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No Myth: Eye-Gouging Is Rare Symptom of Untreated Psychosis

When the mythical Greek king Oedipus realized he'd murdered his father and married his mother, he gouged his own eyes out. But in real life, self-blinding is a rare yet devastating consequence of untreated psychosis.

"Self-enucleation," or removing one's own eyes, happens extremely rarely. When it does, it has often been explained in light of the Oedipus myth or the biblical verse Matthew 5:29, which states, "And if thy right eye offend thee, pluck it out, and cast it from thee."

In fact, new research finds that sexual or religious guilt are rarely behind self-enucleation. Reporting in the British Journal of Ophthalmology, Australian psychiatrists Olav Nielssen of the University of Sydney and Matthew Large of the University of New South Wales find that only a quarter of self-enucleation cases involve guilt. Cases also occur in non-Christian and non-Western cultures, where Matthew's gospel and the Oedipal myth play little to no cultural role.

Almost invariably, though, victims of self-enucleation report hallucinations or delusions that their eyes are a danger to them or others. In many cases, patients have untreated schizophrenia.

"Each case is disturbing and it is perhaps not surprising that doctors have sought to explain the patients' behavior in the secure frameworks of their religious and cultural beliefs," the researchers wrote. But in fact, they wrote, doctors should immediately prescribe antipsychotics to patients who have attempted to gouge out their eyes, even if mental illness has not yet been diagnosed.

Self-enucleation is rare, with only about 50 cases reported in medical journals over the past 50 years. Nielssen and Large put the rate of self-blinding at about 1 in 30 million people globally. In some cases, they wrote, people who have been hospitalized for eye-mutilation attempts succeed in plucking out their own eyes in the hospital, highlighting the need for constant supervision and even arm restraints until antipsychotics begin to take effect.

Even the removal of one eye can have broad effects, including complete loss of vision if optic nerve damage is extensive enough. Other complications reported include brain hemorrhage, leakage of the fluid that cushions the brain, and damage to the nearby pituitary gland.

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