In the depth of psychic ignorance: Self-mutilation in the alleviation of suffering—A case report

Abstract

Introduction: In several cultures—primitive, modern, and contemporary—the body represents an object of communication. According to the definition of the Descriptors in Health Science, self-mutilation is the “act of damaging one’s own body until permanent destruction of a limb or other essential body region is achieved.” Self-mutilation is a kind of agreement to avoid total annihilation of the person, in other words, suicide. In this perspective, it represents a victory, sometimes a pyrrhic victory, of the life drive over the death drive, where a dichotomous relationship is assumed. Case Report: An 18-year-old, female, student, smoker, alcoholic, refers that she doesn’t use illicit drugs. She reports that months before her mother’s death she started self-mutilating behaviors on her arm, forearm, and thigh. When asked about the reasons that drove her to practice physical injuries on her own body, the patient verbalized: “I feel relief when I provoke another pain different from the one I feel internally.” She adds: “I don’t feel panic when I see blood running down my arm”; “today I am no longer able to cry, so I feel the need to inflict self-injury.” She affirms that at the moment before the mutilation acts, she is balanced, and there are no triggering factors for the injuries. Conclusion: The undeniable psychic precariousness makes this “private” self-mutilation show, in the recourse to the act-pain, the conceivable damage truly experienced by the subject. In this dimension of absence or emptiness and when facing the act of self-mutilation, the physician is called to exercise not to capture the look of the mutilated body, but to resort to the artifices of a clinic whose ethics is based on listening to a subject trapped in the repetition of the same.