More wishful than clinical, Renfield syndrome is psychiatry’s most gothic disorder.
The gothic horror of vampirism continues to enthrall in books and movies.
Thanks to Bram Stoker we all know the themes: the undead creature who cannot be exposed to the sunlight; the victims, mostly attractive young women, who succumb to the erotic bite on the neck; the heroic antagonists, often doctors; and protective devices such as crucifixes, garlands of garlic and wooden stakes to plunge through the heart.
The history of vampirism goes back in time. Rituals involving blood were common in the Old Testament. The ancient Greeks would threaten to drink their enemy’s blood. The vampire myth was not long in following, commencing with blood-sucking ghosts and bats. It morphed into dead people who returned from the grave to suck the blood of the living.
The vampirism cult was especially prevalent in Eastern Europe and the Balkans. Here arose the most important mythic figure: Vlad the Impaler, a 15th century Wallachian nobleman whose cruelty earned him the epithet of Count Dracula (dragon or devil). The names varied with the location: shtriga in Albania; vrykolakas in Greece; and strigoi in Romania, to mention but a few. In Europe the vampire myth peaked in the 18th century, facilitated by regular epidemics. It was not unknown for victims of plague to be buried prematurely, only to return home later in a less than sanguine frame of mind, hence the belief in their “un-dead” nature.
While there were other authors, it was Stoker’s splendid Dracula (1897) that sparked a lasting vampire cult and introduced us to R.M. Renfield (we never learn his first name). We first meet Renfield at the private clinic in London run by Dr John Seward, a lunatic-asylum mad doctor. This was a time when mad doctors – often not doctors at all – were becoming alienists and, later, psychiatrists. Seward diagnoses his patient Renfield as a “zoophagous maniac”:
R. M. Renfield, aetat 59.- Sanguine temperament; great physical strength; morbidly excitable; periods of gloom, ending in some fixed idea which I cannot make out. I presume that the sanguine temperament itself and the disturbing influence end in a mentally-accomplished finish; a possibly dangerous man, probably dangerous if unselfish.
Renfield has zoophagia, a compulsion to eat insects, eat live animals or drink their blood. He starts with flies, progresses to Death’s-head moth, then feeds the flies to spiders, and the spiders to birds. When denied a cat to accommodate the birds, he eats the birds himself.
This behaviour does not improve his state of mind, to say the least:
His moods change so rapidly that I find it difficult to keep touch of them, and as they always mean something more than his own well-being, they form a more than interesting study.
Renfield is put into a strait-waistcoat and chained to the wall in a padded room, another feature that was to be used in future psychiatric wards. After the lovely Lucy Westenra (having spurned Seward) falls ill, Seward calls Professor Van Helsing, his old teacher from Amsterdam. Van Helsing believes hypnosis is related to telepathy and that Dracula is a kind of “throwback”. They revive Lucy with blood transfusions – again, very modern treatment (but misguided as likely to cause a transfusion reaction) – but it is too late; Lucy is now a vampire (punishment for having spurned Seward?).
Insane, Renfield maintains telepathic contact with his master Count Dracula, who moves from Transylvania to the ancient mansion of Carfax, bringing boxes of earth from his homeland with him.
Renfield keeps trying to escape from hospital to meet Dracula, drawn by his offer: he will make him immortal by providing an endless supply of insects and rats as “the blood is the life”. Renfield attacks Seward, cutting his arm and licking his blood drips from the floor. He is chained to the wall in a padded room.
When Dracula throws him on the floor, severely injuring him, Van Helsing performs a craniotomy (a modern trepanning) on Renfield – dramatic surgery indeed. Faced with the prescribed anti-vampire apparatus of crucifixes and sacramental wafers of bread (but sadly no garlic), Dracula flees to Renfield’s room to break his neck. The last sight we have of Renfield is a bat rising out of the window of his room, flapping westward in approved fashion – a closing scene beloved of movie makers.
The fictional Renfield nevertheless achieved eponymous medical fame, with Renfield syndrome being described by Richard Noll in his 1992 book Vampires, Werewolves, and Demons: Twentieth century reports in the psychiatric literature.
Noll listed three phases in the syndrome. Stage 1 is auto-vampirism: drinking one’s own blood. This starts in childhood, the taste of blood from removing scabs is exciting and later sexually arousing. The true devotees progress to opening their veins and arteries to drink a steady stream of warm blood.
Stage 2 is zoophagia: eating living creatures, specifically drinking their blood.
Finally, there is vampirism, the drinking of human blood, often associated with serial murder and a distinct sexual element.
All well and good. But as reports began to circulate, amused and horrified by the monster he had created, Noll made it clear that he had written about the syndrome on impulse and it was entirely ironic (fang-in-cheek?).
Yet stranger things have happened: monsters tend to have a life of their own. Noll had opened a Pandora’s box. Does Renfield syndrome actually exist?
Regis Olry and Duane Haines had no doubt in their paper “Renfield’s Syndrome: A Psychiatric Illness Drawn from Bram Stoker’s Dracula” in the Journal of the History of the Neurosciences. The diagnostic criteria were met by the serial killer Richard Trenton Chase who kept asking for blood while in prison. The authors cited Van den Bergh and Kelly’s 1964 paper “Vampirism: A Review With New Observations””, which stated that “The syndrome and fantasies of vampirism are more frequent and important than their relative absence in the literature would suggest”. The etiology of the syndrome, however, was unknown.
South Africa, a country perhaps not as far away in the imagination from Transylvania as it may seem, exposed a hitherto unknown African Gothic. In 1983 Helphill and Zabow at the Valkenberg Hospital in Cape Town described three patients showing clinical vampirism as a recognisable, although rare, entity characterised by periodic compulsive blood drinking, affinity with the dead and uncertain identity. [1] The vampirists cut themselves from childhood, drank their own, other human or animal blood, dreamed of bloodshed, associated with the dead, and had shifting identities. Some self-cutters were auto-vampirists; females were not likely to assault others for blood, but males were potentially dangerous. Vampirism should be looked for in violent criminals who were self-mutilators, but there was no specific treatment.
Following up on this study, Herschel Prins, a distinguished forensic social worker originally from South Africa, categorised vampirism as a clinical disorder. Prins pondered whether, at some level, blood-sucking was an extension of the ubiquitous love bite – an idea that, in this day and age of sexual extremism, might not be as extreme as it seems.
And there it stands. Renfield syndrome is a fictional condition that only exists in the mind of those who ignore the dictum that all illness is ultimately social. That actual cases of clinical vampirism are remarkably rare is beside the point. The vampire phenomenon, on the other hand, is deeply embedded in the human need to have a romantic enemy to haunt us. The vampire’s kiss is the ultimate embrace and, for all the shock-horror that we so enjoy, who has not, at some time or other, wondered just how much fun it could be to soar off into the sky like that?
In Love at first bite we find that George Hamilton, the man born under a sun lamp, and the vulpine and nubile Susan St James, as future vampire Cindy Sondheim, had it just right:
Cindy Sondheim: Oh, this isn’t so hard. I think I’m going to love immortality.
Count Dracula: There is one small disadvantage. We can only live by night.
Cindy Sondheim: Oh, that’s all right with me. I mean, I could never really get my shit together till 7, anyway.
Robert M Kaplan’s podcast series Frontal Lobotomy is now out on Apple and Spotify. Renfield syndrome is a chapter in his forthcoming book The King Who Strangled his Psychiatrist and Other Dark Tales.
