Severe Self-Mutilation Among Kenyan Psychotics

Abstract

Four case reports are presented of psychotic patients seen in clinical practice in Nairobi over a period of one year, who inflicted serious bodily harm to themselves during that period. Possible psychopathological basis for this self-damage is briefly considered. A review of the literature reveals paucity of similar reports from Africa and the third world. Reasons for this paucity are hard to come by.

Psychiatric Aspects of Male Genital Self-Mutilation

“…By the year 1986 4 more cases were reported [Thompson and Abraham. 1983;Muluka, 1986: Waugh, 1986, In German publica tions we have come across 5 case descrip tions since 1955 [Lange. 1960;Nette, 1975].…”

“…The group ranging from 30 to 39 years is affected almost as frequently [Greilsheimer and Groves, 1979], Only a few publications can be found on genital self-mutilation in females; between 1957 and 1986 6 cases were described [Coons et al, 1986;Muluka, 1986], These cases of female genital self-mutilation present several characteristic features: they often occur simultaneously with mutilations of other organs: the case histories also show numerous self-injuries or the symptoms of the Münchhausen syndrome. Even hysteri cal features were emphasized [Simpson, 1973], Psychodynamics and the psychiatric diagnoses, however, are essentially similar to those of male patients.…”

“…Of the 4 further cases published by 1986 2 were diagnosed as schizophrenic; 1 patient was rated depressive, the 4th was diagnosed as acute reactive psychosis [Waugh, 1986;Muluka. 1986;Thompson and Abraham, 1983], In the German publications of Lange [I960] and Nette [1975] the diagnoses given are above all such of depressive disorders, partly with additional paranoid, anxious or sadomasochistic features.…”

“…Impulses of suicide can be closely timerelated with self-mutilation [Blacker and Wong, 1963;Hemphill, 1949;Muluka, 1986]. By and large, however, overt suicidality is rather rare [Menninger, 1938]; but in the anamnesis suicide attempts do occur more often [Lewis, 1928;Lennon, 1963;Simpson, 1973], Suicidal ideas can lose im portance due to the relief experienced after self-mutilation [Greilsheimer and Groves, 1979],…”

“…From a psychoana lytical point of view this is the completest form of self-punishment [Lewis, 1928], The psychodynamic mechanisms described in cluding feelings of guilt for sexual reasons can also be observed like the biographic characteristics (broken home) in other forms of self-injuries [Stinnett and Hollender, 1970;Muluka, 1986;Crowder et al, 1979: Miller andBaschkin, 1974]. In the opinion of psychoanalysts other organs are often sac rificed as a substitute for the genitals, in par ticular such organs to which sexual symbol ism is attributed, e.g.…”