Self-mutilation, whether in neurotic conditions, in religious rites, in psychotic behaviour as occurring in organic diseases, or in normal customs, represents a surrender of the active rôle by the removal or injury of a part

of the body. It may at the same time satisfy erotic and aggressive cravings and fulfil the need for punishment. The aggressive element may be both active and passive; erotic gratification may be obtained primarily by the attainment of the passive rôle and secondarily by eroticizing the destructive act. The underlying cause of self-mutilation is the conflict between the aggressive destructive impulses and the will to live.