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April 08, 2015

Circumcise your 4-year-old or go to jail

A mother risks all to keep her son psychologically and physically whole

Lifestyle Parenting
Heather and Chase Facebook /for PhillyVoice

Heather Hironimus holds her son, Chase. Last month, Palm Beach County Circuit Judge Jeffrey Dana Gillen ordered Hironimus to sign consent forms and hand over her son for elective surgery -- or go to jail. And yes, this is America.

Heather Hironimus is one brave woman. 

Currently, she faces public scrutiny, the seemingly ruthless legal maneuvers of her son’s biological father and jail time. As I write these words, Hironimus finds temporary refuge with her 4-year-old son in a domestic violence shelter in Florida. Yet, she’s not fleeing an onslaught of physical aggression. Rather, she stands firmly against the court-ordered genital cutting of her 4-year-old son. Yes, you read the sentence correctly. Last month, Palm Beach County Circuit Judge Jeffrey Dana Gillen ordered Hironimus to sign consent forms and hand over her son for elective surgery -- or go to jail. And yes, this is America.  

Hironimus separated from Dennis Nebus before their son Chase was born. According to Jonathan Friedman, Hironimus agreed to sign any required papers relating to circumcision in their parenting contract. It was Nebus’ responsibility to schedule and pay for the surgery. Years passed. The circumcision question seemed forgotten. Then, when Chase was 3, Nebus made the claim that his son had “medical problems” necessitating circumcision. 

Pediatric urologist Dr. Charles W. Flack of Boynton Beach, Florida, examined the boy. Last May, Flack stated under testimony that the boy was healthy and circumcision wasn’t medically required. When asked if he would circumcise his own son in a similar situation, he answered: “If he’s not having any problems, I wouldn’t want to bear that burden if, God forbid, something happened.”

Despite this, Nebus pushed on, arguing that genital cutting was “just the normal thing to do.” 

A difficult year of legal disputes, court hearings and medical examinations followed. Despite once agreeing to have Chase circumcised, Hironimus refused to give consent to the elective procedure. Why? Through research, she learned how hospitals make hundreds of millions of dollars a year by selling discarded foreskins to bioresearch laboratories and pharmaceutical companies. She came to understand that the surgery carries significant physical and psychological risks, both for infants and young children. She came to see that the foreskin is an integral part of the penis and plays central functions. She learned the majority of men in the world live intact lives. Like a growing number of American parents, she came to view the routine genital cutting of little boys as medically and morally wrong. 

Chase is now 4 years old. He lives with his fugitive mother in a domestic violence shelter because a judge in Florida has ordered the cutting of his penis. 

A Child’s Psychology

“This is not a situation where [the child] is a newborn; he is old enough to remember the procedure and what his body looked like before… Removal of part of the most private part of his body could emotionally scar [the child] for the rest of his life.”  
--Thomas Hunker, attorney 

According to Patrick O’Connor -- a licensed clinical psychologist specializing in the treatment of depression, loss and trauma during childhood and adolescence -- many American attitudes toward children’s experiences of circumcision are “adult feelings being projected onto boys.”

Too often, these projected feelings are far from clear. For example, many circumcised men say, “I’m glad this happened to me,” and many circumcised fathers want their sons to “look like” them. When taken at face value, such statements normalize infant or child circumcision and minimize the physical or psychological risks involved. Yet, if we look more deeply, we can see such sentiments often represent the distorted vision of “reaction formation.”  

Reaction formation allows a victim to avoid all feelings relating to a previously experienced trauma and conclude that the trauma was actually good for him/her. Opening up to what is entailed in genital cutting is a vulnerable experience for circumcised individuals. Reaction formation is easier and involves consciously experiencing a feeling that is the opposite of an intolerable emotional state. This may help explain why many men in the United States have a tendency to not only view circumcision positively but also view their own circumcision as “good.” 

According to O’Connor, we need to be asking how children actually experience circumcision and not project distorted feelings onto them. Gratefully, a good deal of research on this topic has been done using peer-reviewed psychological methods of inquiry. What does the current literature regarding the psychological impact of circumcision reveal? 

Surgeries are “often perceived as traumatic events by children, especially young children,” states O’Connor. This is particularly true when surgeries involve the genitals and/or amputation. Given that circumcision combines amputation with surgery on the genitals, one can expect “a perfect storm of psychological consequences” to manifest. In particular, the circumcision-specific research suggests that children often experience the surgery as “a serious violation of their bodily integrity and develop symptoms that are commonly seen in children who have been sexually abused.” 

O’Connor grew up believing that circumcision “must not really be bad” because it was so prevalent. In his late teens/early 20s, he came across information that people were debating the practice, which inspired independent research. Eventually, he watched a video of the procedure being done. This was the turning point. 

Earlier this year, O’Connor joined other leading psychologists in composing a letter to the U.S. Centers for Disease Control and Prevention (CDC) protesting their pro-circumcision stand. While no health organization in the world advocates for the routine practice of infant circumcision, both the CDC and the American Academy of Pediatrics (AAP) currently claim that, for males, the benefits of the surgery outweigh the risks. 

Such policy statements stand in sharp contrast to conclusions reached by physician groups in Europe, Canada, Australia, Scandinavia, the Commonwealth and even the United States. Consider this statement by the American Cancer Society: “We would like to discourage the American Academy of Pediatrics for promoting routine circumcision as a preventative measure for penile or cervical cancer. The American Cancer Society does not consider routine circumcision to be a valid or effective measure to prevent such cancers.”

O’Connor doesn’t focus upon the prevention of cancer. Rather, he draws upon his specific area of professional expertise in the CDC letter. Study after peer-reviewed study is cited demonstrating the direct link between circumcision and psychological harm. 

For example: 

• Medical traumas experienced in childhood result in many of the same “psychological elements” found in children who’ve been abused, such as the experience of loss of control, fear and the sense that the event was punishment. 

• Men who experienced circumcision as children exhibit more anxiety, interpersonal problems and depression than those who did not undergo the surgery. 

• When circumcision is done before the age of 10, boys were at a “significant increased risk” for autism and attention-deficit/hyperactivity disorder. 

• Upon interviewing men who were genitally cut in childhood, many viewed the experience as “an act of violence, mutilation, or sexual assault.” Violent sexual fantasies, feelings of victimization and inadequacy can be “consciously and unconsciously linked” to childhood circumcision. 

• Boys who were cut between the ages of 4-7 experienced changes in their body image associated with feeling “smaller and incomplete.” They also were at risk for withdrawing psychologically.

• In a study conducted in 2000 involving 1,072 boys who were circumcised in a hospital setting, clinicians found the boys were at a higher risk for having post-traumatic stress disorder (PTSD) than if they had been veterans in the Iraq War.

Tragically, it seems that the research cited above means nothing to Nebus and the court. Gillen referred to circumcision as a “very, very safe” procedure. He refused requests from Hironimus’ lawyers to consider a mental health exam for Chase as well as the appointment of an independent guardian to speak on Chase’s behalf. From the court’s point of view, the parenting contract signed years ago resolves the heated dispute between Chase’s legal guardians. Hironimus agreed to consent to a future circumcision. The father is now ready to schedule the surgery. So what if the boy is 4. 

A Question of Rights

When it comes to protecting children from sexual assault, U.S. laws are clear. We affirm a child’s right to physical integrity and condemn the sexual abuse of children. When it comes to protecting girls from genital cutting, U.S. laws are also clear. In fact, it is a felony offense to practice female circumcision, an act illegal in every state. A girl has the right to genital integrity. Her labia and clitoris are not to be cut. 

What about America’s boys? 

The psychological effect of circumcision on young boys has been proven to be similar to that of sexual abuse. Yet, our laws offer boys no protection on this front. Instead, U.S. laws affirm outdated medical myths and various religious/cultural practices allowing for parents to legally and openly pay doctors to cut the genitals of their sons. Our pro-circumcision attitudes, while slowly changing, not only impact how the penis is presented in medical textbooks but also how legal disputes between guardians with regard to genital cutting are resolved. 

“Basically, the judge has told Chase, ‘You do not have a right to your body,’” states O’Connor. 

Because most Americans adopt this attitude, O’Connor claims that there would be “more of an outcry” if the case was about a girl whose father wanted to have her cut her hair in a very short manner and the judge ruled in favor of the father -- against the mother and daughter. Does a story about a boy forced to undergo circumcision trouble our collective conscience? It certainly troubles the developing conscience of the child at hand. 

Chase “is aware of what is happening and is terrified by the procedure,” observes Hunker. “He is also angry that the procedure is being forced upon him.”

Yes, a 4-year-old is aware. Yes, a 4-year-old can be rightfully angry and afraid. Even Nebus admitted under testimony that, “My son has mentioned things to me that he's scared to have his penis cut off.” 

One can hear the voice of a 4-year-old desperately trying to communicate his fears. Of course, his entire penis won’t be cut off – but the most sensitive part of it is at imminent risk of being severed. 

“This situation shows that our legal system can be distorted by the cultural bias of the judge,” states Greg Hartley, director of the Pennsylvania Chapter of the National Organization of Circumcision Information Resource Centers. Hartley is currently working with the House Health Committee to persuade Pennsylvania to de-fund Medicaid circumcision coverage – something taxpayers spent $2.5 million on last year. If successful in these efforts, Pennsylvania would become the 19th state to end Medicaid funding for routine infant male circumcision. 

“All children, regardless of gender, culture or parental religion, have a fundamental right to all their healthy, functional genitalia,” affirms Hartley. 

What if Chase were older? Would that matter? Do American courts uphold the right of older children to refuse the medically unnecessary cutting of their genitals? 

Consider the Oregon-based Boldt v. Boldt custody case involving a 14-year-old boy. After converting to Judaism, the boy’s father wanted his son to follow suit and be circumcised, against both the boy’s and his mother’s will. Initially, a male judge ruled in favor of the father. It’s hard to imagine a young teen being forcibly sedated in order to violate his will and cut apart his healthy, functioning penis. The mother appealed, and the case went to the Oregon Supreme Court. In 2009, the court ruled that with regard to the circumcision of boys, American parents have “historically and culturally” made the determination. But, because the Boldt dispute centered on custody, the teen’s feelings about the “invasive medical procedure” mattered. Today, the young man remains intact. 

Unfortunately, Hironimus' request for appeal has been denied. 

A Mother’s Courage 

Safeguarding the well-being of her child is at the forefront of Hironimus’ consciousness, and she has paid a heavy price in her effort to protect Chase. Yes, she has been true to her conscience and courageously responsive to research revealing that circumcision places children at physical and emotional risk. But Hironimus is now a fugitive facing significant legal challenges. 

"She doesn't believe she should be incarcerated for protecting her child," states Hunker. 

Neither do I. In fact, neither do many thousands of parents, “intactivists” and medical professionals who have rallied on behalf of Chase.  

So far, more than $45,000 has been raised by "Chase's Guardians" to fund Hironimus’ legal defense. The money is being held by the national organization Doctors Opposing Circumcision. However, on March 24, Nebus’ lawyer filed a motion requesting the judge to prevent Hironimus, or her lawyer, from accessing these funds. The court has yet to respond to this request. If only Nebus’ dogged determinism could be channeled into nurturing what matters most between parent and child: unconditional love, emotional safety, support and kindness. Clearly, Nebus fully and wholeheartedly endorses the American cultural practice of male circumcision. Yet, knowing that his son is so full of fear, he could set this issue aside and nurture what is most significant. In the end, the relationship between father and son matters much more than the presence of the boy’s foreskin. 

If this case was unfolding in nearly any other part of the developed world, Chase’s right to his physical integrity would be affirmed. However, it isn’t an American tradition to grant our boys the right to determine the fate of their own genitals. In a country known for its emphasis on individual freedom and choice, this juxtaposition is striking. It takes a mother’s courage to point it out. 

Will Hironimus be able to access the money raised on Chase’s behalf? Will the outdated parenting contract be legally revised? How long can mother and son stay at a domestic violence shelter? Will Chase be placed under general anesthesia, against his will and the will of his mother? Will his penis be cut because “it’s just the normal thing to do”? 

Time will tell. Hironimus continues to challenge the court-ordered circumcision of her son. Meanwhile, a frightened little boy and his brave mother await our protection.