The Psychoanalysis of Blood

“Blood and its associations, from a psychoanalytic perspective, evoke a mixture of fear and anxiety, on the one hand, but also fascination and desire. The purpose of this thesis is to explore this ambivalence and draw some conclusions from it.”

 

• Abstract
• Introduction
• Chapter I: Historical Overview of the Idea of Blood
• Chapter 2: Blood and Associated Psychoanalytic Concepts
• Chapter 3: Emma Eckstein vs Maria Cardinal
• Chapter 4: Conclusion
• References

 

 

Abstract

In this Thesis, the aim is to explore the concept of blood and its associations from a psychoanalytic perspective. The central argument within this Thesis is centred on the symbolic associations of blood. Blood, as we know it, is a composition of plasma, proteins, minerals, and other components that are of critical importance to the sustenance of life. Blood also carries symbolic meaning, which if analysed from a psychoanalytical perspective appears to have an even bigger implication on human beings. The symbolic associations of blood play a critical role in the relationship between the mind and the body. At the far end of the spectrum, the symbolic nature of blood can evoke a mixture of fear and anxiety on the one hand, but also fascination and desire. The purpose of this thesis is to explore this ambivalence and draw conclusions from it. This will be attained by exploring four psychoanalytical concepts in relation to the idea of blood. These concepts are the libido, the uncanny, anxiety, and trauma.

 

In this Thesis, blood is analysed beyond its physical composition. While it is a vital liquid that enables the sustenance of life, the symbolism attached to it has major implications in our lives. Blood and its biological characteristics have not been isolated from the core argument of this Thesis. Instead, they have been interwoven there to augment the assertions made. In relation to this, there are some forms of ordinary bleeding that may have psychosomatic causes. That is, they are triggered by repressed issues emanating from childhood experiences. The arguments herein have been analysed in relation to two case studies. These are the Emma Eckstein case and that of Maria Cardinal. The two individuals exhibited forms of bleeding that can be classified as psychosomatic, justifying Freud's hypothesis of a "wish to bleed."

 

 

Introduction
 

What is Blood?

The mention of the word blood is likely to evoke a variety of feelings and relations in people because blood is a very sensitive topic. Ordinarily, blood as we know it is that dark reddish thick liquid that flows inside our bodies that perhaps holds the energy required for the sustenance of life (Martini, 2007). From a biological point of view, blood's primary function is to deliver critical components such as essential nutrients and oxygen to the body while transporting waste material out of the cells. Blood mostly contains plasma, glucose, proteins, and mineral elements. Blood also has immunological, temperature regulation, messenger, and hydraulic functionalities. This indicates that blood has biological associations that are mostly essential towards the biological functioning of our bodies.

 

This Thesis is not about the biological associations of blood even though it is not completely dissociated from the core of the argument: Rather it entails the symbolic association of the blood from a psychoanalytical perspective. Psychoanalysis is founded on the theoretical work of Sigmund Freud. Freudian psychoanalysis will be the basis of the argument in this thesis paper. According to Freud, the unconscious is a very "rich reservoir of desires, thoughts and memories which are beneath the surface of conscious awareness" (1933, pp. SI). Freud also believed that there are unconscious influences that have the potential to cause psychological distress and conflicts. Psychoanalysis will therefore form the theoretical basis on which the symbolic associations of blood are explained.

 

 

Purpose of the Thesis

The purpose of this Thesis is to explore the idea of blood, its associations and symbolic manifestations. It aims at drawing conclusions from these from a psychoanalytic perspective. To attain this, the Thesis has been divided into various sections as follows: The first section is the introduction that offers a general overview of the paper, lays the scope and foundation of the argument presented herein. Chapter 1 offers the historical overview of blood, drawing evidence from as far back as ancient Greek mythologies. Chapter 2 offers the psychoanalysis of blood concerning Emma Eckstein, while Chapter 3 compares Emma against Maria Cardinal. Chapter 4 is the conclusion that offers major lessons on what has been learned.

 

 

Psychoanalysis of Blood

Importantly, this Thesis will, therefore, be a psychoanalytic exploration of the idea of blood. Given this approach, the biological properties of blood that is the plasma, the proteins, the blood cells, and the mineral elements shall not form the core of the analysis. Instead, this Thesis shall critically examine how the idea of blood is embodied in the psyche, both consciously and unconsciously. In this sense, blood has attached symbolic significance beyond its biological and physical functions. Exploring the idea of blood involves deploying numerous psychoanalytic concepts such as anxiety, trauma, the uncanny, and libido. Moreover, the symbolic meaning of blood shall be explored vis-à-vis the act of self-harm, attempting to relate it to the central argument proposed herein. However, it is essential to note that the idea of blood and its psychic associations are not entirely separated from biology. Indeed, some of the physical representations of blood, such as menstruation, shall be used to elaborate on the concept of blood from a psychoanalytic perspective. Given the above, blood emerges as a borderline concept between psyche and soma, in a way that is similar to Freud's concept of "libido".

 

Blood as we know it and perceive it, has both the positive and negative associations. On the one hand, a person can lose blood, which portends danger and the threat of life loss. On the other hand, a person can be a recipient of blood through transfusion, saving and sustaining life. This is the psychic representation of the idea of blood. It will be at the center of the discussions in this Thesis.

 

In my own perspective, the associations of blood as mentioned above evoke mixed feelings. On the one hand, blood brings to mind the feelings of fear and anxiety while on the other, it evokes fascination and desire. This suggests the uncanny. There are psychical connotations of blood that draw significant comparisons to the uncanny's dual structure. The uncanny describes something that is both familiar - also means homely, comforting - and strange and weird, frightening, foreign (Freud, McLintock & Haughton, 2003). The origin of the word uncanny means unhomely. Nevertheless, Freud's use of the term has an uncanny connotation to it.

 

In this Thesis, the following concepts have been linked to the idea of blood. The definitions and scope of use of these terminologies are strictly limited to psychology and psychoanalysis. Any other implied definition that does not project psychological or psychoanalytical thought is purely accidental and unintended. The concepts are briefly introduced below:

 

 

Concepts linked to the Idea of Blood

Libido is the first concept that has been used to draw associations with blood. In modern psychology, the term libido mostly means the energy that drives sexual desire. However, to fulfill the central argument of this Thesis, libido is conceived from a Freudian psychoanalytic viewpoint: Freud argues that libido is a form of mental energy that drives one's psyche to do certain things. Freud's view is not necessarily separated from sexuality. It only emphasizes its influence on the psyche. Libido is limited and can be distributed within the human body in various ways (Freud, 1920). Given this, the conceptualisation of libidinal energy is restricted to its association with the idea of blood. This thesis demonstrates that libido can be depleted, just like the blood, which means it can be deprived of specific functions (Boag, 2014). The link between blood and libido draws parallels with the uncanny.

 

Besides libido, trauma also draws uncanny connotations with the blood. In Freudian psychoanalysis, trauma is linked with the intrusion of a "foreign body" into the human psyche, where the foreign body fails to be assimilated or processed. The foreign body can either be an idea, wish, or even an event. The uncanny associations between trauma and the blood are not represented by the wish, the event, or the idea. There is something repressed that is evoked by the wish, event, or idea. It evokes frightening or strange feelings (Freud, 1953). For instance, loss of blood through phlebotomy may not be frightening itself. This thesis demonstrates how the uncanny strangeness emanates from a repressed idea, wish, or an event that is associated with the loss of blood.

 

Anxiety is another idea that is linked to the uncanny connotations of blood. The central concept of anxiety is reflected in Freudian psychoanalysis and argues that anxiety invokes fear of a kind as well as desire (Freud, 1923). For instance, Freud (1927) explains why a person may develop anxiety from the thought of undergoing phlebotomy. To this end, we know that phlebotomy involves the "loss" of blood. Anxiety is not loaded in the loss of blood. Instead, this thesis demonstrates that anxiety is in the idea of what the loss of blood means for the person. Loss of blood may well mean the loss of potency, power (life energy), and life itself.

 

Anxiety is also linked to the attachment of significant figures, particularly the development of attachment disorder (Holmes, 2014). Attachment is the emotional bond involving love, affection, validation, and comfort that is formed during childhood with caregiver mostly mothers (Bowlby; 1969). This link is concerned; the loss of attachment can cause anxiety to an individual, especially young child. In later life, the loss of attachment to a significant figure during childhood can have negative repercussions (Bretherton Waters, 2015). It is not the loss of attachment that causes anxiety. Instead, it is what it portends to the person who has lost it (Simpson & Rholes, 1998). In this Thesis, the loss of attachment is related to blood in that it can trigger bleeding that is aimed at establishing lost attachment: There is an uncanny association with the idea of blood and shall be explained using the Maria Cardinal case.

 

Self-harm is also linked with the symbolic idea of blood. To understand the idea of self-harm from a psychoanalytical perspective, studying Freud's idea of the id becomes paramount: Ordinarily, people think that self-harm is the act of causing injury to the self to end life. However, from a psychoanalytic point of view, self-harm can draw associations with the need to attract attention, communicate, and deal with external conflict (Dale, 2015). Self-harming people draw blood from their bodies. It is not in the drawing of the blood that draws connection with the uncanny nature of the idea of blood. Instead, it triggers the psyche, which triggers self-harm and as such; leads people to harm themselves (Harrison MIND, 1998). To this end, this Thesis demonstrates that the act of self-harm can unconsciously trigger bleeding in that it is related to the idea of a death wish, or "mortido" as referred by Freud (1910).

 

Thesis Case Studies

The ideas presented in this Thesis are not merely presented to fulfil its theoretical framework. This Thesis demonstrates that the theories proposed herein can be brought to bear on real life occurrences. To this end, two separate and unrelated cases involving two women who experienced psychogenic bleeding have been rendered useful. They are Emma Eckstein and Maria Cardinal. The experiences of the two individuals are unrelated and occur at different times in the history of psychoanalysis. Nevertheless, there are similarities between them that render them very relevant to this Thesis.

 

The two individuals experience different forms of bleeding that are linked to childhood experiences. Emma Eckstein was one of the closest allies of Sigmund Freud. She was both colleague and patient. She experienced nose bleeding during her adulthood. She was treated by Sigmund Freud, who suggested that her condition was caused by the wish to bleed. Emma Eckstein's case is further used to critically analyse Freud's wish to bleed idea, bringing it to bear on the central argument of this Thesis. The basis of the criticism is because Emma's nose bleeds appear to have had a physical cause and as such, could be stopped using physical interventions. Regardless, Emma's surgery left her with irreparable deformities and made her an invalid until her death. Freud and his colleague, Wilhelm Fleiss, did not succeed to stop Emma's nose bleeds which disqualifies Freud's assertion that Emma Eckstein's bleeding was psychogenic. Regardless, Freud's characterisation of Emma's bleeding offered valuable ideas that have formed the basis of modern psychoanalysis and forms a huge part of the central argument in this Thesis regarding the symbolic meaning of blood, particularly how repressed wishes can trigger bleeding.

 

Emma Eckstein portrayed several symptoms that were related to menstruation-related depression. Like Emma, Maria's bleeding can be linked to menstruation. She bled through her vagina consistently for three years. She sought the help of a psychoanalyst who declared that her bleeding was psychosomatic. Unlike Emma, Maria was cured of bleeding by the use of psychoanalytic psychotherapy even though the treatment was extended for a period of 7-12 years. Maria Cardinal is essential to this Thesis as it demonstrates the manifestations of psychogenic bleeding.

 

According to Nash, Wade, Garry Loftus (2017), people go through unpleasant experiences or have certain urges and feelings that they keep out of their conscious awareness. This is called repression. Freud's (1953) view is that repression is a defence mechanism that helps our minds keep specific thoughts, feelings, or urges away. Repressing issues can have dire consequences, later in life as evidenced by Maria Cardinal. This Thesis also helps to underline the link between repression and the uncanny representation of blood.

 

 

Chapter I: Historical Overview of the Idea of Blood
 

What is Blood and its Ancient Historic Origins?
 

Blood refers to circulating tissue made up of cells and plasma. The cells in blood include white blood cells, red blood cells, as well as platelets. The Greek word for blood is "hema," which has its roots in another Greek verb "aetho," which loosely translates into "warm" or "heat" (Meletis, 2002). Hema therefore describes the warm, fluid-like material flowing in veins and arteries and which acts as a source of nourishment for warm-blooded animals, including humans. The belief in hema that was very widespread among the Greeks was also evident in the ancient people of the East: these include Egyptians, Phoenicians, Hebrews, and Persians. To these people, hema (blood) was a central element of their existence, especially because it was thought to have a direct link to their religious beliefs.

 

The Greeks' knowledge of blood has also been very instrumental in terms of influencing the perception of blood. The Greeks perceive blood as being vital for life to the point that our very existence hinges on it. Such beliefs were widespread in the Homeric times. Another concept of blood during this period is that lack of blood results in an irreversible and ultimate death (Homer, 1998). Based on racial, ethnological, and anthropological perspectives, blood is largely viewed as constituting a tribal family as well as a national bond.

 

Ancient Greek savants were also of the view that blood and the soul were one and the same thing. In this case, blood was believed to be the source of the soul. Such an identification of the soul with blood is, however, easily refuted; for even in Greek mythology, the monstrous demons lacking in blood (Khan, Daya & Gowda, 2005) are perceived as being without blood, which makes the gods immortal, opposed to being dead.

 

Moreover, Herodotus suggested that members of a family owe a connection to each other on account of the lineage blood which they share. They are hence of the same blood (homaemon). Besides, blood is historically used as an explanation of one's character. For instance, a person who is virtuous and courageous is also said to be of virtuous blood (Meletis, 2002). For the ancient Greeks, blood vessels and the function of the heart have remained largely a mystery. For instance, the Herophilus carry blood and that they are thicker than veins. The Alcameon of Croton is also thought to have been the first to document the fundamental elements of circulation (Ducasse et al. 2006). To them, sleep comes about due to the draining of blood from the heart to the brain courtesy of the veins. Moreover, they also believed that complete draining of blood from the brain led to death.

 

Galenos' work was instrumental in our early understanding of blood circulation. He also drew a distinction between arterial and venous blood. He further identified red blood as the one that originated from the heart and he hence called it arterial blood (Meletis & Konstantopoulos 2010). On the other hand, Galenos described the dark blood originating from the liver as being venous blood.

 

To Galenos, blood production takes place in the liver. It then finds it easy to get to the rest of the body, courtesy of the veins. Galenos further suspected that breathing added life through the inhalation of air. This breath so added to the circulating blood is akin to the breath of life (Galenos). Lavoisier would later on describe this breath to be oxygen. Nonetheless, Galenos was also convinced that food was instrumental in the sustenance of life. A breakdown of this food would then see it being converted into blood in the liver. The blood so formed would then nourish the vital organs of the body, including the heart, brain, mind, and the lungs, among others. The blood was also believed to play a role in the elimination of waste materials from the body.
 

Accordingly metabolism and blood circulation constitute vital aspects of Galenos' philosophical underpinnings (Galenus, 1998). Besides, his pioneering ideas were instrumental in proposing a link between blood, air and food.

 

The role of blood in Greek mythology is also well documented. In this case, blood was associated with the spirit and psyche. There was also a deeply entrenched belief that demons had an insatiable thirst for blood (Cuthrie, 1993). The sustenance of this belief across generations may have been instrumental in the justification of blood sacrifices.

 

On the issue of the scientific views regarding blood, ancient Greeks were of the view that blood and soul constituted the same thing, in that they both acted as nonmaterial things and that they act as a source of life. From the ancient Greek's scientific perspective, blood was viewed as a vital nutrient for warm-blooded animals in the same way that juices are necessary for plants. Animals differ in terms of their blood types, something that Aristotle acknowledged: "...all animals are endowed with fluid whose lack, either natural or symptomatic, causes their death. In some animals this liquid is their blood, while in others it is a colourless liquid which replaces blood" (cited by Meletis & Konstantopoulos, 2010).

 

To Aristotle, blood is the focal point of nutrition. Moreover, blood helps to ensure that the body gets to preserve heat due to its warmth. Similar sentiments have also been echoed by Plato who mentioned in Timaeus that blood circulates throughout the various parts of the body from the heart (Plato). In the same vein, Aristotle maintains that the flow of blood within the blood vessels must not be interrupted so that it can always return to the heart which functions as the genesis of circulation (cited by Barnes 1984). Hippocrates, widely regarded as the father of modern medicine, was of the view that blood flowed throughout the body in a circular motion.

 

To Hippocrates, the liver and spleen act as the center of production of blood from where it then moves to the heart to get warm. The lungs functioned as the source of cooling for such blood (Shoja et al 2008). A patient faced with a case of "humorsanguinicus" was believed to have too much blood, which was responsible for their excessive liveliness and cheerfulness. It was necessary therefore to drain this excess blood by bleeding so that the patient may regain his/her physiological balance.

 

Psychology of Blood

From a psychological point of view, blood has different connotations, depending on the context in which it is used or interpreted. Long-standing superstitions and beliefs about blood have given way to diverse meanings and interpretations of blood. Blood is associated with life and vitality; whereas some people are quite tolerant of blood, for other people, however, the sight of blood is enough to cause such a high level of anxiety and fear to the point of fainting. For such people, the sight of blood triggers images of fear or it evokes memories of bad things having happened in their lives.

 

Hematophobia or the fear of blood is attributed to the fear of getting hurt. The condition can be triggered by the very sight of instruments used to draw blood, such as a needle (Lipsitz et al. 2002). Blood is associated with dying or the loss of health, and this may perhaps explain why some people detest the very sight of blood. However, the sight of blood is important to individuals with self-harming tendencies. An extreme case of hematophobia might be an indication that the person in question had to endure certain traumatic events growing up as a child (Lipsitz et al. 2002). However, it could be nothing more than having an inexplicable character. In the end, hematophobia is an indicator of fear of losing blood, the loss of a vital organ or function, or even death. According to Glenn and Klonsky (2010), the very sight of blood acts as a main source of comfort for these people. Based on the findings of this study, the sight of one's blood resulted in an initial increase in heart rate, followed by a calming effect once the heart rate had reduced.

 

Ritual and natural bloodshed signifies important milestones in our lives. For instance, Meyer (2014) suggests that menarche symbolizes a girl's newborn fertility. Additionally, menstrual blood signifies that a young girl is maturing and is hence ready to sire children. It heralds the potential for both life and death. When menstruation disappears, this acts as a positive sign of pregnancy. In contrast, circumcision in men is a ritual that heralds their ability to assume more responsibilities in life. Initiation bloodletting indicates that the young man is now ready for birthing. It is a rebirth ritual in which boys graduate into men. Blood, then, is associated with the life force. Application of blood on one's body or partaking of it is thought to enable an individual to acquire certain powers, such as bolstered prowess.

 

Blood plays a physiological function in menstruation. It is tied to gene selection from which we have evolved. In the same way, the vast majority of the cultural explanations about blood may have its basis on this evolutionary peculiarity (Emera, Romero & Wagner, 2011). Cultural meanings associated with menstrual bleeding in women are all-pervading, although the ritual types differ. The most predominant cross-cultural presumptions regarding the reproductive life cycle are based on observations of what becomes of blood when menstruation stops (Meyer 2014). It was observed that when a woman stops menstruating, it means that she is now pregnant. Consequently, the blood which they would have menstruated is now used to form the baby. In this sense, blood is perceived as being capable of giving life. It is also fertile and capable of nurturing. For example, a woman would likely fear blood because she was raped as a young girl. Therefore, every time she sees blood it reminds her of this unfaithful event. She therefore remains very fearful of blood. In societies where men undergo circumcision, there is loss of blood involved during this procedure. For some of these men, the sight of blood acts as constant reminder of this very important rite of passage that they had to undergo in their lives. Blood is, in this case, used as an indicator that they have transitioned into manhood.

 

Experiences with blood in dreams also differ from one person to the other. Furthermore, the explanation may also be different based on the content in which the dream took place. In dreams, blood may symbolise different things such as colour, sacrifice, or even loss of vitality. For example, Hamilton-Parker suggests that an individual faced with an emotionally draining situation is likely to dream of losing blood (Hamilton-Parker; 1999). At the same time, blood acts as a symbol of passion, and more so with regards to anger and love.

 

From a cultural perspective, blood is a symbol of attachment. It helps to show the association between people. For instance, members of the same family are said to belong to the same blood lineage. Blood may also have mystical meaning attached to it: This was especially the case with the vast majority of ancient rituals. In this case, participants would often partake in the blood of animals being sacrificed. This act of drinking blood was symbolic on the senses that it implied they shared in the strength and powers of the mystical beings. Also, horror movies depict the main characters as having a lot of power over their victims because they suck their blood. In this case then, blood may be interpreted as implementing a source of nourishment from which vitality and strength ensues. The very act of sucking blood implies that the vampires become all too powerful and are overbearing on the lives of their victims. In the same way, if one dreams of partaking in blood, this may be interpreted to mean that the person in question is in the process of receiving new vitality (Hamilton-Parker, 1999). If partaking in blood is thought to instill vitality in the individual doing this act, likewise, loss of blood ought to manifest in loss of vitality.

 

A dream on flowers and menstruation has psychoanalytical significance to it. Freud has documented a dream involving flowers in his book 'Interpretation of Dreams'. For Freud, the flowers in the dream symbolised menstruation. The patient narrated to Freud that she was going down from a high place. She also had a branch in her hand. The big branch contained flowers. However, the flowers started falling off. Freud interpreted the blossoming of the branch as a signifier that the woman had come of age in terms of being fertile. On the other hand, the falling of flowers was an indication that she had undergone menstruation. A flower is supposed to give rise to some fruit upon maturity. If it, however, withers or falls off, there are no fruits to be had.

 

Menstruation signifies the loss of ability to bring forth a child and is not pregnant. It means therefore that menstrual blood is in itself a life-force.

 

Origins & History of "The Art of Phlebotomy with Nurses"

Phlebotomy or bloodletting is an ancient medical practice that entails withdrawal of blood from the body primarily as a means of containing an illness. The technique involves opening up a vein to permit in drawing of blood for diagnostic or therapeutic purposes. The technique can be traced to ancient Egyptians. Historical evidence traced as far back as 1400 BC in ancient Egypt depicts tomb paintings whereby a leech is being applied to a patient for purposes of bloodletting (Greenstone, 2010). They were convinced that bloodletting helped to cure plague, acne, and other diseases. The practice was also believed to assist in casting out evil spirits. The practice then spread to the Greeks and Romans, before finding its way to the Arabs. During the Middle Ages, the practice was already being practiced in Europe, and it peaked in the Renaissance.

 

Thereafter, bloodletting declined. Today, it is only practiced for a limited number of medical conditions. Hippocrates was instrumental in helping to embrace bloodletting within the medical community. To Hippocrates, four fundamental elements were essential for our existence. These are fire, earth, water, and air. Hippocrates perceived illness as being due to body imbalances (Parapia, 2008). To correct such an imbalance, it was necessary therefore to eliminate the excesses.

 

Bloodletting appears logical at a time when ancient medicine hinges on the four body humors namely, phlegm, black bile, blood, and yellow bile. Each of the four humors was in turn associated with a specific organ. For instance, blood was centred in the brain while yellow bile was centred in the gallbladder (Rush, 2009). Additionally, each humor was linked to a specific personality type that is choleric, sanguine, melancholic, and phlegmatic (Magner, 1992). When the four humors are out of balance, one gets ill. Health could be restored through one of several techniques, including bloodletting, plunging, vomiting, or even starving if necessary (Magner, 1992). As such, treatment entailed eradicating a certain amount of excessive humor via the aforementioned techniques. Consequently, bloodletting gained prominence as a common mode of treatment.

 

At the time of Hippocrates (500 BC), the knife acted as a tool for ridding illness off the body by way of expelling impure fluids. The practice called for an in-depth knowledge of arteries and veins (Schneeberg, 2002). Bleeding occurred at varied points, primarily the knees and elbows. However, only fit patients would be recommended to undergo phlebotomy (Jounna, 1999). In 400 BC, Herodotus recommended the application of cupping to reduce headache, enhance digestion, and improve appetite, among other maladies. Celsus (100 BC) was also an ardent believer in the use of bloodletting in helping to relieve various local conditions.

 

Bloodletting also constituted a central aspect of Arab traditional medicine gained prominence in the Middle Ages with Arab physicians contributing towards its usage (Albinali, 2004). Soon enough, the practice found its way into the Middle East and then Europe. It found application in dislocations and childbirth. In the Middle Ages, barbers and surgeons flourished in the art of bloodletting:

 

Bloodletting reached its peak in the early 19th century. During this time, typical draining would involve about 1-4 pints of blood (Kerridge, Lowe 1995). The practice would only be stopped in case a patient became faint. Multiple incisions were done on different parts of the body as a means of encouraging bleeding. During this time, some prominent people succumbed to bloodletting; a good example is George Washington, the first president of the United States. He had his blood drained for the duration of 24 hours following a throat infection and later succumbed. Due to this and other deaths of prominent individuals, phlebotomy came to be identified as quackery.

 

Phlebotomy entails the use of various devices. In the 5th century BC, the use of a lancet was the in-thing. This entailed making numerous manual cuts to the veins to facilitate in drawing of blood. By the 18th century, the lancet had been replaced by a spring-loaded lancet. The instruments involved the inclusion of a spring onto the blade for enhanced efficiency (Hosgood, 1991). The fleam was also popular during this time. There were various versions of the fleam, including the wooden one. The purpose of the fleam stick was to help drive the vein through the vein. A flint cup would also be used to capture the blood drawn from the vein. The flint cup contained heated air, which effectively created a vacuum, in effect aiding the flow of blood into it (Wilbur, 2003).

 

The use of leeches to initiate bloodletting is also well documented. In this case, the leeches would be attached to the chosen areas using blood or milk as the bait. It was necessary to let the leech first engorge into the skin to permit in drawing of blood.

 

However, the technique became unsustainable because leeches were in high demand and hence very expensive.

 

While phlebotomy is not as widely practiced as it once was, nurses still use it for purposes of collecting blood samples. Since it is an invasive procedure, it is important that nurses adhere to the prescribed guidelines on phlebotomy to minimise the risk of blood borne pathogens to patients and the nurses alike (World Health Organization, 2010). Other adverse events of phlebotomy include fainting, pain at the site where the venepuncture took place, as well as fainting. Nurses are also at risk of getting injured by the sharps used to draw blood and for this reason, it has become necessary to make use of safety devices in phlebotomy. As means of minimising the risks on patients, it is important that nurses undertaking phlebotomy receive sufficient training on how to safely collect blood samples from patients (World Health Organization, 2010). Examples of such procedures entail capillary sampling, the collection of blood culture as well as venous blood flows. There is the need to observe hand hygiene prior to and following phlebotomy procedure with an individual patient. Additionally, nurses must make sure they wear well-fitting gloves during the procedure. Besides, the work surface must be cleaned with disinfectant to minimise contamination. Above all, nurses must make sure they have a patient's consent before drawing blood as it is an indication of respect for patient rights. Such best practices are essentials in phlebotomy because they act as a source of protection not just to the nurses, but to the patient as well.

 

Psychoanalytic literature on Blood
 

Blood and phlebotomy have deeper meanings when explored from a psychoanalytical perspective. In particular, films serve as a useful source of literature on blood and the meanings attached to it: The movie Dracula evokes human fear about death and sexuality. It is a depiction of the problems facing people in the Victorian era. To most critics, Dracula depicts restraints on sexuality that characterised the Victorian era, especially female sexuality. However, it is the connection between sex and blood that is of concern to this paper. It seeks to depict the belief by Victorians that blood and sperm was one and the same thing: Blood sucking, as depicted in Dracula points towards a "spermatic economy" (Hughes, 2008) which likens feeding of blood to sexual intercourse. The vampires in Dracula thrive on human blood. It points towards sexual perversions in the Victorian society. To camouflage these sexual perversions, sexual intercourse is portrayed in the form of blood sucking. In this case, blood is used symbolically.

 

Pervasive sexual behaviour was loathed in the Victorian era. Case in point is Oscar Wilde who had to serve two years in prison for being homosexual (Gale, 2015). In such a state, the blood sucking vampires depicted by Dracula symbolises the chaos within the Victorian society. The vampire further serves to shed light on the anxiety facing society in regard to homosexuality. Blood sucking by the vampires is a metaphorical depiction of sexual intercourse (Biittner, 2008), in which the canines of the vampires penetrate the orifice around the neck thereby drawing blood. This draws parallels with Freud's pleasure principle. In this case, Freud identified the pleasure principle as a guiding light of the id that is concerned with instant gratification for our varied urgent needs. Simply put; the pleasure principle endeavours to meet our primitive and basic needs, such as sex and hunger. In case they are not fulfilled, an individual experiences tension and anxiety. In the same way, Dracula depicts the unfulfilled urges for sexual intercourse in the Victorian era. As noted earlier, sexual intercourse was loathed in the Victorian society and more so, sexually pervasive behaviours. Therefore, to fulfil this suppressed urge, the vampires partook to sucking blood and, in the process, they derived pleasure from doing it: This horrors fiction then predetermines the anxiety and fear of a homophobic society that loathed homosexuals on grounds that they were intent on 'corrupting' heterosexuals. Foster suggests that the blood sucking behaviour that Dracula manifests in, symbolises his childish oral drive which he seeks to fulfil. Foster further suggests that "In so far as he is child Dracula embodies something of the drives and compulsions that we adults have tamed and diminished" (Foster, 2002).

 

The sight of blood has also been used variously by the movie industry to depict varied meanings. For example, in Marnie, a 1964 movie by Alfred Hitchcock, Tippi Hedren (playing the character of Marnie) reacts very strongly when she spots the red colour (Moral, 2013). This is the case, whether the colour is on a piece of cloth such as a jacket or shirt. Marnie manifests in a very strong sensation of fear and mixed emotions. Nonetheless, the meaning of her reaction is hidden from Marnie and the audience as well. As such, her reaction to the very sight of the red colour remains a mystery one which is open to interpretation. As the film nears the end however, the audience is treated to a scene that displays actual blood. From this sight; Marnie's fear becomes apparent. It is only then that the genesis of her fear for red and blood for that matter, comes to light (Moral, 2013).

 

Marnie experiences flashback to her childhood whereby she had experienced a horrific incident. At the time, her mother who happened to be a prostitute was attending to a client in their apartment. Marnie was also in a nearby room in the apartment. Amidst all these developments it is raining outside, and Marnie is scared of the thunderstorm. This draws the client's attention towards Marnie and he begins fondling her. Marnie's mother is startled and grabs a fire poke then proceeds to hit the client on the head with it. Blood gushes from his forehead. Marnie grabs the fire poker and then proceeds to rain blows on the man (Leitch & Poague, 2011). More blood gushes and the man dies. Her fear of anything red, therefore, symbolises repressed memory which acts as a source for her distress. Revealing the source of these repressed symptoms acts to resolve them (Radje, 2016). In this case, the sight of the red colour was a trigger of Marnie's repressed memories of her beating to death the man who had fondled her as a child. This is a clear indication that blood can act as a trigger of our undesirable and often repressed memories. For these reasons, there is the tendency to fear blood because it brings to mind sad memories.

 

Blood loss through menstruation is also taken as a form of expression of the psychological conflict experienced by women when menstruating. According to Paige and Paige (1981), menstruation bleeding symbolizes mutilation. It also acts as an indication that the woman has lost control over her body. It depicts the infantile aggressive impulses of a woman, often directed at her mother because she does not have a penis. This is correlated with Freud's sadistic element of sexuality in which the woman directs hatred towards her mother for her lack of penis, known in Freudian psychoanalysis as "penis envy" in the Electra complex.

 

Deutsch also interprets menstrual blood in a negative light: To Deutshc, menstrual blood is symbolic of castration. Bleeding of genitals acts as a source of reminder for the adolescent of the loss of the feelings of penis she had imagined or wished for. For this reason, menstruation is likely to elicit pain of a loss as well as a hatred towards the mother who in this case is thought to have contributed to the lack of a penis and hence, the pain that accompanies the menstrual cycle. Deutsh has also identified menstrual flow as symbolizing lost children. The flow of blood acts as a constant reminder to the woman that she has failed in her attempt to get pregnant. It is hence a source of disappointment at an unconscious level. This view of menstruation resonates with the views of Erikson. In his essay, Womanhood and the Inner Space, Erikson notes that 'Each menstruation is crying to heaven in the mourning over a child.' To a young woman

experiencing menstruation for the first time, it may be an indication of the suffering that she has to endure because she played with her clitoris, according to Deutsch. Such an interpretation hinges on the self-indicative regressive act of stimulating one's clitoris which Freud sought to advance. As a woman matures, Freud suggests that she must abandon this habit so that she gets to experience vaginal orgasm.

 

The movie Nightmare on Elm Street also depicts scenes with large volumes of blood. For instance, there is evidence of blood gushing from the bed of Glen after he had fallen asleep. His girlfriend Nancy had advised him to remain awake, but he did not heed to her advice. Upon falling asleep, we see Freddy Krueger's long-bladed hand emerging from the bed. He proceeds to suck Glen with his gloved hand. Soon enough Glen's bed is full of blood. The blood constitutes rising across the room, engulfs the entire room up to the ceiling. Glen's mother is startled and she comes to the room. She is treated to a horrific spectacle where the entire room is filled with blood and yet more is still being pumped from the bed. There is no doubt that the amount of blood disgorging from Glen's bed is by miles more than any human being can ever contain. It is a deliberate attempt at self-examination. It also acts as an indication that our bodies are very fragile.

 

Like all other horror movies, Nightmare on Elm Street serves to elicit fear. There is already tension in the community, following the earlier killing of 20 children by Freddy Krueger. The justice system is too slow to charge him, promoting the community to take the matters into their own hands. They then proceed to kill him. His ghost is now on a revenge mission, sucking the blood out of the children in this neighborhood. Glen is the latest victim. The extreme amount of blood evidence from the various scenes in this film acts as a visual tool whose goal is to compel the audiences to deal with the image of "the ruined body". The victims from whom this blood is obtained are distracted from the excessive amount of blood. Such an abstraction acts as a means of articulating the tensions between family and the community. In this way, blood is used symbolically to compel the audiences to realize that they are capable of being transformed into "ruined bodies".

 

Individuals who fear blood are also likely to loathe sharp objects like needles and knives because they are associated with the withdrawing of blood. They act as triggers for their underlying fear of blood. Woody and Teachman (2000) also suggest that such individuals tend to be highly sensitive to scenarios likely to elicit feelings of disgust. Tolin et al. (1997) report that individuals with needle phobia tended to elicit stronger reactions when viewing photos of individuals receiving an injection. Such phobia stems from childhood, implying that the fear of blood is deeply ingrained in our psyche. Over the years, blood has come to be associated with bad events, such as serious illnesses or even death. In this way, it has become a socially accepted norm that blood is something that ought to be feared.

 

Ordinarily, blood flows in veins and is hence not exposed to the naked eye. However, an injection implies that blood gets exposed to the eye. Cutting of a body part using such an item as a knife also results in the loss of blood. This cutting constitutes an invasion on an individual's privacy and is hence against their will. At a sub-conscious level, people do not like being invaded in their lives. It is even worse when such an invasion involves drawing blood.

 

 

Chapter 2: Blood and Associated Psychoanalytic Concepts
 

Blood

From layman's perspective, blood is that darkish red fluid inside the bodies of humans and animals. It delivers core functions such as the transportation of nutrients and oxygen to the body cells. As such, people understand blood to be a vital component in the sustenance of life. As such "blood contains the energies that keep us alive" (O'Neill et al, 2016). While blood is a major biological component; the idea of blood is also important in determining how we relate to blood. It evokes deep emotions that unravel how we relate to blood. Blood is seen as a life force suggesting that our lives are intricately connected to blood. The science of blood has revealed that blood has related its toneurology, psychology; among other scientific disciplines such as psychoanalysis.

 

The psychology of blood is consistent with the notion of blood as a life force that transcends biology. Freud's work delves into the unconscious faculties and how the underlying thoughts, feelings, desires, and memories are brought to bear on reality. When this happens, people are able to experience cathartic relief, which is psychological and emotional relief from distress (Fries, 2005). To this end, Freud suggests that there may be psychoanalytical causes to physical issues and as such understanding the underlying psychoanalytical issues is vital in understanding human behaviour.

 

Regarding the topic of blood, blood (and the idea of blood) can be a source of catharsis that provides emotional relief from which an individual can reconcile the unconscious mind with the harsh realities of life. Emma Eckstein's case is significant herein and is rendered useful in this context. Freud's assertions on the "wish to bleed" analysis relating to Emma's experiences formed the basis of future studies. Freud suggests that Emma had a desire to bleed in order to attract the attention and sympathy of others which is Freud's classical example (Masson, 1985). Yet, Freud's "wish to bleed" theory has been controversial and has been rejected by various critics. In this chapter, Freud's psychoanalysis shall be used to analyze important biological and psychological phenomena such as the blood, libido, anxiety, and trauma.

 

Libido

Freud avers that libido is at the core of the sexual life of humans and the energy that drives it. Freud used the term libido in the Latin sense to imply a 'wish' or a 'desire' (Freud, 1953). Freud explains that libido is one of the "motivating forces of human personality and behaviour" (Freud, 1959). By doing this, Freud focuses on showing that there is a correlation between libido and the sexual urge by using the psychoanalytic approach. Freud's (1919) notion of sexuality expanded beyond sex to include other areas of personal drive. Still, the reference to the body concerning libido indicates its psychical representation in the form of ideas and wishes is distinct from the body and as such libido becomes an 'instinct' or 'drive' from a psychoanalytical perspective. To this end, Freud (1959) sees libido as 'the energy, regarded as quantitative magnitude' involving instinct energy or force.

 

In addition, Freud develops this theory further by asserting that the libido is fixated in various erogenous zones namely "the id, the ego, and the superego." The id is the "strictly unconscious structure of the psyche" which may suggest that libido is fixated in the id and may occur unconsciously. To this end, Freud (1933) often uses the term "psychosexuality" to show that libido goes beyond the physical and may be psychologically manifested. Whereas a person may have the biological desire for sexual activity, psychological conditions may impede that desire. Given this, libido is, therefore, a "borderline concept between body and psyche." This characterization can also be extended in the psychoanalysis of blood. Blood exists in our bodies in physical form but besides this, there is the notional existence of blood in the human mind that is both conscious and unconscious, that we can associate with it: Therefore, libido gets withdrawn or redirected based on an individual’s psychological manifestations.

 

The distribution of libido gives the impression that libido is limited. On this, Freud suggested that because the amount of mental energy that an individual possesses is limited, he is compelled to distribute his libido as best as he can, to accomplish various tasks.

 

According to Freud, when libido gets withdrawn from one area such as an object, it requires deploying to another area, such as the ego. As an explanation to this, the Freudian analogy suggests that illnesses such as narcissism can result where libido is withdrawn from other people and objects and solely devoted to the ego. On the subject of Narcissism, Freud (1914) notes that "We see, broadly speaking, an antithesis between ego-libido and object-libido. The more the one is deployed, the more the other becomes depleted" (Freud, 1914, pp.76).

 

While the blood (the biological composition of it) and libido are not essentially the same, the link between the two lies within the idea of blood and how people represent it consciously and unconsciously. Within the human body, blood can get deployed, depleted, redirected. There is also the psychological idea of blood that can be related to libido such that blood is perceived as a life force that drives sexual behaviour.

 

The Uncanny Connotations of Blood

From a Freudian perspective, the "uncanny" means something that is at once familiar and strange. On the other hand, the word "heimlich" as used by Freud in his work, Das Unheimlich, has its roots in an old German word whose meaning mutates into "unhomely" (Fenichel, 2019). However, its usage in Freud's work construes an uncanny meaning (Freud, 1901). Freud uses Germanic examples to demonstrate that the homely/unhomely dichotomy can be used to describe the uncanny: In this sense, he opines that the uncanny is basically what is both "homely" (the familiar) well as what is "unhomely" (the unfamiliar). Subliminally however, Freud suggests that the homely/unhomely dichotomy offers deeper and deconstructive alignment of what the uncanny entails. The uncanny is based on certain fundamental anxieties where it is familiar and unfamiliar. In relation to the idea of blood the uncanny implies that there are certain anxieties that exist in both the familiar and unfamiliarity relating to our understanding of blood. For instance, blood is familiar under the skin but can significantly become frightening when it is exposed.

 

According to Freud, "frightening element can be shown to be something repressed which also recurs (Freud, 1900). In context of blood, uncanny is nothing really new or alien, but something which is familiar and old-established on the mind and which becomes alienated from it only through the process of repression (Freud, 241). Freud was acutely aware of the varied meanings that would develop from his usage of this term in his work. The usage of the word heimlich is indicative of our familiarity with blood. Nonetheless, even something that we consider being familiar may also be interpreted as constituting varied meanings. For instance, although the blood under the skin is familiar territory this is uncanny. Putting this in mind, the home, and all that relates to it, suggests the existence of something strange and which may have opposite "unhomely". We can therefore rely on the dual structure of uncanny by Freud to examine the psychical connotations of blood. Freud suggests that blood may invoke horror and dread and qualifies for categorization as uncanny (Royle, 2008).

 

The psychical connotations of blood may be likened to the notion of duality of the uncanny as proposed by Freud. From Freud's perspective of uncanny; blood has varied, and often frightening meanings. First, blood acts as a symbol of life. In Freud's view, the idea of the the uncanny in relation to blood is interesting as it goes beyond the surface meaning. He suggests that the idea of the "uncanny" undoubtedly fits into all that appertains to being terrible. That is all that stimulates dread and creeping horror. However, the uncanniness of something isn’t merely in the provocation of dread and terror. "Something has to be added to it" that invokes the dread, terror, and fright (Freud, 1919, Pp 2). There has to be a psychotic element attached to it that elicits feelings of dread and fear; subsequently, the provocation of fear has to lead us back to something that we already know, something that was once very familiar to us. Freud expands his theory in many ways, one of which is to argue that the homely (that which is native, known or familiar to us) can easily become unhomely or unfamiliar - by which Freud also meant that which is "sinister, ghastly, uncomfortable or even eerie" (Freud, 1919, Pp 2). Homely, in Freud's view, that which develops towards uncertainty/anxiety/ambivalence to the point that corresponds with that which is unfamiliar. In relation to blood, Freud uses the expression "eerie and bloodcurdling" to describe the unfamiliar (Freud, 1919, pp. 3).

 

Like the blood, libido may also show characteristics of the uncanny nature as suggested by Freud. We all have varying senses of uncanny experiences. However, some people experience a permanent sense of uncanny, especially related to psychosexuality. How we relate to sexual differences may be traumatic and as such can be classified as uncanny. Its relationship with the idea of blood shall be highlighted hereinafter. Regarding sexuality and libido, the uncanny experiences may gain predominance during adolescence wherein the said individuals may face reworking of the Oedipal conflict (Brunswick 2017). The overpowering drives of sexuality during this stage may have enduring effects on the individual's life (Laplanche, 1970; 1987). The developing sense of sexual pleasure (growing libido) may be familiar to the person; yet the person may experience strangeness emanating from lack of understanding of the psychosexual developments (Freud 1933). Given this, 'disquieting unfamiliarity' may be experienced in parts of their body that experience sexual pleasure, making such person believe that the whole body is inhabited by libido. The relationship furthers Freud's notion that the libido is uncanny, especially during adolescence. Freud (1905) suggests that the duality of the libido is the product of a process of dissociation within which sexual desires enter into the body girl where they possess and control Emma. This may lead to rising desires for sexual intimacy, unexplained arousal and the growing will to procreate. At face value, these are the positive purposes of the libido which are familiar to the teenage girl. Nevertheless, within the psychosexual development lies strangeness associated with sexual development that the pubescent individual is unfamiliar with: During this stage, the body goes through a cascade of changes as the body adjusts to the growing libido (Freud, 1923).

 

Blood loss during menstruation is uncanny in Freud's view highlighted herein after. It is mainly associated with the potential loss of a would-be life. It means that the female egg had no contact with the male sperm: However, menstruation also has another physical connotation - it signifies mutilation. It is the repression of the desired wish, namely to have a penis (Housman 1973). Blood is a very private component in the body of a human being.

 

Freud avers that the topic of menstruation is related to the uncanny through the concept of taboo. By taboo, Freud implies the 'sacred', 'consecrated' (homely), and (the unhomely) which he refers to as the 'uncanny', 'dangerous', 'forbidden', 'unclean' (Freud, 1913). He observes that taboo status is given to among other things menstruation.

 

One of the strange changes experienced by girls during puberty is the onset of menstruation. The loss of blood during menstruation is seen as a sign of sexual maturation. Therefore, it may not be related to loss of life. This process of menstruation may feel strange.

 

Notably, the heightened emotions and mood swings caused by menstruation may further heighten the strangeness. North (2015) explains that the manifestation of hysteria during menstruation may further point at the psychology of menstruation. Moreover, the pubescent female may feel persecuted for having sexual fantasies emanating from the growing libido. She may, therefore, want to dissociate with such feelings. This is relevant to Emma Eckstein's case.

 

Trauma

Trauma is the Greek word for wound. Freud described traumatic events as any form of excitations that originates external to the body and which has sufficient power to permeate the protective shield (Freud, 1961). The concept of wound is very much connected to blood. That is, wounds when incurred lead to depletion of blood (Laplanche and Pontalis, 1973). The Greek word for a wound is also derived from a Greek word meaning to "pierce." The Greek analogy of the concept of the wound is very relevant to phlebotomy.

 

In reference to traumatic events, Freud notes: "Such an event as an external trauma is bound to provoke disturbance on large scale in the functioning of the organism's energy and to set in motion every possible defence measure" (Freud, 1920, p. 301). According to Laplanche, the 'foreign body' encompasses the intrusion of trauma. The 'foreign body' becomes an intrusion of ideas into the mind (Laplanche, 1985, p. 134).

 

This happens because the individual experience with external trauma is transposed onto the psychic sphere. This is the view of trauma held by Freud (1920), who associates trauma with the invasion of the psyche by 'foreign body.' When the 'foreign body' has intruded the psyche, it becomes hard for the psyche to process or assimilate such 'foreign body.' In this case, the foreign body can take one of the varied forms, including wish or idea.

 

The "foreign body" may also take the form of an event such as that which may lead to the drawing of blood from the human body (Akhtar, O'Neil, & Freud, 2011). Drawing of blood in itself may not be traumatic. Trauma is derived in the idea of drawing blood that would be traumatic in the psychoanalytic sense. Trauma is not simply the event where blood is drawn from the human body. In view of this, the trauma that is associated with phlebotomy does not arise from the actual drawing of blood but from the idea of blood and what drawing it from the human body entails.

 

To this end, we already know that a person can either have traumatic and non-traumatic responses to drawing of blood by the means of phlebotomy. In line with this, phlebotomy also leads to both the physical and psychological traumata. Phlebotomy can cause physical trauma on the veins caused by injured veins. Ordinarily, this can be treated with painkillers to relieve the physical pain. In severe cases, phlebotomy may cause anxieties that may make it impossible for the individual to receive medical care through phlebotomy. For instance, the fear of needles (and injections) is a traumatic response related to phlebotomy.

 

Whereas there are improved venepuncture practices, venepuncture trauma is a recurrent medical complaint nowadays. Phlebotomy involves drawing blood from a person for diagnosis, which may lead to saving the life of the patient. The very notion that blood is being drawn from the body may be bizarre to the patient and as such, cause psychological trauma. Blood is a very private component of an individual and as such, phlebotomy can amount to the intrusion of privacy.

 

Phlebotomy, therefore, can be experienced by someone undergoing it as an exposure of what is private and hidden under the skin so that it becomes visible, foreign, and frightening. For some people, even the sight of blood is alarming because what is hidden beneath the skin gets exposed. Besides, the idea that blood carries crucial energies of life may exacerbate the psychological trauma since the patient may feel that life is being sucked out. This notion while evaluated vis a vis Freud's view on trauma tends to the notion of psychological trauma. Freud (1926) explains that the importance of traumatic situations is elevating the "experience of helplessness on the part of the ego where a person feels suddenly overwhelmed.

 

Anxiety

In this Thesis, the scope of the definition of anxiety is limited to the Freudian perspective. The Freudian definition of anxiety has changed significantly throughout the evolution of psychoanalysis. Initially, Freud thought that anxiety was linked to sexual excitation (libido). However, the final phase of the development of this theory suggests that the "ego is the actual seat of anxiety" (Freud, 1953, pp. 74). Freud identified anxiety occurring in two ways: the form of anxiety that is triggered by traumatic experiences where the ego becomes overwhelmed. There is also the anxiety signal that is more of an ego response to imminent danger. As such, defences are triggered to deal with anxiety. Freud termed this neuroses (1953). Further, Freud (1953) modified his theory on anxiety and its relationship with repression. His final amendment to this theory suggests that anxiety is not caused by repression but rather anxiety precedes repression and as such causes it.

 

Regardless of this, Freud demonstrates that in the face of such anxiety, an individual pursues tension reduction mechanisms means of minimising feelings of anxiety (Freud, 2001). The driving-force of such anxiety is fear of punishment associated with the articulation of the desires of the Id. This happens in the absence of proper sublimation. Strong love or attachment to objects leads to more intense anxiety.

 

Human beings tend to confront such anxiety; both unconsciously and consciously while being aware of the loss that may ensue. When undergoing phlebotomy, a person is bound to be anxious out of the repressed worry and fear of discomfort and/or pain when the needle punctures the skin. During phlebotomy, the needle physically only involves brief and mild discomfort. It is the unconscious ideas and associations that produce anxiety in the strict psychoanalytic sense.

 

Additionally, the person undergoing phlebotomy is also likely to be anxious because the procedure entails a 'loss'. In this case, the individual is sure to experience blood loss. Blood is associated with the sustenance of life, and as such, its loss is bound to cause anxiety as the individual is fearful that the lost blood may impact negatively on their health and wellbeing. Besides, the psychic association between blood and life implies that just as the transfusion of life is associated with life sustenance, in the same way, blood loss may signify the loss of life. Loss of blood may also signify the loss of potency by an individual. Blood is in itself the source of potency and power.

 

The drawing of blood from the body therefore signifies the loss of such power and potency. The individual is concisely or unconsciously aware of the impending loss, and this, therefore, acts as a source of anxiety. To this end, Freud avers that anxiety emanates from the desires to reduce the tension that originates from events that violate a person's view of themselves (Freud, 1953). Real events, those which can cause anxiety, include events that may be perceived as causing danger by violating how a person views themselves, leading to anxiety (Freud, 1926).

 

Blood in the process of castration and such real anxiety occurs. For instance, when a soldier is on the battlefield, they are ready to "spill" the blood of the enemy, thereby leading to the death of such an enemy (Ury, 1997). At the same time, the soldier is careful not to get injured because the loss of blood might cause their own death. This, therefore, is an indication of the conflict between life force and deadly force. At this point, it is important to distinguish anxiety.

 

Freud offers several ways through which a person combats anxiety. These, he calls defences or defence mechanisms. Freud (1953) explains that neurosis is an instance within which the ego is unable to deal with the anxiety by the means of repression and other forms of defences mechanisms. As such, a person "can fall ill of a neurosis" where the ego is unable to allocate the libido appropriately.

 

Freud proposes numerous defence mechanisms such as denial (rejecting the reality), the intellectualisation of the prevailing anxiety-causing event, projection, rationalisation, reaction formation, sublimation, regression, and repression. Freud further explains that defence mechanisms are not conscious efforts implying that an anxious person does not choose which mechanism to adopt to mitigate anxiety. Instead, they lie within the unconscious self and as such an anxious person may utilise one or more of the anxiety mitigation methods mentioned above.

 

This account on anxiety can be linked to psychoanalysis where it remains to be uncanny. This is because anxiety involves bringing back home to the psychic mind the anxiety of what is unknown.

 

Self-Harm

The concept of trauma is very central to defining and understanding self-harm. From Freudian point of view, there are several statements that define the various conditions that precipitate the occurrence of a traumatic state. Freud himself calls it "excitations from outside" that breakthrough one's defence barrier (Freud, 1963 Pp. 359). Freud's concept of trauma suggests that there is an "efficacious barrier against the stimuli" (Freud, 1963, Pp. 361). This barrier is Freud's description of a mental apparatus. It also indicates that there are psychological circumstances that precipitate self-harm.

 

The National Institute for Health and Care Excellence (NICE) defines self-harm as "self-poisoning or self-injury; irrespective of the apparent purpose of the act" (2004, p. 6). Elsewhere, the World Health Organization (WHO) defines self-harm as an act with the non-fatal outcome in which an individual deliberately initiates a non-habitual behaviour that, without intervention from others, will cause self-harm, or deliberately ingests a substance in excess of the prescribed or generally recognised therapeutic dosage, and which is aimed at realising changes which the subject desired via the actual or expected physical consequences (cited by Platt et al. (1992, pp. 3).

 

These definitions appear to contradict popular opinion in which self-harm is perceived to be self-injury that draws blood and in which loss of life is the intended outcome. Many communities relate self-harm with suicide and poor mental health. However, from a psychoanalytic perspective, the action of self-harm may not necessarily indicate that the individual wishes to die. There appears to be underlying psychoanalytical conditions that suggest that people who self-harm are not motivated by death. People who harm themselves appear to be motivated by other things besides suicide. These include the desire to communicate, to draw the attention of others to ask for help, as well as the desire to get respite from devastating situations.

 

Self-harm may also be an indication of a person who wants to punish the self. By causing harm to oneself, a person may be showing remorse for wrongs done to one's self or to others. This kind of self-harm is cathartic as it is a form of revenge. Self-harm, paradoxically, may be a morbid sense of self-help, an idea that is consistent with Freud's theory of anxiety in which the anxious person unconsciously engages in a defence mechanism in self-defence against an external threat (Rado, 1933). Cutting oneself with the intention of drawing blood is usually regarded pathology. Yet, people still do it anyway. Self-harm happens because the self acts as an active participant in such a punishment in which the body becomes an object of self-harm.

 

By cutting oneself to draw blood, the release of blood is an indication that the Id has taken over control of the body. In this way, self-harm functions as a powerful mechanism through which an individual gets to release deep-seated tensions. It affords the individual a feeling of euphoria, albeit temporarily, while others experience an orgasmic sense of relaxation and relief. This might explain why self-harming behaviour tends to be addictive (Gottlieb, 1991).

 

Nonetheless, such a sense of orgasmic relaxation or relief is only short-lived as soon enough the mind gets preoccupied with powerful images of self-harm. As an individual rehearses these images, it leads to the development of destructive feelings associated with self-harm. Cutting oneself signifies that one is alive, seeing as blood is a symbol of life (Compton, 2017). Additionally, cutting oneself and the knowledge that you are going to bleed tends to relieve tensions (Zepf, 2010). Such tension may take the form of disillusionment or anger: As the blood oozes out, it leaves a distinct mark which signifies a sense of separation with the tensions in question.

 

One takes confidence in the knowledge that he or she has the power to control the rate at which tension gets released from the body, which in this case refers to the rate of flow of blood. By the knowledge that one has in him/herself the power to self-harm, there is also a feeling of an accomplishment of the will-to-be. A person may also self-harm in order to fulfil an underlying wish: This will be apparent in the cases of Emma Eckstein and Marie Cardinal, to which now turn.

 

(END OF CHAPTER) Psychoanalysts such as Freud have argued variously on the relationship between bleeding, the psyche, personal, and underlying medical conditions.

 

Involving patients such as Emma Eckstein, a famous patient of Freud, reveals a lot about this subject.

 

At the time of going to Freud, her symptoms were not clear but it is believed that she exhibited severe menstrual problems which can be linked by Freud's notion of underlying sexual problems. Eckstein also is believed to have suffered from serious nosebleeds, and Freud was convinced that the nosebleeding was psychogenic. In other words, a wish to bleed had triggered the physical symptoms which did not have any underlying organic cause. Freud's conception of traumatic memories acted as a basis for the development of psychoanalysis. In his psychoanalysis, Fleiss involved the body in various invasive means. For example, in the case of Emma Eckstein, he was convinced that there was a connection between sexual problems and the anatomical features of the nose.

 

Freud has been criticised on this since Eckstein's bleeding had been caused by physical trauma on her nose. It, therefore, could not have been triggered by a psychological need for attention and sympathy from others. There are various contrary opinions to Freud's wish to bleed where he characterised Eckstein's bleeding as desired. However, his concepts that related bleeding to the psychological need for attention, affection, and sympathy still hold true. Particularly, the heightened desire for attention during menstruation is consistent with this theory.

 

Wilhelm Fliess, the medical professional who operated on Emma Eckstein, was also a collaborator and a friend to Freud. When Freud asked Fliess to examine Emma Eckstein, Freud was convinced that the patient was hysterical. He thus went about treating hysteria. According to Freud, excessive masturbation had triggered the development of hysteria in the patient (Bonomi, 2015). Eckstein had undergone a surgical procedure on her nasal cavity with Fliess conducting the operation.

 

The surgery took place under local anaesthesia. However, after the procedure, the patient was left with permanent disfigurement. She also developed postoperative haemorrhage. According to Freud, Eckstein had brought the problem upon herself as she sought to pursue affection by others (Josephs, 2010). Freud was of the view that Eckstein intended for herself to bleed and hence termed the bleeding as "wish bleedings." Freud writes, "she positively liked to bleed, so that the symptoms allowed her to demonstrate her various ailments to be real, rather than imaginary, and this gave her claim to the affection of others" (1898, pp. 116). Freud's diagnosis of Eckstein has been queried. After the operation, Eckstein went on to develop a serious infection that nearly cost her life.

 

The surgical error occasioned Emma's incident. Fliess had conducted the surgery, but he forgot to remove a gauze that remained dislodged in the patient's nasal cavity, thus resulting in bleeding. Freud's treatment of Emma Eckstein can also be related to his treatment of Irma, in one of his popular cases called the Irma's dream. While treating Irma, Freud proposed a unique treatment plan that involved an injection. Irma was unwilling to take this injection, yet the treatment method appeared to work. Considering the relationship between Freud and Fliess, the Irma dream is largely perceived by psychoanalysts as an attempt by Freud to exonerate his collaborator from any wrongdoing. In a letter addressed to Fliess, dated January 24, 1897, Freud recounts his experience with the circumcision of a patient whom we later on learn was Emma Eckstein.

 

In the letter, Freud wrote:

 

Imagine, I obtained a scene about the circumcision of a girl. The cutting of a piece of the labia minor (which is even shorter today), sucking up of blood, after which the child was given a piece of the skin to eat. This child, at age 13, once claimed that she operation you once could swallow a part of an earthworm and proceed to eat it. An performed was affected by haemophilia that originated in this way: (cited by Bonomi_ 2015.

 

While Emma bled intermittently following the nasal surgery Freud was convinced that she had been bleeding since her childhood: To Freud, Emma's bleeding was the result of hysteria. Hysteria is connected to high libido, which may portend the redistribution and redeployment of blood based on the urges of the id. Freud's assertions are based on his understanding that the patient partook in compulsive self-mutilation. Also, Emma engaged in self-cutting behaviour as she "always has been a bleeder" (Masson, 1985, p. 186). It could be that Emma cut herself as often as she was suffering from real trauma or she fantasised about it, in that Freud called "wish bleeding."

 

 

Chapter 3: Emma Eckstein vs Maria Cardinal

This section will delve into the analysis of blood by comparing the psychoanalytic associations of blood in the context of Maria Cardinal and Emma Eckstein. According to Freud, the idea of blood is well represented in the psyche, both consciously and unconsciously. For Freud, these become separated through repression or displacement: The concepts that have already been discussed in chapter two shall be brought to bear on both the cases of Maria Cardinal and Emma Eckstein especially as related to bleeding:

 

Maria Cardinal - A Brief Background

Maria Cardinal biography is perhaps the best account of psychoanalysis from a patient's point of view. In this story, she claims to have reached a "cul-de-sac" (Cardinal, 2000). Translated, it means that she has reached a dead-end where there is no escape. She seeks psychoanalyst's help having experienced bodily symptoms that also involved continuous bleeding from her vagina for three years. In the course of the psychoanalysis treatment that lasts seven years, those symptoms disappear.

 

During her first session with the psychoanalyst, her bleeding is characterized as psychosomatic. At their first session, the psychoanalyst pronounces her bleeding to be psychosomatic, the same as what Freud thought about Emma Eckstein's nosebleeding. While the psychoanalyst declares that the line of thought did not interest him, Maria's bleeding stops that day. The psychoanalyst explores Maria's childhood revealing that she had a troubled childhood. Her mother ignored her by instead choosing to grieve over the loss of Maria's first-born sister continuously. Maria's mother was too engrossed in grief for her dead daughter to pay any attention to Maria, her living daughter. During her pubescent years, Maria's mother reveals that she attempted to abort Maria on several occasions (Cardinal, 2000).

 

Maria Cardinal's case depicts a fascinating occurrence. It is also a fascinating equivalent to the Emma Eckstein case. Both of these cases can be used as illustrations on the various associations around the idea of the blood. It shall be used to render some of the arguments discussed hereinbefore.

 

Libido

In Sigmund Freud's perspective, Emma Eckstein's nosebleeds were psychosomatic. In other words, Emma's bleeding was a result of her wish to bleed. Many critics of this theory have differed with it on many accounts. There were physical causes for Emma's bleeding; nevertheless, it helps us to untangle the associations between bodily functions and the human mind.

 

In this section, the concept of libido shall be brought to bear on psychosomatic bleeding: Boag (2014) explains what libido is from a psychoanalytic point of view, suggesting that libido encompasses the energy that is created for basic survival. For Freud, the libido is not just sexual energy; it also encompasses the psychic energy and such is part of the id. The id, part of the primal energies, seeks to fulfill immediate impulsive urges. The pleasure principle controls the id.

 

It appears that libido may have a bearing in explaining the cause of bleeding by Maria Cardinal. The relationship between bleeding in Maria's case and libido is made relevant due to Freud's characterization of libido as a psychic energy distributed according to pre-needs. Essentially, bleeding may have been triggered by Maria's overuse of the libido. In this sense, bleeding is seen as a bloodletting experience that is connected to the aggressive need to identify with her mother.

 

In Freud's view, Maria's bleeding can be explained in relation to the id. The id attempts to direct all of the bodily energies (the libido) towards the actions, behaviours and processes that guarantee the maximum amount of pleasure possible (Sterba, 2008). Being loved and shown feelings of satisfaction in Maria's case and as such her affection by her mother could have led to psychic energy may have committed the highest amount of energy reserves towards that attainment of this. Since Freud postulates that libido seeks to gratify our most basic urges, the id's desire in Maria's case was to gratify her most urgent wants.

 

As explained earlier, both Maria and Emma's primal wish to be loved. For Emma, she bled to arouse affection from her doctor (the need to be loved in her sickness). For Maria, her need to be loved was centred on the desire to identify with her mother and become someone she could love. Unconsciously Maria bled to arouse death that would make her dead just like her elder sister as it was the only way to attract the attention of her mother. She took a secret pleasure from summoning the blood. Since her mother attempted to abort her by inducing vaginal bleeding, her psyche may have unconsciously wished to identify with her mother and fulfil that wish. As such, the psyche directed all her libidinal energies towards vaginal bleeding that lasted for three years. Unknown to her, her psyche was overspending libidinal energies towards bleeding her to death. At the same time, the libidinal energy was getting depleted for use in other bodily and cognitive activities. This is the frightening (strange) element of the idea of blood and validates why Maria had reached a "cul-de-sac."

 

Trauma

Freud asserts that a traumatic event is a type of excitation with external origins (foreign body) to the human body. The traumatic event has enough power to permeate a person's protective shield.

 

Furthermore, Freud explains that the traumatic event can provoke a "disturbance on large scale in the functioning of the organism's energy" in such a way that it would activate a person's defence mechanism (Freud, 1920, p. 301). Since the foreign body "encompasses the intrusion of trauma into the human body, it, therefore, becomes the instructions of (foreign) ideas into the psyche" (Laplanche, 1985, p. 134).

 

Laplanche's idea purports that the intrusion of trauma occurs because the person experiencing the traumatic event has been transposed onto the psychic sphere. Laplanche's idea on trauma bears significant resemblance to Freud's ideologies on the same. Like Laplanche, Freud links trauma with the "invasion of the psyche by a foreign body." When the human body is intruded by the "foreign," the psyche is unable to process and integrate instructions from the foreign body. Consequently, the intrusive foreign body assumes either a variety of forms, such as a wish, idea, or an event. Examples of events that can be characterised as traumatic may include the drawing of blood from a person (an example is phlebotomy). Where the traumatic event is phlebotomy, it constitutes the intrusion of the human body by a foreign body. It is important to note that trauma does not originate from the act of drawing the blood. Much of the trauma originates from what the act of drawing blood entails, which is based on the repressed fears and notions associated with bloodletting.

 

Both Emma and Maria experienced traumatic events in early life. Masson (1985) argues that Emma's trauma is related to the sexual abuse she experienced as a child, which, while analysed through psychoanalysis, Freud's view may have triggered sexual fantasies. The abuse may have introduced foreign feelings in her body that were repressed, becoming a wish to bleed. This is tantamount to discharging a "foreign body." Similarly, at the time of seeing the psychoanalyst, Maria appeared to have experienced a traumatic event since she claimed to have reached cul-de-sac in her life" point in which her entire being could no longer function (Strachey, 2000). Examining Maria's childhood reveals that there could have been many events that may have caused trauma to her leading to her condition.

 

Nevertheless, since this paper is about blood and the psychoanalytic concepts, the scope of argument shall be limited to those events that relate to blood. During Maria's pubescent years (coincidentally when she had started to menstruate), the preferred methods of abortion would have triggered bleeding the foetus out of her body through the vagina and subsequently lose the pregnancy. This confession made Maria understand why her mother never showed her motherly affection. They could have triggered a feeling of parental rejection that caused mental trauma.

 

Subjected to Freud's (1920) views on trauma, the traumatic event that Maria had experienced had penetrated her defences and as such provoked disturbances within her body so large that it made it impossible for her body and mind to function. This is what is referred to as a "cul-de-sac moment." The result of the trauma is that it led to experiences of terror that had gripped Maria because she had gradually lost control of her body as well as her mind. The terror that had occupied her mind originates from what she called "the thing."

 

The mention of "The Thing" in Maria's memoirs opens up opportunities for the exploration of the uncanny in relation to Maria's experiences. In Maria's view, "The Thing" only existed through its myriad reflections. It resisted direct contact such that Maria could not be able to touch it; or even find words to say. This suggests that the thing that she experienced was psychological in nature. It existed in her mind and acted as a window into a dark place that was frighteningly unfamiliar. Maria was terrified of the enigmatic thing; the presence of which was overwhelming, enthralling, and tormenting. Unbeknown to her, the thing could have instructed her psyche to bleed herself to death through menstruation. This demonstrates the uncanny connotation of menstrual blood from a trauma perspective.

 

Anxiety and Attachment Disorders

The main question in this section is whether Maria's experienced anxiety and whether that experience triggered her bleeding: Anxiety is triggered by an unconscious conflict where the patient’s ego had been approached by an idea which proved incompatible, which provoked on the part of the ego a repelling force of which the purpose was defense against the incompatible idea. Where anxiety is experienced, the individual seeks the mechanisms that minimize or eliminate the anxiety-causing tension. From a psychoanalytic perspective, childhood experiences are linked to the development of anxiety, especially the kind that is related to attachment disorders. According to Bowlby (1969), attachment disorders develop out of childhood experiences with caregivers and other important figures during childhood. Where strong attachments are formed, the more intense the anxiety is likely to be.

 

The above assertions can be related to Emma as well as Maria Cardinal's life experiences as children. Emma appeared to have formed a very strong attachment to her doctor and as such sought the doctor's sympathy through illness. Maria's childhood was devoid of parental affection, validation, and love. Maria grew up without the emotional bond between a child and their caregiver, in this case, her mother. These are the primal desires of the id linked to anxiety minimizing mechanisms such as repression. In psychology, this emotional bond to a significant other is called attachment. The attachment has a significant impact on the life of a person through adulthood. It keeps the child physically and emotionally closer to the caregiver and as such "improving the child's chances of survival" (Bowlby, 1969, pp. 174). This suggestion is significant in describing the role of attachment in the development of anxiety for Maria Cardinal.

 

Maria had very strong identity with her mother, which is significant any form of attachment. The absence of attachment appears to be one sided. On the one hand, Maria's identity with her mother points to presence of strong emotional attachment towards her mother. On the other hand, there appears to have been no feelings of attachment from her mother, which may have caused a rise in anxiety.

 

Freud (1953) used the word neuroses to describe defences against anxiety. These defences include repression. Throughout her childhood, Maria Cardinal repressed the need for parental affection, love, and validation that was only revealed during psychotherapy. This can be related to attachment loss in her childhood, which explains the condition of her neuroses. In the Freudian model, the term anxiety indicates that there exist internal unconscious conflicts. Anxiety prevents the victim from functioning normally. Such individuals exhibit signs of traumatic experiences, especially during childhood. Freud (1953) explains that the traumatic experiences may demonstrate a mechanism of conditioned fear which is believed to play significant role in precipitating anxiety disorders. Repression (which portends the frightening and weird idea of blood) is one of the defence mechanisms associated with anxiety that can also be used to explain the existence of conditioned fear: It originates from the loss of attachment to an important figure. Seeking to regain the emotional attachment to her mother, Maria wished to bleed.

 

From a psychoanalytical perspective, loss of blood is related to loss of life. It may also signify the loss of potency by an individual (Sadoff; 2014). Individuals who experience the loss of blood are consciously or unconsciously aware of the loss of life and potency. This can be a major cause of anxiety, which is repressed in the form of a wish. Wish bleeding, therefore becomes justifiable explanations for both Maria and Emma's experiences.

 

Menstruation and Self-Harm

In the previous chapter self-harm was defined as "self-poisoning or self-injury" (National Institute for Health and Care Excellence, 2004, p. 6). Contrary to popular opinion, self-harm is not driven by the desire to draw blood and die. As evidenced in Maria Cardinal and Emma Eckstein, self-harm can be psychosomatic. The underlying psychological conditions may trigger self-harm. Besides death, people self-harm may be triggered by repressed desires such as the need for attention, love and affection. By harming oneself, a person could be seeking attention for sympathy, affection, and love from others (Doyle, Keogh & Morrissey, 2015).

 

Talking about menstruation is talking about blood coming out of the vagina (though not all bleeding is menstruation). As such, blood is at the centre of the menstruation debate. Blood, as Freud suggests, has a variety of meanings, all of which have an element that can be frightening. There are, therefore, certain frightening connotations that are associated with the idea of the menstrual blood. This includes self-harm. They shall be explained in the sections that follow.

 

Ordinarily, menstruation is the single most function that defines womanhood, according to Newton (2016). Newton (2016) assertions have several implications on the subject of menstruation and its definitive role in the gender debate. Most importantly, it raises many questions about the relationship between the mind and the body concerning gender. Since menstruation is about vaginal letting, it also raises many questions on the link between menstruation and the human mind, from where ideations of the menstrual blood are derived.

 

Lupton (1993) explains that there are both biological and psychological links between the human mind and menstruation. Menstruation is controlled in the hypothalamus section of the human brain. There are major biological associations about life and death that can be linked to menstruation blood. Mostly, these associations maintain specificity in the role of menstruation in reproduction. This indicates that the prevailing association of menstruation apart from the taboos associated with the menstrual blood is linked to a woman's life-giving abilities. In other words, this is the life-giving biological function of the woman's body. Given Freud's meaning menstrual blood is associated with the source of life. This is perhaps the familiar idea of the menstrual blood.

 

There is also some idea that is perhaps has become alienated from us through repression. We already know that menstruation involves blood loss through the vaginal canal, the same canal used during birth (bringing forth life). Menstruation is actually draining the blood from the womb of the woman after the failure of conception. This indicates that a core component of life is being drained from the body, the experience of menstruation for an extended period of time, it becomes frightening as it is an abnormal loss of blood. As such, through the menstrual bleeding, strong associations with the loss of life are established.

 

Seeing that menstrual bleeding is associated with the depletion of life, the same argument can be brought to bear on Maria Cardinal's experiences. At her pubescent stage, coincidentally, Maria's mother revealed to her that she attempted to abort her by having horseback riding as well as taking a considerable amount of quinine. The mother had a wish to abort the fetus by inducing bleeding from her womb. She had wished to cause death by literally bleeding the fetus out of her body through the vagina. This is familiar to both mother (the deliberately wished to abort) and daughter (after the revelation).

 

Maria sought the help of a psychoanalyst for a number she was facing, including vagina bleeding for three years continuously. During the first session, the therapist declared that her bleeding was psychosomatic. That indicates that Maria's vagina bleeding was caused by psychological rather than biological/physical factors. To this end, establishing her bleeding's real psychological cause may be cumbersome unless the psychoanalyst relooks into Maria's childhood.

 

Certain psychoanalytical perspectives can be used to elaborate on the relationship between the wish and how it may be expressed overtly through behavior and/or biological functions. They will be used to demonstrate that Maria's bleeding during her adult years could have been psychosomatically linked to unmet childhood desires. According to psychoanalysis, a wish is "fulfilled when the ego and superego repress unconscious desires" (Sandler, 2013, 44).

 

Repressing a wish may occur due to guilt, unfulfilled desires as well as taboos that have been imposed by society. In addition to this, people's aggressive impulses can be subdued. Even though they may be expressed in overt behaviors, they can be concealed from our consciousness. This explains the idea of wish bleeding concerning Maria Cardinal.

 

Repressed wish to bleed can be explained with evidence from Maria's childhood experiences as revealed in the autobiography. During her mother's grieving period, Maria attempted unsuccessfully to win her love and affection, and approval. She wanted to be loved like her dead sibling. Maria's wish to be loved by her mother like her dead sister was unmet, was also a repressed desire. Her bleeding could have been a way of identifying with her mother and attract her attention. In view of this, Maria wished to bleed to death since bleeding to death would make her mother notice her and as such, give her love, attention, and affection just as she did to her dead first daughter: Maria's wish to bleed points to self-harm that is not driven by the desire to die. Rather, self-harming is a means to an end; it is meant to attract her mother's attention, love and affection. It is strange and expresses the uncanny nature of vaginal bleeding.

 

Maria's bleeding can be analysed against Emma Eckstein's attempts to describe nuanced circumstances that may precipitate wish bleeding. On the one hand, Maria's vaginal bleeding was strictly cured through psychotherapy with no physical interventions. In addition, there appears to have been no physical cause of her bleeding. On the other hand, critics of Freud's school of thought pertaining to Eckstein's bleeding suggest that her condition may have had physical causes. The bleeding did not stop until surgery was performed on her nostrils. While Freud's characterisation of Eckstein's bleeding as having been caused by the desire to be loved, his ideas that show a link between bleeding to the psychological need for attention, affection, and sympathy are still relevant and have been validated through Maria Cardinal. Most importantly, the repressed desire for attention and affection is consistent with this theory and can be related to Maria's unconscious death wish through the vaginal bleeding. This is the unfamiliar yet frightening idea of blood that could have triggered her bleeding.

 

In summary, Maria's childhood events bear significantly to her experiences later in life. The effect of her childhood can be expressed by her neuroses, which suggest that the myriad of conditions she was suffering, including vaginal bleeding, were psychosomatic. The desire to bleed to death was a repressed wish, which originates from her need for attachment to a significant figure, her mother. It still remains an open question whether Emma Eckstein's bleeding was to some extent caused by psychic factors. Contrasted to Emma Eckstein, Maria's bleeding did not have a physical cause. As such, only psychotherapy, instead of surgical or pharmacological interventions, would have cured her.

 

 

Chapter 4: Conclusion

From a biological point of view, blood is a significant component of the human body. While people see it as just a dark reddish thick liquid in our bodies, blood holds restorative power in the biological functionalities of the human body. The darkish red appearance is due to the components that make it up. These components are glucose, proteins, liquid plasma, and mineral elements. It has the energy necessary for the sustenance of life. Mainly, blood is used to transport important components that sustain life. These include essential nutrients and oxygen to the body while transporting waste material out of the cells. It also has immunological, temperature regulation, messenger, and hydraulic functionalities. This indicates that blood is perhaps the most important biological component in the sustenance of life.

 

While the biological compensation and functions of the blood are important to this study, they have not formed the basis of argument herein. This does not imply that the biological idea of blood has been overlooked. Regardless, this Thesis brought psychoanalysis to bear on the concept of blood. Psychoanalysis, as conceived by Sigmund Freud, has helped us to understand that there are unconscious forces that significantly influence. Freud states that the unconscious is a very "rich reservoir of desires, thoughts, and memories which are beneath the surface of conscious awareness." From the psychoanalysis of blood, several conclusions can be drawn from this study.

 

The Symbolic Meaning of Blood

The symbolic meaning of blood is attached to how people perceive it beyond its biological functions. The symbolic meaning of blood is attached to the idea of blood that can be drawn from psychoanalysis. The symbolic meaning of blood does not necessarily imply the abstract notions of blood that have been drawn away from the physical/biological manifestation of blood. For instance some of the ordinary manifestations of blood such as menstruation can indeed have an attached symbolic meaning, as explained by Schneiderman (2010). Menstruation is basically vaginal bleeding that means a woman has attained the age of giving life. As such, menstruation can be a symbol of the possibility of life. However, it entails the drawing of blood from a woman's body through her vagina: Depletion of blood from a woman's body can have a significant negative effect as the loss of blood may be symbolic to loss of life.

 

As demonstrated above, blood can have both the positive and the negative associations. This polarity extends to the fact that blood can have both familiar and strange associations. On the one hand, receiving blood through medical processes such as blood transfusion can have positive connotations associated with the sustenance of life. Similarly, menstruation (vaginal bleeding) implies that a woman is capable of giving birth, which means giving life. This is the familiar idea of blood.

 

On the other hand, where a woman bleeds consistently, there are likely to be negative associations that imply loss of blood, which can be associated with loss of life. Other forms of sustained bleeding are likely to evoke negative connotations. This is the strange association of blood.

 

From a psychoanalytic perspective, the uncanny connotation of blood evokes mixed feelings. On the one hand, the idea of blood can evoke feelings of fear and anxiety in a person. On the other hand, it can also evoke fascination and desire. This is the uncanny (psychical) association of blood, suggested by Freud (1920). By this, Freud suggests that the psychical connotations of blood relate to the dual structure of the uncanny.

 

The uncanny (psychical) connotations of blood have been brought to bear on the life experiences of two individuals, namely Emma Eckstein and Maria Cardinal. Both individuals were psychoanalysts and patients and as such, their findings have had significant influence in psychoanalysis. The experiences of the two individuals relate to numerous conditions they suffered, including bleeding, their mental health and childhood experiences. From their experiences, several lessons can be drawn. These lessons will be presented through several psychoanalytic concepts, namely the libido, self-harm, anxiety, and trauma. These can trigger psychogenic bleeding in people.

 

Libido and its Psychic Associations with Blood

The term libido does not merely imply the sexual drive but rather the psychic energy that is the driving force of all behaviour (Freud, 1920). The libido is linked to the primal desires of the id, and as such, directs an individual to seek fulfilment of his/her primitive desires. It directs the psychic energy towards the attainment of the highest amount of pleasure. Libido is not an endless reservoir of energy. It is limited. This has major implications on how it is distributed and used within the body so as to accomplish various tasks. Libido distribution is a kind of competition (between the id and the ego). Where it is over deployed in one area, it is depleted in another. This is likened to the idea of blood as we know it and can be depleted, deployed, or even redistributed.

 

The id is an unconscious yet powerful energy that seeks to fulfil immediate, primal desires. As such, the psyche can overspend libidinal energies in the pursuit of the fulfilment of primal desires. This implies that it is depleted for the fulfilment of the ego. This creates imbalances in the distribution of libidinal energy within the body that can create a conflict of interest: In the case of Maria Cardinal, her bleeding was caused by the unfulfilled desires to be loved by a significant other. In order to fulfil that desire, the psyche was over deploying to cause vaginal bleeding that would have inadvertently made her become a person worthy of her mother's love. Her greatest primal need was the love and affection of her mother: Since the id seeks basic survival, her psyche may have directed all her libidinal energies towards basic survival and depleting it for other uses. This is why she had reached the "cul-de-sac."

 

Trauma is very simply the intrusion of a foreign body into our psyche. The foreign body also contains foreign instructions that are introduced into our psyche. The psyche is unable to handle, interpret, or process these instructions. As such, the foreign body and the instruction require being transformed into something that can be interpreted by the psyche, such as an event, idea, or desire. This is called repression. Where trauma is repressed causes disturbances so large that it makes the body unable to function. As such, the body seeks to compensate the imbalances and as such instructs the psyche. In Maria Cardinal's case, the psyche is likely to have asked the body to bleed so to compensate the great internal disturbances caused by childhood trauma. As such, childhood trauma can trigger psychogenic bleeding in adulthood.

 

Similarly, self-harm can also trigger psychogenic bleeding albeit differently. Self-harm is not necessarily the causing of self-injuries intended to end one's life. It can also be a way of communicating as well as drawing attention. A person can therefore self-harm by deliberately drawing their blood to attract the attention of others. This is not psychogenic. Instead, it is a deliberate effort to seek attention from others. A person can also hold a repressed wish to attract the affection of another person and as such may experience psychogenic bleeding: An example is Maria Cardinal, whose bleeding was a form of self-harming vaginal discharge driven by the need to identify with her mother.

 

Anxiety can also trigger psychosomatic bleeding: Anxiety is mostly related to the occurrence of attachment disorders. In this sense, the loss of attachment can be traumatizing experiences that cause anxiety. Anxiety causes tensions within the individual. The stronger the attachment; the higher the anxiety tension experienced by the individual. Where a person suffers from such tensions, the mechanism to minimise tensions is activated. The psychic association between bleeding and anxiety can be activated unconsciously where bleeding is seen as a way of minimising the tension.

 

The uncanny associations of blood that have been described here show an interesting relationship. The psyche is the underlying power that appears to influence human behaviour. Therefore, the psyche is constant within these associations. Moreover, there appears to be correlation in the way these associations influence human behaviour. For instance, trauma is associated with the idea of blood in that it can cause psychogenic bleeding. Repressed traumas can activate defence mechanisms. The psyche redirects the energies in favour of the defence mechanisms. Trauma is also a factor in the way anxiety triggers psychogenic bleeding. Overall, childhood experiences bear significantly on how people interpret the world around them in later life. Repressed traumas and anxieties seem to stem from childhood experiences. They are harboured unconsciously in the human mind. Psychoanalysis enables us to unearth how they are manifested.

 

 

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