Penis amputation and self-castration from marijuana-induced psychosis: Really?
In February, I covered a case report about a transsexual woman who castrated herself when her insurance company wouldn’t pay for the procedure. Today, I have a sort of follow-up, about two self-mutilation cases that doctors are ascribing to a completely different reason: Pot-induced psychosis.
In one case, titled “A case of self amputation of penis by cannabis induced psychosis,” a group of doctors at Aligarh Muslim University in India
…present a case of a 35-year-old male who self mutilated his penis due to dependence on cannabis for the past few years that led to a condition called cannabis induced psychosis.
Here’s the authors’ evidence for why marijuana was to blame:
Remission of symptoms within weeks and no relapse with poor compliance of antipsychotic medication suggest that the psychosis was primarily induced by cannabis.
But it’s worth noting that this case study appears in the Journal of Forensic and Legal Medicine, which could explain that interpretation, as well as the paper’s stern conclusion:
The consumption of cannabis products other than bhang, have been prohibited in India under NDPS Act, 1985. By doing so he may warrant imprisonment for a term of six months, or a fine which may extend to ten thousand rupees, or both (NDPS Act, 1985).14 Different amendments of the act tried to prohibit the trading but no stress had been on its use in community. Cannabis is used regularly in different religious ceremonies and other social gatherings have made it impossible to ban in India. A strong policy or act is further needed and rather its implementation is required to avoid chronic addiction or habituation in the society which is prevalent from centuries.
This wasn’t the first such case in the medical literature, it turns out. From a case report by doctors in Morocco and the Netherlands in the Journal of Medical Case Reports last year:
We report a case of a 40-year-old Berber man, who was presented to our emergency room with externalization of both testes using his long fingernails, associated with hemodynamic shock. After stabilization of his state, our patient was admitted to the operating room where hemostasis was achieved.
The authors explain why they blamed pot:
We report here the first case of a patient who self-mutilated his testes with his long fingernails under the influence of cannabis. Many theories consider self-mutilation to be a strategy to reduce distress or tension, an expression of anger or shame, or manipulative behavior. Some authors link this behavior to borderline personality disorder  or treat it as a means for the patient of controlling traumatic childhood experiences . Our patient, however, had no history of childhood trauma or any axis II disorder. A high consumption of cannabis just before his act led us to the belief that cannabis abuse was the trigger for testicular self-mutilation. Self-mutilation may also be linked to difficulties in impulse control, as here. In any case, the clinical characteristics of self-mutilation are manifold, and its etiology is a topic for debate .
So, are these two case studies Reefer Madness, overinterpretation, or both?
found that the use of cannabis and other illicit substances was associated with an earlier age at onset of psychotic disorders.
The authors write:
A number of hypotheses have been proposed to explain the association between cannabis use and schizophrenia, including the following: (1) that cannabis use is a causal factor for schizophrenia; (2) that cannabis use precipitates psychosis in vulnerable people; (3) that cannabis use exacerbates symptoms of schizophrenia; and (4) that people with schizophrenia are more likely to use cannabis.43 This study lends weight to the view that cannabis use precipitates schizophrenia and other psychotic disorders, perhaps by an interaction between genetic and environmental factors as has been suggested for cannabis and catechol O -methyltransferase21 - 22 or by disrupting brain development, especially during the important neurological maturation that takes place during adolescence.44
So there does appear to be a correlation between psychosis and pot use — but correlation does not mean causation. And figuring out the definitive cause of a particular act is difficult at best.
Perhaps it doesn’t matter, but it seems a bit of caution is called for.