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Dracula on the Couch: The Psychiatry of Vampires

Myth, medical Illness, madness, and modern "real vampires"
Nachtmahr (The Nightmare), Johann Heinrich Füssli (1781)

“When other little girls wanted to be ballet dancers, I kind of wanted to be a vampire.”

-- quotation attributed to Angelina Jolie

With Psych Unseen covering zombies last month and Halloween now fast approaching, it seems only appropriate that this month’s post be devoted to vampires.

We all know something about vampires. Folk legends and mythological tales about beings that prey upon others to drink of their blood have been told for millennia across myriad cultures. Over the past few centuries, modern vampire myths emerging out of Europe have painted vampires as those who have risen from the dead to feed on human blood by night, sleeping in coffins by day to avoid the perilous effects of the sun. Bram Stoker’s 1897 gothic novel Dracula gave us the now iconic Count who has served as the archetype for the ubiquity of vampires in modern culture, evolving into new characters as seen on the likes of Buffy the Vampire Slayer, Interview with the Vampire, The Twilight Saga, True Blood, The Strain, The Vampire Diaries, and even Sesame Street.

Along this fictional backdrop, psychiatrists and other mental health professionals have found it irresistible to interpret the symbolic meaning of the vampire myth. It has often been said that vampire tales probably emerged out of a fear of death, such as during the Middle Ages when those infected with the plague risked premature burial.1 With modern vampire stories dripping with equal parts blood and sexuality, psychoanalysts have had a field day through the years, jumping at the chance to invoke Freudian theory to explain their appeal:

“The myth can be understood along various levels of psychosexual development: in oedipal terms, for example, the vampire is seen as an abductor of women, killing and enslaving any men who cross his path… The significance and universal persistence of the myth suggests deep roots in the evolution of our psyche. It suggests the omnipresent desire to conquer the secret of life while containing the elements of its renewal. It represents the terrible desire for survival, destroying others to maintain his own existence… Vampirism, as a mortal sin, is contained in the image that most often comes to mind, the perverse nature of the vampiric act, in which the bite and the sucking of blood produce an orgasmic sensation which supercedes coitus.”2

“…the popularity of the vampire figure evidences a role for Freud’s notion of an inherent primary masochism. This erotic impulse is primitive in nature and seeming non-oedipal. Vampire dramatizations are a convenient location for the playing out of these repressed tensions.”3

“Vampirism is defined as the act of drawing blood from an object, (usually a love object) and receiving resultant sexual excitement and pleasure… The specific symptoms of vampirism have their dynamic basis not only in the unresolved conflicts at the oral sadistic level, but at other levels of libidinal development as well… Oedipal wishes, fear of castration, and aggressive hostile wishes, are examples of these many various unresolved conflicts which can be symbolized in the patients’ minds by the blood.”4

If these interpretations seem inconsistent (are vampire tales Oedipal, or aren’t they?) and overwrought with psychoanalytic lingo, True Blood creator Alan Ball summed up the Freudian relevance and popular appeal of vampires much more simply in a Rolling Stone article when he said, “To me, vampires are sex.”5

Looking beyond myth and symbolism, some have theorized that vampire legends may have represented cases of those affected with actual medical illnesses. The most popular theory along these lines was advanced by a chemist named David Dolphin who theorized that historical vampires might have suffered from porphyria, a constellation of diseases that affect one’s ability to synthesize an iron-containing molecule called heme that carries oxygen in the blood. In 1985, Dolphin presented his case to a reporter-packed meeting of the American Association for the Advancement of Science such that his theory was carried widely in mass media at the time and thereafter (see for example this New York Times article).

Dolphin’s hypothesis highlighted one particularly severe form of the disease called congenital erythropoietic porphyria that he characterized as featuring disfigurement of the skin causing the “nose and fingers to fall off” and the teeth to “[jutt] out in a menacing, animal like manner.”6 Worsening of this skin condition by exposure to sunlight, he said, might have led sufferers to “venture forth only at night, as werewolves and vampires were said to do.” Dolphin also claimed that those with porphyria might have craved blood in an attempt to self-medicate their illness and “instinctively sought heme by biting human victims and drinking a large amount of their blood.” He even went so far as to note that sufferers “might well have been afraid of garlic” since it “contains a chemical that exacerbates the symptoms of porphyrias.”

Despite the allure of this theory and its provocative suggestion that vampire myths may have been grounded in medical truth, Dolphin’s claims were never published in the peer-reviewed scientific literature where they have since been largely debunked. For example, a 1990 article by Mary Winkler and Karl Anderson published in Perspectives in Biology and Medicine noted that in reality, porphyria is not associated with blood craving, is not made worse by garlic, is not associated with heme deficiency, and cannot actually be treated by ingesting blood.7 The authors, funded by the American Porphyria Foundation, highlighted that “sensationalism and superstition rather than science” have been responsible for porphyria’s association with vampires. While the porphyria community has for the most part been eager to dispel any such link, articles publicizing Dolphin’s claims continue to appear in the media to the present day. On a related note, another disease variant called variegate porphyria has been suggested as a medical explanation of “the madness of King George III,” but this too has been refuted in the scientific literature as “implausible.”8

Extraordinary cases of real-life blood-sucking in the context of sexual violence and murder have led psychiatrists and mental health clinicians to invariably view vampire-like behaviors as representing psychopathology and deviance, with the term “clinical vampirism” emerging in the 1980s and 90s. In 1984, Herschel Prins, a social worker, surveyed “either forensic psychiatrists or psychiatrists with a particular interest in serious deviancy” and concluded that vampirism was a clinical condition most associated with “schizophreniform disorders, hysteria, severe psychopathic disorder, and mental retardation.”1 He proposed four categories of vampirism, including “complete vampirism” characterized by “ingestion of blood, necrophilic activity, and necro-sadism.” A decade later, Philip Jaffe and Frank DiCataldo echoed this sentiment, noting that “clinical vampirism [is] a rare condition described in the forensic literature covering some of humanity’s most shocking behaviors [including] necrophilia, sadism, cannibalism, and a fascination with blood.“9

More recently, a somewhat more charitable view of vampirism has emerged in the psychiatric literature, with the term “Renfield’s syndrome” coined by psychologist Richard Noll in his 1992 book, Vampires, Werewolves, and Demons: Twentieth Century Reports in the Psychiatric Literature. In Bram Stoker’s Dracula, the character R.M. Renfield is hospitalized in an insane asylum and under telepathic control, serves the infamous Count. While not a vampire himself, Renfield consumes insects and rats on the belief that their blood will supply him with life-force and potential immortality. Accordingly, Noll suggested that Renfield’s syndrome is characterized by a “blood drinking compulsion” that “almost always has a strong sexual component associated with it,” with blood taking on “an almost mystical significance as a sexualized symbol of life or power.”10 Noll claimed that those with Renfield’s syndrome typically start drinking their own blood (auto-vampirism) at an early age and then progress to drinking the blood of animals (zoophagia) and finally that of living human beings (vampirism).

Although “clinical vampirism” and “Renfield’s syndrome” are often used synonymously, the use of Renfield’s name seems to have disentangled vampirism from older associations with murder and instead invokes an image of someone who is more sympathetic victim than violent perpetrator (in Dracula, Renfield ultimately betrays the Count and is killed by him rather than being turned into a vampire). In their paper, “Renfield’s Syndrome: A Psychiatric Illness Drawn from Bram Stoker’s Dracula,” Régis Olry and Duane Haines noted that:

“Contemporary popularization of the types of behavior exemplified by Renfield, such as programs/movies portraying vampires or werewolves, may actually serve a positive scientific purpose. While they do not get to the root of the clinical condition, and rarely or never offer a “treatment,” the observer is treated to a vivid impression (and hopefully some degree of understanding) of the personal and societal torment that individuals with actual clinical conditions of similar types actually experience. Renfield would probably feel somewhat vindicated.”11

In a similar vein, the recent medical literature now includes a few articles on “adolescent vampire cults,” with warnings to clinicians about the perils of such groups for at-risk youth. A 1999 article by Thomas Miller and colleagues opined that:

“Contemporary interest in cults that focus on ‘vampirism’ have grown out of several games and myths as well as new age computer technology and computer-based games that are out-growths of games like ‘Dungeons and Dragons’ of the previous two decades… At the core of vampire cult activity are a series of games and rituals that include bloodletting, sacrifice, group sex and drugs in which membership engage… In the “rights of passage,” for the vampire cult, drinking blood becomes a unique bridge to acceptance. For some, blood-letting and sexually perverse activities are the ultimate sexual experience. It is a means of intimate communication with another person, which has been lacking in their family and peer experiences.”12

A related article by Megan White and Hatim Omar published in 2010 likewise suggested:

“Emerging as an offshoot of the Gothic movement of the 1980s, today’s contemporary Vampire subculture comprises individuals who claim to be “real vampires.” Such individuals may engage in vampire-like behavior, including only emerging at night, sleeping in coffins, wearing fangs, and even blood-sharing… The image of the vampire has changed throughout history from the monstrous, living-dead vampire in Bram Stoker’s Dracula, to the alluring, romantic, and compassionate vampire seen in Anne Rice’s Interview with the Vampire and in Stephanie Meyer’s Twilight series. As such, more individuals are drawn to vampirism, thus perpetuating the emergence of vampire cults.”13

The emphasis here on the harmful effects of cults, with removal of the affected teenager from their vampire peer-group advised as intervention, is curious given that White and Omar include in their paper a case study of a 15-year old teen who claimed to be “addicted to blood” and engaged in auto-vampirism despite having “no association with a vampire group.” Noting the discrepancy, the authors suggested that auto-vampirism might be “an emerging behavior and possible acceptable coping strategy amongst the modern adolescent community.”13

In fact, the so-called “vampire community” is by no means limited to teenagers and while it remains a little-known subculture, several articles (see here and here) have appeared in the mainstream popular press just this week about “real vampires,” of which there may be as many as 15,000 in the U.S.14 In contrast to claims linking vampires to cosplay and role-playing games, “real vampires” draw a sharp distinction between themselves and “lifestyle vampires,” though there can be overlap. Whereas the latter choose to live lifestyles patterned after iconic vampire themes by dressing the part, sporting fangs, and sleeping in coffins, “real vampires” define themselves based on a perceived “need to consume blood or to feed on the ‘subtle’ energy of other people in order to sustain their physical, mental, or spiritual health” and view this as an unchosen personal identity, in a manner similar to sexual orientation.15 A more detailed definition of a “real vampire” has been outlined by the Atlanta Vampire Alliance, one of the largest organized vampire communities in the country:

“A vampire is essentially an energy feeder or blood drinker that may display various levels of psychic ability. While the causality, interpretation, and sometimes even the “proper” spelling of vampirism are debated, vampires are generally individuals who cannot adequately sustain their own physical, mental, or spiritual well-being without the taking of blood or vital life force energy from other sources; often human. Without feeding the vampire will become lethargic, sickly, depressed, and often go through physical suffering or discomfort. Vampires often display signs of empathy, sense emotions, perceive auras, and are generally psychically aware of the world around them. To a degree, the specifics of vampirism manifest differently on an individual basis and these nuances sometimes insulate the confusion in defining the vampiric range of ability and experience.”16

The Atlanta Vampire Alliance is part “vampire house” and part education/advocacy group, with a sizeable community and online presence. In addition, the co-founder of the group, a man who goes by the pseudonym “Merticus” within the vampire community, spearheaded the Vampirism and Energy Work Research Study (VEWRS) and the follow-up Advanced Vampirism and Energy Work Research Study (AVEWRS), conducted under the auspices of Suscitatio Enterprises, a limited liability corporation dedicated to researching the phenomenon of self-identified “real vampires.” VEWRS/AVEWRS involved a two-part survey of self-identified “real vampires” with nearly 1000 questions (see here for the actual VEWRS and AVEWRS survey questions) and 950 respondents from around the world.17

Although self-reported survey data has its limitations, VEWRS/AVEWRS provides a unique introspective view into what kind of people self-identify as “real vampires.” For example, most “real vampires” are adult, Caucasian (72%), heterosexual (55%), and have a self-reported IQ well above average. Contrary to the medical literature on clinical vampirism, “real vampires” are mostly women (63%) rather than men (35%), only 35% identify as “Goth,” and only 24% belong to an organized vampire group such as a “house, clan, coven, haven, order, or court.”18 While 52% of “real vampires” identified as “sanguinarians” who actually drink blood, 68% identified as “psychic vampires” who claim to take psychic energy from others, either by touch or non-physical means, and 40% identified as both, known in the vampire community as “hybrids.”

Since “real vampires” don’t view their identity as a lifestyle choice, many are curious about whether medical testing might help to reveal a cause of their “symptoms.”19 Accordingly, the VEWRS/AVEWRS surveys included several questions about self-reported medical and psychiatric disorders. For medical conditions, both anemia (17%) and chronic fatigue syndrome (20%) were reported by sizeable minorities. For psychiatric disorders, 31% reported major depression, 16% reported bipolar disorder, and 16% reported panic disorder.20 However, the vast majority had never seen a psychiatrist and reported no addictions to drugs or alcohol, no history of sexual abuse, and no history of being convicted for a violent crime.18,20

In short then, based on VEWRS/AVEWRS, “real-vampires” seem to be pretty much like the rest of us. Except, of course, that they believe themselves to be vampires. In a similar fashion, 86% identified themselves as “energy workers,” a somewhat vague term describing “any practice of manipulating, cultivating, or perceiving energy, regardless of the personal theory of the energy's nature, origin, or spiritual significance;”21 79% of respondents endorsed believing that their spirits have existed in a former lifetime; and 72% believed their senses to be more acute than the average person.18

In psychiatric terms, endorsing such beliefs suggests that “real vampires” and “energy workers” might rate highly on psychologic measures of “magical thinking” or “schizotypy,” but then again, so might the many Americans who believe in fortune telling, aliens, angels, or the power of prayer. What VEWRS/AVEWRS therefore really suggests is that psychiatry and psychology might be less useful as frameworks to understand “real vampires” than anthropology and sociology. Just so, Dr. Joseph Laycock, an assistant professor at Texas State University who studies new religious movements and author of Vampires Today: The Truth about Modern Vampirism, performed an ethnographic study of the Atlanta Vampire Alliance in 2007 and concluded that “real vampirism” is best thought of as an identity rather than a social or religious institution, as is often suggested.15 Indeed, this is exactly how most “real vampires” view themselves.

In much the same way, Dr. DJ Williams, an assistant professor of social work at Idaho State University who specializes in “deviant leisure and sexual diversity,” has argued that while “real vampires” are typically viewed as deviant, if not delusional or even evil, such views are “unfounded and unjust.”22 Similar to those with divergent sexual identities or those engaging in bondage-discipline/dominance-submission/sadomasochism (BDSM), Williams notes that those identifying as “real vampires” risk considerable stigma and marginalization. In an article widely carried by the popular press this year, Williams, along with co-author Emily Prior who researches deviant and marginalized subcultures and serves as Executive Director of the Center for Positive Sexuality, highlighted how “real vampires” often have considerable fear about “coming out of the coffin.”23 They offer the following recommendation for clinicians:

“It is important for helping professionals, such as social workers, to remember that people with vampire identities are just that, people – they have common issues like those with mainstream identities… [and] are fearful that clinicians will label them as being psychopathological in some way (i.e., delusional, immature, unstable), perhaps wicked, and not competent to perform in typical social roles, such as parenting. These fears, of course, reflect common normalizing social discourses that have shaped perceptions and interpretations of the vampires of myth and popular culture, along with perceptions and interpretations of those who are assumed to believe in such stories… Real vampires seem to be ordinary human beings with common, everyday human issues, such as trying to be successful in relationships and careers, managing stress, coping with daily living tasks, and adjustments to transitions, to name a few. …social workers and helping professionals should learn more about alternative identities and communities, listen and learn from clients, strive to become more aware of our own potential biases and stereotypes, and interrogate and challenge common social discourses that pathologize and demonize. By doing so, social workers can establish trust with clients who have alternative identities and belief systems, provide services to a more diverse clientele, and establish strong alliances that contribute to effective service.”23

Psychologist Dr. Jolene Oppawsky has described a case in which she treated a 36-year old man who self-identified as a vampire and reported sharing blood between five other adult men who also considered themselves to be vampires.24 After becoming engaged to a woman, the man entered psychotherapy highly motivated to stop this behavior. After switching to auto-vampirism, he later stopped drinking blood altogether after two months of cognitive behavioral therapy. The therapist’s awareness and cultural competence concerning “real vampires” proved vital to the success of treatment.

Suscitatio LLC’s website includes information and speculation about declining online participation in the vampire community.25 Although this is not thought to necessarily reflect a decline in the actual numbers of those who self-describe as vampires, it does raise the possibility that “real vampires” might prove to be a fad of sorts. And yet, in terms of seeking treatment specifically for vampirism, only 8% of VEWRS/AVEWRS respondents stated that they would “permanently end their vampiric condition and instead live a normal-vampiric life" if given the chance.18

In the final analysis, the psychiatry of vampires provides an illustrative example of the dynamic tension between the pathology and stigma associated with diagnosis on the one hand and the empowerment and acceptance associated with identity on the other (see my previous blogpost on diagnosis, stigma, and euphemisms). Throughout history, the vampire archetype of mythology has evolved and has been variously appropriated to describe abnormal behavior, medical illness, and personal experience. Going forward, the use of the term “vampire” will no doubt continue to evolve with time, but remain entwined with older cultural meanings, just as it has with words like “queer” or “deviant.”

For “real vampires” themselves, some are interested in finding a scientific or medical explanation to validate how they feel and few seem to be asking for a psychiatric explanation. But whereas psychiatry, as a branch of medicine, tends to view behavior through the lens of pathology, it has been argued that this narrowed focus is a relatively recent development resulting in loss of meaning for the discipline and a missed opportunity to understand phenomena like “real vampires.”26 Just so, the premise of Psych Unseen is that a broader scope of psychiatry may be useful in understanding a more diverse spectrum of human behavior that may or may not represent psychopathology. In that sense, vampires may be a perfect example of the “psychiatry of everyday life.”

The author wishes to thank Merticus for generous support in providing some of the information and resources about “real vampires” used in preparation of this blogpost.

Dr. Joe Pierre and Psych Unseen can be followed on Twitter at To check out some of my fiction, click here to read the short story "Thermidor," published in Westwind earlier this year.


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14. Wagner M. 5000 vampires live in the U.S., drink donors’ blood for energy: report. New York Daily News, October 27. 2015

15. Laycock J. Real vampires as an identity group: Analyzing causes and effects of an introspective survey by the vampire community. Nova Religio: The Journal of Alternative and Emergent Religions 2010; 14:4-23.

16. Atlanta Vampire Alliance, House [AVA] Mission statement.

17. Atlanta Vampire Alliance, Vampirism and energy work research study.

18. Suscitatio Enterprises LLC. Vampirism and energy work research study: A detailed sociological and phenomenological study of the real vampire and energy worker community.

19. Atlanta Vampire Alliance, Demystifying 'real' vampirism for the rest of us: An overview of modern vampirism for the general public.

20. Suscitatio LLC. Diagnosed Physical & Mental Conditions Of Self-Identified Real Vampires

21. Suscitatio LLC. Definitions and precedent.

22. Williams DJ. Social work, BDSM and vampires: Toward understanding and empowering people with non-traditional identities. Canadian Social Work 2013; 15:10-24.

23. Williams DJ, Prior EE. Do we always practice what we preach? Real vampires’ fears of coming out of the coffin to social workers and helping professionals. Critical Social Work 2015; 16:79-92.

24. Oppawsky J. Vampirism: Clinical vampirism and Renfield’s syndrome. Annals of the American Psychotherapy Association 2010; 13 (available at:

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26. Mac Suibhne S, Kelly BD. Vampirism as mental illness: Myth, madness and the loss of meaning in psychiatry. Social History of Medicine 2010; 24:445-460.

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