The rabbis derive this ruling from Leviticus 19:16; Neither shalt thou stand idly by the blood of thy neighbour. It could certainly be argued that circumcision of an 8-day-old baby constitutes a condition which could, and sometimes does, suddenly deteriorate.

The Talmud goes on to say (Hul. 10a) that One should be more particular about matters concerning life and health than about ritual observances. It insists, for example, that even the laws of the Sabbath must be broken to give medical treatment or comfort to a sick person or a postpartum woman (Yoma 85a). This is despite the fact that keeping the Sabbath is of the Ten Commandments; circumcision, significantly, is not.

Jewish law is an evolving process that has always taken into account new developments in science and understanding, and attempted to integrate them. Given what is known about life-threatening complications of neonatal circumcision, there is an argument from within Judaism to adapt Jewish law, so that the circumcision of helpless, non-consenting babies becomes forbidden, not demanded.

The medieval rabbi Maimonides, regarded as the greatest Jewish sage of all time, writes of circumcision: ……one of its objects is to limit sexual intercourse, and to weaken the organ … the use of the foreskin to that organ is evident … there is no doubt that circumcision weakens the power of sexual excitement, and sometimes lessens the natural enjoyment; the organ necessarily becomes weak when it loses blood and is deprived of its covering from the beginning³². Maimonides was a physician as well as a rabbi. His words foreshadow current medical understanding of the protective and sexual functions of the foreskin. Although he was writing in defence of circumcision, the text might be interpreted very differently today.

Difficulties of questioning circumcision in the Jewish community

Many Jewish people, when they encounter the arguments outlined in the first section about the pain, trauma, and dangers of circumcision, say something along the lines of: Well, youre quite right. I cant disagree with you. — I know its completely irrational, but I just feel we must carry on doing it. Others become very angry, dismissing solid medical evidence and genuine humane concern as an anti-Semitic attack. To make sense of these responses, and of the tremendous resistance (i.e. fear manifesting as defensiveness) which will be encountered by any person challenging Jewish circumcision, whether from within or outside the community, the psychological meaning of circumcision for the Jewish people must be understood. To understand that requires some knowledgeof Jewish history.

Persecutors of the Jews have always attempted to ban circumcision. That their motivation was the extermination of the Jewish people, rather than any humanitarian concern for children, is shown by the fact that circumcision is frequently punishable by death. In 168 BCE, Antiochus IV Epiphanes of Syria ordered his soldiers to execute circumcised Jewish babies and their parents. In CE 135, the Roman Emperor Hadrian forbade Jewish religious teaching and the keeping of the Sabbath, and made circumcision an offence punishable by death. Jews defied these decrees, and thousands were tortured and died the death of martyrs, refusing to abandon this symbol of their faith. The story was repeated in the Spanish Inquisition, under the Soviet government and under the Nazis. Circumcision thus became an emblem not just of faith, but of loyalty, courage and the defiant fight for freedom against terrible oppression. Even in the cattle-cars on the way to Auschwitz, Jews circumcised their children. They were doing what they believed to be right, affirming their identity and faith even in the depths of hell.

All Jewish people, including myself, carry this history in our collective memory, and any challenge to circumcision evokes it, whether consciously or unconsciously. Even the most well intentioned criticism can therefore sound like a massive threat. Circumcision has become, in Pollacks words, laminated to our psyches by generations upon generations of trauma²⁸¹.

As well as those features that are specific to Jewish history, there are other powerful reasons why ritual circumcision continues, i.e. psychological mechanisms common to any communities practising circumcision or equivalent rites. Familiarity breeds numbness and denial. The men present at a Bris Milah (Covenant of Circumcision; women are usually absent, from choice in the Reform Jewish world and by exclusion in Orthodox circles) have all been circumcised themselves. To them, it is the normal state. They are present at a celebration, bringing their child into the Covenant. In a very real sense they do not hear the childs screams of agony. This desensitization is a cross-cultural phenomenon; it was apparent in the obstetric wards of the 1970s and 1980s, where nurseries full of screaming newborn, isolated from human touch in cribs far away from their mothers, were approvingly dismissed with phrases such as healthy pair of lungs. This was also normal. For the circumcised Jewish man, therefore, it takes tremendous courage and insight to say I have been damaged. My parents made a mistake. I wont pass this wound on to my son.

Fear of anti-Semitism must not be allowed to stifle dissent. Nevertheless, for those choosing to challenge Jewish circumcision from outside, it is necessary to know the history outlined above and to be aware of how any criticism may therefore be misinterpreted. It is also crucial to be absolutely certain that the message and motivation are free from racism in the present. Specifically, criticizing a custom must to degenerate into attacking or demonizing those who practise it. They are good-hearted people who love their children, but have grown up with a different set of rules. Most people of all races and religions do what they have always done, unquestioningly most of the time, and Jews, Muslims and others who circumcise are no exception. One way to avoid racism is to take the broad multicultural view, that we all have something to learn from each other. An example will make this clearer; many African mothers have their daughters genitally mutilated. White westerners find this appalling and wonder secretly whether the parents can really love their daughters. But then, many white western parents even now leave their young children to sob, alone, behind a closed door, night after night, because it is past 7.30 pm and they must learn that bed-time means bed-time. Any African mother would be appalled and would wonder secretly whether the parents can really love their children. She would tell us that young children need human contact, carrying and cuddling, whatever time of day or night; she would tell us that we are doing something wrong.

Anti-Semitism is a particularly virulent form of racism and avoiding it while challenging Jewish circumcision must be a matter of deep intent, not merely of style. This is not only because racism is counterproductive in the effort to educate people fully about the reality of circumcision, but because racism is itself as cruel and unethical as the circumcision of helpless babies. I am challenging circumcision because it is the particular form of violence to children that occurs in my own culture: however, every culture has its own form of oppression that needs attention.

Religious circumcision and Jewish identity

The usual defence advanced for Jewish circumcision is that it is commanded by God (Genesis 17: 11–14) so it simply must be done. However, on closer examination, this statement (which in any case is not amenable to rational argument) turns out not to be the real reason, except for the tiny minority of Jews who take the Bible literally. Surveys show that even among traditional Jewish women (those attending orthodox synagogues), only 32% consider belief in God to be central to being a good Jew³³. Most Jewish people do not carry out most of the 613 biblical commandments. Even the ultra-orthodox would not dream of carrying out the whole of the circumcision commandment, which actually states that servants and non-Jewish house-guests must also be circumcised! (Genesis 17: 12).

The inconsistency is even more striking when considering Reform, Liberal, atheist and unaffiliated Jewish people. The Reform and Liberal movements select freely among commandments, modernizing the tradition and re-interpreting biblical texts in metaphorical, socially conscious ways. Atheist and unaffiliated Jewish people have often abandoned all contact with the tradition. Yet all these groups still circumcise their sons, indicating that they feel psychologically just as bound as the strictest traditionalist. What binds them is not a sense of devine command, but a fear of not belonging; there is a real terror of being the one to break the chain. The weight of history and the resultant social pressure mediated through thefamily are very difficult forces to resist.

For all of these reasons, and those discussed in the previous section, circumcision seems to be inextricably welded to Jewish identity and challenges to that identity are experienced as challenges to Jewish survival itself. Yet there are arguments to show that Jewish identity is not, after all, as dependent upon continuing circumcision as it might appear.

First, whose Jewish identity? Only that of the men. Jewish women have maintained their identity perfectly well for 4000 years, with no equivalent marking or scarring, and to say that circumcision is vital to Jewish identity is to exclude 52% of the Jewish population. Second, although Jewish people like to think of circumcision as an identifying sign unique to them, it clearly is not. It is also practised by Muslims, non-Muslim Africans, Australian Aborgines and much of white North America (and Korea, see Kim and Pang, this supplement), and is described in Egyptian papri from 4000 BCE. Thirdly, although some rabbis still believe that circumcision will keep Jewish males within the fold, the reality is that it has not stopped many young Jewish men from leaving the faith. Lastly, in Jewish law (Halacha), the son of a Jewish mother is de facto Jewish, whether circumcised or not.

Conclusion: Possibilities of cultural change

All cultures evolve and change, and what was indepensible in one era becomes redundant in the next. Generations of Chinese women were crippled by footbinding, a practice that was considered absolutely essential to the Chinese way of life, until the 1920s, when feminist campaigners successfully stopped it, and the predicted collapse of the culture failed to materialize. Similarly, the Sabine people of Eastern Uganda have recently abandoned their long-entrenched, traditional practice of female genital mutilation; their culture, too, has survived.

In the British Jewish community, a small but growing member of young parents are refusing to circumcise their baby boys. They are beginning to create alternative non-violent rituals, gentle ceremonies to welcome babies of both sexes into the Jewish community and the wider world. The greatest fear of Jewish parents, that their child will be ostracized from the community if he is not circumcised turns out to be a circular, self-perpetuating argument, only true so long as everyone believes it. As more parents have the courage to say no, then the intact Jewish boy becomes no longer the exception, no longer the odd one out. In fact, the uncircumcised Jewish boys and their families have remained firmly within the Jewish community. Judaism has many joyful and life-affirming customs to maintain and pass on, and I believe Jewish culture will be strengthened, not weakened, by our outgrowing of neonatal circumcision.

I have shown that circumcision is painful, traumatic and potentially dangerous, but that because of our past, it carries huge symbolic significance to the collective Jewish psyche. However, I suggest that our tremendous historical suffering does not negate or justify the continuing pain of our baby boys. Chief Rabbi Jonathan Sacks, interviewed on the BBC³⁴, stated that the purpose of circumcision was to sanctify sexuality. When asked how it could do so, he replied, Its not causal, its symbolic. However, in the final analysis, circumcision is not symbolic for the baby: it is horribly real. Now is the time to lay the knife aside and to move forward into the 21st century with a form of ritual that is truly welcoming and that is truly purely symbolic.

Correspondence: J. Goodman, c/o BJU, 25 John St. London WC1N 2BL, UK.

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