My Friend Thinks He’s a Vampire, Wants to Drink Wife’s Blood

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Reader’s Question

My friend thinks that he is a vampire. He believes it completely and gets very emotional when he starts talking about it, even to the point of crying. He seems to be completely delusional, and I am extremely worried about him, especially since he has started talking about drinking the blood of his wife, killing people, and even dying himself. I have no idea what to say or do, but I am horrified. I have talked to his wife before, but now she seems mysteriously absent. What should I do?

Psychologist’s Reply

Unfortunately, many forms of mental illness entail a lack of awareness or insight into the fact that there is a problem. This is frequently the case even when the symptoms are severe, such as delusions, hallucinations, mania, or depression. That leaves friends and family to recognize the problem and do what they can to ensure that the ill person receives adequate treatment. Of course that is often easier said than done when the individual needing treatment does not believe there to be a problem.

If you’ve tried to talk your friend out of his belief that he is a vampire, you’ve most likely run into resistance. Delusions are false beliefs that are deeply entrenched in the person’s ways of making sense of the world. Instead of appealing to your friends’ logic (which may be impaired due to a disorder), it may be more productive to appeal to his friendship. That is, express that you’re concerned about his well-being (happiness, safety) and are not accusing him of being crazy. In some cases, appealing to the delusions may be necessary, such as explaining that seeing a doctor might provide some help with problems he’s having with vampirism.

Confronting a loved one over his or her mental illness is never easy, and we can expect the individual to be defensive. For that reason, it’s important to pull in as many others as you can who also are worried about your friend. That makes it more difficult for him to dismiss your concerns as uniquely yours. Also, in hopes of reducing defensiveness, stay focused on your concern rather than your friend’s “problem” or “illness.” Make it clear that what you’re asking is for your friend to be evaluated by a professional to allay your concerns. For example, “Joe, I know you think you’re fine (or that nothing can be done), but I’d feel much better if you got a professional opinion about that. And I’d be happy to go with you so that I can express what my concerns are and be reassured that you’re fine. I’ll sleep better if you’ll do this for me.”

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There is also the legal option of civil commitment, although the hope is that it never comes to that. I’m only familiar with civil commitment proceedings in the United States, but each state has a defined process for having someone committed for evaluation against his or her will. Typically, there is a magistrate or judge who hears appeals for civil commitments, and loved ones make their case as to why the ill individual is a danger to himself or to others (the criterion warranting forced evaluation). The proposed harm most typically is that individuals are not taking adequate care of themselves due to the mental illness. Substance abuse is often the problem warranting commitment.

If the judge agrees that there is cause to be concerned, he or she will issue a warrant for the individual to be picked up by police and taken to a state mental health facility. The staff there will evaluate the individual and make their case to the judge within a very short time (perhaps within 72 hours). The person will not be released until the evaluation is complete or the judge makes a ruling. If diagnosed as impaired, the individual may be committed for inpatient treatment, or agree to monitored outpatient treatment.

Of course the process of civil commitment often causes negative reactions from the person subjected to it, but the hope is that after treatment, he or she will recognize that it was necessary and that it was initiated out of caring concern. It’s a difficult step to take, but sometimes it is necessary for the safety of the person we care about. Here again, pulling in other concerned people helps make a valid case as well as spreads out the responsibility and the (hopefully temporary) blame the ill person may hand out.

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