Clinical Vampirism: Blending Myth and Reality* Philip D. Jaffe and Frank DiCataldo Vampires arouse strong popular interest and attract large print and film audiences. Their influence is also notable in clinical vampirism, a rare condition described in the forensic literature covering some of humanity's most shocking behaviors. Defi- nitions of vampirism involve aspects of necrophilia, sadism, cannibalism, and a fascination with blood. Its relationships with established diagnostic categories, particularly schizophrenia and psychopathy, are also examined and illustrated by the presentation of a "modern" vampire. As myth and reality are disentangled, clinical vampirism reveals the complex mother-child dyad's blood ties running amok. In the modern age, vampires have be- manity. In this article, we review the come media stars. Published in 1897, clinical aspects of overt vampiristic be- Dracula by Bram Stoker' made the word havior and its various definitions and "vampire" a household term. More re- describe its relationship to more estab- cently, the vampire trilogy by Anne lished psychiatric disorders. The original Ri~e~-~became a bestseller. On the silver case study of a "modern vampire" will screen, W. Murnau's Nosferatu (Prana help illustrate how myth and reality can Films, Berlin, 1992) remains a classic blend and solidify in dramatic fashion. and a new Dracula movie is periodically But first, by way of introduction, we released to please today's audiences. review the vampire myth to which clin- This enduring fascination with vampires ical vampirism owes its existence. evolved from beliefs and superstitions Mythological Precursors to the dating back to medieval Europe and to Modern Vampire humankind's most archaic myths. Cur- Records of vampirelike figures exist in iously, while providing inspiration for several ancient religions. Commonly the arts, their legacy is also found in the mentioned are the Vajra deities of Tibet rare clinical condition of vampirism, represented as blood drinkers, the which groups some of the most shocking Atharva Veda and the Baital-Pachisi in pathologic behaviors observed in hu- ancient Indian literature, and Mexico's Ciuateteo, who was associated with Philip D. Jaffi is a faculty member of Psychology and women in Mexico having died during Education Sciences, University of Geneva, Switzerland. Frank DiCataldo is affiliated with Bridgewater State their first labor. Summers5 describes Hospital, Bridgewater, MA. Address all correspondence to Dr. Philip D. Jaffk, University of Gcncva, FPSE, 9 what is perhaps the first pictorial evi- route de Drize, 1227 Carouge, Switzerland. dence of the vampire, an Assyrian bowl Bull Am Acad Psychiatry Law, Vol. 22, No. 4, 1994 533 Jaffe and DiCataldo showing a man copulating with a female vapor and mist. In addition, because the vampire whose head has been severed. vampire is "dead" and soulless, it has no He also reports on Babylonian, Semite, reflection. Those who the vampire at- and Egyptian beliefs involving a dead tacks are generally in a trance and are person that continues to live in its orig- almost sensually embraced while their inal body and feeds off the living. Similar blood is sucked. Summers5 also relates ancient beliefs are traced to ancient Eu- more cannibalistic practices, whereby ropean, Chinese, Polynesian, and Afri- the vampire bites the victim's abdomen can cultures, and most refer to demonic and sometimes extracts and eats the female figures and fused relationships heart. The victim eventually dies and, between the living and the dead, ex- unless proper measures are taken, will pressed through blood rituals as well as in turn become a vampire. Other ways sexualized and aggressive exchanges. to join the "undead," depending on local Current manifestations of these ancient tradition, are to commit suicide, practice beliefs still are found in voodooism and black magic, be cursed by parents or the associated practices in the Caribbean church, be a werewolf, or even be an and in Latin America. In Catholicism, unlucky corpse in Greece on the way to wine continues to symbolize Christ's the cemetery and have a bird or cat cross blood and is consumed by priests during in front of the procession. Jones6 reports mass.+ that in Dalmatia vampires were divided The modern vampire media myth in two categories: innocent and guilty, probably originated in Scandinavia and respectively called Denac and Orko. the British Isles, but it most firmly took Some of the prerequisites to becoming hold in medieval Central and Eastern an Orko vampire were working on Sun- Europe. It owes its etymology to Slavic day, smoking on a religious holiday, and languages (e.g., upir in Bulgarian, vopyr incestuous relations with a female as- in Russian, vapir in Serbian, vampir in cendant, in particular, a grandmother. Hungarian). Periodic vampire scares To counter vampires, schemes rang- agitated these regions and their supersti- ing from the crude to the elaborate were tious inhabitants late into the 19th cen- designed to identify potential vampires tury. A prevalent belief involved a per- and to eliminate them from the world son who had died leaving his tomb at of the living. Garlic and the crucifix were night to attack his victims, often friends considered effective apotropaics (i.e., and relatives, to suck their blood to re- protective measures against evil). Iden- tain his own immortality. The vampire tifying vampires in many ways paral- then returned to his coffin before sunrise leled witch-hunting techniques. Tell-tale or risked paralysis and total helplessness. signs indicating a possible vampire were Some superstitions give the vampire unusual birthmarks, infants born with the power of metamorphosis, the ability teeth, red-haired and sometimes blue- to transform into animal form (most eyed children, tall and gaunt people, and frequently a butterfly or a bat)$ or into epilepsy. Tombs often were opened to 534 Bull Am Acad Psychiatry Law, Vol. 22, No. 4, 1994 Clinical Vampirism see if the cadaver had moved, if it had people were perhaps mistakenly buried fresh cheeks, open eyes, and if the hair alive while suffering from catatonic stu- and nails were still growing. Similar rit- por and hysterical state^.^ Barberlo offers uals were performed in Connecticut in elements of forensic pathology to under- the 18th and 19th centuries.' stand the combined effects of premature Suspected vampires or suspicious burials and human tissue decomposition corpses faced a variety of measures. (e.g., cadavers may change position and These ranged from symbolic exorcism hair and nails may continue to grow). to brutal mutilation. In Bulgaria a sor- There is also an explanation based on cerer armed with a saint's picture would the porphyrias, genetic disorders that drive the vampire into a bottle, which produce reddening of the eyes, skin, and was then thrown into a fire.8 Elsewhere, teeth; receding of the upper lip, craclung the suspected vampire would be put to of the skin; and bleeding in ~unlight.~~'I death, and some of its blood or flesh These reality-based speculations can- consumed. If already buried, the cadaver not fully account for the vampire myth, was unearthed and the head severed and which is too psychologically complex placed between the feet. If necessary the and deeply embedded in ancient pow- heart was also boiled in oil and dissolved erful beliefs and symbols. Indeed, in vinegar. The most popular response Wilgowicz12 points out that Dracula is was to impale the vampire on a wooden only the "typical figure of a large family stake with a single blow through the with entangled branches." In a sense, the heart. Sometimes a priest was called on more modern and media-inspiring im- to shoot the vampire with silver bullets. age of the vampire masks fundamental The image of the vampire also owes aspects of the underlying myths and ar- much of its notoriety to reality. A com- chetypes, the very ones that may allow panion in arms of Joan of Arc, Gilles de for a more significant understanding of Rais, in the 15th century and the Hun- the rare clinical condition of vampirism. garian Countess, Erzsebet Bathory, two Indeed, today's human beings who are centuries later, are famous for having described as vampires owe this label pri- murdered up to 600 children to obtain marily to overt behavior. Yet, closer ex- their blood. Dracula, Bram Stoker's lit- amination reveals the power of the more erary creation, was probably inspired by ancient vampire myths and the process Vlad, a Walachian nobleman in the 15th by which they are transposed into mod- century whose cruelty earned him two ern manifestations. epithets "Tepes" (i-e., "the Impaler") and Count "Dracul" (i.e., "dragon" or Clinical Vampirism: Overview "devil"). and Definitions Several authors suggest that the "un- Both clinical and forensic psycholo- dead" quality of vampires may have re- gists and psychiatrists have described sulted from inadequate or premature cases that involve acts that are strongly burial during times of plague.%any reminiscent of some aspect of the myth- Bull Am Acad Psychiatry Law, Vol. 22, No. 4, 1994 535 Jaffe and DiCataldo ical vampire's behavior. Clinical defini- object (usually a love object) and receiv- tions of vampirism reviewed in the lit- ing resultant sexual excitement and erature place the emphasis on overt pleasure." In this view, the sucking or vampiristic behavior. drinking of blood from the wound is In the broadest definition, Bour- often an important part of the act but guignon13 proposes to call "vampirisms not an essential one. They report on a [. .] all sexual or aggressive acts- case of a young man serving a prison whether or not there is blood suction- sentence who came to the attention of committed on a deceased or a dying prison authorities after several inmates person." This view tends to cover a va- were caught stealing iron tablets and riety of behaviors that the author himself expressed a fear of developing anemia.