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Attempted and completed self-enucleation, or removal of one's own eyes, is a rare but devastating form of self-mutilation behavior. It is often associated with psychiatric disorders, particularly schizophrenia, substance induced psychosis, and bipolar disorder. We report a case of a patient with a history of bipolar disorder who gouged his eyes bilaterally as an attempt to self-enucleate himself. On presentation, the patient was manic with both psychotic features of hyperreligous delusions and command auditory hallucinations of God telling him to take his eyes out. On presentation, the patient had no light perception vision in both eyes and his exam displayed severe proptosis, extensive conjunctival lacerations, and visibly avulsed extraocular muscles on the right side. An emergency computed tomography scan of the orbits revealed small and irregular globes, air within the orbits, and intraocular hemorrhage. He was taken to the operating room for surgical repair of his injuries. Attempted and completed self-enucleation is most commonly associated with schizophrenia and substance induced psychosis, but can also present in patients with bipolar disorder. Other less commonly associated disorders include obsessive-compulsive disorder, depression, mental retardation, neurosyphilis, Lesch-Nyhan syndrome, and structural brain lesions.

Fetishism has been often linked to misrecognition and false belief, to one being “ideologically duped” so to speak. But could we think that fetishism may be precisely the very opposite? The purpose of this paper is to explore the potential of this at first sight counterintuitive notion. It locates the problem of fetishism at the crux of the problem of disavowal and argues that one needs to distinguish between a disavowal – marked by cynical knowledge – and fetishistic disavowal, which can be understood as a subcategory of the same belief structure of ideology.

This conceptual paper is based on literature review and utilizes examples from the author’s ethnographic fieldworks in India (2008-2013) and central Europe (2015-2019).

The paper provides a new insight into the structure of fetishism, relying on the psychoanalytic structure of disavowal, where all disavowal is ideological, but not all disavowal is fetishistic, thereby positing a crucial, often unacknowledged distinction. Where disavowal follows the structure “I know quite well how things are, but still […],” fetishistic disavowal follows the formula: “I don’t only know how things are, but also how they appear to me, and nonetheless […].”

The paper develops an original conceptualization of fetishism by distinguishing ideological disavowal from fetishistic disavowal.