essay on fear of blood

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Hemophobia (Fear of Blood) Signs and Coping Strategies

• What Is it?

Hemophobia is a psychological disorder characterized by an extreme fear of blood . While it's normal to feel a bit queasy or uncomfortable at the sight of blood, people with hemophobia react to blood in irrational ways and can become highly distressed at the mere thought of it.

This article explains what hemophobia is and what causes it. It also covers how hemophobia is diagnosed and treated, along with ways to cope with the fear of blood.

Verywell / Danie Drankwalter

What Is Hemophobia?

Hemophobia, or blood phobia, causes an irrational fear of seeing blood. This persistent fear causes those who experience hemophobia to have intense feelings of distress upon seeing blood or even thinking about it.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies blood phobia as a specific phobia . A specific phobia is an anxiety disorder that presents as a fear of a certain object or situation. The DSM-5 characterizes the fear of a specific phobia as out of proportion to the actual danger posed by a specific situation or object.

Specific phobias are divided into five categories, and blood phobia falls within the category of blood-injection-injury type. Other examples of phobias within this category are those related to seeing or experiencing an injury, or even something as simple as getting your blood drawn .

Symptoms of Hemophobia

Many people living with a blood phobia may only experience symptoms if they see blood. But for some people, even the thought of blood can make them feel panicked or anxious. This is referred to as anticipatory anxiety.

Each person with hemophobia may react to blood differently, but some of the more common symptoms are:

• Tremors or palpitations
• Chest tightness or pain
• Shortness of breath
• Faintness or dizziness

Those with a fear of blood may be highly distressed and go out of their way to avoid situations that involve blood.

Symptoms in Children

Symptoms of hemophobia can also vary from child to child, but some of the most common include:

• Increased heart rate
• Trembling and shaking
• Feeling like they are choking
• Chest pain or discomfort
• Fear of dying
• Feeling numb
• Chills or hot flashes

Additionally, a child with hemophobia may display extreme, irrational fear when faced with a situation in which blood may be present, such as going to a doctor's appointment.

Such situations may cause the child to cry, throw tantrums, or cling to their parent or caregiver.

Diagnosing Hemophobia

Hemophobia is formally diagnosed using seven criteria outlined in the DSM-5:

• The fear is persistent and is considered unreasonable or excessive. The fear may occur in the presence of blood or in anticipation of seeing blood.
• Seeing blood nearly always results in an anxious response. This may include a panic attack. In children, the response may take the form of clinging, tantrums, crying, or freezing.
• The person with the blood phobia knows that their fear of blood is excessive (though in children this may not be the case).
• The person either avoids blood or experiences intense feelings of anxiety and is distressed in situations that involve blood.
• The fear of blood significantly disrupts the person's daily life and may impact their work, schooling, relationships, or social activities. They may have significant distress about having their phobia of blood.
• The fear of blood typically persists for at least six months.
• The feelings of anxiety or behaviors associated with the blood phobia can't be explained through other disorders like obsessive-compulsive disorder , social phobia , panic disorder , and post-traumatic stress disorder (PTSD) .

Not everyone with a blood phobia is formally diagnosed. Many people with blood phobia are already aware they have a phobia and may choose to live their life without a diagnosis. These people may also go to great lengths to avoid blood or situations that involve blood.

This approach is not advised, as avoidance of blood may make a blood phobia worse.

The cause of specific phobias like hemophobia are often complex and may be due to a variety of reasons like past experiences, learned history, and biological factors.

Past Experiences

Some people may develop a phobia of blood after a past traumatic experience. A car accident, for instance, can equate negative emotions with the sight of blood, and may lead to an irrational fear of blood.

Learned History

A learned history can be one factor that contributes to the development of a blood phobia. There are three forms of learned history:

• A direct learning experience refers to a specific experience that involves blood. This experience might have been traumatic.
• An observational learning experience refers to learning a fear by observing other people show fear in a situation that involves blood. This may involve a child seeing their parent be afraid of blood, then developing their own fear of blood.
• Informational learning refers to a fear that might come from reading or hearing about a situation that could be considered dangerous.

Often, learned history is not the sole reason for developing a phobia. Other factors like genetics and overall mental health can play a role in phobia development.

Biological Factors

There may be a genetic component to developing a specific phobia, as it is believed that some people are born with a predisposition to feelings of anxiety compared to others.

If a person with hemophobia sees blood, they may experience a number of biological changes in the body:

• Release of cortisol , a primary stress hormone
• Release of insulin , a hormone produced in the pancreas that turns glucose to energy
• Release of growth hormones, which help give your body energy as part of its response to stress
• Changes to the activity in the brain
• Increased blood pressure

Many phobias can be treated or potentially cured. Specific phobias like hemophobia can be treated through desensitization or exposure therapy .

This involves a person with a phobia of blood gradually being exposed to blood or situations that involve being around blood. These exposure techniques can be performed with the help of a professional.

Other treatment options include psychotherapy , counseling, and cognitive behavioral therapy .

Typically, medication is not used to treat phobias. In some cases, it may be prescribed to help with anxiety. Medications that may be prescribed in this context include beta-blockers , benzodiazepines, and antidepressants.

Coping With Hemophobia

Having a blood phobia can be distressing, but there are techniques that can help you cope with this fear.

Distraction Techniques

Distraction techniques involve focusing on something else or performing an activity to distract from a situation that may involve blood or the thought of blood.

You may be able to distract yourself by:

• Listening to music
• Playing games
• Arts and crafts, like painting or embroidery
• Walking or going on a bike ride
• Meeting up with a friend

Visualizing a situation that evokes feelings of calm may be beneficial for those with hemophobia. Creating a calm image in the brain and thinking about how it felt to be in that situation can reduce feelings of anxiety.

Challenge Negative Thoughts

Negative thoughts associated with a specific phobia can bring on symptoms of anxiety. By challenging these negative thoughts, those with hemophobia may better cope with their fears.

For instance, if you have hemophobia and think you can't cope with having your blood drawn, you may challenge this thought by reminding yourself that a blood test is a normal procedure that many other people experience regularly without issue.

Relaxation Techniques

When a person with hemophobia thinks about blood or is in a situation involving blood, they may notice their body tenses up and their heart rate increases.

Using relaxation techniques like muscle relaxation, meditation, and deep breathing may help reduce feelings of anxiety.

The exact cause of hemophobia may be hard to pinpoint, but there are steps a person can take to reduce their fear of blood. Gradual exposure to blood or situations that involve blood may help a person desensitize their irrational fear.

Those with a blood phobia can also benefit from mindfulness exercises that may improve mental health overall, such as exercising regularly, eating a healthy diet, staying hydrated, and attending therapy.

American Psychological Association. Blood phobia.

American Psychological Association. Specific phobia.

SAMHSA. Anxiety disorders .

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Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 changes on the national survey on drug use and health .

Barlett A, Singh R, Hunter R. Anxiety and epigenetics . Adv Exp Med Biol . 2017;978(1):145-166. doi:10.1007/978-3-319-53889-1_8

National Institute of Mental Health. Mental health medications .

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Understanding and Overcoming the Fear of Blood

Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.

JGI /Tom Grill / Getty Images

Hemophobia (also called hematophobia) is the fear of blood, wounds, and injuries. Hemophobia is categorized by the American Psychiatric Association's Diagnostic and Statistical Manual as a “blood-injection-injury” (BII) phobia. This subtype, which also includes trypanophobia or fear of needles can cause symptoms that are not frequently seen in other types of specific phobias .

Having an aversion to blood is natural—in fact, horror movies often prey on our discomfort by showing large quantities of fake blood to inspire fear and unease in their audience. However, hemophobia causes much more than discomfort, and someone with this condition will experience highly distressing and disruptive symptoms at the sight of blood.

This article explores the symptoms, diagnosis, and causes of hemophobia. It also covers the treatments and coping strategies that can be helpful.

Symptoms of Hemophobia

Hemophobia can cause physical symptoms like:

• Increased heart rate initially, followed by a sudden drop in heart rate and blood pressure
• Nausea and gastrointestinal upset
• Rapid breathing

It can also cause emotional symptoms, including:

• Anticipatory anxiety ahead of medical procedures
• Extreme fear and anxiety at the sight or thought of blood
• Feeling of intense disgust at the sight of blood
• Panic attacks
• Persistent avoidance of medical procedures that might involve the sight of blood
• Problems functioning in other areas of your life

Children can also show signs of hemophobia by clinging, crying, freezing, and throwing tantrums as a response to their fear of blood.

While most types of phobia lead to an increase in cardiac activity, BII phobias such as hemophobia can cause an abrupt and sometimes dangerous reduction in blood pressure and heart rate. This sudden drop can lead to fainting at the sight of blood, which is relatively common for people with hemophobia.

Rarely, an extreme reaction to the sight of blood could lead to cardiac arrest and even death. If you or a loved one is experiencing serious cardiac symptoms after the sight of blood, call 911 or seek help immediately.

For help dealing with hemophobia, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 .

Diagnosis of Hemophobia

When diagnosing a phobia , your doctor will look for signs that show your fear of blood is extreme, has lasted for at least six months, and causes significant problems in other areas of your life.

Your doctor will also check to see if you have symptoms of a related phobia, like the fear of hospitals ( nosocomephobia ) or needles ( trypanophobia ), or if you show signs of a common comorbid condition, like:

• Agoraphobia
• Animal-based phobia
• Obsessive-compulsive disorder (OCD)
• Panic disorder
• Social anxiety disorder (SAD)

To diagnose hemophobia, your healthcare provider will ask question about your symptoms, their severity, and how long they have lasted. They will also ask questions about how these symptoms affect your life and may evaluate you to determine if your symptoms might be caused by another mental health condition.

Causes of Hemophobia

Hemophobia affects around 3% to 4% of people. While it's hard to determine an exact cause, BII phobias may have a genetic component. Many people with this type of fear have multiple family members with the same condition. It's also possible to have developed this phobia during childhood if a caregiver or another adult showed extreme discomfort around blood.

Hemophobia can also be related to trauma. If you have experienced or witnessed a severe injury involving significant blood loss, you may develop a phobia.

Your phobia may also be rooted in another underlying fear, like:

• Dentophobia , or fear of dentists
• Iatrophobia , or fear of doctors
• Illness anxiety disorder , or fear of severe health conditions
• Mysophobia , or fear of germs
• Nosophobia , or fear of a specific disease

In some cases, the fear of blood may be related to a fear of loss of control or even a fear of death .

Types of Hemophobia

Hemophobia symptoms can occur in a variety of situations; you don't necessarily need to be in sight of blood to experience discomfort and anxiety. While phobias may begin as a fear of a specific stimulus, they can become generalized over time.

That means you may experience symptoms by encountering fake blood in images, movies, television shows, or video games.

Impact of Hemophobia

Hemophobia can cause a wide range of difficulties that may prove life-limiting or even dangerous. If you are afraid of blood, you may be reluctant to seek medical treatment. You might postpone or avoid annual physicals and needed medical tests. You may refuse surgery or dental treatments.

Parents with hemophobia may find it difficult or impossible to bandage their children’s wounds. You might pass these tasks off to your spouse whenever possible. You may also overreact to minor injuries in your children as well as yourself, frequenting emergency rooms or walk-in clinics when home treatment would suffice.

A fear of blood may also cause you to limit activities that carry a risk of injury. You might be unable to participate in outdoor activities such as hiking, camping, or running. You may avoid sports, carnival rides, and other activities that you perceive as dangerous.

Over time, such avoidant behaviors can lead to isolation. You might develop a social phobia or, in extreme cases, agoraphobia . Your relationships might suffer, and you might find it difficult to participate in even the normal activities of daily living. Feeling depressed is not unusual.

A fear of blood can have a limiting impact on your life. You might avoid any situation that could lead to injury or exposure to the sight of blood. As a result, normal daily activities may be severely impaired, which can affect relationships and contribute to loneliness and social isolation.

Treatment for Hemophobia

Hemophobia responds very well to many treatment methods. Therapy is generally the first-line treatment option, and medication may also prove helpful.

If your phobia is severe, medications like antidepressants or anti-anxiety drugs may help. These may be prescribed to control the anxiety and allow you to focus on your treatment, or they may be useful in situations where you have to undergo a medical procedure or otherwise face your fear of blood.

Psychotherapy

One of the most common psychotherapy options for phobias is cognitive-behavioral therapy (CBT) . In CBT, you learn to replace your fearful self-talk with healthier responses to the sight of blood. You also learn new behaviors and coping strategies.

Your therapist may also try exposure therapy , where you are gradually exposed to things that trigger your fear. In exposure therapy, your therapist provides you with guidance and a safe environment to help you learn how to calm yourself down at the sight of blood.

Other forms of talk therapy, hypnosis , and even alternative treatments may also be helpful.

A skilled therapist can guide you through the process of recovery, which can be difficult or impossible on your own. With help, though, there is no reason for hemophobia to control your life.

Coping With Hemophobia

You can learn to manage your hemophobia , and seeking professional treatment is an important part of that process.

Taking other steps can also help, like:

• Learning more about your condition and understanding what triggers your fear
• Incorporating stress-management techniques into your daily routine
• Leaning on friends and family for support

If you experience fainting at the sight of blood, familiarizing yourself with the symptoms that typically precede a fainting spell may help you reduce your chance of injury. If you feel faint, try to:

• Get to a safe area to prevent a fall
• Practice breathing exercises to combat any hyperventilation
• Tense the muscles in your arms, legs, and core to try to prevent yourself from fainting

In addition to seeking professional treatment, there are self-help strategies that can help you cope with a fear of blood. Understanding the condition and practicing relaxation strategies can be helpful. Knowing how to respond when you find yourself feeling faint upon the sight of blood may help you avoid injury due to a fall.

While it is natural to feel uncomfortable at the sight of blood, if your fear is keeping you from undergoing regular medical check-ups and necessary procedures, it may be time to consult with a mental healthcare professional who understands how to treat phobias. Treatment can alleviate the anxiety associated with hemophobia and help you recover from your symptoms.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed . Washington, DC; 2013. doi:10.1176/appi.books.9780890425596

Wani AL, Ara A, Bhat SA. Blood injury and injection phobia: The neglected one . Behav Neurol . 2014;2014:471340. doi:10.1155/2014/471340

Samra CK, Abdijadid S. Specific phobia . In: StatPearls . StatPearls Publishing; 2021.

Pan Y, Cai W, Cheng Q, Dong W, An T, Yan J. Association between anxiety and hypertension: a systematic review and meta-analysis of epidemiological studies . Neuropsychiatr Dis Treat . 2015;11:1121-30. doi:10.2147/NDT.S77710

Wani A, Bhat S, Ara A. Persistence and inheritance of blood injury and injection phobia . Gulhane Med J . 2016;58:67-73. doi:10.5455/gulhane.172838

Singh J, Singh J. Treatment options for the specific phobias . Int J Basic Clin Pharmacol . 2016;5(3):593-598. doi:10.18203/2319-2003.ijbcp20161496

Pitkin MR, Malouff JM. Self-arranged exposure for overcoming blood-injection-injury phobia: a case study . Health Psychol Behav Med . 2014;2(1):665-669.

Spiegel SB. Current issues in the treatment of specific phobia: recommendations for innovative applications of hypnosis . Am J Clin Hypn . 2014;56(4):389-404. doi:10.1080/00029157.2013.801009

Ritz T, Meuret AE, Ayala ES. The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm . Int J Psychophysiol . 2010;78(1):50-67. doi:10.1016/j.ijpsycho.2010.05.007

By Lisa Fritscher Lisa Fritscher is a freelance writer and editor with a deep interest in phobias and other mental health topics.

An Overview of Hemophobia: Symptoms, Risk Factors, and Treatment

• Updated: 12.09.2022

Rabia Khaliq

Dr. william grigg.

Phobia is a disorder characterized by an extreme, persistent, and irrational fear of specific objects or situations. People with any phobia feel vulnerable and will go to any length to avoid the source of their anxiety. The main categories include complex phobias ( agoraphobia and social phobia ) and specific phobias . Hemophobia — a fear of blood — is in the latter category.

The sight or thoughts of blood cause distress or anxiety in people with hemophobia. Moreover, the condition interferes with a patient’s life. For instance, one may skip a doctor’s appointment so as not to take a blood test.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) categorizes hemophobia as blood-injection-injury (BBI) phobia. According to the National Institute of Health [1*] , the disorder is prevalent since it affects about 3% to 4% of the general population.

Fear of blood can be managed. Book an appointment to see a doctor and get medical phobia treatment .

Main Causes and Risk Factors for Blood Phobia

The exact cause of hemophobia is not clear. However, it has been established that anxiety disorders such as hemophobia can pass through bloodlines. A person with a neurotic personality usually overreacts to distress and is likely to develop phobias too.

In some cases, the disorder is a result of direct traumatic experiences or hearing a narration of a frightening experience. It is also possible to acquire the condition by witnessing a blood-associated trauma.

Aside from genetics and traumatic experiences, a few more factors make a person more susceptible to hemophobia. These risk factors include:

• Other psychoneurotic disorders. A person with other psychoneurotic disorders like panic disorder may also develop hemophobia.
• Caregiver’s anxiety. If a caregiver usually gets anxious at the sight of blood, the minor in his/her care may develop similar fears. Eventually, the fear may evolve into a phobia.
• Gender. Research indicates that women are more likely to have specific phobias than men. For instance, statistics [2*] show that the occurrence of blood-injury phobia is approximately 2.2% among males and 3.9% among females.

A mental health professional can help you identify the root cause of your anxiety and recommend useful techniques.

Hemophobia Symptoms

Hemophobia symptoms [3*] are evident if the affected person sees blood. The reactions may be emotional or physical.

Emotional Symptoms:

• Feeling unreal and detached from self
• Extreme anxiety
• Panic attacks
• Feeling as if one could die or pass out
• A powerless and helpless feeling
• An unsettling feeling in the stomach
• Desire to escape or disappear from a scene that has blood

Physical Signs:

• An increase in heart rate
• Chest tightness or pain
• Cold or hot flashes
• Difficulty breathing
• Dizziness or lightheadedness
• Excessive sweating
• Nausea or vomiting
• Trembling or shaking

Although the symptoms of hemophobia may be obvious, only a doctor can make a diagnosis and determine the right treatment.

How to Diagnose Hemophobia

Hemophobia diagnosis involves a psychological evaluation by a mental health practitioner. To make a formal diagnosis, the doctor uses the criteria outlined in the DSM-5.

The seven-point criteria include the following:

• An excessive, persistent, irrational fear of seeing blood.
• The fear of blood persists for at least six months from the first experience.
• Anxiety or panic attacks as a response to the sight of blood.
• The extreme fear of blood is out of proportion to the actual danger it poses.
• Someone actively tries to avoid the sight of blood and has intense distress or anxiety when in a situation with blood.
• The fear of blood interferes with the daily functions of a person.
• The patient’s irrational reactions to blood differ from other specific disorders’ symptoms. The symptoms differ from panic disorder, social phobia, obsessive-compulsive disorder, or post-traumatic stress disorder signs.

Treatment and Management of Hemophobia

Psychotherapy is the most effective treatment for hemophobia. In severe cases, a doctor may include a pharmacological treatment. Therapeutic interventions to treat hemophobia include:

• Cognitive-behavioral therapy (CBT)

This therapy [4*] helps a patient understand and confront the irrational fear of blood. It also helps them learn new coping techniques to manage their fears.

• Exposure therapy

The patient is gradually and systematically exposed to experiences that involve blood until he/she develops a coping mechanism to overcome the fear of blood.

• Relaxation techniques

The client learns relaxation techniques like yoga, meditation, and breathing exercises. They use these techniques to release physical tension, diffuse stress and eventually get over the fear of blood.

• Applied tension

The Applied Tension technique [5*] is helpful to patients that faint at the sight of blood. In the technique, a person tenses his/her muscles for timed intervals. The exercise happens concurrently with the exposure to the trigger. The tension helps the patient to watch a scene with blood without fainting.

• Medications

When it comes to medications prescribed for hemophobia, the doctor may prescribe selective serotonin reuptake inhibitors (SSRIs) , a well-known class of antidepressants.

Hemophobia is a distressful disorder that can interfere with a person’s life. For instance, a patient may not keep medical appointments or be able to help someone in an emergency. People with hemophobia symptoms should seek treatment to be able to have a productive life. If you notice any warning symptoms and want to manage them, MEDvidi doctors are here to help.

• Blood Injury and Injection Phobia: The Neglected One. (2014) Source link
• Blood-injury phobia. (1994) Source link
• The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm. (2010) Source link
• A comprehensive group-based cognitive behavioural treatment for blood-injection-injury phobia. (2022) Source link
• Applied tension. A specific behavioral method for treatment of blood phobia. (1987) Source link

Consult a healthcare professional online and receive a treatment plan tailored to your needs.

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This article is based on scientific evidence, written by experts and fact checked by experts.

Our team of experts strive to be objective, unbiased, honest and to present both sides of the argument.

This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

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Fear Of Blood: Everything You Need To Know About Hemophobia

Are you someone who feels uneasy or anxious at the mere sight of blood? You’re not alone! Hemophobia, while it might sound like a mouthful, is simply the fear of blood. Picture this: a remarkable and capable individual, just like you, who, when faced with blood, experiences an overwhelming sensation of discomfort.

But fear not! Understanding hemophobia and its quirks is the first step toward managing this common yet intriguing phobia. So, let’s delve into the fascinating world of hemophobia, unravel its mysteries, and discover ways to navigate it confidently and easily.

Fear of Blood (Hemophobia/Blood Phobia)

Hemophobia is a specific phobia characterized by an intense and irrational fear of blood. People with hemophobia may experience severe anxiety or panic attacks when confronted with blood, whether it’s their own, someone else’s, or even just the sight of blood in general. This fear can be quite distressing and may interfere with daily life, causing avoidance of situations involving blood or medical procedures.

Why Some People Fear Blood?

The fear of blood, known as hemophobia, can stem from various factors. For some, it might be an instinctual response to the fear of injury or illness. Others may develop it due to a negative or traumatic experience involving blood, such as witnessing a serious accident or undergoing a distressing medical procedure.

Sometimes, cultural or societal influences can also play a role. The sight of blood might be associated with danger or vulnerability, triggering a fear response. Our brains are complex, and fears can develop for many reasons, often without a clear cause. Understanding the origins of this fear can be an essential step in overcoming it and finding ways to cope.

How is Fear of Blood Diagnosed

Diagnosis for the fear of blood, or hemophobia, typically involves a comprehensive assessment by a mental health professional. The process may include:

• Clinical Interview: A therapist or psychologist will conduct a detailed interview to understand the individual’s symptoms, fears, and the impact of the fear of blood on their life.
• Diagnostic Criteria: The mental health professional will use the criteria outlined in diagnostic manuals (such as the DSM-5 – Diagnostic and Statistical Manual of Mental Disorders) to determine if the fear meets the criteria for specific phobias, like hemophobia.
• Assessment Tools: Psychological assessments or questionnaires might be used to evaluate the severity of the fear and its effects on daily functioning.
• Medical Evaluation: Sometimes, a medical evaluation might be recommended to rule out any underlying medical conditions that could contribute to the fear response, although hemophobia is primarily a psychological issue.

Exploration of Triggers: Understanding the specific situations, thoughts, or images related to blood that trigger fear and anxiety is crucial in diagnosing hemophobia.

Blood Phobia Symptoms

Some of the symptoms of fear of blood are as follows

These symptoms can vary in intensity from person to person and may occur immediately upon exposure to blood or even at the mere anticipation of encountering it.

Overcoming Fear of Blood (Blood Phobia)

Treating blood phobia, or hemophobia, typically involves therapeutic approaches aimed at reducing anxiety and gradually desensitizing individuals to the fear of blood.

Cognitive-Behavioral Therapy (CBT) : Therapy isn’t just about lying on a couch and talking about your childhood (though that can be part of it, too!). It’s about learning how to rewire those brain circuits to react differently to the sight of blood. This therapy helps identify and challenge irrational thoughts or beliefs about blood. Techniques like gradual exposure to blood-related stimuli in a controlled and supportive environment can help reduce anxiety.

• Exposure Therapy: Exposure therapy might sound intimidating, but it’s like dipping your toes in the water before you take the plunge – slowly getting used to the sight of blood in a safe and controlled way. Gradual exposure to blood-related situations or images, starting with less anxiety-provoking scenarios and progressing to more challenging ones, can help desensitize individuals to their fear.
• Relaxation Techniques: Learning relaxation and breathing exercises can assist in managing anxiety responses when confronted with blood or blood-related situations.
• Mindfulness and Meditation : Practices focusing on staying present in the moment can aid in reducing overall anxiety levels and managing the fear response to blood.
• Medication: In severe cases where the phobia significantly impacts daily life, a doctor might prescribe anti-anxiety medications or beta-blockers to manage symptoms during exposure therapy or specific situations.
• Support Groups or Counseling: Joining support groups or seeking counseling can provide a supportive environment to discuss fears and gain insights from others facing similar challenges.

The most effective treatment often involves a combination of therapies tailored to an individual’s specific needs and the severity of their hemophobia. Seeking help from mental health professionals or therapists experienced in treating phobias can guide individuals toward overcoming their fear of blood.

Prevalence Rate

Now, here’s a mind-blowing fact: hemophobia isn’t as rare as you might think. Surveys suggest that it’s among the top fears people have, right up there with heights and spiders. So, if you’ve ever felt queasy at the sight of blood, you’re not alone in this wild phobia club.

Interesting Fact

Did you know that some people overcome their fear by actually training to work with blood? Yep, phlebotomists – individuals who skillfully draw blood were once fearful too.

Trypanophobia and Hemophobia

The fear of needles is known as trypanophobia . It often ties into a broader fear of medical procedures or injections rather than solely the sight of blood. This fear can stem from various sources, including

Past Trauma: A negative or painful experience during a medical procedure involving needles can lead to a fear of needles. Traumatic events can leave a lasting impact, causing significant anxiety when faced with similar situations.

Fear of Pain: Some individuals fear the physical sensation associated with needle pricks, even if it’s minimal. The anticipation of pain can trigger anxiety or panic responses.

• Sensitivity to Bodily Intrusions: The idea of a foreign object entering the body, even for a beneficial or necessary reason like drawing blood, can cause discomfort or fear in some individuals.
• Anxiety about Health Procedures: For some, medical settings can induce anxiety or fear due to the environment, leading to a broader fear of medical procedures or needles specifically.
• Lack of Control: Feeling a lack of control over the situation, especially when someone else is administering the needle, can intensify the fear of certain individuals.

Though it’s normal to be uneasy around blood. If this fear is hindering your ability to get routine medical check-ups or necessary treatments. Seeking help from a mental health professional trained in treating phobias could be beneficial. Effective treatment for hemophobia can ease the anxiety linked to this fear and support your recovery from its symptoms.

Next time you catch yourself feeling woozy at the sight of blood, remember, that you’re not alone, and there are a whole bunch of fascinating ways to tackle that fear!

ALSO READ: FEAR OF DARKNESS: EVERYTHING YOU NEED TO KNOW ABOUT NYCTOPHOBIA

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Fear of water: everything you need to know about hydrophobia, fear of decision making: everything you need to know about decidophobia.

Very good information

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8 Phobias of Blood, Needles, Doctors, and Dentists

• Published: August 2006
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Chapter 8 focuses on phobias of blood, needles, doctors, and dentists, and explores the association of these phobias with fainting, the prevalence of medical phobias, treatment strategies, and ways that the treatment plan can be tailored to treat this type of phobia.

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How to get over a fear of blood tests

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Blood tests are a great diagnostic tool, giving vital information to doctors about the state of a patient's health. But for many of us, the idea of having blood drawn from our arm can put us into a panic. If you're feeling nervous about an impending test, try our tips for managing the procedure.

If you're someone who generally takes life in your stride, you might feel a little embarrassed to admit that you're anxious about a blood test . But many people feel nervous when they have blood taken. "It's natural to feel a little anxious about a medical procedure of any kind," agrees Dr Kate Mason of Roots Psychology Group . "Being open and honest about that - with others and yourself - can help you to feel better."

How to prepare for a blood test

A blood test is one of the most common medical tests and is a good way to get a picture of your ...

What is a full blood count - and what can it tell us?

What to expect when you give blood

Eat breakfast (if allowed)

If your blood test doesn't involve fasting (check with your healthcare professional) then it can be helpful to have a healthy breakfast/meal before your appointment (depending on the time of day). "When we’re anxious, it can affect our appetite," says Mason. "But having something to eat can stabilise blood sugar and help us to feel stronger."

Having something to eat immediately after the test (especially if you've been fasting) can also be helpful.

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Locate your fear

Although many of us are worried about blood tests, we're not all anxious for the same reasons. For some, it's a worry about whether the procedure will hurt. For others, it might be a fear of fainting, or nerves that rise up during the wait beforehand. Other people might be nervous about the reason for the test and what their result may mean.

In order to manage your anxiety, it's important to identify where your fear stems from - once you've highlighted what's driving this, you can manage your reaction more effectively. For example, if you're concerned about pain, you may wish to ask for a product to numb the area beforehand.

Manage the wait

If you're feeling nervous about a procedure, managing the wait is very important. "You find with many people that their anxiety is worse before a test rather than when it's actually taking place," agrees Mason. "If you're likely to have to wait, think about how to manage that time. Take a book, or find an interesting article to read on your phone to take your mind off the test itself."

If you're particularly worried, it's also worth asking someone to come with you. They will be able to offer support and distraction as you wait for your name to be called. "Having someone at your side can really help you to feel supported," agrees Mason. "Explain to your friend beforehand how you are feeling and what support you might find helpful."

Manage your physical reaction

If you're concerned about fainting , you can take steps to minimise the risk of this. "Some people are worried that they'll panic so much that they’ll pass out," says Mason. "But panicking tends to raise our blood pressure, and it's low blood pressure that would cause us to faint. Understanding this physiology can be helpful."

It's also helpful to mention at your appointment if you're worried about or prone to fainting or feeling wobbly. "The nurse or phlebotomist will be able to take blood with you lying in a more reclined position if you're worried about dizziness or passing out," Mason advises. "It's worth raising the issue with them - they will be used to patients feeling this way."

Speak to the clinician

Phlebotomists and nurses will have seen it all - and witnessed many different reactions to blood tests. Don't be afraid to mention your misgivings - they will be able to put your mind at rest. "If you let the nurse or phlebotomist know how you're feeling, they'll be able to take that into account and offer reassurance or support," says Mason.

It's also worth thinking how you're going to manage the moment when blood is taken. "Some people find counting is helpful - after all, a blood test doesn't tend to take very long," says Mason. "Or you may wish to look in the other direction and scroll on your phone. Distraction can be a useful way of coping with anxiety and nervousness."

Tips from a nurse

Nurse and Midwife Laura Mudie has her own advice for those nervous about an impending blood test.

"Being nervous about a blood test is very common - both in children and adults. In some people this can become a real phobia," she says. "If you feel this way, it's important to speak to the practitioner taking your blood as they will be able to help."

"Tell the nurse or phlebotomist how you're feeling - they will be able to take a little more time to make sure you're OK. They may be able to use a smaller needle, and make an effort to distract you during the test."

If you have a severe phobia, or the blood test is for a younger person, there are also products available that can numb the site. If you feel that this may help you, it's worth talking with your GP when they refer you for the test, or asking a pharmacist beforehand.

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Hello, I have a question can i take THC cannabis when i inject blood thinners? I have a knee injury and I'm using blood thinner but I also usually use THC for my head pain reduction because pills... Volavka

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Does the Sight of Blood Make You Anxious? It Could Be Hemophobia.

It’s a common scene: A phlebotomist guides her patient into the room, asks him to sit. She cleans his skin with rubbing alcohol, loops a tourniquet around his forearm. She puts the needle in position and warns him that he may feel a slight pinch. The clear vial attached to the needle fills with a bright pool of red. Minutes later, the procedure is over, and the patient is free to go.

It seems simple enough, but for many people, appointments like these are impossible to complete. If you’re always postponing your regular doctor check-ups in a cold sweat, you may be facing the anxiety condition hemophobia.

Hemophobia is the fear of blood , and it can be extremely inhibiting for those who live with it. People who have hemophobia may avoid necessary medical care or stay away from activities or sports that involve the risk of being injured (and bleeding). Just thinking about surgery or seeing one acted out on a TV show can be enough to make your heart race if you live with the condition.

If any of this sounds like you, you’re not alone. Researchers estimate that hemophobia affects approximately 3-4% of the population , but with the right treatment, you can get past your anxiety. Read on to learn more about hemophobia and what you can do if you’re struggling.

What Is Hemophobia?

Hemophobia is an intense fear of blood. It’s listed as blood injection injury phobia in the Diagnostic and Statistical Manual of Disorders (DSM-5), though it differs from injection phobia and injury phobia in a number of key ways.

“[Hemophobia] can come on as a result of seeing one’s own blood or the blood of another,” Sheva Rajaee , LMFT, director of the Center for Anxiety and OCD, told the Mighty. While many people experience unease at the sight of blood, your discomfort may rise to the level of a phobia when your “anxiety response to the sight, mention or thought of blood causes an exaggerated or prolonged fear response.”

Hemophobia can manifest in a number of ways, according to Rajaee. Some common experiences of people who live with the condition are:

• Avoidance of blood, including the sight or mention of blood
• Avoidance of situations or activities that could result in bleeding or injury
• Experiencing sweaty palms, dizziness, nausea or racing thoughts at the sight of blood

Dr. Tabasom Vahidi, Ph.D. , told The Mighty that unlike other phobias , people living with hemophobia can experience a vasovagal response, or “fainting induced by a decrease in blood pressure.” John Sanford, who used to struggle with hemophobia, once described the vasovagal response in a piece for Stanford Medicine :

Observing blood seep from a wound, flow into a syringe or spatter on the ground, blood phobics initially will respond like other phobics — that is, their heart rate and blood pressure will increase. But then something else will happen: Their heart rate and blood pressure will suddenly drop, causing dizziness, sweatiness, tunnel vision, nausea, fainting or some combination of these symptoms. This is a vasovagal response … which does not generally occur with other phobias.

It’s worth noting that the vasovagal response is usually harmless, though it is possible to be injured from falling when the response is activated.

What Causes Hemophobia?

Researchers have yet to determine what exactly causes hemophobia. While Rajaee said that phobias can manifest in response to something that happened in your environment, she noted that “unlike other psychological conditions, many phobias and anxiety-related disorders do not have a basis in trauma and do not need to have a rational or familial basis in order to manifest.”

Some studies have suggested that individuals can be genetically predisposed to develop the condition. Researchers have also put forward the idea that hemophobia developed as an evolutionary response to being injured. According to this theory, ancient humans injured by predators may have escaped a grisly fate by catching sight of their own blood and fainting. Predator species tend to pass over prey that abruptly stops moving.

Another possible cause of hemophobia is “an overactive amygdala,” according to Rajaee. The amygdala is a part of the brain responsible for detecting threats and initiating the body’s survival fear responses . Several researchers have proposed a link between amygdala dysfunction and anxiety disorders, including phobias.

Treatment for Hemophobia

In order to protect themselves, people living with hemophobia often engage in “safety” or avoidance behaviors to temporarily reduce their anxiety. It may seem to help in the moment, but unfortunately, these patterns of avoidance actually worsen your fear over time: “Research has confirmed that any attempt to reduce anxiety or avoid your fear can intensify it in the long run,” Vahidi explained.

For that reason, treatment for hemophobia centers on staying with your discomfort and anxiety in small but increasingly difficult steps while a therapist teaches you tools to manage your anxiety. “[It] involves a great deal of motivation and willingness to temporarily intensify anxiety to ultimately overcome your fear,” Vahidi said. This may feel scary at first, but phobias have high recovery rates when treated in this way.

Exposure therapy also happens over a long period of time, and exposures are repeated. In this way, the brain “gets retrained to experience the fear as safe so that the body’s ‘fight or flight’ [response] does not get activated each time one is faced with a trigger,’ Vahidi said.

While some phobias — such as the fear of snakes — can be relatively benign because it’s typically best practice to avoid dangerous situations anyway, “the risks are high” for people who live with hemophobia:

“One of my patients had an intense fear of needles and she avoided getting her blood drawn for years, in spite of the medical risks,” Vahidi said. “Everyone, at some point in their lives, may need to have surgery and medical assessments that involve blood and needles.”

Vahidi guided her client through a series of exposures, including watching videos of blood draws, tying a tourniquet on her arm, being exposed to a medical lab and watching in-person blood draws. “We worked collaboratively to plan every exposure, and I closely guided her through the steps while tracking her anxiety,” Vahidi said. At the end of treatment, the patient had her blood drawn by a phlebotomist.

If you have experienced a vasovagal response, your therapist may also teach you the “applied tension” technique developed by Swedish psychologist Lars-Göran Öst . The technique involves tensing the muscles in your arms, torso and legs to counter the lowered blood pressure and slow heart rate that can lead to fainting.

Vahidi said it’s also important for you and your therapist to identify what is triggering your fear: “As a clinician, it’s important to identify the fear. Do they fear fainting or do they fear the needle?”

If exposure therapy sounds difficult to you, that’s because it is. Dr. Vahidi, who went through exposure therapy for her fear of flying, knows that firsthand. But “treating your fear is possible,” Vahidi said. “In fact, phobias have high recovery rates when treated properly.”

“Anxiety disorders, including phobias, are highly treatable with the right treatment ,” Rajaee agreed. “Though it may seem incredibly difficult to imagine, rewiring of the fear response when faced with blood or possible contamination is achievable.”

For more on phobias, check out the following stories from our Mighty community:

• Is Pistanthrophobia Getting in the Way of Your Relationships?
• The Reality of Emetophobia and How I’m Beating It
• Trypophobia: The Anxiety Struggle That Can Make Your Skin Crawl

Article updated Feb. 14, 2020.

Image via Getty/Daria Zaseda

Hi! I was a reporter at The Mighty.

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The Importance of Blood Is Infinite: Conceptions of Blood as Life Force, Rumours and Fear of Trial Participation in a Fulani Village in Rural Gambia

Sarah o’neill.

1 Unit of Medical Anthropology, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium

Susan Dierickx

2 Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands

3 RHEA, Centre of Expertise on Gender, Diversity and Intersectionality, Vrije Universiteit Brussels, Brussels, Belgium

Joseph Okebe

4 Medical Research Council Gambia, Fajara, The Gambia

5 University of Antwerp, Antwerp, Belgium

Edgard Dabira

Charlotte gryseels, umberto d’alessandro.

6 London School of Hygiene and Tropical Medicine, London, United Kingdom

Koen Peeters Grietens

7 School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan

8 Partners for Applied Social Sciences (PASS) International, Tessenderlo, Belgium

• Conceived and designed the experiments: SO KPG.
• Performed the experiments: SO.
• Analyzed the data: SO KPG.
• Contributed reagents/materials/analysis tools: SO SD ED JO.
• Wrote the paper: SO SD KPG.
• Data collection: SO. Literature review: SO. Co-ordination of study: KPG UDA. Co-ordination of administrative arrangements: JO ED SO. Edits and scientific review: UDA KPG CG.

Associated Data

The data presented in the manuscript is confidential and sharing it would infringe the informed consent procedure since participants did not consent to having their transcripts made publicly available. The data are publicly stored at the Institute of Tropical Medicine data management office. Please contact the data manager Jef Verellen ( eb.gti@nellerevj ) for access to data.

Clinical trials require high levels of participation and low drop-out rates to be successful. However, collecting blood samples from individuals recruited into clinical trials can be challenging when there is reticence about blood-taking. In addition to concerns regarding the feasibility of medical research, fears of ‘blood-stealing’ and ‘blood-selling’ have ethical implications related to cultural sensitivity and informed consent. This study explores anxieties around blood-taking during a malaria treatment trial in the Gambia.

This case study is based on ethnographic research in one theoretically selected village due to the high reticence to screening for the clinical trial ‘ Primaquine's gametocytocidal efficacy in malaria asymptomatic carriers treated with dihydroartemisinin-piperaquine’ carried out in the Gambia between 2013 and 2014. Data collection tools included in-depth interviews, participant observation, informal conversations and group discussions.

In total only 176 of 411 habitants (42%) in the village accepted having a bloodspot taken to screen for malaria. Although trial recruitment was initially high in the village, some families refused screening when rumours started spreading that the trial team was taking too much blood. Concerns about ‘loss of blood’ were equated to loss of strength and lack of good food to replenish bodily forces. Families in the study village were concerned about the weakness of their body while they had to harvest their crops at the time of recruitment for the trial.

A common recommendation to prevent and avoid rumours against public health interventions and trials is the provision of full and consistent information during the consent procedure, which is assumed to lead to more accurate knowledge of the purpose of the intervention and increased trial participation. However, even when information provision is continuous, the emergence of rumours can be related to times of uncertainty and perceptions of vulnerability, which are often a reflection of structural inequalities and diverging value orientations between communities and public health institutions.

Introduction

Medical research involving human subjects has increased substantially over the last decades [ 1 , 2 ]. Although the number of clinical trials conducted in Sub Saharan Africa is lower than in Europe and the United States, their number has grown significantly, a consequence of the higher availability of resources for public health-orientated research and the need to address the high burden of diseases in these countries [ 1 , 2 ].

Clinical research is regulated by internationally agreed ethical principles, formulated into guidelines, national laws and regulations [ 3 – 5 ]. Nevertheless, the ethical conduct of research specific to developing countries has been subject to discussion [ 6 – 8 ]. People’s decision to participate in medical research and clinical trials in Sub Saharan Africa can be influenced by the perceived benefits [ 7 ] and the level of trust patients place on investigators [ 1 , 9 ]. Furthermore, potential trial participants’ understanding of research methods, such as blinding and randomization, and perceptions of risk can influence the decision to participate [ 1 ]. Even when procedures are guided by approved protocols and followed by the book, collecting blood or other bodily samples from individuals recruited into clinical trials can be challenging when rumours arise [ 10 – 13 ]. Fears of blood-stealing, body parts trade, sterilization campaigns and the deliberate spreading of diseases in relation to public health interventions have been documented since colonial times [ 10 , 13 – 15 ], and continue to influence medical research and clinical trials [ 6 , 12 ].

When rumours arise, investigators often respond by intensifying community sensitization and providing additional information. At times, research participants and influential members of the community are taken to the clinic and to the laboratories to demonstrate scientific procedures. Such measures are often facilitated by fieldworkers who speak the local languages and are able to explain the scientific procedures. Some trials strongly encourage the placement of fieldworkers in the study villages and thus fieldworkers often reside in trial participants’ homes [ 16 ]. This seems to have a positive effect on trial participation since misunderstandings and emerging rumours can be dealt with immediately. However, this can also have ethical implications when villagers agree to participate on the basis of friendship, social kinship and trust, rather than with the intention to contribute to the advancement of science and medical research [ 16 – 18 ].

Clinical trials require maximum participation and low drop-out rates to be successful [ 6 , 19 , 20 ]. An improved understanding of potential study participants’ concerns and beliefs about blood-taking in medical research could improve free and informed decision-making for potential participants and enhance the overall trust relationship between medical institutions and research participants [ 1 ]. This case study explores anxieties around blood-taking as a reason for reticence towards screening for the inclusion in a malaria treatment trial in one village in rural Gambia.

Study design

The presented research is a case study. Case studies can be defined as ‘an empirical inquiry that investigates a contemporary phenomenon within its real-life context; when the boundaries between phenomenon and context are not clearly evident; and in which multiple sources of evidence are used’ [ 21 ]. It allows for an in-depth understanding of ‘how’ and ‘why’ rumours about blood-sampling emerged, and takes into account the local context [ 22 , 23 ].

This case study used an ethnographic approach. Qualitative data were gathered by triangulating in-depth interviews, focus-group discussions, and participant observation, including informal talks during fieldwork, in order to enhance the reliability and validity of emerging results. Sampling was theoretical and analysis was a process concurrent with data collection in line with a grounded theory approach[ 24 ].

The case study was ancillary to the trial ‘ Primaquine's gametocytocidal efficacy in malaria asymptomatic carriers treated with dihydroartemisinin-piperaquine’ (ClinicalTrials.gov: {"type":"clinical-trial","attrs":{"text":"NCT01838902","term_id":"NCT01838902"}} NCT01838902 ) (hereafter, Prinogam ), evaluating the effect of different doses of primaquine to clear gametocytes. This health facility based trial was carried out in the Upper River Region and the Central River Region during the 2013 and 2014 rainy seasons [ 25 ]. The initial pre-screening was done to determine infection (rapid antigen test kit) and to establish a baseline parasitaemia (microscopy). The pre-screening took place in 56 villages.

For the anthropological case study, a Fula village was theoretically selected from 12 villages in which ethnographic fieldwork during the Prinogam trial took place. The selection was based on the substantial reticence in the village, in comparison to other villages participating in the Prinogam trial. The study took place in November and December 2013 and in August 2014. Ethnographic research methods were employed to understand reasons for low participation.

Study site and population

The selected village for the case study comprises 12 compounds located about an hour’s drive south east of Basse, where the Medical Research Council Gambia (MRCG) field station is located. It is two kilometres away from the border with Senegal. According to the census data of 2013, 411 individuals were officially registered as residents, some of whom were absent at the time of screening (see Table 1 ). All inhabitants were Fulani and lived off cattle herding and subsistence farming (predominantly millet, maize, groundnuts and rice) as well as remittance from family members living in urban areas or from relatives living abroad. There was no electricity in the village and inhabitants fetched water from a nearby well. For healthcare and business, participants either went to Madina Samako, a large village nearby, or to Velingara in Senegal. Basse was perceived to be less accessible and transport less affordable.

The principal malaria parasite in The Gambia is Plasmodium falciparum , which is transmitted by three mosquito species of the Anopheles gambiae complex [ 26 ]. Malaria transmission is moderate and highly seasonal, starting during the short rainy season (June-September) and peaking from November until December/January. Malaria prevalence is heterogeneous, with the eastern part of the country having the highest prevalence [ 27 ].

Research on treatment-seeking-behaviour for malaria in the Gambia found that in 2003, 63% of respondents took their children to the health centre for malaria treatment and 13% to a health village post [ 28 ]. Wiseman et al. (2008) found that 48.6% of respondents went to the hospital for malaria treatment, 21.7% to the health centre and 4.5% to the clinic [ 29 ]. Recent evidence suggests that treatment seeking depends on the symptoms, perceptions of the cause and severity as well as the development of the malaria episode, the healing process or the lack of recovery. Patients do not necessarily go to the health centre if they interpret the symptoms of the illness as a self-limiting febrile illness or a folk illness ( Jontinooje/Kajeje )[ 30 ]. A visit to the health centre is often delayed until the patient is seriously sick [ 30 ].

The Prinogam trial

The case study was part of the Prinogam trial in which the following procedures were followed:

Community sensitization

In agreement with the village chiefs and the village councils, sensitization meetings were held before any research activity started. All inhabitants of the village were invited. At these meetings the purpose of the study and the procedure were explained in detail by the study team, consisting of fieldworkers and nurses from the MRCG.

The Prinogam study team moved from compound to compound and verbal consent was taken for a rapid clinical assessment and a Rapid Diagnostic Test (RDT) (pre-screening). Blood from a single finger prick from all non-febrile people was used to prepare a blood slide and perform an RDT. If the RDT was negative, the blood slide was discarded and the person was told that they did not have malaria. Otherwise, the blood slide was taken to the laboratory, stained and read by microscopy to determine the parasite density. Participants with a Plasmodium falciparum mono-infection with a density of at least 20 parasites/μL were informed of the result and invited to be taken to the clinic with the MRCG car the following day. After obtaining the written informed consent, a finger prick blood sample was collected for haemoglobin (Hb) measurement using a handheld machine (Hemocue®) and G6PD screening by the fluorescent spot test (SQMMR500, R&D Diagnostics). If eligible, participants were referred to the trial clinician for randomisation and enrolment.

Enrolment, treatment and follow up

After successful screening, consent (day 0) and clinical review, each participant was randomized into one of the four study groups and followed up on days 1, 2, 3, 7, 10, 14, 21, 28, 35, and 42 or on any other day outside scheduled visits if they felt sick. At each visit, a blood sample (about 0.5ml by finger prick) was collected for the determination of gametocytaemia (QT-NASBA), parasite clearance (blood film and PCR) and Hb. In addition, a venous blood sample (3ml) was collected from a subset of 100 participants that consented for a direct membrane feeding assay to determine infectiousness to mosquitoes on day 7 (for more details see [ 25 ].

Qualitative data collection

Participant observation.

Participant observation is a key method in ethnographic research [ 31 ]. It involves participating in everyday activities in the community setting, observing events in their usual context and carrying out reiterated informal conversations with a maximum variety of research subjects. This method provides a more contextualised understanding of the research questions and helps cross-check the validity of the information obtained in semi-structured interviews. Participant observation reduces biased responses in interviews. Establishing a rapport and certain level of trust with the research participants is central to participant observation in ethnographic fieldwork. For this research, the main author and fieldworkers repeatedly visited and stayed in the village for a few days at a time over a time period of one year. During these stays, people’s everyday routines were observed, trust was established and informal conversations about relevant themes (i.e. the trial, the MRCG, blood, health and malaria) were held. Informal conversations were conducted in English and Fula and written down after the interview as soon as appropriate.

In-depth interviews

In-depth interviews were conducted at participants’ residences in private or in places where they felt most at ease. In total 30 interviews were conducted ( Table 1 ). All formal in-depth interviews were recorded at this site and translated with the assistance of trained field assistants. These interviews were fully transcribed. The interviewees were visited and informally interviewed again on various occasions after the formal recording.

Group discussions

Two group discussions were conducted. The first (i) comprised a group of women who were looking after children in the same compound; this group discussion was about trial participation, the MRCG and blood-taking. The second (ii) was a group of men resting together at the bantaba (central meeting place). This discussion was about the history of the village, social structure and politics. The participation of various members enriched the data by providing different points of view in a discussion.

Participant recruitment was carried out through a mixed-sampling approach, including both purposive and snowball sampling techniques. Informants were purposively selected based on the questions emerging from the on-going analysis of collected data. Respondents were selected to ensure that all social groups were represented (maximum variation), regardless of local hierarchy or locally perceived expertise. In addition, snowball sampling was used to enhance participants’ trust and confidence in the research team when information was needed on sensitive subjects. Information about the respondents was collected and categorized in relation to relevant criteria, such as gender, age, social standing, trial participation and refusal, and role within the village [ 32 ].

Data analysis

Data analysis was concurrent to data collection using a constructivist grounded theory approach [ 32 ]. Key analytic concepts in ethnographic research such as reflexivity, positionality and subjectivity were considered during the ethnographic fieldwork as well as during the data analysis. Relevant categories for analysis were established during the field research based on the participant observation, interviews and group discussions. Once patterns and themes relevant to the research question emerged, the results were constantly tested for their validity by including and confirming or refuting critical cases. The verification and validation of the results took place by systematically interviewing people belonging to different socio-demographic categories on the same topic, e.g. men versus women; trial participants versus non-participants; high versus low status groups. Once data saturation was reached for recurrent themes during the fieldwork, the results were further analysed and categorised after the transcription process. For the coding and analysis, the principle of retroduction was used combining inductive analysis from field data and theory from existing anthropological literature[ 24 ]. An initial coding framework was set up and further deepened through open coding. The analyses were carried out by means of a careful reading of the coded text fragments and with attention to potential interrelations. Through the analysing process data were constantly subjected to theoretical perspectives as to ensure theoretical triangulation and to embed the findings in existing literature. Data were imported, managed and analysed using NVivo 12 Qualitative Data Analysis software (QSR International Pty Ltd. Cardigan UK).

Ethical considerations

The social science study was approved by the Gambia Government/MRC joint Ethics Committee (SCC number 1351) and the Institutional Review Board of the Institute of Tropical Medicine, Antwerp, Belgium (880/13). The interviewers followed the Code of Ethics of the American Anthropological Association (AAA). All interviewees were informed of the study, the type of questions to be asked and the intended use of the results prior to the interview. Anonymity and confidentiality were guaranteed and they were informed that they had the right to refuse or stop the interview any time. Verbal instead of written consent was preferred as requesting the subject’s signature could have been a potential reason for mistrust. A witness acknowledged the verbal consent and signed a documentation of consent sheet.

For ethical reasons and in order to avoid potentially negative repercussions for village inhabitants in the future (e.g. stigma), the name of the village and further details on the study subjects have been omitted from the manuscript.

Details of screening and refusals

Among the 411 inhabitants of the village, 174 were approached and pre-screened for the trial. 43 people were absent or had moved away from the study area; 39 were not eligible because they were pregnant, breast-feeding or too old; 3 individuals refused to be screened and 149 were not pre-screened because the compound heads refused screening for the entire compound (5 out of 12 compounds) ( Table 2 ).

Although initially recruitment went smoothly, after one month the Prinogam study team encountered problems when no one wanted to be screened and some people refused to go to the hospital for follow-up.

Reasons for refusal of blood sampling

Conceptions of blood as reasons for non-participation.

The main reason for refusing participation was “blood taking”. Some trial participants spread the news that a lot of blood was taken at the hospital, which instigated rumours in the village leading to a sudden halt in screening due to the villagers’ complete refusal to participate. The given reason was fear of loss of strength through loss of blood, the latter associated with depleting life-force and body strength. Although people were told and had understood that the blood was taken to see if the person had malaria or not, most respondents believed that loss of blood was worse for a person’s health than the presence of malaria in the body. It was thought that the blood taken could not easily be replenished.

Blood as a life-force

Blood was inextricably linked to being alive and to health. Sickness was associated with lack of blood in the body, as illustrated in the following quote:

“The importance of blood is infinite. Blood is very, very important. Even for us here, who are sitting here talking, we are only able to do so because we are in good health. We are with the health that God lent us. No one can over-emphasize the importance of blood. When a bit of blood is missing from your body, you cannot be anything. It will affect some people’s brain, there is nothing negative that has not been said about blood taking.” (Elderly herder )

“For me when you talk about blood I think straight away about life because without blood, life will be very difficult to achieve. If you fall sick you might need blood because I think it circulates all over the body.” (Middle aged herder )

In respondents’ discourses, blood and work were closely linked. A person was thought not to be able to achieve much in life if the quality of their blood was not good. If a person was not able to endure long working hours on the fields or in the bush it was thought to be linked to their blood.

Nutrition and blood

Different conceptions of the ‘quality’ and ‘quantity’ of blood existed, which were linked to nutrition. Respondents reiterated that although they had ‘enough blood’ the ‘quality’ of their blood was not good because they were not eating well. People believed that their diet, which was almost entirely based on subsistence farming and herding, was not healthy. In order to replenish the strength lost through hard work, farming, cattle-herding or blood taking, more nourishing food was needed. The types of food that were thought to produce blood in the body were meat, oily food and rice.

“For us here, currently people are not strong because we are fully depending on cow milk. The groundnuts are just ripening. We don’t eat oil or meat; we only eat the fish people bring here for sale. We only eat our village food so where should we expect to get blood from? Even if you take our blood and put it in a small bottle it will cause us problems.” (Elderly woman)

“It’s because in the village here, the diet we take is in between bitterness and sourness and you know that cannot add blood in the body, our ways of surviving are not the same. Now if you are not surviving on a good diet and your blood isn’t much and people want to reduce that blood from you, it is going to be a problem. That is why most of the time, people in the village resist for their blood to be taken from them. If only you have enough money to eat good diets, diets that will give you vitamins, you will not be scared.” ( Elderly herder)

“Before giving us food to replace the blood taken from our body, why don’t you just leave the blood that is in our body? [laughing] We are farmers and we don’t have blood. But right now the groundnuts are ripening and after eating enough groundnuts, if you take our blood we will not feel it. (…) You know, Fulas don’t like eating too much meat because they cannot buy it. We fully and surely depend on milk.” (Elderly woman)

Blood as fuel

It became evident from respondents’ explanations that the ‘quantity’ of blood was crucial for strength, which was thought to be needed on a day-to-day level to undertake the work necessary for subsistence farming. The more blood a person was thought to have, the stronger and more enduring they were believed to be farming “under the hot sun” or herding animals in the bush. If a person worked hard under the sun for extended periods of time, their blood was thought “to burn like fuel”, making him/her more vulnerable to weakness and sickness:

“(…) When your blood is taken and you have a lot of work to do in the sun, your blood will burn very well and that will make you scared so that for a few days you will not work. You will be asked to rest.” (Young herder )

Interviewer: “What is so important about blood? Is it that when you lose blood you will lose strength or do you think people can use the blood for evil?”

Respondent: “It is the strength you will lose of course because you see, even a car, it requires both petrol and water, if there is no water in the car it will obviously not go. Just like the petrol, if there is no petrol in the car it won’t go either. Is it not like that?” (Middle aged herder)

Blood and gender

Women were generally perceived to be more vulnerable to weakness than men because of pregnancy, child-birth and menstruation. Blood-donation was thought to be impossible due to health risks to the mother and the unborn child. Pregnancy was believed to last for at least eight months, in some cases up to two years. Thus it was thought that blood-taking was very bad for pregnant women, particularly those who had young children.

“I don’t know whether they don’t have enough blood but a woman is always giving birth. A woman who gives birth to a lot of children, if she gives out her blood, you know, that will be a problem. I am not saying that this is the case if you are not giving birth or when you have stopped giving birth. A woman cannot just start giving birth and give out blood, that is the problem.” (Elderly woman)

Blood testing, blood donations and blood stealing

People did not conceptually distinguish between blood sampling for testing and blood donation. Although the trial procedure and eligibility criteria of the trial had been explained on numerous occasions, many people seemed to think that some of the blood taken during the trial would be donated to someone or potentially sold. Although many of those enrolled in the trial said that too little blood was taken for the MRCG to use for other purposes and that they had seen them “check the blood with a machine”, those who refused to participate stated they did not have enough “blood to give away”. The following elderly herder compares trial participation to an event in his life when he was asked to donate blood:

“They asked me to donate two litres of blood but I insisted and only gave them a litre because that was what my daughter needed. But today with the condition that I am in, I know perfectly well that I cannot donate anyone even a litre of blood, I don’t have that amount of blood in my body because I really do know myself. My body is very weak as I am now.” ( Elderly herder)

These beliefs arose particularly because the MRCG was not recruiting the ‘sick’ with malaria but asymptomatic carriers who were perceived to be completely healthy. Some believed that the drugs given to ‘healthy people’ were to make up for blood loss.

“… they say that if you are taken to the hospital, they will take your blood and in return the only thing they give you back is medicine, and we are told that this medicine is to replace the blood that has been taken from your body and that’s all they give you. They also said that you people are only after healthy people, those whose blood is good and healthy are the people you are after. You are not after the sick, and they are saying all that.” ( Middle aged herder)

People believed that medical institutions, such as the MRCG, as well as hospitals in general would take more blood if they could get away with it. For some, it seemed a question of weighing up the benefits of trial participation against the risk of having one’s blood taken, which would then probably be sold or donated to someone else or used for sorcery.

Perceived risks of blood-taking

In addition to the more abstract conceptions of health and sickness as being linked to the quality of the blood, some respondents expressed more concrete fears related to blood-taking, such as losing so much blood that they would have to be hospitalised due to lack of blood, which would then require them to buy someone else’s blood:

“People are only suspicious of one thing and that is the issue of blood. So if you are taken to the hospital, and you don’t have enough blood, if they want to take your blood then you will be scared. Because if I lack blood today and I am taken to the hospital it may cost me a million to get blood, or 1500 Dalasi, 1000 Dalasi, or 500 Dalasi. The issue of blood is very hard and difficult. So this is the reason why people are suspicious of their blood being taking, if you need more blood and the little you have is about to be taken, you will obviously be scared.” (Middle aged herder)

Symptoms of weakness that were perceived to be linked to loss of blood were dizziness and loss of consciousness:

“I have seen many people, when their blood is taken or reduced they will faint and everything will be black in the person’s eyes. That is the problem. But there are some people who, when their blood is high, will make a request for their blood to be reduced and nothing will happen to the person.” (Elderly woman )

The latter quotation demonstrates the common belief that high blood pressure can be remedied through blood taking. It is thought that those suffering from high blood pressure should have their blood reduced regularly and that blood taking does not affect them in the same way as those who “do not have a lot of blood”.

The refusal to participate in public health campaigns or clinical trials in both African and European settings is commonly interpreted as caused by a lack of, or misunderstanding of the purpose of the intervention. ‘Myths’ and ‘rumours’ are often treated as irrational residues and by-products of people’s insufficient knowledge about new technologies and practices [ 33 ]. Additional documented factors leading to rumours are the lack of trust in public health institutions [ 33 – 35 ] and stigma related to trial participation [ 20 ]. This case study’s results show that concerns about daily subsistence and vulnerability related to poverty can also contribute to reticence. Those who refused were afraid of losing life-force and strength, which they associated with the quality of their blood. Particular concerns regarded the necessity to increase the quantity of blood in their body to restore strength. Previous research in the study region found that people evaluated different kinds of food in terms of their impact on blood and some foods are particularly sought after because they are thought to replenish blood and strength [ 36 , 37 ]. Those who refused to participate believed that the research team was going to give the blood to others and that they would be left weak, bloodless and vulnerable to sickness. Such beliefs seemed to be linked to the fact that only apparently ‘healthy’ people were being recruited in the trial and not those who were sick. Refusers felt that they were not in a position to “give away” their blood because they did not have enough and were afraid of getting sick if they lost more strength and, as a consequence, might need to get hospitalized and purchase blood for themselves. These findings are in line with Fairhead and Leach who describe that many people believe that blood taken during trials is later sold [ 11 , 36 ]. Cham (2003) described how, more than 12 years ago, patients in need of blood in The Gambia were given different options: either to receive blood from a close relative with the same blood group, or to buy blood for cash [ 38 ]. Such accounts may partially explain current blood-selling perceptions.

Vulnerability is a term commonly used to describe the dialectical relationship between poverty, risk and efforts to manage risks [ 39 – 42 ]. Locally perceived risk is socially constructed and depends not only on the nature of a hazard but also on political, social and cultural contexts [ 43 , 44 ]. Rather than solely being due to ignorance and misunderstanding, reluctance to participate may instead be linked to distinct forms of experiential expertise grounded in everyday practice, knowledge and epistemology [ 11 , 45 ]. It has been shown that in different socio-cultural contexts people feel vulnerable to different health problems, which do not always correspond to the calculated probability of epidemiological risk [ 46 ]. ‘Vulnerability refers to the actual feeling of susceptibility to illness or misfortune. It is a state of weakness, fear and worry’ [ 47 ]. In everyday language, risk is an expression of hazard, chance and uncertainty. In developed as well as in developing countries people think about and engage with risk and vulnerability in different ways. Whereas some members of an epidemiological risk group may not perceive themselves as vulnerable at all, for others exposure to risk data may trigger a sense of vulnerability [ 47 ]. As Gikonyo et al. [ 47 ] argued, locally perceived risks are often far greater and more dramatic than the biomedical risk mentioned in the informed consent procedures. In this study, the actual risk of taking a finger-prick of blood were minimal/non-existent but it was nevertheless perceived as potentially dangerous in the study village, clearly associated to perceptions of risk linked to poverty, lack of resources and possibly fear of exploitation. The fears around risk and threat to health, point to a social reality that needs to be addressed in informed consent procedures, public health research and policy planning.

It is not clear why these concerns reached the tipping point of non-participation in this study village, while there were few concerns about blood taking and trial participation in other Prinogam trial villages and research shows that people are often very keen to participate in clinical trials conducted by the MRCG in the Gambia [ 9 ]. The concrete results of this case study can therefore not be directly generalized to other trial villages in the Gambia. Nevertheless, individual reticence to trial participation in other places may also be linked to fear of blood taking due to depletion of life-force and fear of exploitation. Rumours can affect overall participation rates in research and disease elimination strategies. Further research might focus on how perceived risks can be appropriately addressed and discussed, for instance during the informed consent procedures.

Acknowledgments

We thank the MRCG social science fieldworkers Fatou Y Manneh, Hejinkey Darboe and Michelle Demba for their assistance with data collection during fieldwork as well as for the transcription and translation of recorded interviews and discussions. We also thank the Prinogam trial fieldwork coordinator Matar Ceesay and team for good co-operation and assistance with fieldwork arrangements. This work is part of the study ‘Primaquine’s gametocytocidal efficacy in malaria asymptomatic carriers treated with dihydroartemisinin-piperaquine’ (MR/K007203/1) funded by the Joint Global Health Trials Scheme (DFID/MRC/Wellcome Trust). The main author thanks the Institute of Social Cultural Anthropology at the University of Oxford, Oxford, UK for the visiting fellowship.

Funding Statement

This work is part of the study ‘Primaquine’s gametocytocidal efficacy in malaria asymptomatic carriers treated with dihydroartemisinin-piperaquine’ (MR/K007203/1) funded by the Joint Global Health Trials Scheme (DFID/MRC/Wellcome Trust). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Data Availability

Essay on Fear

Students are often asked to write an essay on Fear in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Fear

Understanding fear.

Fear is a basic human emotion that alerts us to the presence of danger. It is fundamental to our survival, making us respond quickly when we sense a threat.

Fear’s Role

Fear helps us make decisions that protect us from harm. It triggers our ‘fight or flight’ response, preparing our bodies to either confront or escape danger.

Overcoming Fear

Fear can be overcome by understanding and facing it. When we challenge our fears, we learn to control them, reducing their impact on our lives.

The Positive Side of Fear

Fear can also be positive, motivating us to push beyond our comfort zones, leading to personal growth and achievement.

Also check:

• Paragraph on Fear
• Speech on Fear

250 Words Essay on Fear

Fear is an innate emotional response to perceived threats. It is evolutionarily wired into our brains, acting as a survival mechanism that alerts us to danger and prepares our bodies to react. While fear can be a beneficial response, it can also be debilitating when it becomes chronic or irrational.

The Physiology of Fear

Fear triggers a cascade of physiological responses, including the release of adrenaline and cortisol. These hormones prepare the body for the ‘fight or flight’ response by increasing heart rate, blood pressure, and glucose levels. This process, while crucial for survival in threatening situations, can lead to health problems if sustained over a long period.

Fear and the Mind

Psychologically, fear can be both a conscious and subconscious experience. It can be based on real threats or imagined ones, leading to anxiety disorders and phobias. Fear can also influence decision-making, often leading to risk-averse behavior. Understanding the psychological aspects of fear is essential for effective mental health treatment.

Overcoming fear involves recognizing and confronting it. Techniques such as cognitive behavioral therapy, exposure therapy, and mindfulness-based stress reduction can be effective. These strategies aim to change the thought patterns that lead to fear and teach coping mechanisms to manage fear responses.

Fear in Society

Fear also plays a significant role in society, influencing politics, economics, and social interactions. It can be used as a tool of manipulation, or it can drive societal change. Recognizing the societal implications of fear is crucial for fostering a more understanding and empathetic society.

In conclusion, fear is a complex emotion with profound impacts on individuals and society. Understanding its mechanisms and implications can help us navigate our fears and use them as catalysts for growth.

500 Words Essay on Fear

Introduction.

Fear is a universal human experience, an essential part of our biological makeup that has evolved over millions of years. It is a complex emotion that can be both protective and paralyzing, serving as a warning signal for danger while also potentially hindering personal growth and exploration. This essay explores the multifaceted nature of fear, its psychological implications, and its role in shaping human behavior and society.

The Biological Basis of Fear

Fear is fundamentally rooted in our biology. It is a response triggered by the amygdala, a small, almond-shaped structure in the brain that processes emotional stimuli. When we perceive a threat, the amygdala activates the body’s fight-or-flight response, leading to physiological changes such as increased heart rate, rapid breathing, and heightened alertness. This response is adaptive and has been crucial for human survival, allowing us to react quickly to potential threats.

The Psychological Aspect of Fear

Psychologically, fear is a multifaceted emotion with wide-ranging implications. It can be both acute, as in the immediate response to a threat, and chronic, as in the long-term fear associated with anxiety disorders. Fear can also be learned through conditioning or observation, which explains why different individuals may have different fear responses to the same stimulus.

Fear can lead to avoidance behavior, where individuals steer clear of situations that they perceive as threatening. While this can be protective, it can also be limiting, preventing individuals from pursuing opportunities and experiences that could lead to personal growth.

Fear and Society

On a societal level, fear can be both a unifying and a divisive force. It can bring people together in the face of a common threat, but it can also be exploited to manipulate public opinion and justify oppressive policies. Fear can lead to stereotyping and discrimination, as individuals or groups are scapegoated as threats to societal safety and order.

Overcoming fear involves recognizing and understanding it. Cognitive-behavioral therapy (CBT) is one effective method, as it helps individuals reframe their fearful thoughts and gradually expose themselves to feared situations. Mindfulness and meditation can also be beneficial, allowing individuals to stay present and focused rather than getting caught up in fearful thoughts.

In conclusion, fear is an integral part of the human experience, with deep biological roots and far-reaching psychological and societal implications. While it can be protective, it can also be limiting and divisive. Understanding and managing fear is therefore crucial, not just for individual well-being, but also for societal harmony and progress. As we navigate through an increasingly complex and uncertain world, the ability to confront and overcome our fears will be more important than ever.

That’s it! I hope the essay helped you.

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How politicians abuse language to magnify fear and reflect grievances

Orwell, trump, and the zombie apocalypse: an essay about diss, dys, and dat.

An essay by George Orwell, “Politics and the English Language,” changed the trajectory of my career. I pivoted from a job as a college literature teacher to become a writing coach for students, journalists and other public writers.

“Political language,” wrote Orwell, “is designed to make lies sound truthful and murder respectable, and to give an appearance of solidity to pure wind.”

The author of the dystopian novels “Animal Farm” and “1984” posited this vicious yin-yang: that political corruption requires language abuse; and that abuse of language enables political corruption.

Orwell found evidence of language abuse at the heart of the most oppressive political systems: from fascism to communism, from British imperialism to heartless capitalism.

Rereading his essays on language, I wondered what the author of “1984” might think of the political language of 2024, especially the rhetoric of one Donald Trump.

Euphemism and dysphemism

In the immediate aftermath of World War II, Orwell argued that tyrants made murder sound respectable by their use of euphemisms and other forms of cloudy language. Euphemisms are language veils that can be thrown over any reality you don’t want people to see. Edward R. Murrow described what he saw in the concentration camps in vivid language. Nazi propagandists called it the “ultimate solution” to the “Jewish problem.”

When someone dies, and we explain that they “passed away,” or, in religious terms, “transitioned,” we are using euphemisms in harmless, even beneficial ways. When we revert to slang phrases such as “kick the bucket,” or “push up daisies,” or “food for worms,” we are at the other end of the spectrum. At some point in the last century, undertakers became morticians became the caretakers of funeral homes.

Political battles are often fought with verbal weapons such as euphemism vs. dysphemism. The argument over those rare abortions that occur late in pregnancy depends, in part, on whether you refer to the procedure as the soft jargon “intact dilation and extraction” or as the visceral “partial-birth abortion.” Think of the difference between “illegal aliens,” which sounds like an invasion of Martians, and “undocumented workers,” which sounds like a clerical error.

Orwell offers evidence of the power of euphemism to blind us to what is really happening:

Defenseless villages are bombarded from the air, the inhabitants driven out into the countryside, the cattle machine-gunned, the huts set on fire with incendiary bullets: this is called pacification . Millions of peasants are robbed of their farms and sent trudging along the roads with no more than they can carry: this is called transfer of population or rectification of frontiers .

His examples go on and on.

Orwell’s discourse makes me wonder if he would be surprised or even puzzled by the political rhetoric of Donald Trump and its influence on his followers. The former president — perhaps the once and future president — is no euphemist, and would scoff at the pointy-headed term. He is the dysphemist-in-chief, a speaker and writer who does not want to hide things from sight, but who wants you to see things that are not really there.

Language of Trump

There is no need for a full recitation of Trump’s statements and overstatements, especially when the topic is immigration or crime.

Immigrants, he insists, are “poisoning the blood of our country,” a familiar Nazi trope. Those crossing our borders are a horde of drug dealers, gang members, murderers and rapists. Some of them are coming from “shithole countries.” His political opponents are “vermin.” Crime in Chicago amounts to “carnage.”

Even when he was imagining the possible collapse of the auto industry, he could not avoid the dysphemism that it would mean a “blood bath” for the country.

An old propaganda tool is to dehumanize the enemy, which explains this description of some immigrants: “I don’t know if you call them people. In some cases, they’re not people. But I’m not allowed to say that because the radical left says that’s a terrible thing to say.”

Here’s his promise: “Among my very first actions upon taking office will be to stop the invasion of our country.” Invasion is a strong word, a scary word, so scary that when American troops have invaded countries, such as Vietnam, the generals and politicians preferred the Orwellian euphemism “incursion.”

Zombie apocalypse

Words such as euphemism and dysphemism can be used to describe the language of political discourse. More important, that language creates stories; narratives that can be used to spread hate or to support the common good.

When I read descriptions of immigrants as aliens or invading hordes, I am reminded of perhaps the most popular form of horror entertainment over the last quarter century: the narrative of the zombie apocalypse.

You must have seen at least one of the cinematic versions by now. Some outside force or infection or radiation turns ordinary people into monsters. Not just ordinary monsters, but flesh-eating ones. If they scratch or bite you, they pollute your blood so that you too turn into a zombie. The only way to stop them is to burn them, decapitate them, or shoot them in what is left of their brains. There are delightful variations, but that is the crux.

In the old days, zombies shambled. The more recent living dead can move quickly and in hordes.

Look, we’ve suffered through a pandemic, countless mass shootings, terrible problems on the southern border, race hatred and other forms of intolerance. No wonder the stories we tell, even for entertainment, are dystopian.

The word dystopia is the opposite of utopia. Plato wrote “The Republic,” Thomas More wrote “Utopia,” both narratives of ideal places. I have been more influenced and entertained by dystopian fiction: “Brave New World,” “1984,” “A Clockwork Orange,” just to name the ones I read in my youth.

In the cinema, Godzilla, a monster created by radiation, appeared in the aftermath of the atomic bombings of Japan. In the 1950s, during the anticommunist witch hunts, we were introduced to body snatchers who looked like us. More recently, gorgeous androgynous vampires multiplied just as Americans became more tolerant of gender differences.

I have no record of Donald Trump including “zombie” in his lexicon of insults, but there can be little doubt that his language and storytelling are meant to reflect the fears and grievances of his followers, fears that they are being invaded by creatures who are not quite human.

Voice of the people

It would be comical to argue that Trump has the eloquence of presidents such as Abraham Lincoln, Ronald Reagan or Barack Obama. Joe Biden has his own verbal issues, but Trump has something distinctive in his rhetorical style that has inspired an army of followers. We can begin by calling it a populist style, speaking and tweeting insults, slogans and catchphrases more associated with the feuds of professional wrestlers than the discourse of common politicians.

Orwell might have used Trump-speak as an example in his essay “Propaganda and Demotic Speech.” The word “demotic” is fancy talk that I had to look up: “Of or relating to the common people.” It shares the same root as “democracy” and derives from the Greek word for “people.”

As a world war became more inevitable in the early 1940s, Orwell noted that to defeat fascism the British people would have to make significant sacrifices. Life would change in countless undesirable ways. Who could persuade them to make the effort? Not the aristocrats, he argued. Not the high-toned speakers on the BBC. Not politicians with fancy educations. Their voices might only alienate people already feeling oppressed by rigid class distinctions. Persuasion could only come from those who spoke in the voice of the people.

Those who defend Trump’s language say things like “he tells it like it is” or “he says what he means” or “he speaks in plain English.” Others argue that we should “take Trump seriously, but not literally.” Or, “I don’t judge him by what he says. I judge him by what he does.”

I think I am pretty good with words. I can go high or low. I am a Philistine with a Ph.D. That means, if I were running for office, I could lie to you in the voice of a super scholar or the voice of the barely literate. I have wondered whether the language of Trump’s messages, filled with “mistakes” in grammar and usage, were so intended, to attract an audience already cynical about “elites” and their phony talk.

In 1976, I met the segregationist governor of Alabama, George Wallace, who made fun of people going up to the statehouse holding briefcases. The only thing in them, he argued, were “baloney sandwiches.” He described political speech as “getting the hay down where the goats can eat it.”

Even if we understand how certain politicians are abusing language, we are left with a problem: how to diss the effects of Trump’s dysphemistic language and dystopian narratives without having to resort to those fancy “dys” words in an essay such as “dys” one.

Roy Peter Clark is the author of “ Tell It Like It Is: A Guide to Clear and Honest Writing ,” now available in a paperback edition.

Opinion | Wall Street Journal marks one year of reporter’s detainment in Russian jail

Evan Gershkovich was arrested a year ago today in Russia while on a reporting assignment for the Journal

A Baltimore bridge collapsed in the middle of the night and two metro newsrooms leapt into action

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Private equity reporting grants show good return

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Opinion | How misinformation will be gender-based in Ghana’s upcoming elections

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Blood and Society

By William Aird

Introduction

Just as blood itself is fundamental to biological functioning, the  concept  of blood is fundamental to human culture. From linguistics to art to spirituality and religion, blood flows through collective consciousness across history, shifting and changing in context, but always meaning something to us. In this essay, we ask what does blood symbolize, beyond its role in medicine? What functions does it serve socially, culturally, and politically?

We will begin with prehistoric times, when blood was seen as a life-force, at once revered and feared. We will see that prehistoric man does not distinguish between medicine, magic and religion, and that blood as entity and concept breaches each of these boundaries. From this cultural cauldron emerged a number of stereotypic blood rituals, including blood sacrifice, bloodletting, blood consumption and blood taboos, which were collectively designed to appease the gods and to provide the common man with strength, vitality and protection. Remarkably, these practices, which we will discuss in turn, arose independently over and over again in different populations around the world, separated by thousands of years, suggesting a kind of innate universalism in our reckoning with this mysterious red fluid.

Modern medicine, for all its advances, has done little to quell our uneasy – and often irrational – relationship with blood. When a nurse or phlebotomist draws blood from my arm, I am sure to turn my gaze. Otherwise I become queasy watching my own blood pour into a vacutainer. Not everyone does, but I know I am not alone. Why should we be distraught at the sight of our own blood? We have all experienced nosebleeds before. In most cases, we regard the occurrence as a mere annoyance. However, if the bleeding is heavy, we may become frightened. Although epistaxis (a medical term for nosebleed) is rarely a matter of life and death, there is something about spilled blood, especially when it’s our own, that evokes a sense of horror, an emotion that resides deep within the brain’s amygdala, most certainly shared with our earliest ancestors.

As we will discuss, the fear of blood (or is it awe?) can be overridden by certain powerful societal and cultural forces. How else can we explain parents attending circumcision ceremonies in the Jewish religion (faith over fear of blood), partners providing support during childbirth (love and commitment over fear of blood), those who attend a tattoo parlor or piercing shop (pursuit of self-expression over fear of blood), and blood donors who lose up to half a liter of blood in one sitting (goodwill over fear of blood)? The loss of blood during war is often considered a noble venture, if not by the fallen, then certainly by the leaders of nations. We commemorate these brave soldiers by attaching a blood-red poppy to our lapel every year.

And we can always play out our visceral horror of blood in the safety of our stadium seats, theaters and living rooms. Whether through the gladiator fights of Ancient Rome, the cockfights of past and present, the Broad Street Bullies of the 1970s (the infamous Philadelphia Flyers of the National Hockey League who, in the 1970s, “spilled enough  blood  to fill a decade’s worth of Stanley Cups”) 1 , or modern-day mixed martial arts, we have set up the rules so that we can engage with blood without having to sacrifice a single drop of our own. Some of us welcome, indeed even relish, such opportunities. Others are more likely to recoil and avoid such scenes altogether.

There is no shortage of television shows and movies on vampires, not to mention films of the Gothic horror genre. When we watch these offerings, we may experience intense emotions. As history has taught us, some of these reactions are undoubtedly hard-wired and shared between most viewers. Other reactions are shaped by individual life histories, and in this way are highly subjective. That’s the wonder of blood: it is universal yet so deeply personal.

Blood magic

The concept of blood has held our collective fixation since the earliest humans recognized that uncontrolled bleeding at the hands of an animal predator or an enemy tribe spelled certain death. To prehistoric humans, blood was observed to flow when a wound was opened and to stop flowing when life was gone, no matter the cause of death. In a world driven by incomprehensible forces, yet to be probed and mapped by modern science, blood was held in evidence to be equivalent to life itself.

There is no evidence of medicine until the Neolithic period, about 7,000-10,000 years ago, when prehistoric humans exchanged their food-gathering ways for a life of agriculture. Even then, medicine was inseparable from magico-religious ideas. Neolithic peoples saw danger everywhere: they were surrounded by hostile forces, and lived on constant guard against disease-causing ghosts, spirits, deities and sorcerers. A man felled by the spell of a sorcerer was the target of another man’s wrath, or magic. When illness arose from a supernatural agency, a religious explanation was in order. “We must remember,” writes Henry Sigerist (1891-1957), a renowned Swiss medical historian, “that the primitive does not distinguish between medicine, magic and religion… to him they are one, a set of practices intended to protect him against evil forces and to bring him good luck.” 3

In keeping with this trend, the earliest recorded engagements with blood as concept and substance interweave spirituality, ritualism, and prehistoric medicine. Neolithic peoples could see blood, smell it, taste it and feel it. They could watch it pour out of a wound until an animal went cold, but they had no idea what its true purpose was. Such knowledge would elude humankind for the next several thousand years. What they saw was an animating life force that could be leveraged for magical and religious purposes to appease the gods and win favor with or punish their fellow tribesmen. Writing about prehistoric man, Bernard Seeman concluded that “Our knowledge of blood has been colored by magical concepts often disguised as philosophy, theology or science… the greatest offering man could make to the demons of his shadowy world was the gift of blood.” 4

Blood sacrifices

Ritualized blood offerings as both spiritual practice and early medicine permeate anthropological data across disparate geographic regions, reflecting the near-universalism of blood as spiritual symbol and ritual tool. In the Neolithic period, people who lived by tilling the soil routinely offered up blood sacrifices in preparation for the spring harvest. 5

The Aztecs, a Mesoamerican culture that flourished in central Mexico between 1300 and 1519 AD, were known to use blood and sacrifice (including humans) as offerings to the Sun God. 6 They were reported to have sliced out the hearts of victims and spill their blood on temple altars. Such ritual killings and sacrifice of blood served to appease the Sun God, and to remind enemies of the strength of the empire. 7

The Maya, another rich culture indigenous to modern Mexico, incorporated ceremonial blood-drawing, self-mutilation and auto-sacrifice in their spiritual practice. Describing 16th century Maya civilization, Diego de Landa writes:

They offered sacrifices of their own blood, sometimes cutting themselves around in pieces and they left them in this way as a sign. Other times they pierced their cheeks, at others their lower lips. Sometimes they scarify certain parts of their bodies, at others they pierced their tongues in a slanting direction from side to side and passed bits of straw through the holes with horrible suffering; others slit the superfluous part of the virile member leaving it as they did their ears. 8

Half a world away, the Vikings made frequent blood and animal sacrifices to keep on good terms with the gods. They chose dedicated sacrificial sites where they believed they would have the strongest contact with the gods. In the 13th century, horses were the preferred sacrificial animal. They were made to bleed into bowls, and twigs were then used to paint the altars, walls and ritual participants with blood. 9

Today, ritual bloodletting continues in certain parts of the world. During the festival of Ashura in Kabul, Shi’ite participants enact ritualized penitence and colorful celebration in memory of Imam Hussain, the Prophet Muhammad’s grandson who was killed in a battle in 680 AD. 10 During the last day of the festival, participants are whipped with flails tipped with razor-sharp blades. Aryn Baker, who wrote an essay on this ritual in Time Magazine, quoted a local participant: “Our imam was killed, his blood was shed for Islam, so we shed our blood for Islam.” 11

To this day, different ethnic groups from Ghana travel to the shrine and dwelling place of the West African deity  Tongnaab , near the remote northern village of Tengzug, to consult with the deity. These worshipers bring chickens, goats, sheep, donkeys, cows, and even dogs to sacrifice—offerings to curry favor in their search for fertility, stability, prosperity, and security in life. Others sacrifice to make amends for evil acts and to reverse the negative consequences of sin or curse. The spirits in the shrines are believed to feed off the life-blood of animals, so requests made for help and atonement must be accompanied by sacrifice. Jawbones and skulls of sacrificed animals are often displayed to show the number of sacrifices a person has performed or to demonstrate the power of a particular shrine. 12

Contemporary circumcision is an outgrowth of prehistoric blood sacrifice, in which the firstborn son was sometimes offered as a sacrifice, possibly for continued fertility. 13 In the Jewish faith, circumcision is sometimes referred to as the covenant of Abraham, who circumcised himself in order to become a Jew. Today, Orthodox and Conservative Jews still practice circumcision or, in adults, a ritual reenactment called  hatafat dam brit,  in which the mohel (circumciser) pricks the skin around the glans penis with a hypodermic needle or a lancet and collects the blood on a gauze pad, which is then shown to three witnesses. 14 Through this practice, the adult convert is accepted into the Jewish faith. In a New York Times article, Jeffrey Rosen describes a male circumcision ritual practiced by some Hasidic Jews in New York: “The ritual is called oral suction, or metzitzah b’peh . After removing the foreskin, the mohel, who conducts the circumcision, cleans the wound by sucking blood from it.” 15

The shedding of blood in ritual sacrifice spans thousands of years. Whether the offering is embedded in magico-religious beliefs or is carried out as a purely symbolic gesture, it has withstood the test of time as a powerful cultural motif.

Bloodletting

Blood removal has played a prominent role in magico-religious-medical practice since the dawn of mankind. “Bleeding,” wrote the historian Erwin Ackerknecht, “is an almost universal trait in primitive medicine.” 16 In Mexico, prehistoric hunters and gatherers left evidence of ritual bloodletting in a small well-hidden cave named Cuevo Pilote. Prehistoric tribes across South America used venesection (bloodletting by cutting a vein) or scarification (bleeding by creating scratches in the skin) to drive out a spirit, which escaped with the blood that flowed. 17 The ancient Maya practiced sacrificial bloodletting to communicate with their dead ancestors and their gods. 18 When Ancient Egyptians slaughtered a cow or an ox, they would lay it on its back and cut the arteries of its throat with a metal knife. Its blood was collected and examined to make sure that the animal was not possessed by a spirit. 19

Bloodletting would become a therapeutic panacea from the early centuries BC to the 1800s. It was believed to restore humoral balance, a system of physiology that was codified by Galen in the 1st century AD and promulgated by the Church over the following 17 centuries. Bloodletting gradually fell out of favor as Galen’s system of humors gave way to an understanding of the circulation as a closed system with limiting quantities of recycled blood. Today, bloodletting is still practiced by tribes around the world on magico-religious grounds, while Western medicine leverages bloodletting for both diagnostic and therapeutic purposes. 

A modern-day form of bloodletting is also seen with the practice of self-cutting. This mode of self-injury is often described as a coping strategy to deal with overwhelming feelings or experiences of dissociation. 20 Sociological enquiries have shown that self-injurers place high value on the sight of their blood. A participant in one study was quoted as saying, “I loved the sight of my own blood seeping out of fresh wounds.” 21 The study’s author explains that “Looking at blood is perceived as exhilarating or fascinating, comforting or calming.” 22 It symbolizes to the self-injurer that they are alive, vital and real. Reminiscent of ancient bloodletting, today’s self-cutter often feels their inner pain and fear flow outwards with their blood.

Blood meals

The fusion of ritualism and ancient medicine involved “treatments” and cures that we now know to be symbolic, but which seemed clinically sound (and why not?). For some early humans, blood was viewed as a source of strength (a life force) to be consumed for its vitality. The blood of a mammoth might provide strength, while that of a hawk might sharpen vision. When a warrior of ancient Scythia killed his first opponent in battle, he drank his victim’s blood to gain strength from the life-giving fluid. 23

In Rome during the early centuries AD, country-folk who practiced self-help medicine were said to treat epilepsy by drinking the blood of a gladiator whose throat had been slit. 24 Certain tribes indigenous to New South Wales would feed the sick with raw or slightly cooked blood drawn from their male friends, who willingly bled themselves for the sake of the patient. 25

The consumption of blood as food and drink continues to this day. The Maasai, a pastoralist people living primarily in southern Kenya and northern Tanzani, traditionally live off a diet of beef, milk, and blood. 26 Beyond its dietary function, the mixture of blood and milk is also used as a ritual drink for special celebrations and for healing the sick. 27 Maasai tradition also involves giving blood to drunken elders to alleviate intoxication and hangover.

Readers who have travelled to the British Isles may have tried black sausage, made with blood from pigs and cows and recommended for those on a shoe-string budget because blood is an inexpensive ingredient.

And then, of course, there are the vampires, so frequently represented in popular culture. Vampire folklore began with Bram Stoker’s  Dracula , published in 1897. Today, there is no shortage of vampiric television offerings: The Vampire Diaries, Buffy the Vampire Slayer , and True Blood , to name just a few. A common theme in these shows is the fictional vampire’s dependency on blood as an essential life force.

Vampires are not merely figments of our imagination. The annals of true crime attest to the occasional deranged killer caught up in some twisted vampiric roleplaying. On top of that, there are scattered, peaceful blood-feeding communities in the United States, and perhaps elsewhere around the world. In a fascinating piece by David Robson for the BBC in 2015, one such group in New Orleans was uncovered. They are an eclectic bunch, bound together by a common “need” to drink blood. He describes a donor-vampire pair engaged in a “feeding”:

It begins as clinically as a medical procedure. His acquaintance first swabs a small patch on Browning’s upper back with alcohol [Browning being the name of the blood donor]. He then punctures it with a disposable hobby scalpel, and squeezes until the blood starts flowing. Lowering his lips to the wound, Browning’s associate now starts lapping up the wine-dark liquid. 28

We learn that donors, who are hard to come by, can at least choose whether the blood is collected from a cut with a scalpel, or intravenously with a cannula or butterfly needle.

While blood feeding practices span thousands of years, their justification and rationale should be considered in the context of the times. Before the discovery of the circulation and the unraveling of humoralism, blood was widely seen to contain spirits – good and bad – that could be passed on to the consumer. Blood meals made perfect sense, if only you could find a source with the desired spiritual mix. Today, of course, we understand that blood, when ingested, is no greater than the sum of its nutritional parts and that its consumption is more likely to reflect a dietary preference or a ritualistic practice.     

Blood taboos

Rules of avoidance – or taboos – are among the oldest of unwritten code of laws. 29 Taboos are designed to protect against terrible consequences. With blood’s intimate connection to life and death, and its seeming potency as a magical force, there have been occasions where blood was viewed not as a positive life force, but instead as an evil force to be reckoned with.

We noted earlier that prehistoric peoples drank blood as a source of vitality. Others avoided drinking blood because it contained unwanted qualities. So, while one prehistoric tribe might drink blood from a hawk to sharpen their vision, other tribes might place a taboo on such an activity out of fear they would be possessed by the hawk’s spirit.

Invocations of blood in mainstream religious doctrine include dietary taboos. The Jewish taboo against blood is clearly articulated in the Old Testament: “And whatsoever man there be of the children of Israel, or of the strangers that sojourn among you, which hunteth and catcheth any beast or fowl that may be eaten: he shall even pour out the blood thereof and cover it with dust” (Lev. 17:13). Islam also forbids the consumption of blood. In both Jewish and Islamic faiths, draining of blood from the animal is required before consumption of the meat (though not all followers adhere to these guidelines). Blood taboos are only one dimension of religious mobilization of blood imagery. We will discuss the centrality of blood symbolism in Christianity in the section on “Blood Covenant”.

Perhaps the most notable (and universal) of blood taboos has revolved around menses, that natural phenomenon perpetually shrouded in secrecy and fear. Prior to our understanding of the inter-connection between ovulation and menstruation in the 1800s, mystical explanations prevailed, the most common being that menstruation periodically rids the woman’s body of something undesirable that had accumulated in the blood. According to this view, menstruation is a process of purification. A more magical belief was that menstrual blood contained an evil spirit, which would then have the capacity to harm her environment. For this reason, women were isolated during their menstrual cycle. For example, in prehistoric times menstruating women were typically quarantined for fear that anything they touched or looked at might be destroyed. Women in the Kafir tribes of South Africa were secluded from the cattle and milk supply, while Galela women were not permitted to enter tobacco fields for fear of damaging the crop. 30

Contemporary blood taboos related to menstruation continue to shape themselves around symbols of impurity and filth. Cultural responses to this symbolism often involve gestures of isolation and social exclusion during the period of menstruation. In an article about menstruation myths in modern day India, Garg and Anand review some of these practices, writing that in many Indian households, menstruating women are barred from entering the kitchen (preparing and handling food is strictly forbidden) and restricted from offering prayers and touching holy books for fear of contamination. 31 In Nepal, menstruating women are traditionally banished to a specially built hut, often lacking a proper bed, until menstruation has ceased. During the period of menstruation, they are forbidden from touching plants, cattle, or men. Such taboos around menstruation have caught the attention of global health leaders, who recognize their negative impact on “women’s emotional state, mentality and lifestyle and most importantly, health.” 32 Cultural symbolism that associates menstruation with impurity shapes the routines, identities, and power dynamics experienced by menstruating women within those cultures.

Discomfort with menstrual blood extends to Western cultures. When discussed, it is frequently characterized euphemistically as ‘that time of the month’. There is rarely explicit reference to blood itself. Advertisements for hygienic products have traditionally tiptoed around the concept of menstrual blood. Women are typically portrayed as fun-loving, physically active and dressed in white.

Interestingly, recent advertising campaigns have started to dismantle the taboo. For example, Kotex posted a new advertising campaign for pads featuring red liquid instead of the traditional blue. A company executive was quoted as saying: “Blood is blood. This is something that every woman has experienced, and there is nothing to hide.” 33

Libra, a supplier of menstrual pads, launched a destigmatizing ad campaign in 2017 called Blood Normal. 34 Not only did they show menstrual blood as red, but they did so on the inside of a woman’s thigh.

While blood taboos around menstruation are pervasive, the stigma of uncleanliness and disgust are particularly troublesome in women who cannot afford hygienic products. This situation, which has been labeled ‘period poverty’, leads to the use of unhygienic measures, such as paper towels, cardboard and toilet paper. Cultural shame associated with menstruation prevents these individuals from talking about their predicament. 35 This is an example of how symbolic associations with blood may have material impact and supports the notion that symbols are important.

Seeman writes that blood taboos, as with blood magic, “must have arisen out of humanity’s relatively common response to a common need at a common level of cultural development”. 36 That being said, the practice of blood consumption, which we discussed in the previous section, is antithetical to blood taboos and cautions against adopting a purely universalist interpretation of humankind’s cultural reaction to blood.

Blood covenant        

With the development of organized religion in the early centuries BC, we see the consolidation of blood-related symbolism from disparate spiritual traditions into religious texts. This development is important in our tracing of cultural engagement with blood as substance and symbol. The advent of the printing press in the mid-15th century and the rise in literacy rates over ensuing years accelerated the dissemination of cultural ideas through language. Colonial violence and global expansion furthered the reach of ossifying notions of body, spirit, and symbol.

Blood is a pervasive Christian religious symbol. The Catholic Church holds that the blood of Jesus can cleanse us from all sin and that Christ’s shedding of blood at the Crucifixion represents the hope of salvation. The Bible mentions blood more than 400 times. 37 In John 6:54 in the Bible, Jesus states: ”The man who eats my flesh and drinks my blood enjoys eternal life, and I will raise him up at the last day.” 38

The “blood” of Christ is mentioned in the writings of the New Testament nearly three times as often as the “Cross” of Christ, and five times more frequently than the “death” of Christ. 39 The blood of Christ stands not for his death but rather for his life released through death.

Today, Christians take communion with the understanding that the cup of wine symbolizes Jesus’s blood. This is not unlike imitative magic practiced by prehistoric peoples. Some Roman Catholics even believe in transubstantiation , or the change of substance or essence by which the wine becomes in reality the blood of Jesus Christ.

Since the days of Jesus’s apostles in the 1st century, Christians have been directed to “abstain” and “keep” from blood. 40 As mentioned above, both Jewish and Muslim doctrines forbid the consumption of blood. Kosher Jews adhere to the practice of draining blood from meat, both at the time of slaughter and through salting. 41 Jehovah’s Witnesses traditionally implicate passages from both the Old and New Testaments in their refusal to receive blood transfusions, even when it means the difference between life and death. 42

So, we see that religion, which until the emergence of modern medicine held sway over our views of blood as entity and concept – primarily through the promulgation of Galenism, but also by virtue of ritualization – continues to shape our cultural understanding of blood. As illustrated by the refusal of some Jehovah’s Witnesses to accept blood transfusions, such influence may have serious material consequences from a health standpoint.

Blood bonds

Blood has been used to cement relationships between individual members of society for centuries. Such transactions – typically carried out in the setting of a ceremony – are termed blood bonds or blood oaths . In 440 BC, Herodotus, an Ancient Greek historian, wrote:

Oaths among the Scyths are accompanied with the following ceremonies: a large earthen bowl is filled with wine, and the parties to the oath, wounding themselves slightly with a knife or an awl, drop some of their blood into the wine… lastly the two contracting parties drink each a draught from the blow. 43

A blood oath was famously used to seal a pact among the leaders of seven Hungarian tribes in the 11th century. Participants cut their arms and let their blood spill into a chalice, sealing their status as blood brothers. 44

The essence of the symbolism imbued in the practice of blood bonds persists in contemporary life. Blood oath ceremonies, which involve two or more people pressing together small cuts (generally on a finger, hand, or forearm), represent the idea that each person’s blood now flows in the other participant or participants’ veins.

Blood oaths establish people who are unrelated by birth as “blood brothers” or “blood sisters.” They appear in contemporary culture in a range of contexts. For example, blood oaths are used in initiation rituals in the Mafia, as well as in prison gangs.

There are variations on the theme of a blood oath. Consider, for example, the blood vial that was popularized by Angelina Jolie and Billy Bob Thornton. The actors each wore a necklace containing each other’s blood. “She thought it would be interesting and romantic”, said Thornton, “if we took a little razorblade and sliced our fingers, smeared a little blood on these lockets and you wear it around your neck just like you wear your son or daughter’s baby hair in one”. 45

Lest others wish to follow suit, they can order their own vial necklaces online. Why would you choose to go this route? Well, they inform us, “to carry your lover’s blood is said to create a bond between two souls”. 46 The vials and necklaces are purchased as part of a kit, which also contains a full set of medical supplies for drawing a few drops of blood. It even includes medical grade anticoagulant to keep the blood in liquid form!

Popular culture is rife with linguistic invocations of blood and oath, whether in the form of blood oaths, blood brothers, or blood pacts. They have been featured in numerous television shows and movies including Game of Thrones, Buffy the Vampire Slayer, It’s Always Sunny in Philadelphia, The Andy Griffith Show, Punky Brewster Malcolm in the Middle, Star Trek, The Hangover, and The Lord of the Rings. The pervasiveness of imagery related to blood as ritual connector reflects the ongoing potency of this symbolism.

The mobilization of the color red as a symbol of vitality and magical powers can be traced back to the paleolithic period, with burial customs calling for the use of ochre as a symbol of life-giving blood. 47 A symbolic link between blood and red – both essential and timeless – finds expression in practices, rituals and symbols such as power, love, vigor, and beauty.

Prehistoric man painted bodies of the sick and dead the color red using ochre, likely in an effort to provide them with life force. Red was also used in prehistoric art, evidenced by traces found in caves across the world. 48 In signifying blood, red – for example, in the form of jewelry or clothing – has symbolized love and fidelity for centuries. Red, symbolic of the blood of Christ, features prominently in Christianity, including the red robes worn by Cardinals.

With blood as its essential and organic signified, the color red continues to carry symbolic currency in mainstream contemporary culture. “New” trends, rituals, and practices engage red in gestures of vitality, danger, and remembrance.

In advertising, the color red is used to convey sensuality, desire, love, vitality, strength, power and danger. 49 Research has shown that red, relative to other achromatic and chromatic colors, leads men to view women as more attractive and more sexually desirable. 50 The extent to which the red-attraction or red-sex links are related to blood imagery and whether or not these connections are culturally conditioned or genetically programmed is unknown.

Nonetheless, modern day lipstick manufacturers have leveraged these concepts to advertise and display their red lipstick with great pride, if not guilty pleasure. One such brand is called Forbidden Lipstick: Written in blood, “the most perfect blood red lipstick we’ve ever found“. 51 Another company markets a red lipstick for “its blood-red vitality”. 52

In signifying blood, red makes us think of war and by extension sacrifice, danger and courage. Blood-red poppies, mentioned in the Introduction, have a long association with Remembrance Day. They are worn on lapels as a memorial, representing the sacrifice of the fallen soldiers in past wars. They are also presented on graves in the form of wreaths.

The symbolism of red, then, is highly context dependent. A parishioner may be spiritually enriched by the red robes of the clergy, whereas the same man may be aroused by the red lipstick of his partner. When Remembrance Day comes around, he may be surrounded on the streets by red poppies that conjure images of bravery and sacrifice in ways that a purple or back colored poppy would simply not evoke. And of course, whatever responses I have to the red color in these three scenarios may well be quite different from yours.

Blood language

The history of blood has seen no shortage of irrational ideas about its larger meaning. While modern science has laid to rest many of the folk theories and superstitions about blood (blood lore), they continue to permeate society, influencing our customs and language. Our everyday language is riddled with references to blood: hot-blooded, cold-blooded, bloodcurdling, bad blood, blue blood, bloodline, lifeblood, bloodbath, fresh blood, bloodthirsty, blood sport, blood money, bloodcurdling, half-blood, young bloods, blood feud, and bloodlust to name just a few examples.

In some cases, blood is used as a metaphor for language and emotions. Consider, for example, the following sentence, which draws on an analogy between blood and language: “Language is the blood of the soul into which thoughts run and out of which they grow”. 53 Or the idea that blood running cold is related to fear, and boiling blood to anger. 54 In other cases, the word blood is incorporated into terms (many examples are listed in the previous paragraph) used in reference to the qualities of a person, or a group of individuals. 55 The interpretation and contextualization of these and other blood metaphors is highly language-dependent and varies between different societies.

There are potent associations between blood, identity and social relations. Keith Waloo, an historian from Princeton University, points out in his book Drawing Blood that blood is a “rich symbol of individual identity, social health and group relations.” 56 Before the discovery of genetics, it was widely believed that blood carried the essence of the individual, the family, the race and the nation. Blood was believed to hold the soul of an individual and perpetuate special qualities. The intersection of symbolism, racism, and (pseudo-)science contained within this framework has mobilized blood as an agent of racial exploitation and extermination.

The notion of blood as a carrier of social, emotional, and intellectual worth through race was instrumental to the operation of slave society in America. Invocations of blood historically served to quantify Blackness and Whiteness, and systems of racial classification contributed to structural oppression, informing citizenship and basic rights.  

Such notions continued to rhetorically and materially uphold anti-Black racism long after abolition. African-Americans were routinely categorized by the amount of their “blood” that was considered “African”, a measurement influenced by introductions of “white blood” into their lineage (with this miscegenation often perpetuated through acts of sexual violence).

During the Jim Crow era (from around 1880 to 1960), most states prohibited marriage between a “white person” and “a mulatto or person having one eighth or more of Negro blood”. 57 Contemporary critical race scholars continue to explore the “one drop rule”, by which “anyone with a visually discernable trace of African, or what used to be called ‘Negro,’ ancestry is, simply, black”. 58 In the structural oppression of African-Americans we see the potency of blood language as a determinant of lived and material experience.

Ideas around blood as an essential carrier of racial superiority and inferiority similarly propelled genocide during the World War II. Hitler’s racial conquest was rhetorically upheld by the violent defense of German or “Aryan” blood” While the term Aryan technically refers to a group of languages and not to people or nations, it was mapped onto notions of purity, nationhood, and whiteness.

To have Aryan blood meant that one had pale skin, blond hair and blue eyes, and non-Aryans were construed in Nazi Germany as impure and variably evil. Hitler became obsessed with “racial purity” and used the word Aryan to describe his idea of a “pure German race.” He argued fiercely for the superiority of the Aryan “race” and systematically confined, tortured, and murdered millions of people with “impure” (non-Aryan) blood.

As is the case across linguistics, any sense of neutrality related to blood language is illusory. Blood as substance or semiotic unit does not inherently mean identity, race, gender, culture, or citizenship. These associations, like all language, have developed through repetition and over time, here with material and sometimes lethal implications. De-naturalizing the link between blood and its colloquial referents allows us to uncover its ideological functions and effects.

Cultural imaginings of war have long invoked imagery related to blood to reflect the tremendous loss of life wrought by conflict. “The tree of liberty,” said Thomas Jefferson, “must be refreshed from time to time with the blood of patriots and tyrants.” In 1913, a war enthusiast penned an essay for Life magazine in which he wrote, “War… causes the blood of the young to tingle so that they do the bidding of other, craftier and wiser men, and shed that blood so that these older, craftier and wiser may profit. Patriotism of this sort is a wonderful and essential thing in a Nation.” 59 In 1921, the US Supreme Court proclaimed: “They (soldiers) pay the cost of war with their blood and their lives, and what is the greatest sacrifice of all, with the blood and lives of their loved ones.” 60 During D-Day, about 4,000 men were killed or wounded on Omaha beach. The beach ran red with blood, earning it the grim name “Bloody Omaha.”

The word blood is often used metaphorically to describe wartime circumstances. “Chinese blood continued to flow after the Japanese surrender,” wrote an author in a piece for the New Yorker on the second world war in Asia, referring to the resumption of civil war between Nationalists and Communists in China. 61 Soldiers in the Crimean war were “up their elbows in blood.” 62 Churchill famously declared to his cabinet in 1940, “I have nothing to offer but blood, toil, tears and sweat.” In these examples, the use of the word blood objectifies violence and death, rather than animating the suffering and dying of actual people (someone’s brother, or someone’s son). When it comes to building and reinforcing patriotism and war effort support through language, the substitution of the word blood for the harrowing suffering of individual humans may serve a protective function to depersonalize and sterilize the narrative.

And the stripped-down narrative – with blood as euphemistic protagonist – has widespread appeal. A brief perusal of war literature reveals many examples of book titles that contain the word “blood”: Sealed with Blood War, Sacrifice, and Memory in Revolutionary America ; Blood, Oil and the Axis: The Allied Resistance Against a Fascist Sate in Iraq and the Levant, 1941 ; The Field of Blood: Violence in Congress and the Road to Civil War; Treaties, Trenches, Mud, and Blood – A World War I Tale . Titles help sell books, and the frequent appearance of blood on the front cover of these volumes cannot be an accident.

It is hard to imagine any publisher of a war book preferring a title that describes spilled guts, decapitation, or dismemberment. After all, this isn’t Hollywood or the boxing ring. This is the ‘real deal’. Perhaps we have a need to insulate ourselves if we are to scratch the surface and explore the subject with purpose. As a word that has both positive and negative meanings, and is familiar to every one of us, blood may provide a convenient aid or tool for navigating narratives of unspeakable tragedy.

In prehistoric times, blood was seen as seen as a life force. We did not really begin to understand the function of blood until the 1800s. So for tens of thousands of years, we were left to our imagination, and it is this imagination that has shaped our concepts of blood through the millennia.

Many of these ideas arose independently. For example, the practice of bloodletting spans all human eras, as do blood taboos. Attitudes towards menstruation are an example of behavior that connects prehistoric man with popular culture. Something about blood evokes near-universal reactions, as though we are somehow bound by immutable, cultural blood laws.

But then again, there are also interesting differences in blood concepts across time, and geographically. As just one example, some groups of individuals follow blood taboos while others consume blood for dietary or spiritual reasons. The existence of distinct blood practices between different people suggests that they are shaped, at least in part, by the contingencies of cultural and societal peculiarities.

This is important, because it suggests a certain fluidity or flexibility in the tapestry of blood concepts whereby cultural reactions or behaviors towards blood that are unhelpful or harmful, may be changed. We may never rid the entertainment world of blood sport and horror movies. But, as discussed earlier, efforts to encourage explicit communication about menstrual blood loss have reached the level of large-scale advertising. Though time will tell, there is hope that such strategies will minimize the shame associated with periods.

Blood is pervasive in body and mind. As substance, it is hidden from view, concealed within skin and flowing in veins. As symbol, it looms large as a fantastical construct whose meaning mutates at the whims of our imagination. We don’t talk about spleen sacrifice or liver bonds. There are no poppies decorated with the color of the pancreas. Blood occupies a privileged place in the hierarchy of body organs and tissues, inexorably woven into society in ways that transcend time and culture.

Acknowledgements

The author is grateful to Alison Aird for her invaluable input and editing, and Marianne Grant for reviewing the final draft of the manuscript.

About the author

William C. Aird received his MD from University of Western Ontario. He completed a fellowship in Hematology at the Brigham and Women’s Hospital, Harvard Medical School in Boston and is presently a practicing hematologist at the Beth Israel Deaconess Medical Center and Professor of Medicine at Harvard Medical School. He is founder and Executive Director of The Blood Project. Click here to learn more. 

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