SOURCE: Shuster, Seymour. “Dracula and Surgically Induced Trauma in Children.” The British Journal of Medical Psychology 46 (September 1973): 259-70.

[In the following essay, Shuster claims that Dracula is a result of Stoker's long-repressed anxiety stemming from the author's childhood experience with doctors.]

The first portion of this paper is intended to show that a connection probably exists between the horror story Dracula and surgically induced trauma experienced by its author as a child. In the second portion of this paper I will try to draw some practical inferences from the work I have done.

In a personal communication with Anna Freud, the author expressed his belief that a connexion existed between the creation of monsters like the Frankenstein monster, Dracula, and Dr Jekyll's evil counterpart, Mr Hyde, and surgically induced trauma. In her reply, Miss Freud expressed fairly strong agreement with the author and added:

I think that, probably, it is not the surgical experience as such which creates the ‘horror’, but rather this experience as it is understood and distorted by fantasies of assault and misunderstandings of adult sexual life, as they are found in every child's mind. The surgical trauma then lends reality to impressions which before had a place in imagination only. Whenever we have to prepare a child for a surgical experience, we find that the greatest difficulty is to keep the event down to its ‘real’ significance. The extraction of a tooth, the removal of tonsils or of an appendix would not be so frightening in itself. They become horrifying when the child's imagination turns them into amputation, castration, annihilation, etc., i.e. into dangers which existed previously as threats in his conscious or unconscious mind.

Extending Miss Freud's reasoning a bit, I would like to add that I think that when a child has been frightened by a doctor during an examination, innoculation or operation, an important part of that child's fear lies in his fantasy that the doctor has been a loser in the sexual-aggressive battles of the primal bedroom (i.e. he is empty or castrated), has become ‘mad’, and is seeking to alleviate his misery either by castrating the child or by emptying his body of its content. If this belief be true, then it probably provides the main reason for the chronic appearance of that hardy perennial of the fictional horror story, ‘the mad doctor’.

We will be concerned with the origin of the horror story Dracula, which was inspired by a nightmare experienced by its author, Bram Stoker (1847-1912), when he was 48 years of age. I suggest that the nightmare resulted from the emergence of long-repressed anxiety relating to the author's childhood experiences with doctors—I suggest that the character Stoker came to call ‘Dracula’ basically represents a child's perception of the surgeon who operates upon him.

In the period of Stoker's life in which we are most interested (1850-55) surgery was relatively rare. Ailments that today might be treated with drugs or by surgery were, in those days, often treated by blood-letting. However, I believe and intend to show that the quality of the terror evoked in a child by either blood-letting or surgery is similar and I think it matters little as to which procedure Stoker was subjected.

According to Katan, many child psychiatrists know that when a child has been frightened during examination by a doctor, he will soon after suggest playing ‘doctor’ with a friend. Only now, he will reverse the role. He will be the doctor and try to make the other child feel the anxiety he had just suffered (Katan, 1962, p. 476). Essentially, I believe Bram Stoker was doing just this when he wrote Dracula.

Dracula was inspired by a nightmare about ‘a master vampire at work’ and I shall treat Stoker's writings on the events that take place in Dracula's castle as if these writings were Stoker's free associations to this nightmare.

The literature is replete with papers warning of the dangers of severe, often long-lasting, emotional trauma that can be induced in children by a hospital/anaesthesiological/surgical experience. Menninger (1934) provided the earliest note of caution I can find on the acute danger of medically induced emotional trauma in children when he wrote:

Certainly there is nothing in the practice of medicine so barbarous and so fraught with psychological danger as the prevalent custom of taking a child into a strange white room, surrounding him with white garbed strangers, exhibiting queer paraphernalia and glittering knives and at the height of his consternation pressing an ether cone over his face and telling him to breathe deeply. The anxiety stimulated by such horrors is probably never surpassed in the child's subsequent life.

[1934, p. 173]

The subsequent papers of Pearson (1941), Levy (1945), Jackson (1951), Freud (1952), Jessner et al. (1952), Eckenhoff (1953) and Lipton (1962), among others, have supplied convincing evidence to attest to the accuracy of Menninger's words.

Surely, one of the most common defences, both short-term and to a lesser degree long-term, aroused by traumatic surgery is identification with the doctor. Katan made this abundantly clear on the short-term level with his remarks about children playing ‘doctor’. Miller (1951) reported on a man of 26 who underwent tonsillectomy at the age of five. Because of his identification with the surgeon, the patient suffered from a very distressing fear that some day he would knife his wife and small daughter.

I can cite other instances of long-term, active identification with the surgeon and I believe that it is not an unusual phenomenon. Hence I contend that Bram Stoker combined his literary talent with his active identification with the surgeon, became a ‘literary doctor’, and produced one of the most terrifying novels ever written.

A paper by Buxbaum (1941) encompasses almost all the ideas I have expressed so far and presents them as a unified whole in a single case history. The paper concerns the analysis of a 12-year-old boy who was taken to a therapist because he suffered extreme anxiety and was unable to study. The child's symptoms were found to be related to two instances of surgically induced trauma that occurred at the ages of five and six. The trauma had so riddled the boy with anxiety that he simply had no time to study or do his homework. In an effort to alleviate his anxiety, the boy developed a compulsion to read detective-horror stories, hoping to externalize his terror, thereby making it easier for him to deal with it. Buxbaum described the boy as ‘an addict who is afraid of going to pieces’ when deprived of his required detective-horror stories. She shows how the surgically induced trauma had woven itself into the overall fabric of the boy's psychosexual life, tying together his hostile feelings towards his family, his feelings about masturbation, and encompassing a fear of his mother's epileptic condition. The surgically induced trauma had greatly reinforced all the problem areas in his fantasy life. I believe the same thing happened to Bram Stoker and, instead of developing a compulsion to read horror stories, he developed a compulsion to write them.

BRAM STOKER

Very little is known about the childhood of Bram Stoker. From the book Twentieth Century Authors there is the following biographical information about Stoker.

British novelist and miscellaneous writer, best remembered as the author of Dracula, was born Abraham Stoker in Dublin, the second son of Abraham and Charlotte Matilda Blake Thornley Stoker. He had a sickly childhood being unable to stand upright until the age of seven. Stoker's illness, he said later, made him thoughtful. (The thoughts of youth, in this case, were such long, long thoughts that they led to the writing of Dracula, probably the most blood-curdling horror story in the language, when he was fifty.) This invalidism Stoker outgrew so thoroughly that he was the athletic champion of Dublin University, particularly in football, in his twentieth year, and had great physical strength for the rest of his life, which included twenty-seven strenuous years as Sir Henry Irving's manager.

[Kunitz & Haycroft, 1942, p. 1350]

Mr H. Ludlam has written the only biography of Stoker. It is called A Biography of Dracula and the first chapter deals with Stoker's childhood illness. However, this chapter provides no details of its nature or of the type of medical treatment Stoker received. I wrote to the author for this information, but he could not supply it. He did, however, provide some interesting titbits about Stoker. Mr Ludlam wrote that the dream that inspired the writing of Dracula

conveyed to [Stoker] the idea or image of a master vampire at work, a monster which Stoker came to call Dracula. To his family and friends he has always referred to the vampire as ‘Drac’, and he often had a chuckle over how he had this vampire monster wait hand and foot on Jonathan Harker as a servant (bringing Harker food at the castle, etc.).

Despite the lack of details of Stoker's medical history, I will try to show that the sense of terror and helplessness that Stoker was trying to evoke in his reader in the castle portion of the book is that of the child who has been left by his mother in a hospital to undergo surgery and/or blood-letting. Obviously, I am presupposing that Stoker had been hospitalized as a child. If he had been unable to stand upright until his eighth year, then, in all probability, those years were spent in confinement at his home and at least occasionally in a hospital.

SYNOPSIS OF DRACULA

A young Englishman, Jonathan Harker, is sent on a business trip to visit Count Dracula in his castle in Transylvania. Dracula is interested in buying some real estate in England. Harker becomes apprehensive about his trip when he sees the anxious reaction of the Transylvanian peasants when they learn of his destination.

Upon his arrival at the castle, it seems that Harker's apprehension was justified. He is impressed by Dracula's strange appearance and habits, the strangest being Dracula's disappearance during the daytime and reappearance when the sun goes down. In exploring the castle, Harker finds that he is a prisoner with no means of escape. His demands that Dracula release him are to no avail. Three female vampires attempt to attack Harker on two occasions but Dracula protects him. Harker, meanwhile, is learning some of Dracula's secrets, which include his ability to turn himself into a bat, the location of his bedroom, and the kind of ‘bed’ (a coffin) in which he sleeps, and various other peculiarities; all of which increase Harker's terror. His business with Harker completed, Dracula departs for England, leaving Harker trapped with his three lecherous wives. Ultimately, Harker escapes, physically unscathed but a complete nervous wreck. He is forced to remain in a Budapest Hospital for many weeks recuperating from emotional trauma.

Meanwhile, Dracula has been in England, vampirizing women, who in turn become vampires too. The females prey only on children, while Dracula cathects his weird libidinous desires only on young, attractive women, one of whom, Lucy Westenra, is a close friend of Harker's fiancée. When Lucy comes down with an apparent ‘illness’, Dr Seward is called in. Unable to stem the tide of Lucy's condition, Dr Seward calls in an Amsterdam specialist, Dr Van Helsing. With a number of clues to guide him (and the help of Harker, who has by now married his fiancée, Mina Murray, and has returned to England), Van Helsing correctly diagnoses Lucy's condition—too late to protect her. She has become a vampire and in order to protect her eternal soul, she must be killed in a ritualistic fashion. With the ‘good’ doctors (Dracula is the ‘bad’ doctor) learning more and more about the strengths and vulnerabilities of vampires, Dracula makes a hasty retreat to his castle fortress in Transylvania. His enemies follow him, and catch him up just as he is about to enter his castle, and with the sun just going down (i.e. Dracula is helpless in daylight), they ritualistically kill him, too. The vampire is no more.

ANALYSIS OF THE CASTLE PORTION OF DRACULA

In reading the book it is obvious that Stoker's active identification is with Dracula and his passive identification is primarily with Jonathan Harker. In reading the synopsis we can see that it is only Harker who visits and is trapped in Castle Dracula. Therefore I believe my task is greatly simplified. I propose to show that Harker's ordeal in the castle represents Stoker's terrifying experiences in a hospital. I say it was the reinforcement of his psychosexual fantasies by these experiences that compelled him to write Dracula, just as the reinforcement of the psychosexual fantasies of a 12-year-old boy by medical treatment compelled him to read horror stories. Harker's ordeal in the castle must then represent the origin of Dracula.

In a paper (as yet unpublished) entitled ‘Dracula, Prolonged Childhood Illness and the Oral Triad’, Bierman cites the knighting of Stoker's doctor-brother in 1895 as having provided some of the inspiration for the nightmare that resulted in the writing of Dracula. In an attempt to show that Stoker had experienced blood-letting as a child, Bierman cites a short story which Stoker published in 1882 entitled ‘How 7 Went Mad’. The essence of the story concerns a child who is called ‘No. 7’ and who becomes mad when he is subjected to blood-letting against his will. Stoker's description of the child's madness is reminiscent of his description of Harker's madness after he escapes from Castle Dracula, and I feel that Bierman's work has provided strong, independent support for my ideas.

In her article on how to minimize the child's fear of a hospital experience, Chenevert writes:

The child only understands that he has been left in a big building called a hospital. Busy big people robed in white scurry about and mumble about shots and drawing blood. He has been abandoned and imprisoned, surrounded by strange people, strange machines, strange noise. Everything comforting and familiar is gone. And, as though that were not enough, he is poked and stuck and jabbed. He is scolded and restrained if he cries or tries to escape. Around him he sees other children who have been abandoned, hurt and mutilated. Since he doesn't understand what is to happen to him, he fears he may be punished that way too.

[1970, p. 30]

Chenevert then went on to tell of a frequently hospitalized five-year-old boy who would spin tales of vampires and witches for his mother when she visited him in the hospital.

The following is a detailed synopsis of Harker's adventures in Castle Dracula, so that we may compare it to details of a child's experiences in a hospital that will be provided later.

A young Englishman, Jonathan Harker, is on his way to Castle Dracula to transact business. He spends his last night prior to reaching his destination at an inn one day's journey from the castle. In the morning, Harker asks the innkeeper if he knows Count Dracula.

Upon hearing the question, both the innkeeper and his wife make the sign of the cross and say they know nothing at all. Harker becomes apprehensive at the strange conduct of his hosts. He arrives at the castle that evening and meets Count Dracula, whose pallid complexion, sharp canine teeth and altogether peculiar appearance tend to reinforce Harker's growing anxiety. He is soon sorry he came and wants to leave as quickly as possible. As he gets to know Dracula better, he realizes that he has never seen him in the daytime, nor has he ever seen Dracula eat or drink.

One morning Harker decides to explore the castle. In doing so, he discovers to his horror that he is a prisoner! All the doors are locked and bolted. He becomes panicky and hours elapse before his panic subsides. That same evening Dracula returns and warns Harker not to stray into other parts of the castle and, most particularly, not to fall asleep there. ‘There are bad dreams for those who sleep unwisely’, warns Dracula, and Harker notes that ‘He finished his speech in a gruesome way, for he motioned with his hands as if he were washing them.’ (Is this a description of a surgeon about to operate?)

Dracula then departs and Harker takes perverse pleasure in not heeding Dracula's warning. He strays into the strange part of the castle and compounds his folly by falling asleep on a couch. Harker is awakened by the presence of three young women. He pretends to be still asleep. The women stare at him and one of them approaches, drawing closer and closer. Harker can feel her honey-sweet breath upon him and starts becoming aroused with anticipation:

I was afraid to raise my eyelids, but looked out and saw perfectly under the lashes. The fair girl went on her knees and bent over me fairly gloating. There was a deliberate voluptuousness which was both thrilling and repulsive and as she arched her neck she actually licked her lips like an animal, till I could see in the moonlight the moisture shining on the scarlet lips and on the red tongue as it lapped the white sharp teeth. Lower and lower went her head as the lips went below the range of my mouth and chin and seemed about to fasten on my throat. Then she paused, and I could hear the churning sound of her tongue as it licked her teeth and lips, and could feel the hot breath on my neck. Then the skin of my throat began to tingle as one's flesh does when the hand that is to tickle it approaches nearer—nearer. I could feel the soft shivering touch of the lips on the supersensitive skin of my throat, and the hard dents of two sharp teeth, just touching and pausing there. I closed my eyes in a langurous ecstasy and waited—waited with beating heart.

[Stoker, 1967, p. 41]

(This passage brings to mind Anna Freud's comment: ‘I think that, probably, it is not the surgical experience as such which creates the “horror”, but rather this experience as it is understood and distorted by fantasies of assault and misunderstandings of adult sexual life.’)

At this point, Dracula enters carrying a sack. He is black with rage. Dracula seizes the woman closest to Harker and flings her away, warning them all to stay away from Harker because, says Dracula, ‘he belongs to me’. But the women have been aroused with a passion and will not be turned away so easily. They notice the bag Dracula had brought with him. One of the women opens the bag and Harker hears the gasp and a wail of a child emanate from it. Dracula permits the women to take the bag. Overcome with horror, Harker falls unconscious.

(I think it is at this point in the distorted and disguised autobiography that Stoker underwent his own ‘medical treatment’. The child in the bag represents not only a fellow child-victim in the hospital, but Stoker as well. His need for mastery over the still terrifying experience keeps him from admitting that such a dreadful thing could have happened to him. ‘Then the horror overcame me and I sank down unconscious’, writes Stoker of his own induction.)

The next morning Harker awakens to find himself in his own room. He realizes that Dracula had carried him there, and now he fully understands the meaning of Dracula's warning about the dangers of sleeping in strange parts of the castle (which represents the operating room). Harker comes to look upon his own room as a ‘sanctuary’.

Sitting in his room a few days later, Harker hears a stirring in Dracula's room, ‘something like a sharp wail quickly suppressed; and then there was a silence …’. Harker then hears a woman in the courtyard. He peers out the window and when she sees him, she screams, ‘Monster, give me my child.’ The distraught woman thinks that Harker is Dracula. Annoyed with the woman for interrupting him at his ‘work’, Dracula signals the wolves who constantly surround the castle, and they devour the mother as Harker looks on helplessly. By now, Harker is at his wits' end. He is determined to escape from the castle. He reasons that Dracula keeps the keys to the castle on his person. Harker has already discovered where Dracula sleeps and knows the kind of ‘bed’ in which he sleeps. During the daylight hours, he goes down to Dracula's ‘bedroom’ opens the lid of his coffin, and

I saw something which filled my very soul with horror. There lay the Count, but looking as if his youth had been half-renewed, for the white hair and moustache were changed to dark iron-grey; the cheeks were fuller, and the white skin seemed ruby-red underneath! The mouth was redder than ever, for on the lips were gouts of fresh blood, which trickled from the corners of the mouth and ran over the chin and neck. Even the deep, burning eyes seemed set amongst swollen flesh, for the lids and pouches underneath were bloated. It seemed as if the whole awful creature were simply gorged with blood; he lay like a filthy leech, exhausted with his repletion.

[p. 52]

(This revealing passage gives us a glimpse of Stoker's childhood fantasies about the doctor. He has suffered an awful defeat in the primal-scene battles and feels empty. Stoker equates this emptiness with a feeling of being dead, as symbolized by Dracula sleeping in a coffin. The doctor is trying to fend off his fear of emptiness—death by drinking the blood of children. I believe that many children experience a similar fantasy when undergoing surgery.)

Harker searches Dracula's body for his keys. No luck. While searching his body, Harker realizes that he must do something to rid the world of this fiend, who is soon to leave for England. He finds a shovel and whacks Dracula on the head, leaving an ugly gash on his forehead. Dracula turns to stare at Harker—and simply grins. Harker's courage deserts him and he runs in panic.

That very same night Dracula leaves the castle bound for England, leaving Harker to the tender mercies of the female vampires. He arrives in England and attacks Lucy Westenra, the friend of Harker's fiancée, while she is asleep. When Lucy awakens, she has no awareness of what has happened. She only knows she is pale and weak, and has a pain in her throat.

Meanwhile Harker's fiancée, Mina, is terribly worried about him. She has not heard from him for weeks. A letter arrives from Budapest. It is written by a nurse who tells Mina that Harker, who had escaped from the castle, has been a patient in a hospital for six weeks, suffering from a fearful shock. He has been ranting and raving while in a state of delirium and the nurse cautions Mina to always be careful with him because ‘The traces of such an illness as his do not lightly die away.’

Mina rushes out to Budapest. Harker recovers sufficiently to marry Mina and return to England. But he is still a nervous wreck. Harker's wife then shows Dr Van Helsing a copy of Harker's diary. Van Helsing writes Mina a letter professing to believe that Harker's journal is a true account and not the rantings of a madman. When Harker hears of this, he writes in his diary:

It seems to have made a new man of me. It was the doubt as to the reality of the whole thing that knocked me over. I felt impotent, and in the dark, and distrustful, but now that I know, I am not afraid, even of the Count.

[p. 170]

Re-reading Chenevert's brief description of the child's perception of a hospital experience, one finds that every line has its distorted, disguised equivalent in some of the passages from Dracula I have just quoted.

But Chenevert's description provides us with a broad, general picture that can only give us a feeling that we may be on the right track. Robertson's work (1956), however, provides solid evidence. She kept a detailed diary of her four-year-old daughter's pre- and post-operative reactions to a tonsillectomy. The following is a portion of her record:

March 1st. Jean was seen by the surgeon today, and he recommended removal of her tonsils and adenoids. The operation was arranged for six weeks ahead, and I have decided not to say anything to Jean about it until about a week before she goes to hospital.

March 2nd to 5th. During these few days Jean became increasingly difficult about her food. She ate little and appeared angry or unhappy at meal times. This puzzled me until I overheard her say to herself, ‘Don't eat it. Better not to eat it or you'll go to sleep.’ So, although I had planned to give her only about a week to adjust to the idea of an operation and a stay in hospital, I decided to begin telling her at the first opportunity lest her eating disturbance was in fact connected with fantasies about anesthetics.

March 8th. At breakfast, she examined her fork and said, ‘This fork would dig right into my throat and it would hurt. I've got a big hole in my throat, haven't I … ?’ ‘Why do the doctors wear that thing on their faces?’

March 12th. At teatime, she cut her poached egg very carefully, saying, ‘I want it [the yolk] to run out.’ She watched her Daddy having tea half an hour later and said, ‘Look, when Daddy cuts his egg it all runs out.’ (A week before this record started Jean had said, ‘When all the blood runs out of cut and hurt people they die.’) She put her thumb and first finger in her mouth and pinched the back of her tongue, remarking, ‘It hurts when I do it.’

March 14th. Jean saw a picture of a man, a prisoner being led between two policemen; and for the next twenty minutes she questioned me persistently about ‘naughty men’. ‘Do children go away when they are very naughty? Were you naughty, Mummy? Did you go away when you were little?’ I spoke of the coming hospitalization, and we talked about the reasons for it.

March 15th. At lunch she talked again of knives and forks being sharp. ‘They could poke our throats’, she said, then ate her lunch mostly with her fingers. She pretended to cut my hand and arm with a knife.

April 4th. Several of the children were playing hospital in the garden, and Jean was the patient.

April 6th. When I discussed with her sister the arrangements for her care while Jean and I were away, Jean asked, ‘Why?’ as if the whole idea were new to her, and added, ‘But I don't want to go to the hospital.’

The child was taken to the hospital in her daddy's car and the diary continues:

April 8th. She held my hand tightly and seemed apprehensive as we walked into the office to register, and as we went into the ward. She said several times, ‘I don't want to have my tonsils out. I don't want to stay in this hospital. …’

For an hour I sat in our cubicle while Jean went to and from the balcony, reporting back to me every few minutes as one child after another was examined by a doctor in the open ward.

At 5 o'clock she was invited into the ward to see television, but unluckily, the anesthesist came just then to examine her. She cried when I brought her back to the cubicle, and made examination almost impossible by her struggling and screaming.

April 9th. At 9 a.m. the ward sister came on duty and told Jean she could get up and walk around in slippers and dressing gown. Jean commented, ‘I like that Big Nurse. She is kind because she lets me get out of bed.’ For the next hour she walked about aimlessly, saying again and again, ‘I want to go home … I don't like doctors and nurses … I don't want my tonsils out.’

At 10 a.m. she took her premedication (two pills) from me with great difficulty … She sat quietly on my knee for half an hour, and then had an injection (Atropine) which made her cry bitterly.

The child undergoes the tonsillectomy and Robertson's diary continues:

April 10th. Her restless doze continued until 3 a.m. when she became fully awake …

She talked a lot. ‘My tonsils are out now …

‘I didn't feel my tonsils coming out.—When did the doctor take my tonsils out?—Were you there?—My throat does hurt me now.—You said it would hurt.—I didn't smell the funny smell to make me go to sleep.—I didn't like the pills, or the prick in my legs—I didn't feel my tonsils come out; that's funny, I thought I was in my cot all the time.’

Many times during the day she asked me to tell her how she got her tonsils out. Each time I reminded her of what she already knew: ‘You had pills and a prick in your leg, and you sat on my knee going to sleep. I was going to put you on the trolley with the red blanket, but you didn't want that so I put you into your cot. When the doctor was ready to take out your tonsils I carried you to the trolley and I took you to the special room. I was with you when you smelled the funny smell, then you slept the special tonsils sleep. The doctor took out your tonsils and carried you back to your cot …’

After each telling she was ready with questions: ‘Where is that doctor now? Where does he live? Will he come again? Where is the special room?’

April 11th. At 9 a.m. the ward sister came on duty and allowed Jean to walk about … She spoke in a friendly way to her Big Nurse, but then she shot a flying toy which hit the Big Nurse's leg.

At 10 a.m. on April 11th Jean left the hospital and the diary continues:

April 13th. Third day home … she added, ‘Why did you take me to the hospital? I wanted to come home the very first minute I was there.’ She recalled with a laugh how her flying toy had hit the Big Nurse.

April 24th. Fourteenth day home. The ‘why’ questions continued throughout yesterday and today. At bedtime she asked, ‘Who takes people to prison?’ I assured her that children did not go to prison.

April 25th. Fifteenth day home. At breakfast Jean lay back, quietly licking a grape. With a puzzled frown she said, ‘It was my Big Nurse who pricked my leg. I didn't like it. Why did she?’ (This apparently referred to the injection given before the operation by the ward sister—Jean's ‘Big Nurse’. Until today Jean had insisted that the prick had been given by a student nurse with whom she had no relationship.)

April 26th. Sixteenth day home. She told her sister Katherine with impish laughter of the time when her flying toy hit the Big Nurse's leg.

April 27th. Seventeenth day home. During last night she had had a nightmare with ‘doggies’ in her bed. …

A few minutes later I heard her singing in her room. ‘And then her tonsils popped out, and if I do she'll be sure to die.’ (In this she was parodying the end of the nursery rhyme ‘Little Boy Blue’: ‘Will you wake him? No not I, for if I do, he'll be sure to cry.’)

Shortly afterwards she came to me and said, ‘I won't ever have to go to hospital again, will I? I don't want to.’

April 29th. Nineteenth day home. At breakfast she recalled: ‘When I cut my finger the blood came out. I licked it and the blood went down into my tummy. It doesn't matter, does it? Blood can go down?’

Ten minutes later, she called me to the lavatory and said very brightly, ‘Mummy, I feel sick.’ I did not take her seriously, and she said again: ‘I do feel sick—something might dribble out—I did dribble out all the blood, lots of it. Why did I? Why do tonsils make blood in my tummy? I want to go to see the Big Nurse today.’

April 30th. Twentieth day home. (Day of return visit to hospital.)

She showed no anxiety as we went into the hospital. When we reached the ward she skipped ahead of us, almost dancing, and went straight to her former cubicle. …

Her ball ran into the induction room, and she was hesitant to go after it until encouraged by the ward sister. She tiptoed in, and in picking up her ball she peeped quickly into the operating theatre which lay beyond, then hurried out with a flushed face. (She knew the purpose of these two rooms.)

Soon after Jean left the hospital, the detailed portion of the diary ended because:

… it seemed that Jean had worked through her hospital experience. She looked well, ate and slept normally, spoke little of hospital, and showed no special anxieties. She started nursery school for the first time, and settled quickly and happily. After a few days she insisted that I should not accompany her to school, and went cheerfully with a neighbor and her children. Her increased confidence and independence of me was commented on by our neighbors. Her extreme fear of dogs had almost disappeared, as she herself remarked, ‘That dog looked at me, and I wasn't even afraid’.

[Robertson, 1956, pp. 413-26]

Thus we can see more vividly how a child typically perceives the hospital experience. I believe I am justified in calling Jean's reactions ‘typical’, since at the end of Robertson's diary, Miss Freud comments:

From the first part of the diary, which covers the preparatory period we learned that Jean confirmed almost all our theoretical expectations of what operation and hospitalization may mean to children of her age.

[p. 428]

Now let's defeat Stoker's intent to disguise the origin of his story and its autobiographical nature. Let's strip away the disguises and distortions, the aura of the supernatural and its attendant horror, and make a point-by-point comparison of Harker's experiences in Castle Dracula and Jean's pre- and post-operative reactions.

(1) Harker travels to the strange land of Transylvania, where he has never been before, to visit a place called Castle Dracula. Little Jean is put in her daddy's car and taken to a place called a hospital located in an area which is as strange to a four-year-old as Transylvania is to Harker.

(2) Harker has a premonition that he is embarking on a perilous journey as he leaves the inn for Dracula's castle. When the innkeeper and his wife learn of Harker's destination, they display their anxiety by making the sign of the cross and then they lapse into silence. Harker becomes apprehensive. When Jean's friends learn of her pending trip to the hospital, they attempt to cope with the anxiety aroused in them by playing ‘hospital’. Jean is the ‘patient’. Her apprehension grows and soon after she flatly declares that she does not want to go to the hospital.

(3) The castle and its inhabitants are eerie and frightening to Harker. He is soon sorry he came and wants to leave as soon as possible. The child feels the same way about the hospital with its doctors and nurses.

(4) Harker thinks Dracula is a peculiar-looking fellow and wonders about his strange comings and goings. Jean thinks the doctor is a peculiar-looking fellow. She wonders why he wears a mask. She wonders where he lives and when he will return.

(5) Harker explores the castle just as the child explores the children's ward of the hospital.

(6) Harker feels he is a prisoner in the castle and the child has repeated fantasies of being taken away to prison.

(7) Harker is warned that there is danger lurking if he falls asleep in strange parts of the castle. The child warns herself about the dangers of falling asleep.

(8) ‘There are bad dreams for those who sleep unwisely,’ says Dracula. So do many of the authors of papers on surgically induced trauma without, of course, couching their warnings in language or tone designed to terrify. Harker spends six delirious weeks in a Budapest hospital, proving the correctness of the warning. Jean confirms the truth of the warning by having a nightmare with ‘doggies’ in her bed.

(9) Harker strays into the strange part of the castle. The sight of a child (who also represents Stoker) being dragged into a ‘special room’ causes him to fall ‘unconscious’. Jean is wheeled into an operating room and is anaesthetized.

(10) A vampire tries to sink her sharp teeth into Harker and a nurse jabs the child with a needle.

(11) The only victims that Harker sees in the castle are children. The only ‘victims’ that Jean sees are also children. (Children's wards did exist in hospitals during Stoker's childhood.)

(12) While it is true that Jean did not see any children being dragged into the ‘special room’ as did Harker, there is no doubt that until a few years ago, the dragging of terrified, screaming children into an operating room was a fairly common event in American and European hospitals.

(13) While ‘unconscious’, Harker is carried back to his own room by Dracula, and the child learns that while asleep the doctor had carried her from the ‘special room’ to her cubicle.

(14) Harker becomes so terrified of the forbidden parts of the castle that he comes to look upon his own room as a ‘sanctuary’. For the child, the strangest and most frightening part of the hospital is the ‘special room’. On her return visit to the hospital, just a glimpse of the operating room is enough to make her face flush. She is so afraid of the operating room that she cannot bear to look at it long enough to absorb the reality of its existence. It is as if she feels that if she consciously acknowledges its existence, doctors and nurses will grab her and drag her in to undergo another operation.

(15) I have reasoned that Harker's miraculous avoidance of a vampire attack was simply Stoker's defence against the still terrifying doctors—a defence by denial that it ever happened. During his stay at the castle, Harker and Dracula have a few friendly discussions about business, life in England and Magyar history, and Stoker cannot admit that his friend ‘Drac’ would hurt him. Jean never developed a relationship with the doctor, but a relationship did develop between her and the ‘Big Nurse’. At least on two occasions the child said she liked the nurse. But it was her friend, ‘Big Nurse’, who jabbed her with a needle and the child coped with this betrayal by refusing (for 15 days after her return home) to admit that it was ‘Big Nurse’ who had done this.

(16) Harker is terrified of being drained of his blood, and the child is terrified of bleeding to death. This is why I do not believe that there is much difference between a child's perception of blood-letting and surgery.

(17) Harker sees the vivid proof that Dracula is a blood-sucking fiend and hits him with a shovel. The child sees the nurse who has jabbed her with a needle and flings a toy at her. Even the circumstances surrounding the counter-attacks of our two heroes are similar. Both attacks are farewell gestures. Dracula is about to leave the castle and Jean is about to leave the hospital.

(18) Dracula attacks Lucy Westenra in her sleep. She wakes up feeling weak, sickly and has a pain in her throat. She has no awareness that anything has happened to her. The doctor operates on Jean. She wakes up and also has no awareness of what has happened. She says, ‘That's funny, I thought I was in my cot all the time.’ She too feels weak and sickly, and has a pain in her throat. (It is entirely possible that after blood-letting proved useless, Stoker was forced to undergo tonsillectomy.)

(19) The nurse in the Budapest hospital warns Mina that Harker will suffer long-term trauma as a result of his experiences in the castle. There are also many papers in the literature that warn of long-term trauma resulting from a child's hospital experience.

(20) Weeks after Harker has escaped from Castle Dracula, a sense of unreality pervades his consciousness. He is grateful when Dr Van Helsing positively affirms that his experiences in the castle were real and not imagined. Regaining his sense of reality makes a ‘new man’ of Harker. Weeks after Jean has left the hospital, she is still flooded with a sense of unreality and persists in asking the same questions about her hospitalization. Nineteen days after her release, the ‘why’ questions are still continuing. The child cannot yet believe her mother's explanations. Then Jean says, ‘I want to go to see the Big Nurse today.’ In saying this, the child is struggling to regain her sense of reality. She reasons that if everything her mother has been telling her is true, then she should be able to enter the hospital, see the doctors and nurses and leave the same day without being ‘attacked’. The next day she does visit the hospital and it begins to seem that everything her mother has been telling her is true. The child is now able to accept her mother's assurances and, at this point, Robertson reports that Jean ‘had worked through her hospital experience’. She no longer asks the ‘why’ questions, and she loses her fear of dogs, and becomes more independent. Her mother's assurances have now done for Jean what Van Helsing's assurances have done for Harker—helped her regain a sense of reality. Even the neighbours notice the nice changes in her. Regaining their sense of reality makes a ‘new’ man of Harker and a ‘new’ girl of Jean.

(21) Bram Stoker identified with the doctor by writing Dracula. Jean identified with him by performing imaginary operations on herself and members of her family.

(22) In private life, Stoker often referred to Dracula as ‘Drac’. (It is difficult to overlook the similarity in the common shortening of the word ‘doctor’ to ‘doc’, and the first two letters of the name ‘Dracula’ are the common abbreviation for the word ‘doctor’.) Also, according to Mr Ludlam, Stoker ‘often had a chuckle over how he had this vampire monster wait hand and foot on Harker as a servant’. In both instances, Stoker was still trying to feel a sense of mastery over the terrifying doctor. In the first, by informally referring to the vampire as ‘Drac’, he is saying that the vampire is really his buddy and a buddy would not hurt him. In the second, Stoker goes even further. Not only will the vampire not hurt him, but the vampire likes him so much that he waits upon him hand and foot. So who's afraid of the big, bad vampire? Not Bram Stoker! Jean sought a sense of mastery over the nurse by often chuckling over how she hit her with a toy.

Thus our two heroes, Harker and Jean, have come full circle. From emotional equilibrium to a slowly mounting anxiety, to a flood of terror that leads to emptiness and a loss of a sense of reality lasting a few weeks, to a sudden regaining of the sense of reality coming from assurances from powerful figures, and back to the emotional equilibrium both had enjoyed prior to their ordeal. Many other children have not been so fortunate.

I believe we now know the identity of Dracula and I will not concern myself with the remainder of the story, since I feel that I have reached the heart of the matter in showing that the book was probably inspired by a residue of hospital-reinforced, primal-scene terror that was reawakened in the author some 40 years later.

CONCLUSION

Of what practical use is it to learn the origin of Dracula? One obvious benefit is that we have a much better insight into the fantasies that a hospitalized child can experience. By simply identifying with Jonathan Harker, we can more readily understand the quality of a child's sense of horror.

However, I feel that the deepest significance of the work I have done lies in the question of why the origin of such a popular classic published 75 years ago has remained so obscure for all these years. The basic reason, I believe, is this: surgically induced trauma in children is far deeper than most therapists realize (including many of those who have published papers on the topic). In his superb essay on the psychology of childhood tonsillectomy, Lipton (1962) states that years of psychotherapy may be required before a surgically traumatized patient even begins to uncover the trauma in his associations. I will go further than Lipton and state that I believe that many who have been severely traumatized by childhood surgery can undergo years of therapy without ever being aware that they were ever traumatized.

Only once have I encountered an instance of total repression of an event that occurred as late in life as age 16. This happened when I was telling a lady acquaintance of mine (aged 43) that I was doing research in surgically induced trauma in children and mentioned the fact that some parents take their children to doctors more to punish them than to help them. Suddenly, she gasped and said, ‘My God, how could I have forgotten. It was so excruciating.’ Clearly, the woman was in a state of shock as she began to recall an event she had totally repressed, both in memory and affect. When she was 16 years of age, she suffered recurrent headaches and her mother had taken her to a hospital clinic, where her mother suggested to the doctor that he clean out her daughter's sinuses. Although there was no history of sinus trouble, the doctor proceeded to carry out the mother's suggestion! The woman described the agony she experienced as ‘it felt the top of my head was going to come off’. While she was groaning in pain, she recalled her mother staring at her, saying over and over again, ‘It's good for you, it's good for you …’

When my acquaintance regained her composure after telling me of this event, I asked her if the reason for her total repression might not lie in the possibility that she sensed that a sadistic, unconscious liaison had been established between her mother and the doctor, and that she was the victim. She rejected this idea, but could offer no other explanation for the repression.

I have told this little tale to impress upon my reader the potency of medically induced trauma. Clearly, the mother's sadism played a major role in the subsequent repression of the event. But we should keep in mind that a parent is almost always involved when a child is taken to a doctor, and we can see in reading Robertson's account that, however unrealistically, Jean clearly suspected her mother of harbouring sadistic motives.

I have conducted many informal interviews of adults selected at random and I am convinced that instances of long-term surgically induced trauma are far more prevalent than most people suspect. By asking a few pertinent questions, evidence can be uncovered in minutes that may take years of therapy to uncover. In conducting these interviews, I have taken a hint from Dracula himself, who warned that ‘there are bad dreams for those who sleep unwisely’.

Many people, of course, reported that they could remember no bad dreams right after a surgical experience, but in conducting these interviews, I found a pattern emerging. In its bare essentials, the pattern is this: If a child panics during an experience, either in a doctor's office or in a hospital, and finds to his horror and rage that overwhelming physical force is being used to subdue him or, even worse, if he experiences an asphyxiating induction, then evidence of long-term emotional sequalae will very likely be found and reflected in the dream-life. I have interviewed about 20 adults who were able to recall such grisly events in their childhood and only two could not recall experiencing the same repetitive dream for many months or even years after the event. Two of these people who did recall were about 50 years of age when interviewed and both reported that the dreams that commenced in childhood soon after their medical experiences had continued to the present day!

In closing, I would like to suggest that, based on the informal interviews I have conducted to date, two possibly fruitful studies could be made and used for a Ph.D. thesis by students of clinical or child psychology. The first study would include a fairly large sampling of adults who experienced overwhelming force in order to subdue them and/or an asphyxiating induction during a medical or surgical experience in childhood.

The second study would include a fairly large sampling of adults who could recall a childhood circumcision. These two populations could be interviewed (perhaps by questionnaire) on their dream-life with emphasis on any repetitive dreams. I believe the outcome of these two studies would instil in the practising psychotherapist an enduring respect for the frequency and destructiveness of surgically induced trauma in children.

Works Cited

Buxbaum, E. (1941). The role of detective stories in a child analysis. Psychoanal. Q. 10, 373-381.

Chenevert, M. (1970). Taking the hurt out of the hospital. Fam. Hlth, February.

Eckenhoff, J. (1953). Relationship of anesthesia to postoperative changes in children. Am. J. Dis. Child. 86, 587-591.

Freud, A. (1952). The role of bodily illness in the mental life of children. Psychoanal. Study Child 7.

Jackson, K. (1951). Psychological preparation as a method of reducing the emotional trauma of anesthesia in children. Anesthesia 12.

Jessner, L., Blom, G. E. & Waldfogel, S. (1952). Emotional implications of tonsillectomy and adenoidectomy on children. Psychoanal. Study Child 7.

Katan, M. (1962). A causerie on Henry James's ‘The Turn of the Screw’. Psychoanal. Study Child 17.

Kunitz, S. & Haycroft, H. (1942). Twentieth Century Authors. New York: Wilson.

Levy, D. (1945). Psychic trauma of operations in children. Am. J. Dis. Child. 69, 7-25.

Lipton, S. D. (1962). On the psychology of childhood tonsillectomy. Psychoanal. Study Child 17.

Ludlam, H. (1962). A Biography of Dracula. London and New York: Fireside Press.

Menninger, K. A. (1934). Polysurgery and polysurgical addiction. Psychoanal. Q. 3, 173-199.

Miller, M. L. (1951). The traumatic effect of surgical operations in childhood on the integrative functions of the ego. Psychoanal. Q. 20, 77-92.

Pearson, G. (1941). Effect of operative procedures on the emotional life of the child. Am. J. Dis. Child. 62, 716-729.

Robertson, J. (1956). A mother's observations on the tonsillectomy of her four-year-old daughter. Psychoanal. Study Child 11.

Stoker, B. (1967). Dracula. London: Arrow Books.