A 20-Year-Old Gouged Out Her Own Eyes. Here’s What Makes People Do This.

In the as-told-to article, Muthart describes how she went from a straight A student at her high school in Anderson, South Carolina, to a dropout who regularly used alcohol and marijuana.

After losing her job and boyfriend, Muthart (who says she was later diagnosed with bipolar disorder after the incident), began taking ecstasy and smoking methamphetamine to cope. Muthart described herself as a "religious Christian" and she would read the Bible while high. "I convinced myself that meth would bring me even closer to God," she told Cosmopolitan. Despite multiple attempts to stop using, Muthart became addicted to snorting and injecting meth.

Concerned about her daughter's mental health and drug use, Muthart's mother encouraged her to enter rehab or a psychiatric treatment facility. Her mother recorded a conversation during which her daughter said she didn't "want to be in this world." Her mom hoped to use the recording to obtain a court order to commit Muthart to a facility. The next day, Muthart bought more drugs and that night she used more than she had ever used before.

It may sound like something out of a horror movie, but self-enucleation (or autoenucleation) is a very real and unfortunate psychiatric emergency. It's rare, and in the past 50 years, there have been over 50 documented cases of complete or partial self-enucleation in English medical journals, according to a 2012 study published in the British Journal of Ophthalmology.

What would drive someone to commit such a violent act of self-harm? Psychosis, or the loss of touch with reality. "All of these patients have had a psychotic episode and developed delusions about their eyes," Matthew Large, coauthor of the study and conjoint professor of psychiatry at the University of New South Wales in Sydney, told BuzzFeed News. Just last December, a Colorado prisoner grew out his fingernails and removed his eyes after guards allegedly ignored his psychotic episodes, the Guardian reported.

The symptoms of psychosis include hallucinations, or hearing things that are not present; delusions, or strongly-held false beliefs; and cognitive impairment, or the inability to think logically. "People who remove their eyes due to psychosis often believe that they can see evil or they are casting evil," Large said. Similar to Muthart, many patients believe their eyes pose a threat to their loved ones.

The common psychiatric illnesses that cause psychosis are untreated schizophrenia, psychotic depression, psychotic mania, and bipolar disorder, Large said. "Many of these patients have never-treated schizophrenia, which means they might not even know until they have their first episode of psychosis and remove their eyes," Large said.

Psychosis is also caused by certain medications and drugs, Large said, and methamphetamine is a particularly common culprit. "It is thought that one of the causes of psychosis is too much dopamine, and meth causes a massive release of dopamine in the brain," Large said. While this excess of dopamine (pictured above) can cause a temporary state of euphoria, it can also impair decision-making and cause deluded thinking.

In some of these patients, repeated use of methamphetamine actually induces a psychotic disorder, so the psychotic symptoms like delusions occur after intoxication or withdrawal from the drug. Of those who experience methamphetamine psychosis, Large said, about half will develop schizophrenia over time.

In Muthart's case, her untreated bipolar disorder made her more prone to using drugs like crystal meth and more prone to experiencing psychotic symptoms while high.

"People do react very strongly to [self-enucleation] and it doesn't necessarily help the patients. They are very sick people in need of a lot of care, treatment, and rehab," Large said. It's important to treat the underlying psychiatric illness or drug addiction before the delusions about one's eyes become strong enough to prompt someone to hurt themselves.

Not to mention, attempting to blind yourself can be fatal. "Some of these patients just die because they end up pulling off an artery and it causes a hemorrhage in the brain," Large said.

"The eyes are the only part of the body that hasn't been ritually mutilated by one culture of another, because we have developed very strong prohibitions and mechanisms of protecting our eyes — these can only be overcome by very severe mental illness," Large said. "Self-enucleation is a clear example that delusions are firmly held real beliefs and they can be very strong. [...] Psychiatric problems are not made up."