Major Self Mutilation:

Major self-mutilation refers to acts that severely damage a significant amount of body tissue. These are usually injuries that can only be inflicted once, such as eye enucleation, facial skinning, amputation of the limbs, breasts or genitals. Major self-mutilation is usually inflicted upon the self while in a hallucinatory or "zombie-like" state. This can be caused by mental retardation, schizophrenia, bi-polar disorder, or the influence of drugs or alcohol.

Sometimes major self-mutilators are unable to explain their injuries. In a case reported by Goodhart and Savitsky in 1933, the subject was a 16 year-old girl who had suffered from chronic encephalitis for eight years prior to the described incident. She was found by her nurse holding her right eye in her hand and claimed that it had fallen out while she slept. Two hours later, her left eye also "fell out". She appeared to experience no pain and appeared unconcerned by her eye enucleation. Later, she would confess that she had felt "hypnotized" and gouged her eyes because of an "irresistible urge."

When patients can give explanations, they frequently deal with sexual themes including transsexualism, control of hypersexuality and homosexuality. In a 1931 article, Lewis describes a 28-year-old man who was hospitalized after a castration attempt resulted in significant loss of blood. Severely depressed and terrified of homosexuality, he had attempted castration several times in the past. Of one of his attempts he said, "I thought I was a terrible person....it seemed that it might prevent me from indulging in sodomy."

Another frequent motivation cited for major self-mutilation is religious guilt . Such reasons can include, commands from God or the devil, identification with Christ and punishing oneself for sin. In such cases, a bible verse shows up surprisingly frequently: Matthew 6:22-23: "What I say to you is: anyone who looks lustfully at a woman has already committed adultery with her in his thoughts. If your right eye is your trouble, gouge it out and throw it away! Better to lose part of your body than to have it all cast into Gehenna."

Interestingly, eye enucleation as described here has been found to "occur only in Christian cultural areas." Favazza searched for, but was unable to find, a single case of self-enucleation in China, Singapore, Hong Kong, India, Japan, or in the aborigines of Australia or natives of Papua New Guinea.