Man cuts off penis with axe during psychedelic-induced psychosis

A disturbing case of penile self-amputation following a strong dose of psilocybin highlights a rare but real danger of non-supervised psychedelic use.

A 37-year-old Austrian man amputated his penis with an axe after consuming a heroic dose of magic mushrooms, according to a medical journal.

The case, published in a report titled Penile Replantation after Self-Amputation Following Psilocybin-Induced Drug Psychosis in the Mega Journal of Surgery, is the only known example of its kind — and illustrates the risks involved when high-dose psychedelic experiences take place outside of controlled therapeutic environments.

While alone at a remote holiday home in Austria, the man consumed four or five dried psilocybin mushrooms.

He then experienced a psychotic episode, during which he amputated his penis with an axe, cutting it into four pieces.

The man's pre-existing mental health issues — including depression and alcohol misuse disorder — combined with the high-dose psychedelic likely caused his psychotic break.

After the incident, the man put the severed pieces in a jar filled with snow. He ligated the skin over the wound with a cord and cloth before leaving the house in search of assistance.

A passerby found the disorientated man and called emergency services.

The man was transported to a nearby village and later airlifted to a hospital, arriving about five hours after the amputation.

By the time he reached the hospital, the patient had lost a significant amount of blood and was in critical condition. Doctors transferred the man to the operating room and stabilised him.

The severed penis was contaminated, but the surgeons managed to disinfect and debride the penile fragments.

Surgeons were able to save the glans (the tip of the penis) and approximately two centimetres of the penile shaft, but the rest of the organ was too damaged for repair.

Despite these challenges, doctors successfully replanted part of the severed organ.

The man continued to suffer from psychotic symptoms after the surgery, including auditory hallucinations. He was treated with antipsychotic medications and his condition gradually improved.

After one week, he was transferred back to the urology department to continue his physical recovery.

In the weeks following surgery, the patient developed superficial necrosis (tissue death) on the glans, likely due to the lack of blood flow during ischemia, which healed after several weeks.

The man also regained some erectile function within three months, though the length of his penis was significantly reduced due to the damage.

The authors of the study, Andreas P Berger and Alfred Hobisch from Hospital Feldkirch, wrote: "This unusual case reports the first complete proximal self-amputation of the penis caused by psilocybin-induced psychosis and shows that immediate replantation, even of a significantly destroyed and contaminated amputate after an ischemia time of at least 9 hours, can lead to an acceptable cosmetic and functional result."

This case draws attention to the phenomenon of self-mutilation during psychotic episodes — a rare but serious occurrence often associated with underlying psychiatric conditions.

Known as Klingsor syndrome, these incidents tend to involve self-inflicted injuries to the genitals and are linked to conditions such as schizophrenia or substance-induced psychosis.

The report highlights the potential adverse effects of psilocybin when used improperly, particularly by individuals with mental health issues.

Though cases such as this document individual instances and do not provide statistically significant data, they help doctors and researchers understand the risks associated with certain drugs or medical conditions.

Reports like this one contribute to the broader body of knowledge surrounding psychedelic substances. They help clinicians develop best practices for managing complex cases and ensure that future therapeutic use of psilocybin is approached with caution.

This case underscores the need for responsible psychedelic use and comprehensive patient care.

But it is important to note that this case represents an extreme and rare outcome. Most research on psilocybin indicates that it is relatively safe when administered in controlled environments under professional supervision. The majority of patients treated with psilocybin in clinical trials do not experience severe side effects, and outcomes like self-amputation are extraordinarily uncommon.