Excerpt from THE AMOK JOURNAL

Castration, plus or minus amputation of the penis, was a secret rite of the Russian Skoptic sect which originated early in the 18th century and existed for 200 years. The same rite is practiced by the con temporary hijras of India, a sect comprised of men who live as women and worship the goddess, Behuchara Mata. The practice of becoming a eunuch is sporadic in the annals of today’s medical sexology and sex therapy it represents a renunciation of sex, with or without a transsexual implication. It is a sexual body-image syndrome with three degrees of severity: fixation, neurosis or psychosis. Its etiology is obscure. It is subject to misdiagnosis, and to treatment that proves ineffectual. Once the status of eunuch has been achieved, the prognosis from guarded to good. An autobiographical case report of self-castration and partial denervation of the penis illustrates a variant of the syndrome, which has proved to be self-limiting, with a good prognosis.

In the science of psychology and human sexuality today, there are still unclassified syndromes that need to be reported as detailed logical case biographies. Eventually it will be possible to assemble them in groups homogeneous according to syndrome, and to compare each group with a comparison or control group. The case herein presented is that of a sexual body-image pathology directed toward the eradication of genital eroticism and orgasm as “a threat to identity.” It entailed a progressive program of self-castration and denervation of the penis which eventually proved to he self-limiting as the man’s life stabilized into the role of eunuch. Self-castration may signify either the renunciation of sexuality or, when related to transsexualism, the renunciation of masculinity and the assumption of femininity, partial or complete. Self-castration is a cross-cultural phenomenon.

The case serves also as a guide to the syndrome that pertains to the body image or a specific component of it -- in the instance the sexual body image. In the classified diagnostic file specially devised for my psycho-hormonal research unit, the generic term for the type of pathology is body-image syndrome. Dependent on degree of severity and incapacitation, it may qualify as a body-image psychosis, neurosis, or fixation. In all three degrees, the obsessional personal conviction regarding the body image yields neither to logical reasoning nor empirical evidence.

A body-image syndrome which is defined as a fixation is relatively benign and so sufficiently encapsulated that it is compatible with meeting the daily requirements of existence. The person with the syndrome is recognized socially not as psychotic, but eccentric. By contrast, a body-image psychosis permeates all aspects of living and incapacitates the person from attending to the daily requirements of living. For other people, the person’s conviction regarding his/her body image takes on the characteristics of psychotic hallucinosis or delusion. Though there is no clear dividing line between a body-image fixation and a body-image delusion, it is empirically useful to have the term, body-image neurosis, with which to recognize an intermediate degree of pathology.

The etiology of sexual body—image pathology has not yet been discovered. It is not difficult to recognize an intellectually Superior, but obsessional and self-absorbed, cognitional history. Nor is it difficult to ascertain both antecedent and concurrent psychodynamic variables, but their ascertainment has little hearing on therapeutic outcome. The diagnosis is usually missed, as body-image syndromes are not recognized in the official nomenclature. Treatment is to the impediment of non-compliancy, which is intrinsic to the syndrome. Noncompliance may be manifested as clinic shopping, which entails that cure eludes even the most famous experts who are consulted consecutively. In this respect, the syndrome resembles, but is not identical to Münchausen’s syndrome, and also Münchausen’s syndrome by proxy.

Because of the difficulty of maintaining patients in follow-up, there is no systematic knowledge of the prognosis of body-image pathology. However, some patients are not averse to giving progress reports by mail or long-distance telephone, provided there is no charge. It is from these patients that one has learned that the syndrome may be self-limiting, provided some of the demands of its dictates have been met — as in the case herein reported.

The clinical material on which this report is based comprises a typed biographical letter received, unsolicited, in the mail and, as a sequel to it, by request, photographs of the genitalia, and an expanded biographical statement, handwritten, part of which overlapped the contents of the letter. The letter was addressed to the present author and is here reproduced with the signed consent of its writer who elected to remain incognito.

Recently, on the advice of a friend, I obtained your book, MAN AND WOMAN, BOY AND GIRL, which I read with more than passing interest. I have an unusual psychological and medical history that relates to the issue of gender identity, and I am writing this in the hope of finding out more information, if any is available, on cases like mine.

Gender-wise, I am a male and during childhood I generally accepted and identified with being masculine though I disparaged the aggressiveness of many of the other boys and sometimes found myself thinking that my personality seemed more feminine than masculine. Moreover, I was never comfortable with the anatomical characteristics that define one’s gender. When at the age of six I discovered that I had testicles, I was unhappy because pinching them even lightly caused a surprising amount of pain. I disliked the penis and remember being acutely embarrassed when I had to undress and see others undress in a swimming pool dressing room. B0th the male and female genital orifices were a cause of shame and revulsion. When, at the age of seven, I bad the first erection that I can remember, it happened I was thinking how disgustingly fat one girl in my class at school was. Generally I disliked having an erection and always associated it with some cause of disgust. When I was a little older, I found that older boys were extremely attracted by the female anatomy and liked to ogle pictures of it that I found revolting. The shocking discovery and others of similar nature made me wonder how the world of sexuality I was beginning to learn about could possibly be appropriate for me. Increasingly I turned against it as childhood ran its course.

In puberty I was horrified to discover that the lusts I found so disconcerting in others had now become my own. I was a heterosexual male, aroused by female nudity, though the old revulsions persisted. The orgasm, which I discovered through masturbation, was immensely pleasurable but utterly shattering and devastating, an annihilation of identity and after it was over, a total desecration of the self-image. I detested it and the addictive drive that erupted frequently in all-but-uncontrollable behavior to bring it about. I determined to eradicate sexuality from myself. With an effort of will I was able to stop masturbating but, while essentially I remained continent through my teenage years, I despised the self-repression needed to eliminate the unwanted behavior. I considered my desires a disease and longed for a return to the much more favorable emotional climate I had enjoyed prior to puberty. I regarded the pressures of others to make me “normal” as a threat and concealed my feelings behind a facade of shyness, indifference or even humor. In particular I considered it necessary to defend myself against well-meaning adults such as parents and counselors wh0 would have liked to see me participate in the usual social events of adolescence such as dances, parties and dates. Generally I affected an unobtrusive but determined avoidance.

In the course of my education I studied biology and began to learn about the effects of various glands and secretions on human psychology and physiology. I read about the effects of castration, that it reduced or eliminated the sex drive I found so oppressive, and decided I wanted the5 operation done. But it seemed impossible to approach the medical and psychiatric professions on a matter on which I felt they would b0 so negative. I had never heard of emasculation being performed at the request of a patient, and thought it unlikely that I could obtain satisfaction.

By now it was the mid-sixties and I was in college. Others were astonished at my lack of the usual social and sexual concerns and at what they regarded as strange, warped obsessions. They urged me to seek psychiatric help. Instead what I did was to become involved in secret acts of self-mutilation. At first these were very minor, burning the frenulum of the penis with a match or scratching it lightly with a knife, for instance. Then I became bolder. In September 1966 I removed the frenulum with a pocketknife and after the first attempts to alter the genital apparatus became more frequent and more serious. There were many blunders as the process was slowed by pain and ignorance. But by 1969 1 had managed to remove both testicles. I never once sought the aid of a doctor in the because, having once committed myself, I feared the consequences of disclosure of my yet unfinished operation more than I valued any putative benefits. (Among the fears was that I would be prevented, forcibly if necessary, from completing the operation and made to develop “Normally.”) I was never caught in the act 0f mutilation though there were near misses, and even there are few who know about these acts even among my close friends and relatives. Generally operations were performed in the rest rooms 0f the college dormitory where I lived, and without anesthesia other than sometimes ice or Alka-Seltzer. As implements I used a pocket knife and scalpels made from razor blades; I became expert at cutting razor blades into desired shapes with I, and in fashioning devices from them using epoxy and silicone glue. For an antiseptic I used Listerine or rubbing alcohol (and later, isopropyl).

With the removal 0f the testicles I expected and hoped for a substantial loss 0f the sex drive and a return to much more favorable emotional conditions. In fact there was some reduction in libido and potency but these changes were relatively minor. Underneath the seething madness 0f desire seemed as strong as ever. This I largely attributed to the remaining genital member and accordingly began to attack it with a scalpel in an effort to sever its nerves. Over several months I cut many nerves, (very probably) including the dorsal nerve. This had a far more profound effect than castration, but unfortunately the change was devastating. Apparently my nervous system could not the shock 0f being deprived 0f the excitation 0f the penis, a stimulus on which it had come to depend heavily, even though I despised it. (That, at least, may be a possible or other trauma.) So at that point I experienced an almost total loss 0f ability to feel pleasure in any form, a terrifying of cold and suffocation replacing all the more usual sensations 0f living.

At the time I was in graduate school in Illinois, but being nearly incapacitated, I had to leave school and meanwhile sought psychiatric help. This, however, proved a disappointing and humiliating failure.

Meanwhile the feeling 0f a need to alter my b0dy persisted, and I performed operations to sever emotional collapse. (Oddly, it seemed as if the nerves had been unevenly cut, the left side continuing to throb and irritate more than the right side. Essentially all the cutting I did at this point was on the left side.) By the time I had gone to the state where I now reside, I had given up on psychiatry, in late 1971 I found employment as a computer programmer at a rich institution, a job that continued for several years. The last mutilation occurred in January 6. I was not entirely satisfied but the remaining problems seemed minor or not solvable in that I had been attempting, so that I have never returned to the bizarre and dangerous behavior. All this, I can still urinate normally and retain a masculine genital appearance except for the absence 0f testicles. I retain some potency a minor nuisance to me but it is far less than I once subject to.)

In late 1976 I reentered graduate school, this time in the local state university, where I even obtained a Ph.D. in computer science. Now 38 years old, I am employed by the university computer-related work.

After the emotional collapse in 1969 my state 0f feeling underwent a slow recovery along less biased lines. The improvement has continued over the years SO that now I can say that life, far from perfect, seems well worth the living. (In fact it has so much potential, as I see it, that made arrangements to be frozen in the event 0f death, in case it becomes possible to revive frozen remains at some future date.) No longer do I feel consumed by unwanted passion, shackled by self-repression, or even prostrated by loss of feeling. With the cooling 0f unwanted feeling I no longer feel revolted by nudity or other expressions 0f sexuality. Though a non-participant myself, I accept and approve 0f all sexual behavior involving consenting adults, except when health is endangered. At the same time I feel that sexual abstinence is the best course for some of us to follow (perhaps only a few but not none), and in fact I prefer to be without the sex drive that caused so much difficulty and was a burden to me. But it hardly seems reasonable to have to go through the sort of trauma that has formed such a large part 0f my life. Surely there must be a better way.

Thus it was with a special poignance that I noted, on reading your h00k, that drugs for suppressing sex drive like medroxyprogesterone acetate and cyproterone acetate were available as early as 1965. The5 was before I had done any significant mutilation! One can speculate how my own history might have been different if I had had the appropriate contacts at that time. (But have I gained something from the long struggle, an appreciation 0f the value and meaning 0f life I would otherwise lack? One’s identity is shaped, in large part, by the obstacles one has to overcome and the manner in which one overcomes them. Still I d0 not advocate the course I once followed, given the alternatives that appear to be available.)

You cite the example 0f the Skoptzy, a nineteenth-century Russian sect that practice emasculation and other sexual mutilations. I have read that there were thousands 0f them and that their numbers included several hundred women. And I heard rumors of people today who are taking cyproterone acetate, not as sex offenders hut voluntarily, to reduce unwanted drives? I hope I have not burdened you too much with the details 0f my case. Any reply you can make will be appreciated.