CASE REPORT S Afr Psychiatry Rev 2006;9:163-168 Clinical Vampirism: a review and illustrative case report K Gubb1, J Segal1,2, A Khota1,2, A Dicks1 1Tara Hospital, The H Moross Centre, Sandhurst, Johannesburg, South Africa 2Division of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Abstract This paper aims to review the phenomenology of vampirism and the various forms of its expression including its presentation in the psychopathology of psychotic disorders. We will explore in detail the case of an African vampire in a psychiatric clinical setting. Vampirism does not have roots in traditional African culture or folklore and thus this case is worth examining due to the unusual nature of the patient’s clinical presentation. After a review of the literature, both lay and professional, a clinical case will be described. The discussion will suggest a biopsychosocial and contemporary psychoanalytic understanding of vampirism, and more specifically, of this patient. We also propose an additional type of vampirism be considered for inclusion in the classification of clinical vampirism. Keywords: Vampirism; Psychic vampirism; African; Schizophrenia; Psychoanalytic Received: 21.07.05 Accepted: 07.10.05 Introduction thought and ongoing fascination with the subject is suggested The mythology of vampirism has its roots in several religions by the many websites, books and films dedicated to it.8-10 and cultures.1,2,3 Definitions of vampires and vampirism vary Psychic vampirism is a fairly recently described widely. Vampires in mythology are usually defined as being phenomenon. Psychic vampires are defined as the consumers undead, immortal and shadowy figures that occupy the worlds of the “energy” of others, rather than their blood or other of both the living and the dead. They are able to cross the bodily fluids, but still have the aim of taking the victim’s life- divide between these worlds at will. They are powerful giving powers in order to sustain themselves without resorting creatures that elicit fear, intrigue and fascination, and who take to physical contact with the victim.11-15 The earliest reference in their power from others.4 In psychiatric texts, clinical the professional literature that we were able to access relating vampirism is defined as a belief in bloodsucking ghosts or to psychic vampirism was a definition given in an performing the actions of a vampire with the sense of drawing encyclopaedia of metaphysical medicine.15 This definition blood from an object with accompanying sexual pleasure.5 expanded the concept of psychic vampirism to include Others consider clinical vampirism, or the act of drinking the various forms of physical and sexual contact with the victim in blood of a victim, to be a very rare phenomenon usually the following ways: firstly bodily or close contact with young associated with a schizophrenic disorder.6 Some reference virgins of either sex was considered to be a popular method texts do not index the condition at all.7 Other definitions of of “rejuvenating” the body. Secondly, psychic vampirism was clinical vampirism consider sexual or aggressive acts also associated with sexual activity, where “vital energy” is committed on the dead or dying as central to the condition. mutually exchanged during the course of vaginal penetration. Further definitions reject overt necrophilic activity but do It was specifically noted that the male “feeds” off the females emphasise the libidinal component of the act of drawing “psychic emanations” especially during his orgasm.15 Psychic blood. Yet another component of the condition is vampirism thus adds a newer albeit relatively poorly defined autovampirism, where the subject consumes their own blood.1 dimension to the more traditional definitions of vampirism and The idea of vampires is a popular topic in contemporary will be the primary focus of this paper. Vampirism in the literature Vampirism, regardless of the definition used, is very rarely Correspondence: seen in clinical psychiatric practice.4,16 References to the Dr J Segal, Upton House, Box Hill Hospital, PO Box 94, Box Hill, subject in professional texts have decreased since the Melbourne, Victoria,3128, Australia 1940’s and there is a paucity of research on the condition.4,16 email: [email protected] The authors were unable to find a single case report of psychic South African Psychiatry Review • August 2006 163 CASE REPORT S Afr Psychiatry Rev 2006;9:163-168 vampirism in the professional literature. Also, psychic perverse form of narcissism, where the subject relates to their vampirism does not appear in classifications of clinical objects without actually relating since the object is passive, vampirism.16 Even though the idea of vampires features submissive and under his control. The act itself is immensely strongly in contemporary Western culture, it does not appear erotic and is an oral fantasy of penetration, which incorporates in traditional South African folklore or culture. Demons, taking in, fusing with and destroying the other while at the monsters and ancestral spirits are common, but not vampires. same time repressing the aggressive desires.21 Vampirism An on-line search could find only one African reference, represents a powerful paradox that symbolises the wish for life originating from South Africa relating to vampirism.17 In this and renewal, accompanied by the hideously self-centred series of 3 patients, two were “violent impulsive psychopaths” desire for survival, through the destruction of a living human and the third had a long history of self-mutilation. All were being if necessary. single white males, were not interested in the occult or religion In contrast to the above, psychic vampirism could be and were of normal intelligence. None of these patients were understood as a form of introjective identification. Introjective psychotic or experienced erotic arousal from the act of identification is a psychological process that occurs when an drinking blood, their own or others. Indeed it was noted that individual unconsciously takes into himself, and actively these men were singularly disinterested in sex. These authors becomes, the other. In this way he can attempt to defend considered clinical vampirism to be “specifically against his experience of being the weaker individual and can psychopathic” and suggested a triad of symptoms, that of claim the strength of the other as his own.23 A psychotic blood taking, “uncertain identity” and an abnormal interest in individual may regress to a narcissistic level where the death, to be the cardinal symptoms representing the boundaries between the image of the self and the other are psychopathology of clinical vampirism.17 weak, and this leads to fantasies that these two images are in Literature from other parts of the world reveals a broader fact fused.16 These primitive introjective and projective and less stringent diagnostic approach to vampirism. French identifications are based on infantile fantasies of incorporation, colleagues published a report of a strikingly similar case to devouring and invading (or forcing oneself into the object) as those described above, but one in which the violence and well as being devoured by the object.24 murder associated with the vampirism was committed by a paranoid schizophrenic patient and included acts of Vampirism as multi-axial psychopathology cannabilism.4 A Swiss report described a paranoid The relationship of vampirism to psychopathology is schizophrenic with psychopathic traits, who had the delusion complicated by the low incidence of this behaviour in a of actually being a vampire who had to consume the flesh, clinical setting and the relative dearth of controlled research blood or spinal fluid of humans in order to survive. He was of available on the topic. However, one can consider there to normal intelligence. He was convicted of murder and initially be both a biological and behavioural component to the served a prison term before being placed in a maximum behaviour within the context of DSM IV-TR.25 security forensic hospital.1 American colleagues published a report on two cases, the first consistent with autovampirism, Vampirism on Axis I coupled with a strong libidinal and erotic component in a Particularly gruesome cases of vampirism generally present patient who eventually had a schizophrenic episode, and a with the massively disorganised oral sadistic regressions, second patient who was assessed while in prison, was trading depersonalisation, confused sexuality, multiple concurrent sexual favours in exchange for drinking the blood of multiple delusions, and thought-form and content disorders that are so homosexual partners. Here again there was a powerful commonly seen in schizophrenia.1,4,26 Lacking the capacity for libidinal and erotic association with the act of blood drinking. symbolic thought, the ingestion of blood and/or body parts This man was also considered to be schizophrenic and may be a way for the schizophrenic to literally replenish psychopathic.18 himself. Without a stable sense of self, schizophrenics may Prins has presented a classification for clinical succumb to extremely concrete forms of testing their very vampirism.16 This encompasses an entire spectrum of existence that may result in them having to extract their own activities ranging from blood drinking to the absence thereof, blood to prove that they actually exist.1 Prins in his review necrophilia and associated sadism, haemofetishism