A Case of Genital Self-Mutilation in an Elderly Man

Sir: Genital self-inflicted wounds are generally categorized as self-mutilating behavior or partial suicides. Although genital self-mutilation occurs in all racial groups, cultures, and religions, the vast majority of reported incidents occur in single, male Caucasians in their 20s or 30s.¹

This case highlights the beliefs that precipitated genital self-mutilation in an elderly man.

Case report

Mr. A, a 72-year-old married man, was admitted in August 2006 with a history of genital self-mutilation at home in an attempt to bleed and die. The patient was premorbidly well adjusted with no past suicide attempts or any major psychiatric or medical illness. There was no evidence of sexual conflicts over past experiences and no history of previous self-injury or family history of psychiatric illness. The patient tried to castrate himself, believing this to be lethal. Using a knife, he incompletely amputated his penis at its base and thereby expected to bleed himself to death. He was rescued, and reconstructive surgery was performed. During his recuperation in the hospital, he was assessed by a psychiatrist. Mental status examination revealed no cognitive deficits. The patient had no depression or psychosis, and his only reason for committing the act was a genuine wish to die, precipitated by a dispute among his children related to property and finances. Due to this ongoing dispute the patient preferred to die rather than witness the growing animosity between his children. There was no evidence of any physical, sexual, or psychological abuse of the patient by his family. The patient continued to harbor thoughts of self-castration and was determined to repeat the act if the conflict between his children was not resolved.

Mr. A firmly believed that amputation of his penis would result in his death. He felt justified in indulging in this act of self-mutilation because he thought that the source of life was related to the penis. A similar act by a 24-year-old man to attain salvation (Moksha, defined as “liberation from the cycle of death and rebirth and all the suffering and limitation entailed in embodied worldly existence”) has been reported.² There are case reports of 3 Chinese men who believed that in severing the penis, death was inevitable.³ These men expressed surprise and dismay at finding themselves still alive. In Chinese, 1 term for penis is Ming Gon, meaning “life root” or “life source.”³ The Greeks and Romans had adorned images of the penis on their pottery and household items and considered the symbol to be potent for fertility and longevity. The eponym “Klingsor syndrome” has been proposed for acts of genital self-mutilation involving religious delusions.⁴ Religious and biblical delusions have been associated with autocastration in schizophrenia.⁵

Our patient had no religious delusions but had a belief associating death with amputation of the penis. This belief was culturally accepted and shared by many of his family members. This case highlights the need to recognize cultural and religious beliefs in patients with regard to self-castration.