In an unprecedented case report, doctors in Austria have documented the first known instance of psilocybin-induced penile amputation. After consuming a large quantity of magic mushrooms, a 37-year-old man suffering from depression and alcohol abuse severed his penis with an axe. Fortunately, doctors were able to reattach part of the amputated organ. The unique case is detailed in the Mega Journal of Surgery.

Psilocybin is a naturally occurring psychedelic compound found in certain species of mushrooms, often referred to as “magic mushrooms.” When ingested, the compound is broken down in the body to produce psilocin, a substance that affects serotonin receptors in the brain. This can lead to a variety of mind-altering experiences, including hallucinations, changes in perception of time, and intense emotional shifts. The use of psilocybin has a long history, dating back to ancient cultures that used it for religious or spiritual purposes.

Today, psilocybin is gaining attention in medical research due to its potential therapeutic benefits. Scientists are investigating its use in treating conditions like depression, anxiety, and post-traumatic stress disorder. In particular, studies have shown promising results for psilocybin’s ability to alleviate symptoms in people with major depressive disorder, even when other treatments have failed.

In addition to its therapeutic potential, psilocybin is of interest to neuroscientists for what it reveals about the brain’s inner workings. By studying how psilocybin disrupts and alters normal brain function, researchers can gain insights into how the brain produces consciousness, processes emotions, and constructs a sense of self. These findings have the potential to improve our understanding of various mental health conditions and open new pathways for treatment.

However, while psilocybin has shown promise in clinical settings, its use outside of these controlled environments can lead to dangerous outcomes. The case described in Austria is a stark reminder that, in certain circumstances, psilocybin can provoke extreme psychological responses, particularly when taken in high doses or by individuals with a history of mental health issues.

The case report published by doctors at Hospital Feldkirch in Austria outlines the shocking details of a 37-year-old man who consumed a large dose of psilocybin and, during a severe psychotic episode, amputated his penis using an axe. The man, who had a history of depression and alcohol abuse, ingested four or five dried psilocybin mushrooms while staying alone in a secluded vacation home.

Not long after consuming the mushrooms, the man began to experience a terrifying hallucination or delusion, which led him to take an axe and sever his penis into multiple pieces. The details of the event are unclear to the patient, as he did not fully remember what had occurred.

The man reportedly tied a piece of cloth around his genital area to control the bleeding and placed the severed parts of his penis in a jar filled with snow. He then left the house, bleeding profusely, in search of help. A passerby found him in a confused state and called for emergency services. The man was transported to a nearby village and later to a hospital, arriving approximately five hours after the amputation.

Upon arrival, the patient was in a critical condition, having lost a significant amount of blood. He was immediately taken into surgery, where doctors worked to stabilize him and control the bleeding. His penis was contaminated with soil and snow, and parts of the organ were severely damaged. Surgeons were able to save the glans (the tip of the penis) and about two centimeters of the penile shaft, but the other sections were too damaged to be repaired.

Remarkably, the replantation was successful, despite the significant challenges posed by the extent of the injury and contamination. Despite initial difficulties, the patient’s condition improved after the surgery, although he continued to suffer from severe psychotic symptoms, including auditory hallucinations and religious delusions. He was placed under psychiatric care, and his treatment included antipsychotic medications to help control the hallucinations. His mental state gradually stabilized, and after a week, he was moved back to the urology department to continue his recovery.

In the weeks following the surgery, the patient experienced some complications. Superficial necrosis (death of skin tissue) developed on the glans of his penis, likely due to the loss of blood flow during the period of ischemia, but this healed over time. Remarkably, the patient was able to regain some erectile function within three months of the surgery, though the overall length of his penis was significantly reduced due to the damage. At his last follow-up visit, he was able to urinate normally while seated, though a minor complication called hypospadias developed, where the urethral opening is located further down the shaft than normal.

While this case is the first documented instance of psilocybin-induced self-amputation, it brings attention to a broader phenomenon of self-mutilation during psychotic episodes, particularly among individuals with underlying mental health conditions. Known as Klingsor syndrome, these rare but extreme events often involve self-inflicted injury to the genitals and can be associated with a range of psychiatric conditions, from schizophrenia to substance-induced psychosis.

Case reports are typically used by doctors and researchers to document unusual or rare medical events. They offer valuable real-world examples of how certain drugs, treatments, or conditions can manifest in unique circumstances. However, because case reports usually focus on a single patient, they do not provide the kind of broad, statistically significant data that is needed to establish definitive conclusions about a drug or condition.

In other words, while this case demonstrates that psilocybin can, in rare instances, lead to severe psychotic episodes and self-harm, it does not mean that this outcome is common or likely to happen in most people who use psilocybin. In fact, the majority of research on psilocybin has shown that the drug is relatively safe when used in controlled environments with professional supervision.

What can a German do but a Briton cannot? What can a New Yorker, a Chicagoan and a San Franciscan do, but a Londoner cannot? What can Canadians, Dutch, Portuguese, Chileans, Uruguayans, Maltese all do? The answer is they can legally smoke cannabis. In California there are now courses for cannabis sommeliers. In Britain they would be thrown in jail.

Half a century ago, Britons prided themselves on being in the vanguard of social progress. In such matters as health care, sexuality, abortion, crime and punishment, they considered their country ahead of the times. Now it limps nervously in the rear.

I don’t use illegal drugs, neither am I addicted to nicotine or alcohol or fatty foods. Having sat on two drugs-related committees, I accept that narcotic substances can, in varying degrees, cause harm to their users and, through them, to others. If after half a century of a “war” on drugs, banning had solved or even reduced this harm, I could see the argument for banning. It has not.

Roughly a third of adults in England and Wales aged under 60 have tried cannabis. Almost 8% use it occasionally and 2% regularly. Far fewer use hard drugs. But nearly one in five residents of English and Welsh prisons are estimated to have been jailed for a drug-related offence. Half of all homicides are drugs-related. In many prisons, more than half the inmates use drugs regularly. The authorities turn a blind eye for the sake of peace and quiet.

Successive home secretaries have a terror of even discussing the issue. Tony Blair delegated drugs – as so much of his policy – to the Daily Mail and the Sun. While other countries researched, experimented and piloted innovation, Britain simply shut down debate. When, in 2009, the government’s chief drugs adviser, Prof David Nutt, evaluated the relative harm of different narcotics, he was sacked.