Tuesday, April 2, 2013

Circumcision and Trauma

I don't talk about it a lot on this blog but my day job is in the mental health field.  Trauma informed care is the big buzz word in behavioral health practice right now.  Finally doctors and clinicians are acknowledging the impact that trauma has on people's ability to cope with stress and function in general.  The vast majority of people receiving mental health services are survivors of some kind of childhood trauma, typically physical or sexual abuse.  Many researchers believe that when children experience trauma it affects their developing brains.  There was a recent study called ACES that looked at how the number of Adverse Childhood Events a child experiences is directly related to the likelihood of them seeking mental health and/or drug and alcohol treatment as adults.  More adverse events like sexual abuse, physical abuse, parent being drug addicted, death of parent, etc. means more likelihood that the person will develop mental health and/or substance abuse problems later in life. 

The reason all this is relevant to this blog is that circumcision is traumatic.  Trauma is defined as an event that the person experiences where they feel a lack of control and fear that their life is in danger.  It is also accompanied by a state of heightened central nervous system arousal, a fight or flight type response.  The flood of chemicals released into the brain as a result of these periods of stress/arousal are what is believed to affect the child's developing brain.  Advocates of circumcision often say it makes more sense to perform the procedure on an infant, that he won't remember it and it will be "just a snip" compared to what the experience would be like as an adult who was able to give consent to the procedure.  Ironically, carrying out this violent, invasive surgery on an infant probably causes much more damage to the brain than if it were to be performed on a person old enough to consent.

Circumcision undeniably creates a feeling of loss of control for the infant.  Imagine just a few days after he has left his mother's womb he is taken from his mother's arms into a cold room.  He is then strapped down to a hard plastic circumstraint or he is physically held down by a mohel.  If this isn't a loss of control I don't know what is.  Does he fear his life is in danger?  Is an infant of only a few days able to fear?  For years doctors argued newborns couldn't feel pain.  That ridiculous notion was finally dispelled.  As for fear, I think anyone who has heard an infant scream as he is strapped down, has his foreskin ripped away from the glans and then violently sliced off with a sharp instrument knows that child is afraid.  That child is possessed by the innate understanding of the threat of violent death that has shaped the evolution of the human race.  He knows his mother is safe and that the people that took him from her are hurting him.  He is cold and frightened and by the time he is returned to her he will be missing an important part of his body.  Soon what little relief the local anesthetic offered will wear off and he will scream as the sensitive and suddenly exposed glans chafes at his diaper.  He will cry when his own urine burns the injury.  The pain will interfere with his ability to concentrate on nursing leading to frustration for him and his mother.  The only way he can survive is to teach himself not to think about it, to pretend that everything is ok.  Many circumcised men will do this until the day they die.

Circumcision is trauma.  Trauma is proven to affect a baby's developing brain and to play a role in the development of mental health and/or substance use problems.  Unfortunately your baby's developing brain is one more thing the AAP doesn't seem to give two shits about.

Many survivors of childhood trauma have only vague memories of what was done to them.  I've talked to hundreds of them over the years.  Each has their own unique story but I can tell you it typically isn't a comfort to them if their memory of the event is fuzzy.  They often wonder what other things were done to them.  They wonder what precipitated the event, did they do something to "deserve" what happened to them?  (The answer is always no but they speculate nonetheless.)  Sometimes they wonder why they experience these abstract feelings that something is missing.  So how can people really think that doing trauma to an infant is ok because they won't remember it?  Is sexual abuse not as bad if it's done to a child that won't remember it?  The trauma of circumcision is inscribed in an infant's developing brain just as surely as any other form of abuse.

Trauma affects everyone differently.  Not all combat vets develop post traumatic stress disorder.  Likewise not all survivors of circumcision will go on to develop problems later in life.  Indeed, many will use their ability to achieve ejaculation as proof that there's nothing wrong with them.  Yet they carry what was done to them as surely as I carry what was done to me.  I don't think about it every day, but sometimes when I'm taking a piss I look down at my penis in my hand.  I'm happy with it: it's given me three children, it gives my wife and I pleasure, yet sometimes I look down at that desensitized, exposed glans and I say aloud, "What the fuck?"  And I know that even if I work at restoring my foreskin for the rest of my life I'm always going to know what was done to me, that I was circumcised.  And it will always hurt on some level.  That's the nature of trauma.


  1. I really appreciate this! I'm always trying to convey this very thing to people. I say, think about it....estrogen and testosterone play huge roles in the development of our brains in utero...giving us the venus/mars duality so to speak. Women's emotion center and communication center enlarged, aggression/sex centers are smaller...it is the exact opposite for men...says the author of the Female Brain, she also wrote a book called the Male Brain.
    So, it makes perfect sense to me, that stress hormones, and a lot of them, will also affect the brain and its development.

    1. Absolutely. The stress hormone, cortisol, is also believed to play a role in the development of various heart problems, cancer, and a host of other health issues. Indeed, helping people better manage their stress is a million dollar industry. Why would anyone think it was in the interest of their child's health to purposefully and unnecessarily expose their child to stress and trauma? Certainly we can't shield our children from every stressor in life, but having their genitalia altered without their consent is an early and primal violation no child should have to endure.

  2. jeff, THANK YOU for this article. it is SO right on. we need to protect, not attack with knives, our children. i recognized the trauma that circumcision instills when i saw my first photo of a circumcision. when i found out i'd been circumcised, i realize that was the cause of the mysterious feelings and behaviors i'd exhibited for 50 years of my life. thank god for that realization - and for my experience in helping others release trauma, for then i could turn it on myself. my life is very different now... thank god. after working with my own trauma and the trauma of others, i am convinced these two quotes are true: "All healing is essentially the release from fear"... "Healing is always certain." bless you, darlin!!! this is VERY important information. i'll be sharing it with many.

    1. Thanks very much. Trauma is something that can stay with people for years after the event and affect their quality of life in subtle yet dramatic ways. But there is always hope for healing. Often the first step is just coming to accept what has happened. This is why circumcision is so insidious: most American men deny or just don't realize the impact it has had on their sexuality and their lives. I'm so glad your life has changed for the better; in my opinion this is the reward for all those who face life's slings and arrows in a brave and unflinchingly honest fashion.