Autolobotomy: a case study

This is a 32-year-old male, a native of Holland, with a psychiatric history of borderline personality disorder and harmful use of alcohol and stimulants. He had previously been admitted to a detoxification center in his home country. A consultation was requested from the Intensive Care Unit to the Psychiatry Department due to an autolytic attempt with a firearm to the cranial region.

Apparently, he had handled several blank guns and transported them from Holland to Spain. At one point during alcohol intoxication and in the midst of an affective crisis, he decided to shoot himself in such a way that the bullet passed through both frontal lobes, with an entry wound and no exit wound. The bullet was lodged in the lobe contralateral to the entry wound. The patient did not lose consciousness; however, his personality changed drastically. He reports that without any distress or surprise, immediately after the shot, he checked out of the room where he was staying, took his car, and drove it in such a way that he set it on fire. He remained in the car for three days until he was found by the police and transported to the hospital in a state of starvation.

Once he was organically stabilized, Psychiatry was called. Upon in-person assessment, the patient showed no signs of facial injuries, no physical or mobility sequelae, or any neurological focal deficits, but did exhibit a striking facial impassivity. Upon our arrival, he was in the intensive care cubicle watching a movie on his mobile phone. His discourse was completely coherent, with normal content and fluency, lacking spontaneity, requiring continuous induction and direction. He recounted the affective symptoms he had experienced in the year prior to the event (emptiness, emotional instability, suicidal ideation, autolytic attempts, euphoria, impulsivity, sadness…) and how he now felt none of this. He also expressed no concern or curiosity about his prognosis, sequelae, or possible bullet infection. He reported that the autolytic ideation and affective symptoms had completely subsided. He denied any emotions, only acknowledging a headache. During his stay in the Spanish hospital until his transfer to his home country (40 days), no affective symptoms appeared; he completely lacked spontaneity, initiative, or motivation. Relatives came to visit him, yet he expressed no emotion. His biorhythms were preserved; he spent hours in bed watching movies (previously he surfed, played sports, and reported being very active). His behavior was strange. He required supervision for showering and eating, as he did so in a disorganized manner. The curious aspect of this case is how the bullet’s trajectory affected the complete modification of the patient’s personality without other physical or neurological sequelae, as well as the remission of affective symptoms and suicidal ideation.

References

No references.