Self-injurious behaviour, self-mutilative behaviour or self-harming behaviour are defined as deliberate destruction of body tissue without conscious suicidal intent (Feldman, 1988). An alternative definition of self-injurious behaviour is repetitive, direct physical self-harm that is evidently not life-threatening (Herpertz, 1995). Some other terms such as autoaggression, purposive accidents and focal suicide are also used. The three most commonly reported types of self-injurious behaviour are self-cutting of the skin, ocular self-mutilation and genital self-mutilation (Feldman, 1988). In Greilsheimer & Groves's (1979) study a majority of cases of male genital self-mutilation had psychosis. Cases of non-psychotic genital self-mutilation include men with character disorders and transsexuality. Many of the patients seemed influenced by religious factors, such as beliefs involving sexual guilt. Meninger (1935) viewed circumcision among Jews as a ‘practical substitution’ of the foreskin for the entire genitalia. In India, we have not before come across any report of penile auto-amputation.
A 24-year-old male was referred from a surgical ward for psychiatric evaluation after he had severed his penis with a knife. He came from a rural farming background and had received four years of formal education (up to 8 years). From childhood, he was preoccupied with religious matters and was always ready to eschew material gains for the betterment of his fellow man. In adulthood, he decided to adopt a true religious life after deciding to forego married life and a family of his own. He became popular in his village and the people would come to him to seek his blessings and guidance. He wanted to fulfil all the obligations to attain Moksha (salvation). His extreme step of penile self-mutilation was also a step in the same direction as he did not want any sexual impulses to disturb him on his way to salvation. There was no past or family history of any psychiatric illness, chronic medical illness or drug misuse. On examination of his mental state, the patient was a pleasant and polite individual. Rapport was easily established. There was no evidence of any thought disorder, depression or perceptual abnormality. His orientation, memory and other higher mental functions were also normal. His explanation for penile self-mutilation was that he did not want to succumb to any sexual temptation which could obstruct his way to salvation.
The case is rare as he did not have any underlying psychiatric illness. His over-valued idea that sexual or married life is contradictory to religious life is also not compatible with Hinduism. The subject did not have any sexual preoccupations but in his apprehension to save himself from any forthcoming sexual temptations, he performed penile self-mutilation.
- © 2001 Royal College of Psychiatrists