Brendon Marotta

What The AAP And Intactivists Don’t Understand About Each Other

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“Wherever there is division, there must be conflict.” – Jiddu Krishnamurti

Right now, both the American Academy of Pediatrics (AAP) and Intactivist anti-circumcision movement are engaged in a heated conflict over the issue of circumcision. Each side feels the other does not see or understand them. When people do not feel seen or understood, conflict increases. When they do feel seen and understood, dialogue can happen.

My goal with this post is to bridge the gap between the AAP and Intactivists, and help each side better understand the other better. As one of the few people who has interviewed top leaders on both sides, I am in a unique position to articulate each sides perspective to the other. My own perspective includes the viewpoint of both sides, and I do not feel I belong solely in either camp.

When I attended the most recent American Academy of Pediatrics conference, I was even physically between both camps, staying at a hotel directly between the AAP conference hotel and the hotel where the Intactivist protestors were staying. The events of that conference illustrate the disconnect between each side. The Intactivists were talking outside about the AAP, and the AAP was talking inside about the Intactivists. Neither had a shared space to dialogue with the other.

If you are involved in this debate on either side, my hope is to give you the understanding you need to effectively dialogue with the other side, and make your own perspective seen and heard, by speaking to the other in language they can understand.

The post is going to be broken into several parts. I’ll first describe the events I saw at the most recent #AAP18 conference, explain to each side what I feel they are missing about the other, and then give a bit of advice on what each side could do to better communicate with the other.

Yes, that last part is a bit self-serving, but hopefully I’ll have earned it by the end.

The American Academy of Pediatrics (AAP)

Disclaimer: The rest of this post is purely fiction, since I would never use a conference badge I found lying on a table to go to a speaking event at the AAP conference.

Inside the conference, the American Academy of Pediatrics held an event on How To Handle Online Challenges To Your Professional Reputation. Originally titled Troll Control, earlier descriptions specifically mentioned the circumcision and vaccination as topics that “trolls” might attempt to attack a doctor over. When activist and YouTuber Jordan Arel made an open letter to the organizers saying that he sympathized with their challenge, but that circumcision criticism is different than trolling, they changed the name and description to be just about online reputation.

The speakers gave some decent general advice on social media. If you build a following, when someone hates on you, your regular readers will stand up for you. The internet is forever, so be careful what you say, and don’t delete a tweet without explanation. Set up google alerts for you name. Don’t be afraid to talk to reporters. Etc.

However, they also had screenshots of specific interactions on social media. Jordan Arel’s video came up, and the woman presenting, Dr. Wendy Sue Swanson, said she was willing to engage with this young man because his approach was respectful. She said it was a bit rambling, but she felt like many activists just want to heard, and was willing to engage with people who behaved the way he did. She showed a screenshot of another activists tweet that included expletives as an example of what she would not engage with.

There was an emphasis in the talk on these kind of expletive-filled responses. The presenters said that with the internet these people could organize and flood your comments en masse. They said it might look like your community is angry with you, when it is actually an organized minority group – the implication being that you could write that off as not your community.

Then they invited Dr. Douglas Diekema, Bioethics Chair of the most recent AAP Circumcision Policy Statement up to speak.

Douglas Diekema was afraid. He said after working on the AAP Circumcision Policy Statement, he had gotten a lot of angry letters and even death threats. He said he felt unsafe, had to hire personal security, and had PTSD from previous AAP conferences where Intactivists had confronted him. I believed him. There was a shake in his voice and he seemed… frail. I would not even be surprised if the stress had given him health problems of some kind.

Diekema said that he had thought this whole controversy would just go away over time, but it hasn’t. Most of his work has nothing to do with circumcision, yet he gets frequent one-star reviews from people he knows aren’t his patients mentioning the issue. His wife won’t let him read online comments about him anymore.

Listening to him speak, I wanted to thank Douglas Diekema for sharing his experience. It’s an experience that most in the Intactivist movement don’t know about. Intactivists who’ve seen Diekema at previous AAP events have described him as angry and aggressive. They see him as unfeeling, because most in the AAP are so quick to dismiss the emotions of activists.

Activists don’t realize that the aggressiveness they perceive in Diekema is a defense, because he feels unsafe and threatened by them. He doesn’t know if the activist confronting him is just going to loudly disagree or is one of the people who sent him a death threat who might physically hurt him.

After hearing Diekema’s experience, I wanted to shake his hand, thank him for sharing, and tell him that if he ever wanted to talk – totally off the record – I’d be happy to. However, that didn’t happen.

While walking back from the podium, Diekema looked at me and made eye contact. His eyes went wide with fear. Previously, I wasn’t sure if the AAP even knew who I was, but Douglas Diekema was able to immediately recognize my face from a single glance. Two minutes later, security was tapping me on the shoulder asking me to leave the premises. I left and didn’t go back.

The Intactivist Protest

Outside the conference, I met the activist who left the expletive-filled tweet featured most prominently in the AAP talk.

The tweet featured in the AAP talk

He pitched me a project. He wanted me to do a version of the opening of my film where instead of a baby being put in a circumstraint and cut, a grown man would be put through the same ordeal.

The man would make the same faces the baby does in the opening of my film, but instead of just baby sounds he would talk. “Where am I going? What’s happening?” When the cutting started, he would curse his captors, screaming and swearing at the top of his lungs, and they would use the same minimizing excuses people use about infant circumcision. “He can’t feel anything.” “It’s just a little snip.” “He’s just exercising his lungs.”

What the majority of the AAP doesn’t see is that behind those angry expletives is a man who feels like there is still some part of him trapped in that circumstraint – an “inner child” or aspect of him still frozen in trauma. He wants it to be seen and acknowledged, which is why he likes my film, but pitches me something more extreme. When his trauma is not acknowledged, it reaches for the language of an adult. Would an adult who was having part of his penis cut off without anesthesia use PG language in expressing his pain?

What The AAP Doesn’t Get About The Intactivist Movement

The AAP sees the Intactivist movement as a few upset trolls or consumer revolt, when the movement is actually a multi-decade long social justice movement.

Right now, the AAP seems the Intactivist movement as what you might call a “consumer revolt.” When they talk about Intactivists, they frame it as “trolls” and complain about people 1-starring their Yelp or business page. Their attitude toward the Intactivist movement is that most families are happy with the services they provide, but that you ‘can’t please them all’ and there will always be a few crazies who hate what you do.

In reality, Intactivism is a social justice movement. Activists involved on the issue do not see themselves as upset customers or internet trolls, but as members of a human rights movement and moral cause on par with any other significant human rights movement. They believe human beings have the right to their own bodies, and that holding down a child and cutting off part of his genitals violates that child’s right to his own body.

The AAP focuses on angry Intactivist rhetoric, because through the “consumer revolt” lens having people protest your business, say mean things, and 1-star your page is pretty bad. However, through the social justice lens, Intactivists are actually very moderate.

So far the most that extreme factions of the Intactivist movement do is say mean things. Compare “saying mean things” to what other major activist organizations that have received mainstream media acceptance do: 

  • Greenpeace regularly breaks the law to spread their message, by disrupting businesses and breaking into buildings for political stunts.
  • Black Lives Matter has shut down businesses (like Starbucks), blocked highways, and even destroyed property in riots.
  • Antifa – which has never been disavowed by mainstream media organizations – has repeatedly engaged in street violence, destroyed property, shut down speaking events, protested outside people’s personal homes, and even allegedly thrown bricks at reporters heads.

To be clear – I do not support the tactics mentioned above. If an Intactivist were to propose tactics this extreme, I would advise against it, and even report them to the proper authorities if I thought they might do something illegal. I oppose all political violence and illegal activity. I believe in peaceful social change through art and non-violent communication. However, these tactics have been accepted by many mainstream organizations and press as part of social justice activism.

Photo by James Loewen

In comparison to these more mainstream organizations, Intactivism is one of the most gentle and moderate social justice movements there is. I frequently see mothers bring their babies to Intactivist events to breastfeed. I can’t imagine any sane mother bringing her newborn baby to an Antifa street brawl. 

What Intactivism does have in common with these other social justice movements is anger. Most activists feel anger at what they see as the injustices of the world, which is why they became activists. This anger sometimes leads to tactics that are not effective, not just in Intactivism, but all social justice movements.

For example, some Black Lives Matter activists have chanted that they want more “dead cops.” Although this language is violent and threatening, most people would not claim that black Americans have no legitimate grievances simply because some activists engage in extreme rhetoric. Rather, they would understand that those activists are behaving extremely, because they feel the injustice oppressing them is that extreme.

However, the AAP dismisses all criticism of circumcision because of rhetoric far less extreme than anything mentioned above. I would propose that this is because they (and some legacy media organizations) see the grievances of black Americans as legitimate, and see the grievances of Intactivists as illegitimate or non-existent.

For Intactivists, male and female circumcision are comparable. When I interviewed Brother K, leader of the Intactivist protest group Blood Stained Men, he said “Imagine this was happening to little girls across America, and you’ll understand why I’m angry.” If female circumcision were as widespread as male circumcision, how do you think mainstream women’s organizations would respond? What level of rhetoric and tactics would pussy-hat wearing feminists use?

Photo by James Loewen

This is also why when some pediatricians protest that they are moderate or neutral on the issue because don’t recommend circumcision, and only do it when the parents ask, Intactivists still see them as pro-circumcision. If a doctor performed female circumcisions, but “didn’t recommend it” would he be seen as neutral on the issue?

The Intactivist view is that circumcision is a human rights violation. They view doctors who try to do circumcision’s better (“we use pain relief now”) the way an abolitionist in the 1800s might view a slave owner who tries to treat his slaves better (“I don’t beat my slaves now”). If the whole whole practice is wrong, moderate reforms do not change the fact “moderate” doctors are still participating in an evil institution.

If you’re a doctor reading this, you may find these comparisons absurd. However, this is the Intactivist perspective. If you wish to wish to engage the movement, you will have to acknowledge where they are coming from. However, the AAP has made an institutional decision not to engage the Intactivist movement, which leads to a greater problem.

When The AAP Does Not Engage The Intactivist Movement, It Creates More Extreme Activists

Right now, the AAP has largely chosen not to engage the movement. This is the right move if you are dealing with a troll group, and the worst move if you are dealing with a social justice movement. What do social justice movements do when their concerns are not heard or addressed? They get louder. That is how we got to where we are today.

Photo by James Loewen

Most Intactivist organizations and institutions are polite and professional in their approach. However, in recent years some activists have felt that more moderate voices aren’t reaching the AAP, and that activists need to get more extreme. Whereas early activists would never have used language that might offend the public, I’ve started to see signs that say “f-ck circumcision” or some variation thereof at a protests. The AAP is right that in the past five years, the language of some activists has become more aggressive.

I can understand where these angry activists are coming from. When I tried to place an ad for my documentary American Circumcision at the most recent AAP conference, I was rejected without explanation. My documentary features both sides of the debate, including top members of the AAP. If the AAP won’t accept $10,000 to listen to a fair hearing of both sides of the circumcision debate that includes top members of their organization, why would any activist think moderate rhetoric works?

If the AAP does not publicly engage the Intactivist movement, I predict rhetoric will become more extreme. The movement is not “going away” any more than any other social justice movement goes away when their concerns are not addressed. If activists are not heard, they will keep trying more extreme tactics to find what works. The longer the AAP waits, the more extreme activists will be able to say “see – they finally listened because we tried my extreme tactic.”

My advice to the AAP would be to reward moderate voices with engagement. If moderate voices are publicly acknowledged, then Intactivists will use more moderate tactics, because they will see that those tactics work. However, the AAP is not engaging the Intactivist movement. No answer to the Intactivist movement is an answer, and in some ways, the worst answer.

What The Intactivist Movement Doesn’t Get About The AAP

The Intactivist movement believes the AAP is not listening to them, when the AAP is actually listening very carefully – and afraid.

Right now, the Intactivist movement sees the AAP as a cold impenetrable multi-million dollar organization. They believe the AAP does not hear anything activists say, because the organization never responds publicly to Intactivists. The AAP keeps Intactivist protestors as far away from events as they can, and attempts to enter the event through official channels, such as buying advertising or a booth are denied. Activists see themselves as up against a big institution whose inner workings they don’t understand and can’t access, so their only move is to get louder and protest harder.

In reality, the AAP is listening to everything activists say. They are screenshotting every tweet and every message. Douglas Diekema specifically referenced Eric Clopper’s performance Sex & Circumcision: A Love Story as something he felt particularly threatened by. He was also familiar enough with me to recognize my face from a passing glance. I am 100% certain that members of the American Academy of Pediatrics will read this blog post, which is part of the reason I’m writing it. If you’re an activist on the circumcision issue, you should assume the AAP will read and log everything you write publicly.

The reason the AAP is not responding publicly to Intactivists is because they are scared. They’ve never faced a problem like this before. These are not media-trained people, who got into a political issue knowing the fight involved. Many did not even realize the positions they took would make them public figures who might receive the level of hate that all controversial political figures receive. Imagine if overnight you were receive hundreds of letters calling you evil, even a child abuser or pedophile, simply because you were doing what you thought was your job. Wouldn’t you be afraid too?

Activists see the AAP as an opaque corporate organization, but on the inside it’s full of individuals. Only a handful are involved with the circumcision issue and fewer still actually know what’s actually going on. Among them, I would guess there is a greater diversity of opinion than the organization can admit publicly. Some have made statements that indicate they might know the truth about this issue. Some may even feel guilt and shame for the role they played in perpetuating circumcision.

These are not stupid people. They can understand the arguments when presented well. However, almost every decision made within the organization is made by committee, with legal liability as a determining factor. Even if doctors in the AAP wanted to condemn circumcision, there may be institutional concerns that prevent them from speaking publicly, let alone changing policy.

Most just want this controversy to go away. When Intactivists protest, doctors often given them a thumbs up or tell them they agree with them. What if there are more in the leadership who understand what activists are saying but cannot say so publicly? While earlier pro-circumcision leaders in the AAP like Edgar Schoen (who appears in my film) were clear in their belief that Intactivists were wrong, the current AAP leadership is more afraid than defiant. They just don’t know what to do.

The AAP Uses Intactivists Anger To Dismiss Them

The AAP is listening to everything Intactivists say.

  • When Intactivist use expletives, or make what the AAP perceives as hateful comments, they use it as evidence they can ignore activist concerns, and need to circle the wagons to unify the organization against an external threat.
  • When Intactivist make their arguments in ways that are not threatening or profane, members of the AAP can listen, be influenced, and maybe even feel some of the feelings they cannot admit publicly on this issue.

The same way that the AAP can empower moderate voices in the Intactivist movement by engaging with them, Intactivists can disempower people within the AAP who would dismiss Intactivist arguments on the basis of angry rhetoric, and create space for those within the AAP who feel guilt and shame over this issue to feel those feelings.

In his book on political organizing Rules for Radicals, Saul Alinsky tells a story of a conference organizer who asked protestors outside what they want. After a long silence, one says “f-ck you.” The conference organizer leaves, and nothing changes. Alinsky cites this as a huge missed opportunity, because you don’t want to be protesting outside the conference – you want to be inside organizing the conference.

The movement has the AAP’s attention, and where there is attention, there is the possibility for influence. There exist inroads through which Intactivists can influence the organization, if they can find them. To influence the AAP, activists will have to learn to speak without attack or anger – even if their anger is justified. They will have to learn to create space where members of the AAP can reply and have their concerns and fears treated as valid, even if these conversations only happen privately.

Sun Tzu in The Art of War says you should never corner an enemy, because a cornered enemy will have no choice but fight to the death. If you leave him a path of escape, he will go the direction you allow. What path of escape does saying “f-ck you cutter” leave for the AAP? It puts them entirely on the defensive, with no choice but to protect their identity. This approach will cause the AAP to become more opaque, fight activists every step of the way, and maybe even hire outside organizations to deal with the Intactivist “problem.” A different approach could offer them a way to gracefully exit or change on the issue. Many in the AAP just want this to go away. How could you offer them an exit while still achieving your goal?

Knowing how to give them this will require understanding their internal concerns. Are there powerful people who refuse to change? Legal concerns about admitting fault? Economic forces that incentivize the practice? To find out, activists will have to let members of the AAP know that they can share these needs and be helped, rather have their needs used against them.

This is not an easy task. Up until this blog post, many in the Intactivist movement might not even have known that the AAP is actually listening to them. Yes, the AAP needs to communicate better with their critics, but activists also need to create spaces and voices that will allow that communication to happen. You’re the ones who want change, so it may be on you to become that change first.

How Each Side Can Hear The Other

Each side can allow the other to feel heard by acknowledging and being present with the other’s feelings. It is possible to be present with someone’s feelings while still maintaining your own perspective.

If the AAP wants to bridge the gap, they will have to learn to listen to anger. Many activists feel too great a sense of injustice and trauma to speak without anger. Rather than seeing anger as a reason to dismiss someone, members of the AAP will have to see the need behind the anger.

Remember that tweet I mentioned that the AAP cited as an ignorable angry comment? Contained in the tweet is the argument that the AAP is aware that circumcision complications are common, knows that circumcision is an unnecessary surgery, and is ignoring their ethical duty. Presented in the language I just used, the argument seems rational, but the addition of “SICK F-CKS” all in caps makes it dismissible (in the eyes of members of the AAP).

If the AAP wants to bridge the gap, they will have to learn to do what I just did – see the argument behind the anger. They will have to acknowledge that someone who believes doctors are doing something they know to be unethical might feel anger and disgust. If they are really perceptive, they might even notice the hurt behind that anger at feeling betrayed by a trusted institution on such a personal and intimate level.

However, I suspect my Intactivist readers are rolling their eyes at this point, thinking “that will never happen.” Okay, if you don’t think the other side will bridge the gap, then it’s on you.

If Intactivists want to bridge the gap, they will have to learn to “speak the truth in love” as Proverbs says. They will have to use language that can be understood by the AAP, that makes their case without it feeling like a personal attack or threat. They will have to create enough safety that doctors within the AAP can share their concerns and whatever needs or challenges there are to creating change on the issue of circumcision.

Just as most doctors will not be able to hear criticism that comes from anger, many activists may not be able to speak without anger. If your trauma is so great that trying to silence your anger would feel like you are betraying the part of you that feels harmed by this practice, pursue your own healing first. However, if you are interested in playing such a role, here is how you would do it.

If Intactivists Heal, They Will Win

In order to talk with someone you disagree with or someone you feel is oppressing you without getting triggered, you first have to heal your own pain. It is telling that the one person who was able to reaching to AAP talk on trolling, Jordan Arel, is also an activist who has spoken publicly about healing work and is putting together material to help men heal from their circumcision trauma.

If there is one idea I could push through the Intactivist movement, it would be that activism is not therapy. Therapy is therapy. If you have trauma, you cannot put the burden of healing that trauma on the strangers you talk to about this issue, and certainly not your opposition. I could not do the work I’m doing now without healing work.

This first step to all healing work is acknowledging your feelings. I am capable of acknowledging the feelings of activists as valid, and acknowledging the feelings of the AAP as valid, because I’ve already acknowledged my own feelings as valid. There is no risk that acknowledging someone else’s perspective will take my truth away from me.

Once you’ve created safety for your own feelings, you can create safety for the feelings of others. I believe activists are afraid to acknowledge the feelings of doctors – doctors who feel that this issue could destroy their self-image, their livelihood, and their organization – because that perspective has been used to invalidate the trauma activists feel. However, if you can acknowledge both perspectives, there may be a third option that allows doctors to get what they need and activists to get what they need at the same time.

And that brings me to the last part.

What Each Side Doesn’t Get About Me

Hopefully I’ve done enough listening to share my personal perspective.

Right now, I believe the AAP sees me as a threat. They believe me sitting silently and listening at their conference is a reason to call security. They want to avoid acknowledging me, though they know they won’t be able to forever.

The Intactivsts see me as an ally. They are not used to having their perspective heard, and certainly not on the level my film has listened to them, so anyone who listens to them is welcomed at their table.

However, as I have said publicly before – I am not an Intactivist.

People coming from an oppositional frame don’t understand that statement.

“So… does that mean you’re for circumcision? That you’re with the AAP?”

Let me explain what I actually am:

My religion is integration. My practice is “and consciousness.” This means that I hold both perspectives, and am not seeking to make one side win, while the other loses. I am trying to find a third option where both sides win.

I believe the AAP perceives me as a threat, because they’ve never had anyone understand the Intactivist perspective and NOT become oppositional to them before. While I’ve had my moments of oppositional consciousness – everyone does – I’ve regretted it and moderated my approach. My goal is to become as non-oppositional as possible.

The reason I created a film that shows perspectives from each side of the circumcision debate is that I believe that in order to have a dialogue and create change, we first have to understand one another. Most people do not understand even the most basic facts about circumcision, and this film serves as a first step for people unfamiliar with the issue.

However, it is not the last step. Right now, the AAP would like to see Intactivists just go away. Intactivists would like the AAP to go away. I see a third possibility where both sides can win, and get what they really want, without one side destroying the other.

I think many in the AAP would be surprised to hear that I see their concerns as valid. I am working to address those concerns as best I can, but I cannot address concerns that the AAP doesn’t share. Until hearing Diekema’s perspective at #AAP18, I was not aware of the fear doctors like him feel, and would have assumed that the problem was that they weren’t hearing the other side at all.

If the problem is that the AAP won’t give the issue attention, then you have to use attention-getting tactics. If the problem is that they are too afraid to speak, then you have to create safety for dialogue to happen. I have shifted my perspective based on new information, and am looking for ways to engage members of the AAP in dialogue in a way that feels safe to them.

I believe there are further ways we could integrate both perspectives, but this can only happen if people are willing to share those perspectives. Although we are all busy, I’ve made myself easy to access, and am willing to speak totally off-the-record members of the APP or any doctors organization about their concerns.

If you contact me, I will not share anything publicly, unless you specifically ask me to do so. I have an audience with both sides, so if there is something you’d like the other side to understand, I am open to relaying it. I won’t share the name of anyone who talks with me or that we have spoken. At this time, I’m just looking to make contact and understand other perspectives better.

My goal is to find ways where we can all “win.”

Thank you for reading. I hope this post has brought you greater understanding of the other side.

If you’d like to understand the circumcision debate further, please check out my film American Circumcision. We recently released bonus features that allow to you watched extended interviews with major interview subjects, so if you just want to understand one person or perspective better, you can watch those here. You might want to get the film, because we interview both sides of the circumcision debate.

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