Self-Injury to the Eyes—A Discussion

My first introduction to this shocking and apparently incomprehensible form of self-mutilation was as a junior psychiatrist, when I was asked to an Eye ward to see a psychotic who had enucleated one of his eyes, damaged the other, and tried (unsuccessfully) to cut off his penis. More recently, I supervised the NHS psychotherapeutic treatment of a disturbed woman who, it emerged, had a secret compulsion to her face and eyes, causing corneal scarring which had been puzzling her GP and ophthalmologist. This latter case has been beautifully described by the psychotherapist, Margaret G, who is here today, and her paper, published in the British Journal of Psychotherapy two years ago, has contributed helpfully to my thinking about this subject.

The thirty or so relevant articles from the psychoanalytic, psychiatric and ophthalmological literature I have unearthed, give a fascinating example of the way our professions interrelate. This is something of which I know Patrick Trevor-Roper has long been aware; and I found helpful and thought-provoking a review article of his written in 1980, ‘The Psychopathic Eye’, in which he describes the eye as ‘a sounding-board for the travails of the whole persona’. I am going to talk about patients who attack their eyes, either grossly and openly, or in a more hidden, repetitive ways. A psychoanalytic perspective may help to make sense of such acts, dealing as it does with the inner world of primitive structures and relationships. I hope to lead us in to a discussion of how we can work together both to understand and to help such patients.

I will start by telling you about some typical patients described in the literature. Gross attempts at self-blinding, usually by stabbing one or both eyes, are uncommon, but regularly described. A 1994 review by Kennedy & Feldmann identified forty-five known cases in the literature up until then. Most patients described have been young adult male schizophrenics. Their fears and delusions, when enquired in