Adam Henerey. Journal of Men’s Studies. Volume 12, Issue 3. Spring 2004.
The aim of this review is to delineate the beliefs that reify the ritual of circumcising male infants. The practice of circumcising is perpetuated on a generalized fear of an intangible peril, which has taken many forms throughout the course of history. In each evolving normatire system, this generalized fear becomes a pseudo-rationale for the circumcision of infants. As the system of control develops and becomes more refined, the practice becomes suspect and becomes a ritual detached from any larger rationale. When detached in this manner, the ritual’s transmission is limited to heredity until the time at which the ritual finds a pseudo-rationale within an emerging normative system. Predictably, within this new system there is a heretofore unknown peril to which circumcision is prescribed as a potential cure.
The problem surrounding circumcision is not, nor should it be viewed as, some kind of structural phenomenon. Its causes and effects in society occur on many levels but do not serve or perpetuate any kind of self-serving motive by one party or another. Circumcision is relatively crude and inexpensive and, in turn, unprofitable compared with other surgical procedures. The deleterious effects on the sexual excitability of men, although important, are not a driving societal factor in circumcision’s advocacy. There is also adequate literature showing that the medical and psychological benefits are dubious. Circumcision is a practice performed among the masses of America and has endured even strong indictments from the cultural and intellectual elite. So the problem lies far from any sort of structural critique that may suggest that the ritual is of particular use to the powerful of society.
Circumcision should be viewed contextually. It is for all purposes a case study in how beliefs and rituals, regardless of how irrational they may be, can thrive in our society. Many parallels can be drawn between this ritual and other societal practices that seem even more lacking in merit. Most important to remember in this review is that people in our society profit greatly not from circumcision itself but from the system of beliefs that support circumcision. In other words, circumcision is just the tip of a larger iceberg.
The review below was undertaken with the goal of providing a historically thorough and yet theoretically broad examination of circumcision. Review of the literature on circumcision was relatively straightforward, within a specific discourse. In contrast to the ease at which information could be found in a given field, there was very little interdisciplinary research done on the issue, making it difficult to find a “jump-off point” within each discipline. But what resulted from this search of varying disciplines (including religious studies, psychology, sociology, sociobiology, medicine, and others) was a body of research that made it possible to view the circumcision issue in a more abstract, more easily generalized, but no less specific manner. Occasionally, there were other review texts that were particularly helpful in finding primary sources of information to make the overall research picture more complete. Most notable were works by sociologists Peter Conrad (1975) and Thomas Szasz (1996), whose views were most influential in the construction of this review. In these works, circumcision was regarded as a ritual stemming from other social forces, which was a critical leap in the formulation of interdisciplinary work on the subject.
The Social Origin of Circumcision
The first record of male circumcision can be found in a relief in the tomb of King Ankh Manh, circa 3000 BCE (Schneider, 1976). It is believed by some archaeologists that the ritual was restricted to the nobility. This system of demarcation was a primary means of showing deference to the social order. The most notable evidence of this idea of deference is found in the Hebrew Bible. In 1 Samuel 18.25, David brought the foreskins of 200 Philistines to his king, as proof that he had slain them, in exchange for rights to marry the king’s daughter (Szasz, 1996).
David acquired the foreskins as proof for the king that he had subjugated and emasculated the Philistines and was therefore a capable enforcer and more masculine than the lot he had killed. Then by relinquishing the foreskins to the king, he showed deference to the king’s authority and masculinity. The use of circumcision here is slightly different from the earlier instance. Whereas circumcision is used outwardly to enforce the social order (rather than inwardly), it is still a symbolic manner in which people gained entrance to a social group.
Throughout the following centuries, the practice of circumcision was adopted by the lower class of Jews in New Kingdom Egypt. Within their belief structure, the ritual took on a symbol of the less tangible spiritual piety, instead of the earlier allegiance to manifest nobility. This had two effects. The first is articulated in the book of Genesis, specifically in 17.9. Here it is said that circumcision is the covenant of Abraham with God. And by either keeping or violating this covenant, the person will be one with or be cut off from God and his chosen people. This mark of belonging would then signify a deference to this metaphysical God and the manifest group order (Snyder, 1999).
The second effect stemmed from this doctrine and has been called “God giving preferred nation status” to the Jews and their descendants in exchange for their foreskins (Szasz, 1996). This reciprocal effect is illustrated in the Talmudic story that shows Abraham sitting at the entrance to hell; when Israelites that had the mark of this covenant approached, he would prevent their descent into Gehinnom.
At a basic level, hell is the intangible force of evil, and circumcision operated as a tangible means to ward off such a fate. Within the constructs of early Judaism, this belief was pervasive enough that newborns who died before their bris (normally on the seventh day) were circumcised post-mortem to retain their souls in the afterlife. Clearly, this would be an overstatement of the importance of circumcision within current Jewish practice, as the doctrines mandating post-mortem circumcision and even spiritually curative circumcision have both gone the way of the metsitsah and are not even practiced in orthodoxy. Nevertheless, it is this more general construct of preventing an intangible peril that sets a philosophical precedent for circumcision today, even though the older doctrines within Judaism have been reinterpreted. It is outside this early philosophical construct, in the cultural realm, that the changes in circumcision took place in the following millennia.
At the time of Christ, circumcision was a ritual of the lower classes. Under the Roman empire, it was recorded that Jews and other groups that practiced circumcision had to remain robed at all times, even when this was not the case with the Roman nobility. The cultural rationale for this was cosmetic, as members of the Roman populace were not circumcised, and the exposure of the glans of the penis was a sign of penile erection. Therefore it was considered vulgar to see that part beneath a man’s foreskin in public, even if it was the case that a man had none. For this reason, certainly among others, circumcised men were openly discriminated against and were thought to be disgusting and of inferior morality.
The Spread of Circumcision Through Early Religious Groups
The practice of penile scarring and circumcision was not specific to the Jewish community of the time. It had been practiced nearly a thousand years before the Egyptians in American, Australian, and West African aboriginal cultures. In these varied cultures it can be assumed that the rationale for the ritual is also varied, but it is thought that it was always a rite of passage within each culture and that participation was a means of inclusion to the culture (Burger & Guthrie, 1974). The Jews were unique, however, in their inclusion of the practice into religious dogma and their association of the ritual to the metaphysical. The combination of these two phenomena made the ritual far more permanent as well as more transmissible to different cultures.
Abraham’s community by circumcision did not end with the Jewish tradition. After the death of Christ, some of the new Christians preserved the ritual, perhaps believing in the salvation doctrine, but were most likely keeping ties to Jesus’s Jewish roots. Also, when Islam emerged a few centuries later, some groups integrated the mark of belonging. The spiritual connotation of circumcision would be widely discarded until the nature of therapy shifts focus from the spiritual to behavioral in the Modern Era. This evolution would take circumcision from religion into the empirical sciences. The inroad for this change comes out of the pastoral tradition that started well before recorded history.
Within the Christian religion, Bible stories set forth the idea of a spiritual symptomology to human ailments and the possibility of healing through this route. Jesus, in John 5.9 was able to provide spiritual counsel for a lame man who then regained his ability to walk. This story not only served to advance the legend of Jesus, but also influenced the customs of his followers. By the fourth century, anointing the sick came into regular practice as did exorcism. For the Christians, it became an imperative of treatment of physical and mental ailments that sin be removed.
As Christianity moved throughout Europe and the Middle Ages found religion at the center of the philosophical main stage, practitioners became increasingly concerned with the sin and demonism that seemed to be at the core of paganism and witchcraft. Monks sought to cure the mass spiritual unrest through isolation and counsel of the possessed. Ritualistically, this was quite a bit like the methods of treatment used in psychiatric counseling, but with sin as the root cause of the dysfunction and focus of treatment. Through this pastoral counseling tradition, the seeds of clinical psychology developed with a reformulated sense of morality.
Circumcision Adapts to New Theories of the Psychic World
As ideas of evolution of species spread throughout the enlightenment era, the spiritual deviance of sin and demonic possession was replaced with ideas of phylogenic inferiority. Conditions that were once thought to be a result of a sinful existence or demonic possession and would require the attention and isolation of monasteries were thereafter classified as psychotic behaviors stemming from biological tendencies that would require attention and isolation within asylums. This is how sin and damnation became the business of the psychiatric community, and just as in religion, psychiatry had its own hypothesis as to how circumcision fit into a treatment regime.
Freud was instrumental in the development of psychological theory and made several attempts to address circumcision within his studies. His initial position was influenced heavily by the social Darwinists, particularly Jean Baptiste Pierre Antoine de Monet de Lamarck. As a result of this view, he accepted the notion that the Jewish type was somehow more disposed to neurosis (manifesting in masturbation) and thereby was dependent on circumcision as a symbolic alternative to castration and as a behavioral cure (Gilman, 1993).
In the asylums of that era, circumcision actually became a treatment modality for many psychological afflictions, which were thought to be linked with sexual aggression. This was recorded as being generally ineffective, however, except in the cases of neuroses that manifested in masturbatory acts, or “masturbatory insanity,” as it was sometimes called. It was documented that circumcision caused a marked decline in masturbation, which is unsurprising given the amount of pain that was caused in these adolescent and adult test cases (Gollaher, 1994).
Although the scientists at the time may have felt that they were on the cusp of finding cures for the mind, in reality this new empirical therapeutic community was adapting an old practice and philosophy to the new treatment regime. Much as in the earlier religious/spiritual framework there had been an intangible force of suffering that was to be reckoned with, namely sin and damnation, in later times, there was a new form constructed, namely neuroses and insanity. Although these are two very different realms philosophically, both groups found cures within the tangible world of ritual circumcision. Socially, the context had changed from spiritual purification by a mohel to mental cure by a psychiatrist/doctor, but still the treatment was the same, still performed by the therapeutic counselor of their respective communities.
Thirty years after his biological studies with Darwinian Carl Claus, Freud developed a theory of symbolic trauma that took circumcision back out of the realm of curative psychiatry. Freud’s focus up until this point had been on direct trauma. In that mode, circumcision was considered a harsh but necessary end to rampant sexuality that seemed to be inherent in Jews, hence the dogmatic practice. Instead, when Freud developed a theory of symbolic trauma, the trauma of Jews was simply a less universal form of trauma that was actually experienced by all persons, usually indirectly. In this formulation, it was in fact the Gentile that suffered a trauma from circumcision, as he would be in fear of being castrated himself, whereas the Jew could never harbor such a fear for obvious reasons. The net result of this is the removal of circumcision from proper psychiatric treatment.
Circumcision Becomes a Fixture of Modern American Medicine
Around this time, physicians were starting to develop therapeutic connections to circumcision within their practices. One of the most notable examples was the career of Lewis Sayre. In his years as a physician and surgeon, he found in cases of orthopedic dysfunction, hernia, dyspepsia, epilepsy, and even paralysis that circumcision caused varying forms of improvement. His claim was that genital irritation would cause “insanity of the muscles” and “curvature of the spine and acquired deformity” (Gollaher, 1994, pp. 8, 10).
After his election as president of the American Medical Association in 1880, Sayre’s advocacy of circumcision would begin a practice of suspecting genital irritation whenever doctors were confronted with any confusing or seemingly unrelated symptoms. At the time, the support for circumcision in the medical arena was considered empirically sound even though there was no causal link established between the symptoms and the procedure. This system of therapy can be again compared to the psychological and religious models that had advocated circumcision in the past. Here again, we have an intangible force of suffering and illness to be combated by the tangible practice of circumcision. But in the 20th century, social and technological changes precipitated challenges to this practice, just as it became part of routine medicine.
At that time, births happened in homes and were attended by midwives. As a result, circumcision became a clear sign of a hospital birth that was attended by a physician. This class distinction still plays a part in the politics surrounding the issue today, in part due to Victorian ideals of cleanliness. Advances in germ prevention technology have done little to erode the vague notion that uncircumcised penises are somehow dirtier. The hegemonic cultural influence that was present in much of the urban culture of America at the time placed a great deal of importance on hygiene, not only in a physical but also a moral sense. For the first time in Western history since the Old Kingdom of Egypt, circumcision was a mark of the spiritual and social elite.
This new practice of routinely circumcising infants—then under the guise of medicine—would gain momentum until the cultural upheaval of the 1960s. During, and for some time after this period, there was a reexamination of the impact of medicine on society as well as the effectiveness of treatment by the medical community. The change in empathy for normally disenfranchised and underrepresented groups caused refutations of old practices in mental health and pediatric care.
Out of this climate came the resolution by the American Academy on Pediatrics (AAP, 1971), whose committee on fetus and newborns found no valid medical basis to support routine neonatal circumcision. The AAP based its resolution on numerous studies refuting theories on hygiene, irritation, and general infection that failed to show a causal link to the myriad of symptoms first proposed by Sayre in the previous century. However, the ghost of Sayre haunted the medical community, and the debate over circumcision continued.
One of the more definitive works that evaluated the potential health benefits of circumcision was written by two physicians, Warner and Strashin (1981), who noted there was relatively little risk for uncircumcised men when compared with possible risks of circumcision, while arguing the benefits of circumcision were negligible. This kind of re-evaluation of early research done on circumcision and its potential benefits points to the fact that when Sayre first published his findings on circumcision, he lacked evidence of a causal relationship to validate the medical routines that were implemented as a result.
Medicine Gets Quizzed on the Circumcision Issue
From 1971 to 1974, a series of articles were published in the Journal of Urology in an attempt to rally opposition to the AAP (see, for instance, Dagher, Selzer, & Lapides, 1973; Hardner, Bhanalaph, Murphy, Albert, & Moore, 1974). In reaction, the AAP, also in 1974, created an ad hoc task force to investigate the validity of its original statement and found that its original suppositions and resolutions regarding circumcision were correct. In the interest of persuading the lay and professional communities of their revamped (but still congruent) findings, the AAP reconvened the following year (Thompson, King, Knox, & Korones, 1975) and reaffirmed its previous stance on the issue, this time with an itemized list of contended benefits. Further statistics showed that even after the repeated attempt to dissuade America from its beliefs on newborn circumcision, there had been no significant change in the overall public opinion or practice (Patel, Flaherty, & Dunn, 1982). As additional social research within and outside of the medical community has proven, the problem of unnecessary circumcision is multifaceted and requires multi-level social research to solve.
One of the possible problems found by this research could be the relation of doctors’ attitudes toward and acceptance of policy as it is handed down from groups like the AAP. Patel et al. (1982) published the results of a study on the attitudes of pediatricians, obstetricians, and family practitioners in the Chicago Area. The survey was directed at physicians thought to be the most likely to be consulted on issues of circumcision. It was found that only 56% of the physicians reported making any sort of recommendation when asked about the whether or not neonatal circumcision was a good idea. This immediately indicates a certain lack of education or possibly a general lack of concern in regard to the risks of a decision that the parents will have to make regarding a very medically loaded issue. When asked directly if the physicians knew and also recommended that the parents follow the official advice of the AAP in regard to their child’s possible circumcision, only 24% of the doctors answered in the affirmative. In addition, of the group that did present the recommendation that the AAP stood upon, 31% of the physicians still recommended that circumcision be performed, even in the face of professional recommendation and medical research to the contrary.
The study went on to show that a vast majority of the 41% who recommended circumcision, 90% did so regardless of whether they actually told their patients about the AAP’s findings on the subject, replying that they recommend circumcision in the interest of hygiene. As shown by Warner & Strashin (1981), hygienic reasons for circumcision are negligible. Of the 41% of all doctors that recommended circumcision, 30% did so citing their personal religious or cultural traditions as a reason. Given research that is discussed later, this may actually be found as a manifestation of pressures on the American public to “look similar” that is found by theorists to be very much entrenched in American culture.
Additionally, of those doctors in favor of circumcision, 27% came out in its favor because they believed it would reduce the risks of certain types of cancer. In this study, most physicians, if not all, were either acting without proper knowledge of current research or were knowledgeable on the subject and continued to disregard the advice of the AAP. This is clearly an impediment to change in circumcision rates and must be addressed by the policy arenas that can affect such issues.
The degree to which the parents are being informed and encouraged to think about issues of circumcision is also salient in the debate over unnecessary circumcision. In an article written by Wayland and Higgins (1982), 87% of the mothers interviewed were unaware of the risks involved in circumcision. It is also true that a portion of these mothers already have had the procedure done on previous occasions to other children. Also found in the article, the newborn’s parents are asked to make a decision in regard to circumcision only after the birth of their sons, sometimes giving only a few minutes to make a final decision and many times without the consent of both parents. Given the statistics on how many mothers understand the risks involved, is not unreasonable to think that, in many of these cases, the mother also has not given a great deal of thought to the issue and is certainly not adequately informed about the real risks and benefits involved. It is also noted by Wayland and Higgins that the period of time immediately following the child’s birth is a critical time for all parties involved, often accompanied by great stress and anxiety, and not appropriate for decisions that have such a long term consequence. Ironically, parents plan the name of their baby months or even years in advance, but with a relevant medical issue there is much less thought given.
Clearly, the advice given by doctors during delivery would be of great importance. At the time of delivery, it can be assumed that the laboring mother’s obstetrician would be present. Referring back to the findings of Patel et al. (1982), it is true that the doctor most often present during this period is also significantly more likely to recommend the newborn be circumcised, more so than the pediatrician who will have to accommodate treatment for the child, particularly if there are any complications that result in the longer term. Additionally, the most educated professionals had the least amount of contact with patients at the time of birth, and little thought or planning was given to the issue by the parents before the birth of their sons.
A study done on a childbirth education group in Boston by Brodbar-Nemzer, Conrad, and Tenenbaum (1987) found that about one-fourth of the respondents gave a medically based reason when explaining their decision to circumcise. Given this, we suggest these people would likely change their minds if given more accurate information from unbiased and well-informed medical professionals. On the contrary, however, this group was overwhelmed by those concerned with the cosmetics of circumcision.
Circumcision Takes Hold as a Cultural Phenomenon
Up until this point, it has been assumed, wrongly, that the primary catalyst for change in this area of social medicine would be education on the subject. The findings of Brodbar-Nemzer et al. (1987) refute this whole mode of thinking. This would help to explain the findings of another study (Herrera, Hsu, Salcedo, & Ruiz, 1982) in which an experimental group that was counseled on the risks and benefits of circumcision had their sons circumcised at a rate that was not significantly different from the group that was given no such treatment. The examiners opined that socioeconomic status may have influenced the lower level of medical knowledge in the respondent pool. However, Brodbar-Nemzer et al.’s study controlled for this and no difference was found. The findings in the study by Herrera et al. are also congruent with a report by Bennett & Weissman (1981) that showed that even after “routinely cautioning” parents there was still no significant change in the frequency of circumcisions. In short, if the parents of newborn children are not primarily concerned about the possibility of complications in this unnecessary surgery, then it would stand to reason that such attempts by the medical community and policymakers who stand behind the medical research done in the field would have little effect on the rate at which the procedure is done.
Going back to the study by Brodbar-Nemzer et al. (1987), the most frequently cited reason (46%) by parents who chose circumcision for their newborn sons was a desire for their sons “to resemble other males.” The findings in Brodbar-Nemzer et al. are also in agreement with those published by Brown and Brown (1987), who cite the primary concern of parents, particularly fathers, as being the appearance of the child’s penis later in life. Often times, parents cited a potential scenario like in a locker room or during adolescence when children are thought to be vulnerable to ridicule and feelings of incongruity with their peers. In other words, parents didn’t want their children to stand out.
Therefore, it appears that there is a new social system in which circumcision is validated. In the previous modes of thought, as well as here, there is some intangible force of suffering. Now it is discreditability, and again the tangible alternative is circumcision. And as statistics have shown, this is the leader among reasons given that four of every five boys born in the United States will be circumcised.
R.S. Van Howe’s (1997) research addressed the practicality of this “locker room” argument. It is already known that many parents have demonstrated concern over the appearance of their child’s penis as compared with their peers, and this would lead them to want circumcisions for their children. In Van Howe’s prospective study, however, it was found that there is a wide variation in the appearance of penises in circumcised boys, and uncircumcised penises actually tended to look more similar. Then socially circumcision actually placed the child in a more varied group than a lesser one. This showed that parental action regarding the cosmetic appearance of the child’s penis actually aggravated the condition of being different, which they originally intended to avoid. This objective evaluation was of little value, however, because the real difference in appearance was not the issue; rather the intangible belief in difference was what shaped the social reality. This “locker room” defense was also refuted by a study by Schlossberger, Turner, and Irwin (1992). In their study of adolescent males, it was found that only 68% of boys could tell their own circumcision status and that their status had no effect on their perception of body images. In sum, it seems that another intangible fear has presented itself, being addressed by the pseudo-rational practice of circumcision, until such time that it is dismissed within our current normative system.
Social Control Theories and Circumcision
A pattern of coercion and internalization of values can be traced through the history of circumcision. In early religions a system of persuasion was developed to enforce values upon the society without the use of physical violence. In religion, violence was substituted with implied violence (in story form) and a fear of the unknown. The effect was to make what was once a Pavlovian system of benefit and reward into a more cognitively based system. The two systems of control were aligned with the same goal, promoting group identification, but in the first the coercive body had to be present, and in the second there was no such necessity. This thereby made the system of control transmissible beyond its inventor but also left the system open to reform.
In the area of psychology, the use of stories to illustrate the potential outcomes for peoples’ actions took the new form of the case study. Within these stories there was a new form of symbolic violence that operated in a similarly intangible space. Rather than the soul of a person being condemned to a violent outcome, it was the psyche that must suffer in the realm of insanity. Again, because of the subjective and invisible nature of human cognition, the fear of intangible peril was invoked to bend the undesirable behavior of others.
Medicine, in its early forms, was concerned almost exclusively with possible contamination of the body; however, the manifestations of this concern have gone through several transformations as a result of new systems of thought and technologies being introduced. Disease started as an environmental threat to the lower classes within the ancient world, then was transmuted to racial attributes independent of environment and then to cultural proclivities that resulted in compromise in prophylaxis. Nevertheless, all of these curative modalities ran parallel to the model of ritual reification found early in the Abrahamic religions.
The use of the mass media to perpetuate stereotypes and misinform the public is fairly widespread and well-known. In the current social climate, the discussion over sex and sexual hygiene has become inextricably linked to moral issues that predate our current medical and sociological information on the subject. As social activist and author Noam Chomsky points out, when a “fact” emerges in the mass media, it becomes archived in the memories of the general public. These “facts” have a cumulative effect that is far easier to reify than to contradict (Achbar & Wintonick, 1992). So if a study finds that circumcision has a perceived benefit, little explanation is necessary; it has an easy fit with the existing belief structure. If a study runs counter to the practice of circumcising newborns, as the first AAP (1971) report did, much more explanation is necessary for the authors’ words to have the same effect (hence the longer 1975 report) (Thompson et al., 1975).
Nearly a million circumcisions are performed on newborn males each year across the United States. This comes with a price tag of $140 million annually (not including corrective treatments for complications from circumcision) (Zoske, 1998). There is a definite cultural mainstay in the United States (and to a lesser degree across the rest of the Western hemisphere) that promotes this painful surgery. Circumcision is one of the oldest, least invasive, least expensive, and least profitable operations done on the human body, so the motives that would seem to drive a culture to hold on to such a ritual are difficult to understand at best. Given the environment of fear surrounding the issue, combined with the taboos on frank discussion of sexual health issues (not to be confused with the open discussion of sexual practice) there is little doubt that the practice will be reified. Circumcision is only one of many issues of this nature. In examining the cultural climate of the United States, it is highly illuminating to take circumcision as an example of how certain beliefs are transmitted even after their rationales have been refuted. With little controversy, discrepancies in public opinion have been found around issues of social justice, national security, and race. It is the conclusion of this author that the future research on the issue of circumcision should not weigh its merits, for these facts have been established for several decades now. Further interrogation of this practice would be superfluous. What is needed is an aggressive study on the persistence of pseudo-rational beliefs, including but not exclusive to circumcision, and how they are transmitted within cultures.