H.P. Lovecraft once said, “The oldest and strongest emotion of mankind is fear, and the oldest and strongest kind of fear is fear of the unknown.” (Lovecraft 12). Whether passed down in legend or applied systematically by the scientific method, experience acts in part to mitigate that fear. Even so, the limits of experience—due to poorly measured or operationalized phenomena—leave uniquely challenging or frightening phenomena open to wild, un-founded explanations. Disease, historically and contemporarily, often falls victim to this fact.
For example, the benefit of 650 years of accumulated knowledge allows us to view the medieval black death as the flea-borne Yersinia Pestis rather than an act of divine retribution executed through the medium of “‘venomous moleculae’” or comet-borne miasmas (Langer 115). More recently, the COVID-19 pandemic is a reminder of the almost instinctual reflex to grasp for unconventional answers when enduring conditions of personal and universal catastrophe. [page 74] This is evidenced by conspiracy theories ranging from a Bill Gates-funded, satellite-mediated viral disbursement (not so unlike comet-borne miasmas) to abject denial of the existence of a pandemic (Evstatieva). Thankfully, scientific research has emerged to enhance humanity’s understanding of COVID-19. Unfortunately, the misinformation that many latched onto early on leaves them confused about the truth.
Pseudoscientific explanations of disease are commonly employed to explain monster myths, especially regarding the vampire. Mark Collins Jenkins writes, “Science fiction, in fact, has extended and elaborated the vampire myth for years. Shunning the supernatural, it has offered ingenious empirical explanations of the phenomenon, ranging from bizarre psychological conditions to alien species to literal vampire plagues” (Jenkins 13) This article will present a few of these vampire legends which are admittedly ingenious yet still quite flawed. Sadly, these poor scientific explanations for vampirism ultimately cause more damage than good. Using science to explain a supernatural myth stigmatizes people who suffer from very real debilitating illnesses, causes misunderstanding of medical truths, and taints the scientific process.
Finally, as Paul Meehan points out in his seminal work, vampire stories “have evolved in ways that reflect our culture” (Meehan 5), and thus vary in characteristic from myth to myth. The task of examining the empirical expla-nations of all vampire myths is beyond the scope of this article. As such, this article will use the most famous vampire story, Dracula, by Bram Stoker, as a foundation for vampiric attributes and myth.
My first clinical rotation as a third-year medical student was Internal Medicine, where a wide variety of conditions are seen. My preceptor was excited to have me experience unique cases and learn. During visits, he would often pause the [page 75] interview to teach me. Such was the case one day when a patient with porphyria came to the office.
It must have been plain to see how little I understood about porphyria at the time because my preceptor paused to explain some concepts. At one point, possibly to catch my attention, he called porphyria the “Vampire Disease” and explained how the symptoms mirror classic vampire stories. This sparked an interest in me but also provoked a response from the patient.
The patient became upset and explained the difficulty and pain of their condition. They had suffered from the disease for decades and were sick of having their affliction be compared to soulless supernatural beings. They despised the stigma. While I learned much about porphyria from this encounter, I also was awakened to the problem of attempting to compare this real medical disease with a mythological monster. The best way to combat the stigma that my patient suffered is to develop a comprehensive understanding of porphyria.
Porphyria is a metabolic disorder that causes proteins to inappropriately accumulate in one’s red blood cells and cause them to malfunction. Red blood is composed of hemoglobin, a protein made up of four heme groups (a ring-like organic compound that has an iron atom attached to it) that surround a globin group in a tetrahedral formation. As the red blood cells travel to the lung, the iron atom binds reversibly to oxygen, allowing it to be released in the tissues in need of oxygen. Heme is also responsible for the red color seen in blood and muscles. The heme synthesis pathway is a relatively complex system of steps that, when disrupted, results in a decrease in heme synthesis and accumulation of pre-cursor molecules. Subsequently, the body suffers (Anderson).
Porphyrias are usually a genetically inherited disorder, however; some forms, such as Porphyria Cutanea Tarda (PCT), can occasionally be acquired sporadically (80%). PCT can be caused by Hepatitis C, HIV, excessive alcohol consumption, and estrogen drugs (Elder 928, 930). Other triggers for porphyria include exposure to sunlight, recreational [page 76] drugs, dieting, fasting, smoking, emotional stress, and physical stress. Many of these triggers increase the body’s demand for heme production, thus overwhelming a deficient heme synthesis pathway, leading to a buildup of porphyrins (Anderson).
Symptoms of porphyria include severe pain, constipation, diarrhea, nausea, vomiting, myalgia, paresthesia, hallucinations, paranoia, anxiety, confusion, seizures, breathing problems, difficulty urinating, heart palpitations, and high blood pressure. It also famously, and relevantly for the topic of this article, causes skin manifestations if one is exposed to sunlight. Exposure to light causes burning pain, sudden erythema of the skin, swelling, blisters, itching, thinning of the skin, changes in skin color and pigmentation, erythrodontia, and excessive hirsutism. Finally, a unique sign of PCT involves discoloration of urine due to excess porphobilinogen, which oxidizes when exposed to light and turns urine the classic “port-wine” red color (Tschudy et al. 860). Those with porphyria are often anemic, making them pale. Treatment for porphyria includes regular blood transfusions to provide patients with normally functioning blood (Anderson).
The symptoms and treatment for porphyria are ripe for application to vampires, which makes it surprising that a connection between porphyria and vampires was not established until the 1980s (Day 53-54). Since then, many have attempted to strengthen the connection (Maranda et al. 975). However, these explanations are faulty in their reasoning and stigmatizing in their application.
For example, while sunlight is never fatal to Dracula in Stoker’s book, it does cause his powers to lessen and make him weaker. Thus, he avoids it. Some have used this to connect vampires to porphyria patients since they both avoid the sun due to the intense burning and damage it causes (Maas and Voets 945). Another strange aspect of Dracula’s appearance is hair in places it should not be, such as “hairs in the centre of the palm” (B. Stoker 20). Persons with [page 77] porphyria also have hirsutism, an inappropriate growth of hair. Continuing the cutaneous similarities between porphyria and vampirism, just as someone with porphyria has the pale damaged thinning skin that results from anemia, vampires too are noted to have pale, cold skin. People with porphyria can develop erythrodontia, or red discoloration of the teeth, and have red urine. Surely, some say, both are proof that they are ingesting blood (Maas and Voets 945).
Where connections between porphyria and vampirism really start to stretch the truth is vampires’ aversion to garlic. This aversion is linked to porphyria because garlic can induce activity of heme oxygenase-1, a heme degrading enzyme, and worsen anemia (Maas and Voets 945). While interesting, the logic behind this connection is weaker than other listed similarities, notably because the amount of garlic one would need to ingest to cause problems with heme production would be uncommonly large—and normal consumption would unlikely be noted as an aspect of vampiric lore.
The rationalizations are most tenuous with concern to ingestion of blood. With no scientific evidence to back it up, some have speculated that due to a lack of iron, someone with porphyria would develop a craving for blood to replace the needed iron (Maranda et al. 975). While blood is now trans-fused to help with porphyria, it was never a practice for a patient to swallow large amounts, especially not to the degree needed to create the mythos of drinking blood. The idea that someone with porphyria would experience a craving for blood is unfounded, though it should be mentioned that iron-deficiency anemia can cause pica, a condition where persons chew on substances with no nutritional value, like dirt, clay, ice chips, etc. Notably, there are no recorded cases of pica causing a craving for blood.
All this being said, connecting vampirism to porphyria is interesting yet medically unsound. As with previously discussed illnesses, this conflation of vampirism and a debilitating illness has the potential to do great harm to a very real [page 78] population of people who are already suffering, contributing to stigma and prejudice. For example, in South Africa where porphyria is common, especially Variegate porphyria, a popular magazine wrote an article entitled, “Draculas Do Indeed Exist,” postulating that South Africa had a problem with a medical condition that caused “bloodlust.” This led to the misunderstanding and marginalization of porphyritic patients and researchers suspected it dissuaded many from seeking medical care (Maranda et al. 975).
The attempt to explain a fantasy condition with a very real disease does a disservice to the people who suffer every day from porphyria. Living with the stigma of disease is difficult enough without having to be told that one is a monster.
Another disease speculated to be the source of the vampiric myth is rabies. Rabies is a disease that many are familiar with. It is often equated with foaming at the mouth and aggressive dogs and is commonly viewed negatively. Attaching the stigma of vampires to rabies has incredible potential to harm those who suffer the condition. If someone with rabies feels embarrassed and does not seek care, like the porphyritic South African patients, the result will certainly be death. Rabies is a terrifying condition inflicted upon people who often have suffered traumatic attacks by wild animals. They do not need to be judged as monsters for suffering from something forced upon them. Once again, a thorough under-standing of the disease and the flawed arguments that attach it to vampirism can help to erase this stigma.
Rabies is a virus that resides in the nerves and saliva of, typically, warm-blooded animals. The most common route of infection is via bites, classically from an aggressive dog foaming at the mouth. Globally, dogs are the most common vector, although in the western hemisphere bat bites are the most common cause of rabies in humans (WHO). Once the virus invades the blood via salivary introduction, it travels [page 79] through the peripheral nervous system via retrograde axonal transport (Maas and Voets 945) and enters an incubation period of one to three months. During this time, a patient is largely asymptomatic. Eventually, the virus reaches the central nervous system and symptoms begin. Once symptomatic, the prognosis is very grim; death usually results within a few days (Vyas).
Symptoms of rabies begin with fever and headache and progress to encephalitis and meningitis. Persons may experience partial paralysis, agitation, aggression, paranoia, insomnia, behavioral disinhibition, hallucinations, and anxiety. In the later stages, one may develop hydrophobia, i.e., fear of water (DeMaria and Brown). When the virus infects the salivary glands, they begin to overproduce saliva. Attempts to swallow, or even the thought of drinking, can cause painful spasms of the throat. This helps the virus spread, for if one were able to drink, it would help clear the infected saliva from the mouth and reduce infectivity. The inability to drink, coupled with the increased saliva pro-duction, causes one to foam at the mouth. Eventually, without the intervention of a vaccine, symptoms will progress to coma and death (Vyas).
In his highly informative book, Meehan notes that Europe suffered a rabies epidemic from 1721 to 1728 (Meehan 13). Subsequently, the first connection between rabies and vampires was made in 1733 (Parsons; Maas and Voets 945). The most obvious connection to vampirism is the trans-mission through a bite. In Dracula, it is never fully explained how a bite turns one into a vampire. Lucy is the first victim of transformation we see in the story. All we know from her is that two holes appeared on her neck and over time she wasted away, died, and rose again as a vampire. It seems that Dracula drank and drained her of blood. The next victim of vampiric transformation is Mina. She also gets the characteristic holes in her neck; however, we gain further insight into her case when the story’s heroes barge in on Dracula and Mina:
On the bed beside the window lay Jonathan Harker, [page 80] his face flushed and breathing heavily as though in a stupor. Kneeling on the near edge of the bed facing outwards was the white-clad figure of his wife. By her side stood a tall, thin man, clad in black. His face was turned from us, but the instant we saw we all recognized the Count, in every way, even to the scar on his forehead. With his left hand he held both Mrs. Harker’s hands, keeping them away with her arms at full tension. His right hand gripped her by the back of the neck, forcing her face down on his bosom. Her white nightdress was smeared with blood, and a thin stream trickled down the man’s bare chest which was shown by his torn-open dress. The attitude of the two had a terrible resemblance to a child forcing a kitten’s nose into a saucer of milk to compel it to drink. (B. Stoker 305)
Dracula forces Mina to drink his blood or suffocate. One must ask then if vampirism is passed on through an infectious bite or ingestion of a vampire’s blood? Is vampirism passed on when a vampire bites a victim and ingests their blood? Or is it when a victim bites a vampire and ingests vampiric blood? Perhaps this strange scene is simply the cause of Mina’s peculiar connection to Dracula and not the cause of her partial vampiric transformation. If vampirism is passed through blood, it would negate the rabies theory because, while transmission via blood is possible, it is not common. Bites are more likely.
Another tenuous connection between rabies and vampirism is fear of water. As previously mentioned, some-one with rabies will show an aversion to water (Mass and Voets 946). Similarly, vampires are unable to cross running water and are repelled by holy water. Contrasting these, the aversion a rabid person feels towards water is rooted in painful contractions of the throat when swallowing. Vampires, conversely, are nothing but thirsty and always lusting for a drink—though admittedly blood and not water. Therefore, it is ridiculous to link this aspect of rabies to the [page 81] vampire myth because the act of drinking blood, or even fixation on drinking, would cause painful contractions to occur. One would assume that a rabid person would be just as averse to drinking blood as water, if not more so since its viscous nature would make it more difficult to swallow.
Admittedly, it is interesting to attempt rationalization and explanation of our mythological monsters, but I fear it does harm by making very real medical issues the realm of magic and mystery. This can be especially damaging in a disease that already carries negative cultural connotations and the potential for death.
Due to the mechanism of disease in Pellagra, it is often an affliction of the impoverished or alcoholic. Adding the disparagement of vampirism on top of disease and poor life situations further harms those who suffer from Pellagra. Once again, the best way to mitigate the stigma caused by misinformation is to understand the disease and how the explanations for vampirism are ludicrous and flawed.
Pellagra is a disease of vitamin deficiency, namely of niacin (vitamin B3) or tryptophan, a precursor to niacin. Niacin is found in many foods, especially meat products, whole grains, peanuts, and potatoes. Historically, both the rich who could afford meat and the poor who subsisted on grains were able to get niacin in their diet. However, in the 1500s, after the discovery of the New World and the advent of niacin-poor corn in Europe as a replacement for whole grains, poorer classes began to develop pellagra (Meehan 12).
Modern cases of pellagra are generally due not to dietary deficiency, but to an inability to absorb niacin in the gut. Inflammatory bowel disease, such as Crohn’s disease, can prevent proper nutrient absorption. Chronic alcoholism may impair absorption and create a vitamin deficiency as well. Aside from malabsorption, niacin precursors may also be consumed in certain neoplastic processes. Neuroendocrine [page 82] carcinoid tumors in the gastrointestinal tract use up avail-able tryptophan, converting it to serotonin in the gut. This exogenous use of tryptophan causes a deficiency in niacin synthesis (Karthikeyan and Thappa 477).
Physical symptoms of pellagra include hair loss, diarrhea, dilated cardiomyopathy, glossitis, skin sensitivity to light, dermatitis, erythematous glossitis, and weakness. Psychiatric symptoms will manifest later, with dementia, sensitivity to bright lights and strong smells, restlessness, agitation, ataxia, and insomnia. If it remains untreated, it can be fatal in five years (Hegyi et al. 2, 5).
Again, just as discussed with other diseases, researchers have taken a disease with a few symptoms reminiscent of vampires and tried to use it to explain the origin of the myth (Hampl and Hampl 636; Maas and Voets 946). For example, patients with pellagra are exquisitely sensitive to sunlight. When their skin is exposed, it turns red and scaly. Over time, the skin will swell, and eventually thin. Some have tried to connect this to vampires since Dracula says, “I love the shade and the shadow” (B. Stoker 26). Yet, as discussed earlier, in Stoker’s work, the sun does not burn Dracula but merely weakens him.
Insomnia and irritability are more weak associations with vampires (Hampl and Hampl 637). Vampires are awake at night, and Dracula does have a bit of a temper (more due to his ego than a psychological defect), but these conditions are nonspecific. While pellagra can cause insomnia and irritability, this is secondary to the exhausting effects of the disease rather than these traits existing alone. Most debilitating illnesses tend to tax one’s reserves. Irritability when dealing with poor health should not be a reason to think one is a vampire and minimizes the very real suffering that someone with pellagra undergoes.
Diarrhea and anorexia, interestingly, are used to explain vampires as well. Because pellagra is a disease of poor absorption, it is common to have sores in the mouth and gastrointestinal tract (Hampi and Hampi 637). Poor absorption [page 83] also leads to diarrhea. This can make eating insupportable to pellagrins, and it is common for them to refuse food. In Dracula, the Count never actually eats with Jonathan Harker. He always gives an excuse. Mina Harker, in the middle of her transformation into a vampire, says, “I could not eat; to do so was repulsive to me” (B. Stoker 404). Again, this connection is weak since many diseases cause eating to be difficult. Pellagra is not unique in this aspect.
The most fascinating connection between pellagra and vampires was the diet of those who lived near Dracula (Hampi and Hampi). On his way to the castle to meet the Count, John Harker eats “a sort of porridge of maize flour which she said was ‘mamaligia’” (B. Stoker 2). Mamaliga is still consumed in modern Romania and Transylvania. It is essentially cornmeal mixed with water. If one has the resources, it is common to mix in an egg and telemea, a salty cheese made of sheep’s milk. Mamaliga was likely a staple for poor Europeans, and, as previously noted, a diet predominately consisting of corn products is a risk factor for pellagra.
The associations between pellagra and vampires are generally less specific than with previously cited illnesses. Many, such as insomnia, irritability, and anorexia are symptoms of chronic illness. Continuing to associate poor health and chronic disease with monster myths minimizes very real suffering and runs the risk of villainizing or marginalizing those affected.
Movies, books, and video games also attempt to explain the vampiric myth using science. Since this article takes Stoker’s Dracula as the standard source material for the vampire myth, it will examine the pseudo-scientific explanations in the direct sequel Dracula: The Un-Dead, written by Dacre Stoker, the head of the Bram Stoker Estate and great-grandnephew of Bram Stoker, and screenwriter Ian Holt. [page 84]
The Bram Stoker Estate seeks to preserve and protect the intellectual rights and legacy of Bram Stoker. Therefore, Dracula: The Un-Dead is the canonical sequel to Dracula and should uphold the legacy and world Bram Stoker created better than any other modern vampiric interpretation. Unfortunately, it fails to do so in many ways which are beyond the scope of this article. Instead, we will solely focus on the modern medical explanations Stoker and Holt made to explain vampirism. In the endnotes of the book, Holt attempts to explain what causes vampires and heavily implies that vampires may be real. Sadly, he relies on pseudo-science, and it is obvious that he lacks an understanding of the nature of viruses, the brain, and basic psychology.
In this novel, Holt explains vampirism using a virus, or “venom” as he calls it, as these stories take place in the Victorian setting of the original novel, a world in which virology had not yet become commonplace. Thus, within the story, he uses the word “venom” to describe what modern readers recognize is most likely a virus. Holt describes the mechanism of action of the venom/virus as follows:
If a human body was invaded by vampire blood, the body resisted the venom. But, when the human body died and could no longer fight, the vampire venom took over, trans-forming the body into something new and greater. Vampire blood swam through veins and arteries, making the once-dead human into the un-dead. The once-human heart began to pump vampire venom, and the body was reborn to a second life of immense power. (Stoker and Holt 236)
The book goes on to explain that the heart is the “wellspring” of this venom and that is why a vampire dies if pierced through the heart. To keep this “wellspring” full, one must consume blood (Stoker and Holt 236).
Holt goes on to describe his vampire venom by saying, “The vampire virus changes the DNA of a human into a vampire. Part of that transformation is the ability to control the approximately 70 percent of our brains, which we do not [page 85] yet use or know much about and thus allows for nonhuman powers” (Stoker and Holt 422). While this is an interesting trope that has been rehashed in media several times over (Chew), it is based in a much-repeated falsehood with origins likely somewhere in the early 20th-century reserve-energy theories of prominent early psychologist William James (see James). However, like many similar stories, the “unlocked brain” is the crux of Holt’s explanations for vampiric powers: turning invisible because of telepathic mind control; flying via telekinetic levitation. Despite this quasi-medical approach, Holt’s vampires retain susceptibility to damage from religious icons, though this is explained because of their intense psychological guilt and cognitive dissonance caused by their misdeeds.
In reality, no unlocked portion of our brain exists. Our brain is an incredibly powerful energy-consuming organ, using up to 60% of the body’s glucose. The development of the human body simply would not allow such a huge unnecessary expenditure of resources. The “portion of the brain we don’t use” that one hears about so much in movies is simply the glial cells, which were thought to outnumber neurons 10:1, a number now put under scrutiny by recent studies (Bartheld et al. 3866). The glial cells do not perform cognition but play an important supportive role by insulating neurons, providing nutrients to neurons, and cleaning pathogens.
Holt’s medical explanations for other traditional vampire traits are less detailed. For example, he explains vampires’ aversion to garlic as an allergy shared by all vampires. He further goes on to attribute vampires’ incredible healing abilities to the venom, though no attempt at explaining this mechanism is made. The extent of this healing ability is extensive, as the primary antagonist in Dracula: The Un-Dead is lit on fire and electrocuted but easily heals from her injuries. Finally, the lore that a vampire has no reflection in a mirror is simply thrown out as they note, “we could not find any justification in science for this phenomenon” (Stoker and Holt 422), an ironic statement for Holt to be making. [page 86]
Holt’s attempt to modernize the Stoker vampire myth is largely pseudo-scientific. Rather than relying on the fields of neurology, virology, or psychology, the story instead makes use of medical myths and facsimiles of the medical profession. He might not be faulted for this—no fungus, virus, bacteria, or “venom” exists that can enhance a human’s abilities or cause one to crave blood, but it might be noted that something akin to this exists in the animal kingdom, namely, in a fungus of the Ophiocordyceps genus. This fungus targets insects, typically ants, eating them alive. In the process, this fungus works to alter the behavior of its host to promote the spread of the fungus, producing an eerie manipulation of the insect reminiscent of the living dead (de Bekker, et al). Where this process differs from Holt’s venom is in its result: the insect does not rise again, nor is it endowed with super-strength.
All in all, Dracula: The Un-Dead, along with the medical explanation of the vampire myth via vampire venom, perpetuates stories of medical folklore on the nature of the brain, psychology, and the mechanism of viruses. The traditional Stoker myth might be considered weakened by association to these medical myths. Again, no fungus, virus, bacteria, or “venom” exists that can enhance a human being’s abilities or cause one to crave blood. More recently, Dacre Stoker has veered away from this use of folk science in the Stoker intellectual property. He co-wrote prequel novel entitled Dracul with J.D. Barker. Notably, Stoker and Barker do not attempt to explain vampirism with science, favoring instead the classic world of the supernatural.
Renfield Syndrome, otherwise known as clinical vampirism, is a terrifying example of how medical misinformation can permeate into the collective zeitgeist. Renfield Syndrome is a pseudo-diagnosis used to describe persons with a compulsion to drink blood. It was created as a tongue-in-cheek critique on psychology but has somehow [page 87] invaded pop culture and even peer-reviewed medical research, exemplifying how deeply misinformation can pervade society.
To properly understand Renfield Syndrome, we begin with understanding the character: Bram Stoker’s R.M. Renfield. Renfield is an inmate at the psychiatric asylum run by Dr. John Seward, one of the story’s heroes. Dr. Seward describes Renfield as having a “sanguine temperament” (B. Stoker 66), a historical diagnosis derived from the “four humors” theory of disease popular in the period. Each personality type was based on an overabundance of one of four bodily fluids (humors): “Sanguine, Choleric, Melancholic, and Phlegmatic” (Kalachanis and Michailidis 3). Those of a Sanguine type are extroverted, excitable, charismatic, active, social, talkative. This aptly describes Renfield and his almost manic nature. Dr. Seward also describes him as having “great physical strength, morbidly excitable, periods of gloom, ending in some fixed idea which I cannot make out…a possibly dangerous man, probably dangerous if unselfish” (B. Stoker 67).
Renfield has compulsions that prompt him to consume the “life-force” or blood of other creatures. He devises a scheme, much like the nursery rhyme “There was and Old Lady Who Swallowed a Fly,” by feeding flies to spiders, spiders to birds, and birds to cats to accumulate greater life force. Escalating further, Renfield injures Dr. Seward by cutting the doctor’s arm with a blade, greedily lapping up the puddle of blood.
Renfield becomes a disciple of Dracula when he falls for the vampire’s honeyed lies. Dracula promises to make Renfield immortal by supplying him with insects and rats; creatures that Dracula has control over. Dracula says:
“Rats, rats, rats! Hundreds, thousands, millions of them, and every one a life. And dogs to eat them, and cats too. All lives! All red blood, with years of life in it, and not merely buzzing flies! ... All these lives will I give you, ay, and many more and greater, through countless ages, if you will fall down and worship me!” [page 88] (B. Stoker 302)
Later, in a moment of self-awareness and lucidity, Renfield reflects on his own strength and confronts Dracula. Unfortunately for him, his strength is insufficient, and Dracula leaves him incapacitated with a brain bleed. Interestingly, it might be considered that exsanguination is not only a fatal loss of vital force but symbolic of a mystical enfeeblement. However, the nature of brain bleeds, and the tight, rigid space within the skull, precludes exsanguination, resulting instead in increased intracranial pressure, brain herniation, and eventually death (McBride). Ironically, it is the retention of the blood he manically craved that will eventually kill Renfield.
Juxtaposed to this is his final redeeming act—empowered by a surgical loss of blood. This process, which Dr. Van Helsing calls a “trephining,” was a standard surgical procedure in those days utilizing a trephine or auger to bore a hole into the skull (Gross 5ff) to relieve pressure by allowing the blood to escape (Mondorf et al. 615). This procedure and loss of blood allow Renfield to gain a moment of consciousness whereby he conveys information crucial for stopping Dracula, dying a hero.
Renfield’s compulsion to consume blood has rarely been recorded in medical literature, though it is noted among some antisocial murderers, sexual deviants, and in some paranoid schizophrenics (Oppawasky 58). It first was described in 1892 by Richard von Krafft-Ebing, and was detailed in a paper by Richard L. Vanden Bergh and John F. Kelly. They noted rare cases of obsession with drinking blood, primarily associated with sexual pleasure (Vanden Bergh and Kelly 543).
The term “Renfield Syndrome,” however, was not used until 1992, when it was first conceived not as a serious psychiatric diagnosis, but as a tongue-in-cheek critique of the current state of psychiatry in Richard Noll’s Vampire, Werewolves and Demons: Twentieth-Century: Reports in the Psychiatric Literature. Rather than intending to create a term for a largely non-existent condition, Dr. Noll developed the [page 89] diagnosis and its criteria satirizing the Diagnostic and Statistical Manual. He intended to call attention to the seemingly arbitrary method for naming psychiatric pathologies and establishing their diagnostic criteria. This intention, however, has flown over the heads of many who have subsequently used it to explain the existence of vampires (Noll, “Renfield’s Syndrome).
Most of these misguided uses of pseudo-diagnosis Renfield Syndrome have occurred in the world of pop culture, such as the occasional crime television episodes “The Performer”; “Committed”), Halloween documentaries meant more to entertain than inform (The Unexplained), and literature (Yarbro; Sarre). However, there are also examples of its usage in scientific literature, such as in an article from The Journal of the History of the Neurosciences (Olry and Haines), showing how good medical research has been infected with this pseudo-diagnosis. Noll himself amusedly bemoans the creation of his “monster” that has run beyond his original intent and solidified itself in the medical zeitgeist of the day (“Renfield’s Syndrome”).
While some would seek to explain or validate vampirism by pointing out its existence as a mental illness, it does not seem likely that a true disease of “Clinical Vampirism” or specific psychosis revolving around the consumption of blood truly exists. Renfield and his symptoms were created by an imaginative mind who needed an interesting character for his story. In the absence of such an illness, it might be argued that conflating a specific compulsion or delusion belonging to one suffering from schizophrenia or paraphilia with a myth-ical terror stands to dehumanize, or worse yet, demonize those diagnosed with mental illness.
This is a great example of the dangers of using pseudo-science to explain things we do not understand. The fact that it has made its way past peer-review and is seriously used in medical literature is incredibly frightening. It shows how easily misinformation can spread and become commonplace. [page 90]
Humans are full of curiosity. We love to learn, discover, and explore. However, some things do not need to be explained, and doing so causes more harm than good. Monsters are not real and trying to explain them with real concepts does a disservice to the myth and the truth.
Taking real medical conditions and attaching them to vampires, evil bloodsucking creatures, is an insult. Patients get upset when their physician calls their condition “The Vampire Disease.” We need to be sensitive to them and their condition. Proper education on the truth of these diseases and removing the stigma of “vampirism” will help. For every article written about how a certain condition explains vampirism, more articles should be written refuting such claims and explaining the truth about the illness. This will help to protect patients and those who have conditions such as porphyria, rabies, and pellagra.
Misinformation can spread via entertainment or so-called experts like Ian Holt and his flawed explanation for vampiric viruses, which misinforms the layperson on numerous subjects from psychology to virology. Authors are at liberty to craft a compelling story using whatever means they can. However, it can be argued that the most compelling stories are rooted in truth, which Holt’s, and others like him, certainly are not. They slap real scientific labels onto their made-up ideas, which causes misinformation. A truly compelling author certainly does not need a whole section at the end of the book trying to justify poor writing and make sense of a nonsensical virus. Better yet, authors should just leave it in the realm of the supernatural, as a mystery.
The most terrifying danger in trying to explain Clinical Vampirism is when falsehoods spill over into the peer-reviewed scientific world. During the COVID-19 pandemic, many people have claimed to have done “research,” which is nothing more than perusing Facebook and other fringe sites that confirmed their premade bias. The best way to confront [page 91] such research is with real hard science, peer-reviewed work.
Sadly, such writing is not without faults, as seen by the articles that reference “Renfield Syndrome” as a real condition. As demonstrated previously, Renfield Syndrome is nothing more than a runaway joke, yet it has accidentally been established as truth within peer-reviewed writing. Ingrained misinformation is a huge problem; hopefully, better research and better peer review in the future will prevent such mistakes. Paper retractions are not uncommon and may be called for in such cases.
While it is interesting to try to explain supernatural myths, it can be damaging. Damaging to people suffering from illness, damaging to truth, and damaging to our scientific knowledge. To avoid falsehoods, we must instead share truth. Proper education on diseases should be taught, and truth should be guarded to avoid allowing falsehoods to creep in. Using science to explain a supernatural myth taints the scientific process, causes misunderstanding of medical truths, and stigmatizes people who suffer from very real debilitating illnesses.
Anderson, Karl E. “Porphyrias: An Overview.” UpToDate, 13 Jan. 2020. http://www.uptodate.com/contents/porphyrias-an-overview. Accessed 29 Jan. 2021.
Bartheld, Christopher S. von, et al. “The Search for True Numbers of Neurons and Glial Cells in the Human Brain: A Review of 150 Years of Cell Counting.” The Journal of Comparative Neurology, vol. 524, no. 18, 2016, pp. 3865–3895.
Chew, Stephen L. “Myth: We Only Use 10% of Our Brains.” Association for Psychological Science, 29 Aug. 2018, www.psychologicalscience.org/teaching/myth-we-only-use-10-of-our-brains.html. Accessed 1 Apr. 2021. .
“Committed.” CSI, directed by Richard J. Lewis, 2005, CBS Productions. Streaming video.
Day, R.S. “Bloodlust, Madness, Murder and the Press.” New Scientist, 13 Sep. 1984, pp. 53-54. [page 92]
de Bekker, Charissa, et al. “Ant-infecting Ophiocordyceps Genomes Reveal a High Diversity of Potential Behavioral Manipulation Genes and a Possible Major Role for Entero-toxins.” Scientific Reports, vol. 7, 2017, doi.org/10.1038/s41598-017-12863-w.
DeMaria, Alfred, and Catherine M. Brown. “Clinical Manifestations and Diagnosis of Rabies.” UpToDate, 26 Sep. 2018, www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-rabies#!. Accessed 1 Jan. 2021.
Elder, George H. “Porphyria Cutanea Tarda.” Seminars in Liver Disease, vol. 18, no. 1, 1998, pp. 67-75.
Evstatieva, Monika. “Anatomy Of A COVID-19 Conspiracy Theory.“ NPR, 10 Jul. 2020. www.npr.org/2020/07/10/ 889037310/anatomy-of-a-covid-19-conspiracy-theory. Accessed 1 Apr. 2021.
Gross, Charles G. A Hole in the Head: More Tales in the History of Neuroscience. The MIT Press, 2012.
Hampl, Jeffrey S., and William S. Hampl. “Pellagra and the Origin of a Myth: Evidence from European Literature and Folklore.” Journal of the Royal Society of Medicine, vol. 90, no. 11, 1997, pp. 636-639.
Hegyi, Jurajet, et al. “Pellagra: Dermatitis, Dementia, and Diarrhea.” International Journal of Dermatology, vol. 43, 2004, pp. 1-5.
James, William. “The Energies of Men.” The Philosophical Review, vol. 16, no. 1, 1907, pp. 1-20 JSTOR, www.jstor. org/stable/2177575.
Jenkins, Mark Collins. Vampire Forensics. National Geographic, 2010.
Kalachanis, Konstantinos, and Ioannis Michailidis. “The Hippo-cratic View on Humors and Human Temperament.” European Journal of Social Behaviour, vol. 2, no. 2, 2015, pp. 1-5.
Karthikeyan, Kaliaperumal, and Devinder Mohan Thappa. “Pellagra and Skin.” International Journal of Dermatology, vol. 41, 2002, pp. 476-481.
Krafft-Ebing, Richard von. Lustmurder, Necrophilia, Vampires: Case Histories. Elektron Ebooks, 2013. [page 93]
Langer, William L. “The Black Death.” Scientific American, 1 Feb. 1964, pp. 114-121.
Lovecraft, H.P. Supernatural Horror in Literature. Dover Publications, 1973.
Maas, R.P.P.W.M., and P.J.G.M. Voets. “The Vampire in Medical Perspective: Myth or Malady?” The International Journal of Medicine, vol. 107, 2014, pp. 945-946.
Maranda, Eric Laurent, et al. “Porphyria and Vampirism—A Myth, Sensationalized.” JAMA Dermatology, vol. 152, no. 9, 2016, p. 975.
McBride, William. “Subdural Hematoma in Adults: Etiology, Clinical Features, and Diagnosis.” 20 Oct. 2020, UpToDate, www.uptodate.com/contents/subdural-hematoma-in-adults-etiology-clinical-features-and-diagnosis. Accessed 29 Jan. 2021.
Meehan, Paul. The Vampire in Science Fiction Film and Literature. McFarland, 2014.
Mondorf, Yvonne, et al. “Chronic Subdural Hematoma—Craniotomy Versus Burr Hole Trepanation.” British Journal of Neurosurgery, vol. 23, no. 6, 2009, pp. 612-616.
Noll, Richard. “Renfield’s Syndrome, or, How I (Unintentionally) Created a Monster.” Research Gate, Oct. 2013, www.researchgate.net/publication/268278489_ Renfield’s_Syndrome_or_How_I_Unintentionally_Created_a_Monster.
---. Vampires, Werewolves, and Demons: Twentieth-Century Reports in the Psychiatric Literature. Bruner Meisel, 1992.
Olry, Régis, and Duane E. Haines. “Renfield’s Syndrome: A Psychiatric Illness Drawn from Bram Stoker’s Dracula.” Journal of the History of the Neurosciences, vol. 20, no. 4, 2011 pp. 368-371.
Oppawasky, Jolene. “Vampirism: Clinical Vampirism-–Renfield’s Syndrome.” Annals of the American Psychotherapy, vol. 13, no. 4, 2010. Gale Academic OneFile.
Parsons, Sarah. “Rabies: An Explanation for the Vampire Legend?.“ American Academy of Neurology 21 Sep. 1998, www.newswise.com/articles/rabies-an-explanation-for-the-vampire-legend.
“The Performer. “Criminal Minds, directed by John Badham, [page 94] 2009, ABC Studios Streaming video.
Sarre, J.A. The Renfield Syndrome. Mundania Press, 2011.
Stoker, Bram. Dracula. Signet Classic, 1986.
Stoker, Dacre, and Ian Holt. Dracula the Un-Dead. Harper Collins, 2009.
The Unexplained: Witches, Werewolves, and Vampires. Directed by. Terry Landau and Richard Wells, Landau Entertainment 1994. YouTube, uploaded by DocuGods, 3 Aug. 2017, youtu.be/hmoPIopT01U.
Tschudy, Donald P., et al. “Acute Intermittent Porphyria: Clinical and Selected Research Aspects.” Annals of Internal Medicine, vol. 83, 1975, pp. 851-864.
Vanden Bergh, Richard, and John Kelly. “Vampirism–A Review with New Observations.” Archives of General Psychiatry, vol. 11, 1964, pp. 543-547.
Vyas, Jatin M. “Rabies.” MedlinePlus, 22 Sep. 2018. medlineplus.gov/ency/article/001334.htm. Accessed 4 Feb. 2020.
WHO. “Rabies.” World Health Organization, 27 Sep.2019, www.who.int/en/news-room/factsheets/ detail/rabies. Accessed 30 Jan. 2020.
Yarbro, Chelsea Quinn. Apprehensions and Other Delusions. 2003. Five Star, 2004.