Self-surgery

Self-surgery is the act of performing a surgical procedure on oneself. It can be a rare manifestation of a psychological disorder, an attempt to avoid embarrassment or legal action, or an act taken in extreme circumstances out of necessity.

Genital self-surgery

By far the most common type of self-surgery is orchiectomy, removal of one or both testicles. A small number of men resort to self-surgery in an attempt to control their sexual urges or due to gender identity disorder (Lowy & Kolivakis, 1971; Money & DePriest, 1976; Money, 1980).

Rarer still is the phenomenon of attempted repair of injury caused during masturbation or similar activity that would be embarrassing if revealed. One notable example of this is a case report by Morton (1991):

One morning I was called to the emergency room by the head ER nurse. She directed me to a patient who had refused to describe his problem other than to say 'he needed a doctor who took care of men's troubles'...the patient permitted me to remove his trousers, shorts, and two or three yards of foul-smelling stained gauze wrapped about his scrotum, which was swollen to twice the size of a grapefruit and extremely tender.

...Amid the matted hair, edematous skin, and various exudates, I saw some half-buried dark linear objects and asked the patient what they were. Several days earlier, he replied, he had injured himself in the machine shop where he worked, and had closed the laceration himself with a heavy-duty stapling gun...eight rusty staples were retrieved.

This patient had used a piece of machinery for stimulation on the lunch hour at his machine shop job, when the other employees had left the building. His left scrotum had been caught in the machine. He was thrown several feet away and when he awoke, he stapled the wound closed and resumed work.

Boston Corbett, the soldier who killed Abraham Lincoln's assassin John Wilkes Booth, had performed self-surgery earlier in life. He castrated himself with a pair of scissors in order to avoid the temptation of prostitutes. Afterwards he went to a prayer meeting and ate a meal before going for medical treatment.

Abdominal self-surgery

Abdominal self-surgery is extremely rare. Two well-publicized cases have found their way into the medical literature.

The first, in 1979, involved a male student who had already performed a self-castration. He also attempted to reduce the activity of his adrenal glands with an injection of bovine serum albumin, luteinizing hormone-releasing hormone and Freund's adjuvant. When this produced an abscess at the injection site, he resorted to self-surgery. His psychiatrist, Dr. Ned Kalin, reports (Kalin, 1979):

At four o'clock on the morning of his surgery, he disinfected his dormitory room with spray disinfectant and alcohol and draped an area with sheets that he had previously sterilized. For anesthesia, he took oral barbiturates. He also took hydrocortisone and prepared a canister of vaporized adrenalin, readying himself for a possible shock syndrome. He performed the procedure wearing sterile gloves and a surgical mask.

Lying supine and looking into strategically placed mirrors to obtain an optimum view, he began by cleansing his abdomen with alcohol. The incision was made with a scalpel, exposure obtained by retractors, and the dissection carried out with surgical instruments. Lidocaine hydrochloride was injected into each successive tissue layer during the opening. He controlled hemostasis with locally applied gelatin powder, while sterilized cotton thread ligatures were used for the larger vessels. After eight hours he had had minimal blood loss but was unable to obtain adequate exposure to enter the retroperitoneal space because of the unexpected pain in retracting his liver. Exhausted, he bandaged his wound, cleaned up his room, and called the police for transport to the hospital because of a 'rupture'.

More recently, a Mexican woman was forced to resort to self-surgery (a Caesarean section) because of lack of medical assistance (Molina-Sosa et al., 2004):

She took 3 small glasses of hard liquor and, using a kitchen knife, sliced her abdomen in 3 attempts...cut the uterus itself longitudinally, and delivered a male infant.

Both mother and child reportedly survived and are now well.

Medically supervised self-surgery

Dr. Jerri Nielsen was the sole physician on duty at the U.S. National Science Foundation Admundsen-Scott Antarctic research station in 1999 when she found a lump on her breast. She was forced to biopsy the lump herself. Her experience made international news and was the basis for her autobiography, Ice Bound. The lump was found to be cancerous, so she self-administered chemotherapeutic agents. She was cancer-free as of March 2006.

Self-trepanation

In a chapter of his book, Eccentric Lives & Peculiar Notions, John Michell describes a British group which advocates self-trepanation, that is, the drilling of a hole in the skull to allow the brain access to more space and oxygen. The chapter is called "The People With Holes in their Heads".

According to Michell, the Dutch doctor Bart Huges (sometimes written as "Bart Hughes") pioneered the idea of trepanation. Huges' 1962 monograph, Homo Sapiens Correctus, is cited by most advocates of self-trepanation. Among other arguments, he contends that since children have a higher state of consciousness, and children's skulls are not fully closed, that one can return to an earlier, childlike state of consciousness by self-trepanation. Further, by allowing the brain to freely pulsate, Huges argues that a number of benefits will accrue.

Michell quotes a book called Bore Hole written by Joseph (Joey) Mellen. At the time the passage below was written, Joey and his partner, Amanda Feilding, had made two previous attempts at trepanning Joey. The second attempt ended up placing Joey in the hospital, where he was scolded severely and sent for psychiatric evaluation. After he returned home, Joey decided to try again. Joey describes his third attempt at self-trepanation:

After some time there was an ominous sounding schlurp and the sound of bubbling. I drew the trepan out and the gurgling continued. It sounded like air bubbles running under the skull as they were pressed out. I looked at the trepan and there was a bit of bone in it. At last!

There is an active advocacy group for the self-trepanation procedure, the International Trepanation Advocacy Group. Their webpage ^* includes MRI images of trepanned brains.

Examples of Self-surgery in Popular Culture

In the 1984 film The Terminator, the android title character, played by Arnold Schwarzenegger, removes a defective eye using an exacto knife in a gory scene at a bathroom sink.

In the 2004 film The Far Side of the World, Dr. Stephen Maturin is forced to perform emergency surgery on himself to remove a bullet from his abdomen, as there are no other trained medical professionals onboard his ship.

References

Kalin NH (1979). Genital and abdominal self-surgery: a case report. JAMA 241(20):2188-2189.
- (See also editorial: JAMA 241(20):2193.)
Lowy FH and Kolivakis TL (1971). Autocastration by a male transsexual. Can Psychiatr Assoc J 16:399-405.
Molina-Sosa A, Galvan-Espinosa H, Gabriel-Guzman J and Valle RF (2004). Self-inflicted cesarean section with maternal and fetal survival. Int J Gynecol Obstet 84:287-290.
Money J and DePriest M (1976). Three cases of genital self-surgery and their relationship to transsexualism. J Sex Res 12:283-294.
Money J (1980). Genital self-surgery. J Urol 124:210.
Morton WA (1991). Scrotum self-repair. Med Aspects Human Sexuality Jul 1991:15.

External links

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