To the Editor.—
The case report by Ned H. Kalin, MD (241:2188, 1979), and the editorial comment by John P. Callan, MD (241:2193, 1979), concerning two episodes of self-surgery by a psychotic young man certainly made bizarre reading. The case is unusual, indeed, and Dr Callan rightfully concludes that there should be ways to detect such patients before the event occurs. However, this episode may be merely an index case of a much more widespread phenomenon.I frequently see patients who have had one half dozen or more operations for abdominal pain. On a few occasions, the patient's history, physical examination findings, and postoperative state have been convincing enough to lead me to add my name to a growing list of surgeons who have already operated, and probably will again, on such patients. Although I am not a psychiatrist, it seems to me that most of these patients are depressed.