Lumberjack amputates ears and penis during psychotic episode linked to cannabis and kratom use

A new case report published in Frontiers in Psychiatry describes the harrowing experience of a 31-year-old man in the Czech Republic who amputated both ears and his penis during a psychotic episode. The incident occurred after he consumed a combination of psychoactive substances, including cannabis and kratom. The man survived, underwent reconstructive surgery, and later remained abstinent while continuing psychiatric treatment. His case highlights how psychoactive drug use may contribute to rare but extreme self-harm behaviors during psychosis.

Psychosis refers to a mental state in which an individual loses contact with reality. This can involve hallucinations—perceiving things that are not there—or delusions, which are strongly held false beliefs. During psychotic episodes, people may misinterpret their surroundings, feel paranoid, or experience disorganized thinking. Psychosis can occur as part of schizophrenia or bipolar disorder but can also be brought on by substance use, brain injury, or extreme stress.

The patient was a physically healthy man working as a lumberjack. He was admitted to the hospital after severely injuring himself in freezing outdoor temperatures. He had amputated both ears and his penis, inflicted deep cuts on his arms, and sustained frostbite on his feet. Medical personnel found him agitated and paranoid, but he was alert and responsive. Emergency surgery stabilized his condition.

Toxicological tests detected cannabinoids, mitragynine, and 7-hydroxymitragynine—substances found in kratom, a plant increasingly used as a stimulant or pain reliever. The man had a history of drug use dating back to adolescence, including regular cannabis consumption and occasional use of alcohol, methamphetamine, and hallucinogens such as psilocybin mushrooms. He also reported frequent substance combinations, sometimes leading to memory blackouts.

Notably, he had a previous episode in 2018 involving aggression and self-harm after using multiple substances. At that time, psychotic symptoms disappeared once the intoxication resolved, and he was discharged without a long-term psychiatric diagnosis. However, he did not pursue ongoing psychiatric or substance use treatment.

After the 2024 incident, psychological testing suggested below-average intellectual function, poor emotional control, and impaired social judgment. Clinicians found no signs of a chronic psychotic disorder like schizophrenia but diagnosed him with substance-induced psychosis. He lacked insight into his mental state and showed little emotional reaction to the severity of his injuries.

Over the course of his hospital stay, antipsychotic and sedative medications helped stabilize his condition. While he initially refused addiction treatment, he later became engaged with psychiatric care. His desire for reconstructive penile surgery became a motivating factor in his recovery. Five months after the incident, he underwent successful reconstruction and remained abstinent from drugs and alcohol. He also continued outpatient psychiatric follow-ups and appeared free of psychotic symptoms.

Case reports provide detailed accounts of unusual or informative clinical scenarios. While they are helpful for identifying possible links between substance use and mental health crises, they do not prove causation. A single case cannot tell us how often such outcomes occur or whether similar cases would follow the same trajectory. There may also be missing details, such as unconfirmed drug doses or incomplete psychiatric histories.

Despite these limitations, case reports are often the first signal that a particular substance or behavior may be linked to rare or extreme health outcomes. In this case, the unusual combination of self-mutilation, substance use, and psychosis raises concerns about how cannabis and kratom may interact to influence mental health.

Both cannabis and kratom are widely used psychoactive substances, but each carries potential risks, particularly for individuals with mental health vulnerabilities.

Cannabis has long been associated with the onset of psychotic symptoms in some individuals. High doses of tetrahydrocannabinol (THC), its main psychoactive compound, can alter dopamine signaling in the brain, which plays a key role in reward and perception. Some people may develop paranoia, hallucinations, or delusions, especially if they have a genetic predisposition or underlying mental health issues. While most cannabis-induced psychosis is short-lived, it may signal a greater risk for later development of schizophrenia-like disorders.

Kratom is a plant native to Southeast Asia that has gained popularity in the U.S. as an herbal supplement for pain, anxiety, or opioid withdrawal. Its primary alkaloids, mitragynine and 7-hydroxymitragynine, affect opioid and other brain receptors, producing stimulant effects at low doses and sedative, opioid-like effects at higher doses. In rare cases, kratom use has been linked to psychiatric symptoms, including hallucinations, mania, or psychosis. Because its metabolites are not detected in standard toxicology screens, its role in mental health crises may be underrecognized.

In the reported case, both cannabis and kratom were detected, but the exact contributions of each substance to the patient’s psychosis remain unclear. Still, their combined effects may have lowered the patient’s threshold for psychosis, particularly in the context of past substance-induced episodes and ongoing psychological vulnerabilities.

While self-amputation of body parts is an extreme and rare consequence of psychosis, this case is not unique. Other reports have documented similar injuries in the context of drug-induced or primary psychotic disorders. What makes this case notable is the involvement of kratom—a substance often marketed as safe and natural—and the severe physical and psychological consequences that followed.

The patient’s story also suggests that motivation, particularly a concrete goal like reconstructive surgery or regaining a driver’s license, can support engagement in treatment and recovery. Despite refusing formal addiction services, he remained abstinent and continued psychiatric care during follow-up.

The case report, “Cannabis and kratom-induced self-amputation of ears and penis,” was authored by Marek Broul, Xenia Rudenko, Adam Bajus, Jiří Král, Dan Mwemena Kyenge, Zdenka Staňková, and Jakub Albrecht.