Ritual castration in some sects

1. Introduction

Version followed: the historical, legal and clinical record of ritual and religiously motivated castration as the historians, courts, news organisations and clinical reviews cited below document it. This guide describes no procedure.

Ritual castration is the removal or destruction of the genitals for a religious or group purpose, done by a person to themselves or by others in the name of a belief. It is a harmful practice, not a therapy. It is documented among the galli, the priests of Cybele (the Magna Mater) in the Graeco-Roman world [source: McElduff, UnRoman Romans]; among the Skoptsy, a Russian sect that broke from the Orthodox church in the eighteenth century and held that salvation required "the literal excision of the instruments of sin" [source: Princeton History, Engelstein book page; Lelièvre, DicoPolHiS]; among some male members of the Heaven's Gate group, as the San Diego medical examiner disclosed in 1997 [source: AP/Seattle Times 1997]; and in criminal allegations that followers of the Dera Sacha Sauda in Sirsa, India, were induced to undergo castration, a case now before a CBI special court [source: LiveLaw 2018; ETV Bharat 2024]. A separate and contested topic is nirvan, an initiation associated with some hijra communities in South Asia. Community identity has to be kept apart from coercion here, and assumptions about prevalence are often wrong [source: Rehan 2011; Gayan and Sonu 2025].

The groups' own idea of "change" was spiritual: in their teaching, removing the body's sexual capacity brought purity, salvation, immortality or nearness to God [source: Engelstein page; Lelièvre; AP 1997; PTI 2014]. The psychotherapist's idea of change is different. It means recognising the risk early, routing urgent medical care, assessing psychosis, suicide risk and coercion, protecting minors, and helping survivors, former members and families rebuild meaning, identity and safety [synthesis]. Cross-reference: the Heaven's Gate harm account in Domain XIV, guide 143.

2. Framework

This section has two parts: the historical phases of the practice in outline, and then the phases of the psychotherapist's own work.

Historical phases (outline, attributed).

Classical antiquity. The worship of Cybele came to Rome from Pessinus in Anatolia in 204 BCE. Its galli wore saffron robes, processed through the streets with cymbals, and castrated themselves as a sign of devotion. Roman citizens were barred from becoming her priests, apart from the chief priest. A senate decree reported by Dionysius of Halicarnassus kept native Romans from Phrygian rites. Ancient witnesses include Livy, Lucretius, Catullus (Poem 63), Lucian (On the Syrian Goddess) and Prudentius, many of them hostile outsiders [source: McElduff]. [uncertain: modern historians' interpretation of these texts not verified]
Russian Empire, eighteenth to early twentieth centuries. Lelièvre traces the Skoptsy to a peasant, Andrei Ivanov, who in 1757 seized on New Testament passages praising eunuchs, and to Kondratii Selivanov, whom followers believed to be Peter III reborn [source: Lelièvre]. The Brockhaus-Efron encyclopedia dates the first official record to a 1772 decree of Catherine II ordering an inquiry in Orel province [source: ESBE "Skoptsy"]. The two dates differ; both are given as attributed. More than 5,000 Skoptsy were deported to Siberia between 1805 and 1870. A 1905 decree eased residence limits. The sect went underground in the 1920s and had almost disappeared by the 1930s [source: Lelièvre]. Engelstein's publisher page says it was destroyed in the Stalinist Terror [source: Princeton History].
Late twentieth century. In March 1997 the medical examiner in the Heaven's Gate deaths stated that some male members, including the leader, had been castrated well before the deaths, in pursuit of what was described as "androgynous immortality" [source: AP/Seattle Times 1997].
Twenty-first century. In December 2014 the Punjab and Haryana High Court ordered a CBI inquiry, on the petition of a former follower, into allegations that about 400 Dera Sacha Sauda followers had been castrated inside the ashram on the chief's orders [source: PTI/Business Standard 2014]. The case was pending in the CBI special court in Panchkula as of December 2024 [source: ETV Bharat 2024]. [uncertain: later developments]

Phases of the psychotherapist's work [synthesis, drawing on Lupu et al. 2021 for the medical points]:

Recognition and immediate safety. Spot disclosure cues, intent or recent injury. Any recent injury, or a plan with imminent intent, is a medical emergency [source: Lupu et al. 2021]. Move on only once the person is medically safe and immediate suicide risk is managed.
Assessment. Psychiatric evaluation, which the review describes as mandatory after the acute phase [source: Lupu et al. 2021]. This covers suicide risk, psychosis and religious delusions, substance use, coercion by a group or leader, the cultural and religious context, and gender identity. Move on when a formulation is shared with the client and the care team.
Safeguarding and reporting. Child-protection duties, the adult-at-risk route, and police or legal routes where coercion or deception is alleged. This runs alongside every other phase.
Processing and repair. Trauma-informed work on loss, shame, body image, identity, faith and group exit, with long-term follow-up because recurrence is common [source: Lupu et al. 2021].
Advocacy and follow-up. Access to medical, gender and legal services. Reducing stigma against communities that are wrongly assumed to practise castration. Family work.

Format and length: session number and length follow the client's needs and the setting [synthesis]. Plan care around clinical need inside a multidisciplinary team [source: Lupu et al. 2021].

3. Guiding principles

Medical safety first. Genital self-injury is an emergency: route to urgent medical or urological care before any talking work [source: Lupu et al. 2021].
Assume high suicide risk until assessed. The review reports that 55 to 85 percent of people who self-mutilate have attempted suicide at least once. Always ask directly [source: Lupu et al. 2021].
Look for psychosis without assuming it. In older case series most cases were psychotic, but some authors find fewer. Non-psychotic causes include cultural or religious belief, gender dysphoria, personality disorder, sexual guilt and intoxication. Assess rather than presume [source: Lupu et al. 2021]. Where gender dysphoria is part of the picture, the response is affirmation and access to licensed gender-affirming care (4.8), never suspicion of the client's identity [synthesis].
Be tactful and non-judgemental. The review recommends tactful, non-judgemental, long-term multidisciplinary care. Shame closes disclosure [source: Lupu et al. 2021].
Separate belief from coercion. Respect a client's faith while assessing who promised what, who decided and who benefited. Courts treat deception and intimidation as crimes: the Dera case charges include cheating and criminal intimidation [source: LiveLaw 2018].
Gender identity is not coercion. A transgender or hijra client's identity is to be affirmed. India's Supreme Court held that gender self-identification is a constitutional right and that "no one shall be forced to undergo medical procedures" for legal recognition [source: NALSA v. Union of India (2014), Columbia GFoE summary].
No stereotyping of communities. A study of 400 hijras in Karachi and Lahore found genital removal in only three [source: Rehan 2011]. Do not assume any member of a community has been, or will be, castrated.
Never facilitate. The psychotherapist never provides, supervises, endorses or refers for a ritual or non-medical castration. Medically indicated gender-affirming care is a separate matter, handled by specialist services [synthesis].
Children are protected absolutely. The historical record includes the acquisition of boys by the Skoptsy [source: ESBE "Skoptsy"]. Any risk to a minor triggers child-protection procedures [synthesis].
No method detail. In session, in notes and in psychoeducation, never discuss how the act is done. Discuss only safety, meaning and support (safe-messaging practice) [synthesis].
Cultural humility. Use the Cultural Formulation Interview and its spirituality, religion and moral traditions module. Where the problem centres on religion, the DSM-5-TR "Religious or Spiritual Problem" may be coded Z65.8 [source: ICD-10-CM Z65.8 (Unbound Medicine)].
Plan for recurrence. The review calls stopping these behaviours completely "almost illusory", while noting that psychiatric counselling reduces self-aggression. Plan follow-up rather than discharge after one episode [source: Lupu et al. 2021].

4. Intervention inventory

The interventions below are the psychotherapist's own work; steps not drawn from a cited source are marked [synthesis].

None of these interventions describes, rehearses or discusses how a castration is carried out. If a client brings method detail, acknowledge it without exploring it and redirect to safety and meaning [synthesis].

4.1 Historical literacy for the clinician

Purpose: know the documented contexts well enough to recognise religious framing ("eunuchs for the kingdom of heaven's sake", purity, immortality, meeting God) and to avoid both alarmism and dismissal. Use it before working with clients from relevant religious, migrant or ex-member backgrounds [source: Princeton History, Engelstein page; AP 1997; PTI 2014].
Steps: (1) Read the outline in section 2 and the harm account. (2) Note each group's stated justification and the coercive features recorded by sources: material inducement, debt bondage and the acquisition of boys (ESBE), and promises of meeting God (PTI 2014). (3) Note that hostile outsider sources shape the ancient and imperial record [source: McElduff; ESBE]. (4) Keep this knowledge for recognition. Never share method detail [synthesis].
Example language (illustrative): "Some groups in history taught that giving up the body's sexuality was the route to salvation. I'd like to understand what your group taught you about the body."
Watch for: using history to exoticise a client, or presenting a living community (for example hijra communities) as identical to a historical sect [synthesis].

4.2 Recognising disclosure cues

Purpose: catch intent or prior injury early. Clients may hint rather than state.
Steps: (1) Listen for religious statements about the body as sinful or impure, vows of total abstinence, talk of becoming "pure", "androgynous" or "closer to God" through the body, and a leader's promise attached to bodily sacrifice [source: Lupu et al. 2021 on cultural and religious beliefs; AP 1997; PTI 2014]. (2) Note risk factors the review lists: psychosis, depression, bipolar disorder, borderline personality disorder, intoxication, imprisonment, childhood deprivation or trauma [source: Lupu et al. 2021]. (3) Ask a direct, calm question about thoughts of harming the genitals. (4) Do not ask how [synthesis].
Example language (illustrative): "Sometimes when people feel their body or their sexuality is shameful, they have thoughts of hurting that part of the body. Have you had thoughts like that?"
Watch for: sudden calm after distress, giving away possessions, secrecy about a group's "final step", or medical avoidance [synthesis].

4.3 Urgent medical routing

Purpose: get any recent injury, or imminent intent, to emergency care. The review treats genital self-mutilation as a medical emergency requiring urgent urological or surgical care [source: Lupu et al. 2021].
Steps: (1) If injury is recent or suspected, call emergency services or arrange immediate transfer to an emergency department. Do not examine and do not give first-aid instruction beyond telling the person to seek help now [synthesis]. (2) If intent is imminent, do not leave the person alone. Follow your service's emergency protocol [synthesis]. (3) Tell the emergency team, with consent where possible, that psychiatric assessment is needed after the acute phase [source: Lupu et al. 2021]. (4) Record what was said, when and who was informed [synthesis].
Example language (illustrative): "What you're telling me means your body needs medical help right now. I'm going to stay with you while we get you to the hospital."
Watch for: minimising ("it's healed", "it was years ago"). Old injuries still warrant a medical review of complications [synthesis].

4.4 Suicide-risk assessment and safety planning

Purpose: the review reports 55 to 85 percent of people who self-mutilate have attempted suicide, and genital self-injury may be a suicide attempt in major depression [source: Lupu et al. 2021]. Group contexts can add risk: the Heaven's Gate deaths followed earlier castrations [source: AP 1997].
Steps: (1) Ask directly about suicidal thoughts, intent, plans and past attempts. Do not discuss method beyond what lethal-means counselling needs (storage, removal, who holds what) [synthesis]. (2) Ask whether the group or leader speaks of death, "leaving the body" or a coming end [synthesis]. (3) Build a written safety plan: warning signs, coping steps, people to contact, professional contacts and crisis lines (988 in the US; Samaritans 116 123 in the UK and Ireland). (4) Arrange follow-up within your service's timeframe [synthesis].
Example language (illustrative): "When people have hurt their bodies like this, they sometimes also think about ending their life. Are you having thoughts of suicide?"
Watch for: spiritual framing of death as graduation or reunion. Treat it as risk, not just belief [synthesis].

4.5 Assessing psychosis and religious delusion

Purpose: early detection and treatment of psychosis can reduce episodes [source: Lupu et al. 2021]. Religious delusions are linked in the literature to what Schweitzer (1990) called "Klingsor syndrome" [source: Lupu et al. 2021].
Steps: (1) Separate shared group doctrine from idiosyncratic belief: does the client's community hold this view, or is it the client's alone? [synthesis]. (2) Screen for hallucinations (including command hallucinations), delusional guilt and recent onset of psychosis [synthesis]. (3) Refer urgently to psychiatry. The psychotherapist does not start, stop or change medication. (4) Share the formulation with the team.
Example language (illustrative): "Do the people in your faith community believe this too, or is this something that has come to you personally? Are you hearing anything telling you to do it?"
Watch for: labelling a culturally shared belief as delusional, or missing psychosis because the content sounds religious [synthesis].

4.6 Assessing coercion by a group or leader

Purpose: courts and investigators have treated inducement into castration as crime. The Dera case charges include criminal conspiracy, criminal intimidation, voluntarily causing hurt by dangerous weapons, and cheating [source: LiveLaw 2018].
Steps: (1) Map the group: leader, hierarchy, promises made, costs of leaving [synthesis; ESBE notes hierarchy and inducements]. (2) Ask who first suggested the act, who arranged it, who paid, and what was promised (salvation, "meeting God") [source: PTI 2014; synthesis]. (3) Ask about debts, housing, work and family held by the group [source: ESBE on debt bondage; synthesis]. (4) Assess capacity and freedom of choice. (5) Record carefully, because the record may be needed in legal proceedings [synthesis].
Example language (illustrative): "Whose idea was this first? What did they tell you would happen if you did it, and what would happen if you didn't?"
Watch for: the client defending the leader. Do not argue doctrine; stay with safety and choice [synthesis].

4.7 Cultural and religious formulation

Purpose: understand the meaning of the body, gender and holiness in the client's tradition.
Steps: (1) Use the DSM-5-TR Cultural Formulation Interview with the spirituality, religion and moral traditions module [synthesis]. (2) Where appropriate, code a Religious or Spiritual Problem as Z65.8 [source: ICD-10-CM Z65.8 (Unbound Medicine)]. (3) With consent, consult a culturally knowledgeable colleague or faith adviser not linked to the group [synthesis]. (4) Draw on spiritual and religious competencies (Vieten et al. 2013) [synthesis; uncertain: not verified].
Example language (illustrative): "In your tradition, what does it mean to be pure? Are there other ways your tradition offers to live that out?"
Watch for: imposing your own secular frame. Look for counter-voices inside the tradition that protect the body [synthesis].

4.8 Distinguishing gender-affirming needs from coercive practice

Purpose: transgender, non-binary and hijra clients may have genuine gender-affirming goals. These are not ritual castration, and must not be pathologised. Coercion inside a community must still be recognised. Researchers in Chandigarh-Mohali describe nirvan performed by a senior hijra at recruitment, with some entrants required to accept practices against their choice, and a risk of "deep mental and physical injury" [source: Gayan and Sonu 2025]. Prevalence varies widely [source: Rehan 2011].
Steps: (1) Affirm the client's stated gender identity [source: NALSA 2014 on self-identification]. (2) Separately ask whether anyone is pressuring the client toward a bodily procedure as a condition of belonging, livelihood or protection [source: Gayan and Sonu 2025; synthesis]. (3) If the client wants gender-affirming medical care, refer to a licensed gender service, never to a non-medical or ritual route [synthesis]. (4) Tell the client that legal recognition in India does not require any medical procedure [source: NALSA 2014].
Example language (illustrative): "Your gender is yours to name. I also want to check: is anyone telling you that you have to have something done to your body to belong, or to keep your place?"
Watch for: framing gender identity as the problem, or treating every hijra client as at risk of castration [synthesis].

4.9 Working with a client drawn to the practice

Purpose: a client may be considering a ritual or self-performed castration for religious, ascetic or identity reasons.
Steps: (1) Treat this as active risk: run 4.3 to 4.5 [synthesis]. (2) Explore the meaning and need the act is meant to meet (purity, relief from sexual guilt, belonging, gender congruence) [source: Lupu et al. 2021 on motives; synthesis]. (3) Name irreversibility and the documented medical and psychological harms, without method detail [synthesis]. (4) Agree on delay and a safety plan, and bring in medical, psychiatric and, where relevant, gender services [synthesis]. (5) Never assist, endorse, or refer to anyone offering a ritual or non-medical route [synthesis].
Example language (illustrative): "It sounds as if this would bring you a feeling of peace you badly need. Can we look together at that need, and at safer ways to meet it, before anything is done that can't be undone?"
Watch for: rising certainty, contact with people offering to perform it, or secrecy. Escalate to emergency routes if intent becomes imminent [synthesis].

4.10 Safeguarding minors

Purpose: the historical record includes the acquisition of boys by the Skoptsy, and nineteenth-century rumours that children were bought to be castrated fuelled persecution [source: ESBE "Skoptsy"; Lelièvre]. Any present-day risk to a child is a child-protection matter [synthesis].
Steps: (1) If a child is at risk of, or has suffered, genital injury in a religious or group context, follow your jurisdiction's mandatory reporting and child-protection procedures without delay. Do not investigate yourself [synthesis]. (2) Arrange urgent medical care where injury is suspected [source: Lupu et al. 2021]. (3) Inform the child, in age-appropriate words, what will happen next, and seek assent for what can be chosen [synthesis]. (4) Record facts and the words used [synthesis].
Example language (illustrative): "What you've told me is important, and my job is to help keep you safe. I need to tell people whose job is to protect children, and I'll tell you what happens next."
Watch for: pressure from adults to keep the matter inside the community, or a child being moved away suddenly [synthesis].

4.11 Adult safeguarding, reporting and legal routes

Purpose: adults coerced or deceived into castration may be victims of crime. In the Dera case, a former follower's petition led the Punjab and Haryana High Court to order a CBI inquiry [source: PTI/Business Standard 2014].
Steps: (1) Explain confidentiality and its limits. (2) With consent, help the client contact police, legal aid or a human-rights organisation. Where an adult lacks capacity or is at serious risk, use your local adult-at-risk procedures [synthesis]. (3) Keep factual notes that can support later testimony. (4) Prepare the client for the length of legal proceedings: the Dera case was still pending a decade after the probe was ordered [source: ETV Bharat 2024].
Example language (illustrative): "You have the right to report what was done to you. I can't make that decision for you, but I can help you understand the options and support you whichever way you choose."
Watch for: fear of retaliation by the group. Assess safety before any report [synthesis].

4.12 Trauma-informed work with survivors

Purpose: address the "deep mental and physical injury" researchers describe [source: Gayan and Sonu 2025], together with shame, grief for an irreversible loss, and altered body image.
Steps: (1) Stabilise first: sleep, safety, medical follow-up [synthesis]. (2) Give the client control over pace and over what is spoken about. No detail of the act is needed for therapy [synthesis]. (3) Address shame and self-blame, including the effects of deception ("I was told it would bring me to God") [source: PTI 2014; synthesis]. (4) Use evidence-based trauma therapy where PTSD is present, as current guidelines recommend [synthesis; uncertain: specific guideline not verified]. (5) Coordinate with medical and endocrine care. Never advise on medication [synthesis].
Example language (illustrative): "You made a decision inside a system that told you it was holy. Understanding how that happened is not the same as blaming yourself."
Watch for: dissociation, renewed self-harm and isolation. Revisit 4.4 regularly [synthesis].

4.13 Working with former members of a group

Purpose: support identity rebuilding after leaving a group whose teaching required bodily sacrifice [synthesis].
Steps: (1) Explore what the group gave (meaning, belonging, structure) as well as what it took [synthesis]. (2) Grieve community, faith and future plans [synthesis]. (3) Rebuild independent decision-making and social ties outside the group [synthesis]. (4) Where faith continues, support a relationship with the tradition that does not require self-harm [synthesis].
Example language (illustrative): "Leaving can mean losing your whole world at once. What did you lose that you'd like to find again in a safer form?"
Watch for: recruitment back into the group, or an outside group that mirrors its demands [synthesis].

4.14 Family work and bereaved families

Purpose: support relatives of members who were castrated, or who died. Thirty-nine Heaven's Gate members died in 1997 [source: AP 1997].
Steps: (1) Offer bereavement support that respects the family's ambivalence: love, anger, incomprehension [synthesis]. (2) Give accurate, non-sensational information about what is publicly known. Follow safe-messaging practice: no method detail, no glamorising [synthesis]. (3) Help families stay in contact with a member still inside a group without pressure tactics, and route any risk through 4.10 and 4.11 [synthesis]. (4) Assess bereaved relatives' own suicide risk and give crisis lines: 988 (US) or Samaritans 116 123 (UK and Ireland) [synthesis].
Example language (illustrative): "Many families feel they should have seen something. What happened was shaped by the group's teaching, not by your failure to stop it."
Watch for: media intrusion and complicated grief. Refer to specialist bereavement services where needed [synthesis].

4.15 Working with a client's interest in the history or heritage

Purpose: clients may be descendants of Skoptsy families (for example among emigrant communities in Romania [source: Lelièvre; ESBE]) or may be researching the galli or hijra history.
Steps: (1) Explore what the interest means to the client: identity, family story, spirituality, gender [synthesis]. (2) Offer accurate attributed history and note the hostile bias of many sources [source: McElduff; ESBE]. (3) Screen gently for any personal risk if the interest is intense or new [synthesis].
Example language (illustrative): "What draws you to this history? Is it about your family, your faith, your sense of your own body, or something else?"
Watch for: romanticisation of self-sacrifice. If it appears, move to 4.2 and 4.9 [synthesis].

4.16 Multidisciplinary coordination and long-term follow-up

Purpose: the review recommends long-term multidisciplinary care and warns that cases are often repetitive [source: Lupu et al. 2021].
Steps: (1) Agree roles with urology or surgery, psychiatry, primary care and, where relevant, gender services [synthesis]. (2) Share risk information within consent and law. (3) Set a relapse-prevention plan with early-warning signs: return of psychosis, intoxication, renewed group contact, anniversaries [source: Lupu et al. 2021 on risk factors; synthesis]. (4) Schedule follow-up rather than closing the case after the crisis [synthesis].
Example language (illustrative): "Several people will be helping you: the surgical team, the psychiatrist and me. With your permission, we'll keep each other informed so nothing falls through the gaps."
Watch for: disengagement after medical discharge, which is a known risk point [synthesis].

4.17 When a colleague, healer or institution facilitates the practice

Purpose: in the Dera case, doctors at the group's own hospital were alleged to have carried out the castrations, and two doctors were charged alongside the leader [source: PTI 2014; LiveLaw 2018].
Steps: (1) If a clinician, healer or institution is facilitating non-medical or coerced castration, report to the relevant regulator, to police and, for children, to child protection [synthesis]. (2) Do not take part, supervise or refer [synthesis]. (3) If you also hold a role in the client's religious community, consider APA Ethics Code Standard 3.05 (Multiple Relationships) and step back if objectivity or the client's welfare is at risk [source: APA Ethics Code]. (4) Seek supervision and document your actions [synthesis].
Example language (illustrative, to a colleague): "I'm concerned that what's happening here puts patients at serious risk of irreversible harm. I'm obliged to raise it formally, and I wanted you to hear that from me first."
Watch for: institutional pressure to stay silent. Reporting duties override it [synthesis].

4.18 Advocacy and stigma reduction

Purpose: protect communities from false assumptions and improve access to safe care. A Pakistani study found genital removal in 3 of 400 hijras examined, which challenges a widespread belief [source: Rehan 2011]. India's Supreme Court affirmed the dignity and self-identification of transgender people [source: NALSA 2014].
Steps: (1) Correct stereotypes in multidisciplinary teams and case discussions [synthesis]. (2) Support clients' access to legal gender recognition and to licensed health care [source: NALSA 2014; synthesis]. (3) Where coercion exists in any community, support members who speak up, without collective blame [synthesis].
Example language (illustrative, to a team): "Most people in this community have not had any such procedure. Let's assess this client as an individual."
Watch for: advocacy drifting into speaking for a community rather than with it [synthesis].

5. Handling problems

The client insists the act was freely chosen and holy. Do not argue theology. Explore the conditions of the choice: information, alternatives, promises, the costs of refusing. Accept the client's meaning while naming harms [synthesis]. Courts can treat inducement by false promise as cheating even when a follower consented [source: LiveLaw 2018].
The client is still in the group and loyal to the leader. Keep the relationship open, focus on safety and health, and avoid ultimatums. Monitor risk to the client and to any children in the group [synthesis].
Overwhelm and shame during disclosure. Slow down. Tell the client details are not needed. Use grounding, and end sessions with a stabilising summary [synthesis].
Recurrence after an earlier episode. Expect it rather than treating it as failure: the review reports frequent repetition and treatment resistance. Re-engage the multidisciplinary team and review psychosis, intoxication and stressors [source: Lupu et al. 2021].
Non-adherence to psychiatric or medical follow-up. Explore the barriers: distrust of doctors after abuse by group-affiliated clinicians, cost, shame. Offer accompanied appointments where permitted [synthesis; source: PTI 2014 on doctors at the group's hospital].
Rupture over gender identity. If a transgender or hijra client feels pathologised, acknowledge it, restate that gender identity is not the concern, and clarify that only coercion or self-injury is [synthesis; source: NALSA 2014].
Rupture over reporting. If a mandatory report damages trust, explain the duty, express care, and stay available [synthesis].
Clinician reactions (disgust, fascination, alarm). Take them to supervision. They can leak into questioning that is voyeuristic or shaming [synthesis].
Method talk in session. Gently redirect from how to why and what now, and record risk [synthesis].
Media attention or legal proceedings. Help the client prepare for testimony and press coverage. Protect confidentiality, and never disclose a client's identity [synthesis].
Uncertainty about whether a belief is delusional. Seek psychiatric and cultural consultation. Do not decide alone [source: Lupu et al. 2021; synthesis].
Suicidal crisis. Activate the safety plan and emergency services. Give 988 (US) or Samaritans 116 123 (UK and Ireland) [synthesis].

Harm account

What was actually done

Galli of Cybele (Rome, from 204 BCE). Male priests of the goddess castrated themselves as an act of devotion and then lived as her servants, in saffron robes, processing through the streets with cymbals. Roman citizens were barred from the priesthood and from Phrygian rites, except for the chief priest [source: McElduff].
Skoptsy (Russian Empire, eighteenth century to the 1930s). Men and women of a peasant-based sect underwent ritual mutilation of the genitals (and, for some women, the breasts). This was often done as a ritual before the congregation, often after members had had two children. It was justified by New Testament passages praising eunuchs and by the hope of becoming "eunuchs for the kingdom of heaven's sake" [source: Lelièvre; Princeton History, Engelstein page]. Recruitment drew on the poor and, according to the Brockhaus-Efron entry, used material inducement, debt bondage and the acquisition of boys [source: ESBE "Skoptsy"]. The state answered with inquiries, penal labour and mass deportation to Siberia [source: ESBE; Lelièvre].
Heaven's Gate (California, before 1997). Some male members, including the leader, had been castrated well before the group's deaths in March 1997, as the San Diego County medical examiner disclosed. The reported aim was "androgynous immortality" [source: AP/Seattle Times 1997]. [uncertain: where and by whom; not stated in the report]
Dera Sacha Sauda (Sirsa, Haryana; allegations). A former follower petitioned that about 400 followers were castrated inside the ashram, on the chief's orders, by doctors at the group's hospital, with the assurance that they would "meet the God through the Dera head" [source: PTI/Business Standard 2014]. The CBI charged Gurmeet Ram Rahim Singh and two doctors with criminal conspiracy, criminal intimidation, voluntarily causing hurt by dangerous weapons, and cheating. The defence argued that only six castrations were alleged in the chargesheet [source: LiveLaw 2018]. These are allegations, and the case was pending trial as of December 2024 [source: ETV Bharat 2024].
Hijra nirvan (South Asia). Researchers in the Chandigarh-Mohali region describe nirvan as a ritual castration carried out by a senior hijra when recruiting new members, with some entrants required to accept practices against their choice [source: Gayan and Sonu 2025, conference abstract]. Other evidence shows the practice is far less common than often assumed [source: Rehan 2011]. Community members' own accounts of meaning and choice vary [uncertain: community statements not verified].

How it caused harm

Irreversible bodily loss and medical emergency. Genital self-mutilation requires urgent urological or surgical care [source: Lupu et al. 2021]. Non-medical settings add risk [synthesis].
Psychological injury. Researchers describe a risk of "deep mental and physical injury" [source: Gayan and Sonu 2025]. The clinical literature links genital self-injury to psychosis, depression, trauma and very high rates of prior suicide attempts [source: Lupu et al. 2021].
Deception and coercion. Promises of salvation or of meeting God were used to induce the act, and Indian prosecutors framed this as cheating and intimidation [source: PTI 2014; LiveLaw 2018]. Inducement and debt bondage drew in the poor and the young [source: ESBE].
Harm to children. The historical record includes boys acquired by the sect [source: ESBE].
Persecution and community harm. Skoptsy communities suffered exile and decline, and were destroyed under Stalin [source: Lelièvre; Princeton History]. Stereotypes about castration stigmatise hijra communities as a whole [source: Rehan 2011; synthesis].
Group death. In Heaven's Gate, castration was part of a belief system that ended in the deaths of 39 members [source: AP 1997].

Recognising it today

Teaching that the body or sexuality is the obstacle to salvation, combined with a leader's promise attached to a bodily sacrifice [source: PTI 2014; Princeton History; synthesis].
Clinicians or healers inside a closed group performing procedures on members [source: PTI 2014].
A requirement to undergo a bodily procedure as the price of belonging, livelihood or protection [source: Gayan and Sonu 2025].
In an individual: genital self-injury or intent, especially with psychosis, religious guilt, intoxication, trauma or depression [source: Lupu et al. 2021].
Children in a group where adults speak of such sacrifice [synthesis; source: ESBE historically].
Not a sign in itself: a person's transgender or hijra identity, or a request for licensed gender-affirming care [source: NALSA 2014; synthesis].

What to do instead and how to help those harmed

Medical first. Urgent urological or surgical care, then mandatory psychiatric evaluation and long-term multidisciplinary, non-judgemental follow-up [source: Lupu et al. 2021].
Mental health care. Treat psychosis early with psychiatry, which reduces episodes. Assess suicide risk and plan for safety, with crisis lines 988 (US) and Samaritans 116 123 (UK and Ireland) [source: Lupu et al. 2021; synthesis].
Gender-affirming needs through licensed services. Legal gender recognition in India does not depend on medical procedures [source: NALSA 2014].
Safeguarding and justice. Child-protection referral for any risk to a minor. Police, courts and legal aid for coerced adults: a former follower's petition led to the High Court ordering a CBI inquiry [source: PTI 2014].
Survivor, ex-member and family support. Trauma-informed therapy, bereavement support and reintegration work (sections 4.12 to 4.14) [synthesis]. No survivor organisation specific to this practice is known [uncertain].
Professional duty. Never provide, supervise or refer for ritual or non-medical castration. Report facilitators to regulators and police (section 4.17) [synthesis].

Sources

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