Klingsor Syndrome has been used to describe the act of external genital self-mutilation in psychotic patients. Genital self-mutilation acts have also been reported in personality disorder and substance abuse patients. Here we report two cases both with penis self-amputation and parents murder. Both cases were examined at Council of Forensic Medicine.
Case 1: A 21 years old single male:. He had left school from the first year of secondary school and he is unemployed. He was living with his family in Istanbul before the crime. He has history of mixed substance use for 8 years and 5 times addiction treatment cures in hospital. One year before our examination, he murdered his mother with a gun while squabbling with her about money, under the effect of substance. He told that he had amputated his penis in prison because of his relatives’ blames. He has reactive depressive findings, borderline and anti-social personality traits. No active psychopathology was found. There were many psychopathic scars on his body. His penis was amputated by half. In reference to our psychiatric observations and evaluation, it was decided that he might be under effect of substance and he was responsible for the murder crime.
Case 2: 36 years old male, single, unemployed patient. He has graduated from elementary school. He used to live with his parents in a small town until a year ago. He was accused with murder of his father by hitting a thin metal wand onto his head while squabbling with him about a remote control device. He did not have history of substance use. In his anamnesis, it was learned that he had started to run away from home and several maladjusted attitudes, when he was 14 years old. He had shaved his eyebrow before. He had gone to army but he was reported as draft-exempt after three months in army. He started to receive psychiatric treatment after 18 years old but he didn’t take his medications regularly. When he was 23 years old, he amputated his penis and testicles with scissors under the effect of persecutory delusions and auditory hallucinations. When he was 25 years old, he amputated his tongue. There were many cut trails and burn scars on his body, which cannot be defined as due to the anti-social behavior. One year before our examination, he put a torpedo toy (an explosive toy common in Turkey) to his anus and fired it. After that, his anus needed to be blocked surgically due to the injuries in perianal tissue and he had to live with colostomy. In our examination, he was diagnosed as schizophrenia because of active persecutory delusions, bizarre attitudes and cognitive impairment. It was decided that he did not have criminal reasonability for murder crime. Patients with schizophrenia and similar psychotic disorders, don’t have criminal responsibility. It is not easy to predict the risks in severe and chronic psychotic situations. On the other hand, psycho-education of family members may reduce the risk of such behaviors.