Monday, November 15, 2010

Psych Doc Interprets ER Doc's Patient: Blue Balls




I had a 43 year old white male come in for penile pain. He was accompanied by his wife. They seemed like very nice, affluent people.

So I asked him what happened....I wasn't expecting the response I got.

Mr. Blue Balls: "I tried to freeze my penis off 2 days ago by leaving ice packs on it."

Me: "Uhhh...ok. Why did you do that?"

Mr. Blue Balls: "I don't know."

So I proceeded to take a look at the damage. When he dropped his pants. I noticed his testicles were gone. His wife told me that 2 years ago he cut off his testicles HIMSELF. Never said why....always would just say I don't know. She said he was never diagnosed as psychotic or bipolar or schizophrenic. She said he was just diagnosed with being severely depressed. I've seen some really depressed people, and none of them had self mutilated their genitalia!

His penis had 2nd degree burns. It will turn out better than his nuts did. I called our psych team to come out for an eval (team of trained professionals but not physicians). I figured they would deem him a threat to himself and get him admitted to a psych center. Nope. They said he seemed genuinely regretful and set him up with outpatient counseling. Of course, he couldn't tell them why he did it either. So I was left with no choice but to discharge him.


So Psych Doc....what's your interpretation? How much denial is this family in? Should he have been committed?

-ER Doc

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Wow. First off, I hate to question other professionals, but I can't see how this guy didn't get admitted to a psych unit. He meets "Danger to self" criteria more clearly than a lot of the drug overdoses we see. And he's done similar, serious things twice now.

He may or not have been psychotic; however, I would think that if he had been, the evaluating team would have seen it (as would you and the family.) He could have been briefly psychotic, i.e., under the influence of drugs.

My hunch is that this guy has some sexual deviation that is very socially unacceptable. In other words, he probably has urges to commit violent sexual acts. This guy doesn't hate himself; he hates his intrusive, impulsive sexual thoughts. The symbol of the sexual deviance, his own genitalia, have become his enemy.

I have had two male patients that have hinted at things like this. Both of them have intrusive thoughts of molesting kids. One of them admits that when he sees teenage girls at the mall, he visualizes himself raping them. Then he thinks about where he could bury them. Both of them have asked for chemical castration. They both know that these kinds of thoughts are morally and socially unacceptable, which causes them a lot of distress and feelings of shame and guilt. They have problems with depression and anxiety, and both swear they have never acted on these thoughts.

Your patient likely does need some intense outpatient counseling. He may be an outwardly very pleasant, kind, and peaceful person. But the demons are hidden in there. I hope he can afford some good therapy. And I hope that the neighborhood kids stay away from his house.

-Psych Doc

13 comments:

SuFu said...

*shudder*

Holly said...

*blink*

now THAT'S scary.

tracy said...

Sad. Really sad.

Calabresella said...

Psych doc's eval freaked me the f*ck out.

Anonymous said...

I have seen mention in the literature of two other types of men who have self-castrated: men with homosexual impulses who could not tolerate them; and men who suffered from gender identity disorder.

Not nearly as scary to the community. But a source of confusion and dismay to loved ones, and intense suffering to the patients themselves

J.E., Psy.D.

Shash said...

Oy. This is really sad to hear. If his urges are indeed unacceptable, you have to admire his attempts to control them, misguided or not. He is doing what he can.

I do hope he gets the help he so desperately needs.

ladyk73 said...

Ahhhh.... A "trained" professional here... I am a social worker (msw). I work with some individuals with some pretty severe behaviors and self mutilations.

It all depends on clients history and professional supports. If someone can follow up with a doc in morning, if they have friends and family willing to provide supervision...etc...

But at face value...
Wow

He really needs to be admitted. I agree with you.

Did they explain their rationalization?

Anonymous said...

I agree with Anons hunch that it may be related to gender identity disorder. He prob needs a full battering of psych tests including a good Rorschach

The Bus Driver said...

Maybe he just wants to be a woman.....

Anonymous said...

Saw something similar a long time ago, perhaps 15 to 20 years. My guy tried liquid nitrogen because "His penis was evil"

It made me shudder then and your story makers me shudder now.

ERP said...

Didn't want to be thinking with his "head" I guess....

Nurse K said...

100.0000000% chance he was molested as a child.

Anonymous said...

This man may not be as completely disturbed as most of you are thinking...
Body Integrity Identity Disorder is something that his doctors should look into...