Male circumcision and male suicide, is there a link?

 

A paper on male circumcision and male suicide, written by Glen Poole of the Stop Male Suicide project, will be presented at the 14th International Symposium on Genital Autonomy this week. This article is published in memory of Jonathon Conte and includes some extracts from the talk, for the benefit ofthose who cannot attend the event.

On Monday May 9 2016, the prominent, American anti-circumcision campaigner, Jonathon Conte, died by suicide. As one of his fellow campaigners, Jonathan Friedman, wrote at the time:

“For those who knew him personally, he was a bright and friendly person. But on the inside, he was tormented by many things, and circumcision was near or at the top of this list of grievances.”

Most of us will be aware that there is a global drive to end the practice of, what used to be called, “female circumcision” and is now most commonly referred to as “Female Genital Mutilation”. Fewer people are aware about the campaigns to end “male circumcision” which Jonathon, as a non-consenting victim of the practice, was involved in, before his death by suicide

Those who campaign against male circumcision are sometimes called “intactivists” because their core belief is that baby boys’ genitals should be left “intact” at birth. Intactivists are often, though not always, adult men who were circumcised themselves, have experienced ongoing harm as a result and wish to bring about cultural and social change to protect other boys and men from the harm they have experienced.

This article is not about the rights and wrongs of circumcision, but rather that fact that some men who were circumcised are physically, emotionally, mentally and socially harmed by the act. We are increasingly told that “men need to talk” and the response of the Stop Male Suicide is that “we need to learn to listen to men”. As we discuss in our new book—“You Can Stop Male Suicide”—listening is not judging, advising, agreeing or disagreeing—listening is loving and empowering and gives voice to men’s pain.

 

Intactivists generally refer to “male circumcision” as “Male Genital Mutilation”, though I will use the phrase “unnecessary male circumcision”. I use this phrase purposefully because it is the most inclusive term I can find to engage people who aren’t intactivists.

In 2010, when living in England, I learnt of the case of Goodluck Caubergs, a three-week old baby boy who bled to death, from his penis, after to to being subjected to a home circumcision with a pair of scissors at the hands of a midwife who was later jailed for his manslaughter. I began to research the issue more deeply and discovered more boys like Goodluck experiencing death, pain, serious injury, admissions into emergency departments. I was horrified to learn that it wasn’t uncommon for boys in England to be subjected to this painfully, medically unnecessary procedure, without anaesthetic, in unsanitary conditions, at the hands of people with no licence or training to carry out the procedure.

Knowing what I now know, I have yet to have a reasoned conversation with someone who doesn’t think that male circumcision, at some level, is unnecessary. People will draw the line in different places. Some say unlicensed and unsanitary circumcision is unnecessary; some say circumcision without anaesthetic is unnecessary; some say circumcision without a medical, therapeutic reason is unnecessary and some people (even some surgeons) say there therapeutic circumcision is unnecessary as there are other alternatives.

So I use the phrase “unnecessary male circumcision” because most of us, if we take the time to learn the facts, can agree that some (if not all) male circumcision is unnecessary. As 70% of the world’s men are “intact”, it is clearly not necessary for all boys to be circumcised. As for the circumcised men who suffer into adulthood, they generally believe their circumcision was unnecessary and inappropriate and may use stronger words like “forced”, “non-consensual” and “Male Genital Mutilation”.

So how might male circumcision be linked to male suicide?

The pathway to suicide takes men from having problems, to trying to fix problems, to trying to cope with problems, to seeing suicide as a solution to their problems. The problems that lead men to suicide arise in one of four fundamental structures that shape us as human beings: our society; our culture; our psychology and our biology/behaviour.

When men face problems they can neither fix, nor cope with, their risk of suicide rises. While men of all backgrounds are more likely to suicide than women of the same background, it is the men who don’t conform with the social norms such as being mentally well, heterosexual, in a stable relationship and a secure job, who are most at risk.

In general, we know men in high risks groups are more likely to suicide, particularly when faced with other factors such as unemployment, alcohol abuse, relationship separation and mood disorders. Are men who are traumatised by circumcision also be one of these high risk groups? It’s certainly possible.

 At a surface level, one way to explore this question would be to compare suicide rates and circumcision rates around the world and assess whether there is any correlation between a country’s suicide rate and its circumcision rates. However, a cursory glance at the available data suggests we might struggle to find such a correlation. If we compare the male suicide rates in Israel, where we know circumcision rates are high and Finland or Russia, where circumcision rates are low, we find the rate of male suicide in Finland is twice as high as Israel and in Russia it’s three times higher.

JPEG20The male suicide rate in the UK, the US and Australia is also higher than in Israel.

But this doesn’t mean there isn’t a link. Anecdotally, anyone who spends time listening to the lived experience of people in the “intactivist” community worldwide, will soon discover that suicide and suicidality is not an uncommon pathway for men who have been circumcised to take.

The question is not are men who have been circumcised at risk of suicide, because they clearly are. The question we need to consider, is whether suicidal men show up in the intactivist community because suicidality is just a fact of life, or because of a specific phenomena we might call “circumcision-related suicide”

FOUR POSSIBLE EXPLANATIONS FOR CIRCUMCISION-RELATED SUICIDE

When seeking to assess suicide risk, I tend to look at four factors:

  • The Behavioural and Biological
  • Social Factors
  • Cultural and Relational Factors
  • Psychological Factors

These four factors are drawn from Ken Wilber’s work on integral theory and in particular his four quadrants model. According to Wilber, there are four basic ways of looking at any issue which are, to put it simply:

  • From inside the individual (the “I”)
  • From outside the individual (the “it”)
  • From inside the collective (the “we”)
  • From outside the collective (the “its”)

LOOKING FROM OUTSIDE THE INDIVIDUAL

If we think about behavioural and biological causes of circumcision-related suicide, probably the most obvious question to consider, is whether circumcised men carry trauma from childhood, in their minds and bodies, that increases their risk of trauma.

We know that unresolved childhood trauma can leave us more vulnerable to suicide as adults, leaving us less able to cope with the problems that can lead to suicide. We also know that some countries where circumcision is universal have low suicide rates, so this alone cannot be the answer, though it could be a factor.

LOOKING FROM INSIDE THE COLLECTIVE

 What about the cultural and relational factors? According to Shneidman’s “psychache” theory one of the common causes of the deep emotional pain that can lead to suicide is: “damaged relationships, accompanied by subsequent feelings of grief”. When men believe their circumcision was unnecessary, their most fundamental human relationships may be damaged, in particular their relationships with their parents who consented to the procedure and more broadly, the community that allowed the circumcision to take place.

LOOKING FROM OUTSIDE THE COLLECTIVE

 Looking at the social factors of suicide, we know that men are more likely to get help when there are structures and systems in place to empower men with whatever problem they are dealing with. One of the issues that men who believe their circumcision was unnecessary face, is that at a systemic level the problem is not acknowledged. It is becoming increasingly common to claim the solution to male suicide is to “encourage men to talk” about their problems, but intactivists know from experience, that when they talk about the male circumcision as a problem, that society isn’t listening. How then, does a man get help with a problem that society says doesn’t exist?

LOOKING FROM INSIDE THE INDIVIDUAL

At an individual, psychological level, the one belief that seems to unify all men who die by suicide is that at the point of taking their own lives, they genuinely believe that suicide is the best possible solution to the problems they face.

Looking from the outside-in, this may seem illogical. But from the inside-out, men who take their own lives see suicide as the only way to end to the deep, mental pain they feel in response to the problems they face. What men who have survived suicide attempts often reveal is, that on reflection, it wasn’t so much their life they wanted to end, but the mental or psychological or emotional or spiritual pain they were experiencing.

MAKING SENSE OF CIRCUMCISION-RELATED SUICDIE

So what can we learn from this exploration of circumcision-related suicide?

The pathway to male suicide leads men from having problems, to fixing problems, to coping with problems, to seeing suicide as the best possible solution to their problems.

In societies where circumcision is not generally viewed as a problem, if a circumcised man internalises the collective belief, that circumcision is normal and healthy, at an individual level, then it is unlikely that he will be at risk of circumcision-related suicide.

When a man grows to believe that his circumcision was and is a problem, he has taken one small step onto a pathway that can lead to male suicide. It could be argued, then, that the best way to prevent circumcision-related suicide is for us to stop viewing circumcision as a problem—to “man up and carry on” as it were.

As the whole point of intactivism is to change the world’s view of male circumcision, from seeing it as necessary and acceptable to believing that male circumcision is unnecessary and unacceptable, the idea that we should stop seeing circumcision as a problem is not an option for intactivists.

At this point, it’s important to note that the majority of men who grow to believe that circumcision is a problem, do not end up taking their own lives, though they may experience suicidality and other mental, emotional and social issues as they try to come to terms with what happened to them.

Most intactivist men, it seems, find ways to fix or cope with the problem. But while “coping” is a better outcome than suicide, it’s important to remember that there are many different degrees of coping ranging from “coping really well” to “coping very badly”.

So how do we ensure that men in the intactivist community are not just safe from suicide and not just coping, but coping well?

HELPING MEN COPE WITH CIRCUMCISION

The three bits of information that stood out for me when researching this article were:

1. The idea that “damaged relationships” can cause deep mental pain that may lead to suicide

2. The idea that honouring men’s “right to feel and express pain” may lower male suicide rates

3. The idea that men will get help when there are systems in place to empower men to deal with the problems they face

The intactivist community plays a vital role in supporting men who believe that their circumcision was unnecessary and unacceptable. It can provide a support system that endeavours to empower these men, where no such system exists in wider society. It also gives voice to the pain of men’s experience, in societies that generally don’t honour the right of circumcised men to feel and express pain. In these respects, the intactivist community is providing a vital support service to men around the world.

CONCLUSION 

I am left wondering then, what role can intactivists play in healing the damaged relationships that exist between circumcised men and their families and communities?

How can intactivists combine the twin challenge of supporting individual men to heal their pain, while fighting to convince society that this pain exists in the first place?

How does the intactivist community help men to come to terms with what has happened to them in the past, as part of their own healing, while persuading society that is neither necessary nor acceptable, to continue circumcising boys in the future?

As we wrestle with these difficult questions in the wake of Jonathon Conte’s death, it is vital that the intactivist community continues to look out for each other and does its best to keep every member of the community safe from suicide.

FURTHER INFORMATION:

If you want to learn more about what you can do to prevent male suicide and support the work of the Stop Male Suicide project in the process, you can order a copy of our new book : “You Can Stop Male Suicide” by clicking on this link.

HELPLINES:

If you our someone you know is at risk of suicide you can details of crisis support services in your country here

https://stopmalesuicide.com/book/

 

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