Summary:A 24-year-old man involved in a single vehicle motor accident sustained a massive left temporoparietal compound depressive skull fracture. Although initially suffering aphasic symptoms, repeated screening testing at 5 years postaccident found no evidence of aphasia. Two years after the accident, the patient developed a chronic somatic delusion and requested to have his eye removed. The relationship between brain injury and psychosis is explored, as well as the ethical dilemma faced when presented with a delusional patient requesting surgical mutilation.