A Psychopathological Reading of the Blood Sweat Phenomenon and Religious Stigmas: The Case of Blessed Elena Aiello

ABSTRACT

Around 300 cases of stigma have been described since the 13th century. Hematidrosis, hemolacria, bloody otorrhea, vicarious menstruation, and Gardner-Diamond syndrome are dermatological manifestations that are also observed in cases of stigma. This paper presents the disconcerting circumstances in the life of the Blessed Elena Aiello. From 1923 until her death, she suffered severe hematidrosis blood sweating on her forehead, hands, feet and knees, just as stigmata appear at the crucifixion of Jesus Christ. Stigmas, in Christian tradition, are marks corresponding to those left on Christ’s body by the torture and the Crucifixion, it’s said that are impressed on the person body by divine favor. These episodes, among the few recognised as authentic by the Catholic Church would appear each Friday in Lent, particularly on Good Friday. In this unique case study, doctors Fabrizio and Turano performed a medical study where the origin of the sores was unclear. Neurologist and psychiatrist Vincenzo Bianchi, on assessing the case, raised the possibility of simulation or mere suggestion on the part of the patient.

INTRODUCTION

The protagonists

The concept of stigma - or Christ’s marks - was often associated on medical literature with the occurrence of intense emotion or great psychological stress, circumstance that was usual in persons in religious ecstatic trance. It was also used as a classical symptom for diagnosis in the context of simulation, factitious disorder, conversion disorder, and functional neurological symptom disorder (Kechician et al. 2018). This condition has not been historicaly very well-known in medical terms because its rarity, but recently the interest in the subjetc has returned. So, for example, Tshifularo et al. (2014) presented four cases of stigmata in patients aged between 18 and 34, all of them exhibiting severe mental stresses at the time of bleeding. This article aims to relate the historical and specially famous case of the nun Elena Aiello (1895-1961).

Blessed Elena Aiello, popularly known as the Monaca Santa or the Holy Nun, was born to a wealthy family in Montalto Uffugo (Cosenza, Italy), the third of eight children. Her father, Pasquale, was a prestigious tailor. He and her mother, Teresa, were very religious and socially well-regarded (Figure 1). This guaranteed Elena a calm and comfortable childhood. Nevertheless, in 1908, at the onset of puberty, she suffered strong episodes of chronic cough with phases of convulsive laughter and eating problems which appeared to have no clear organic basis and which baffled doctors. She then secluded herself in prayer attempting to overcome these ailments, which induced a first mystical trance after which ensued a “miraculous” cure. This, coupled with the circumstances of her education, awakened her religious vocation. Between 1914 and 1918, as her family considered her still too young for convent life, she chose to assist the poor and sick (Spadafora 1964).

Figure 1.

Elena Aiello in her youth (source unknown).

In 1920, with her father’s permission, Elena entered the convent of the Daughters of Charity of the Most Precious Blood (Nocera dei Pagani, Salerno). There she suffered a back injury that worsened into a painful necrosis of the shoulder which then induced a second mystical trance. Shortly thereafter, in 1921, she was diagnosed with stomach cancer, during which she would experience two new trances, after which a new “miraculous” cure took place. In 1922, Elena Aiello experienced the first of several episodes of hematidrosis -blood sweating- and sores during which the ecstatic experiences would intensify. At this point she began to acquire a reputation for saintliness (Napoli 1978).

The other character in this story, the psychiatrist Vincenzo Bianchi (1878-1940), was born in Naples (Italy), the son of the famous transalpine doctor and politician Leonardo Bianchi (1848-1927), recognised as one of the great Italian neurologists (Figure 2). it might be said that Vincenzo, although less celebrated, matched many of his father´s achievements. He also studied medicine, specialising in neurology and psychiatry, later becoming Professor of Phrenology at the University of Naples (Figure 3). Bianchi entered the Neapolitan hospital of Santa Maria Egiziaca (renamed Hospital Cardinale Ascalesi) as a resident doctor, where he eventually became director of the Psychiatric Service (Pazzini 1950). Between 1909 and 1929 Vincenzo Bianchi was involved in politics with the Italian Liberal Party, holding various provincial government positions. In addition, he had been a medical officer in the First World War between 1915 and 1916 for which he received decoration. In 1929 he founded the Casa di Cura Stazione Climatica Leonardo Bianchi, currently the Bianchi Clinic, in Portici (Naples), which he would manage until his death.

Figure 2.

The transalpine neurologist and politician Leonardo Bianchi (Source: National Library of Medicine, Digital Collections).

Figure 3.

The psychiatrist Vincenzo Bianchi (Source: Clinica Bianchi).

Clinical History

Elena Aiello’s mother died aged 39 from nephritis. Her father was arthritic, with no other notable illnesses. She grew up in a calm, routine psychoeducational environment, which even doctors described as “quite dull”. Nevertheless, it was also a context of extreme religiosity. This contrasts with the fact that one of her two brothers, perhaps chronically depressed, committed suicide by taking sulfuric acid and the other brother later fell into alcoholism. No evidence exists that her sisters suffered from notable psychic ailments, though they were afflicted with peritonitis and pleurisy (Fabrizio and Turano 1925).

At puberty, aged 12-13, for around nine months, Elena suffered from fits of convulsive laughter followed by severe episodes of spasmodic coughing which doctors diagnosed as “hysterical crisis”. This apparently abated by itself without therapeutic help. During the cessation of coughing, a first -and brief- anorexic episode occurred coinciding with her first menstruation (Fabrizio and Turano 1925). However, the hagiographies – in Christian traditions an hagiography is the biography of a person considered as a saint or blessed by God - of the Monaca Santa systematically ignore these reports and explain the following:

One day, while drinking wáter, the liquid entered her trachea and she developed a serious cough which lasted a year and a half, despite treatment including gastric lavage prescibed by a doctor. She was tired from so many problems, since she couldn’t speak well due to her cough, one day she was praying the rosary and made a vow to the Virgin of Pompeii that if she were cured, she would join the nunhood. During the night (1908) she had a vision of the Virgin of Pompeii that assured her of healing. And so, the following morning she was completely cured (Peña 2018).

The doctor referred to in the quote is Dr. Turano (n.d.), second author of the article in the Rinascenza Medica journal on which the first known case history is based, and who was both doctor and close friend to the Aiello family. The doctor’s sister was actually Elena’s baptismal godmother (Peña 2018).

Now aged 22, Elena was in the convent. One day while carrying a heavy box she suffered a muscle tear in the left shoulder. The pain quickly spread to her arm. A doctor observed an incipient process of necrosis and recommended surgery which was apparently unsuccessful. On her way to Cosenza for a second medical opinion, Elena Aiello stopped at a church to pray at the altar of Santa Rita de Cascia. According to her testimony, she had a vision of the Saint which caused her to change her travel plans and return to her family home. That same night, she was visited by Saint Rita once more (Spadafora 1964). Elena would later explain that, during this second vision she was asked by Saint Rita, to spread devotion for her and initiate a subscription to acquire an image of her to be placed in the local church, in the niche where the statue of Saint Joseph was located. Aiello tried to scrupulously follow the orders of the Saint but failed in gaining adherents to her faith […] due to the absolute refusal of the local clergy. […] Thus, one night Saint Rita reappeared and, furious at Elena, “punched her in the stomach” (Bianchi 1926).

The following day, as might be expected from this account, she developed the first symptoms of an upset stomach. She then suffered new episodes of convulsive vomiting and difficulties lasting three more months from August 1921. Following X-rays, she was incorrectly diagnosed with stomach cancer. This explanations are common in all of the Aiello’s biographies, but there isn’t further details or additional documents to this respect. Is very interesting to observe that in the medical history first prepared by Fabrizio and Turano never referred to such a pathology, only to convulsive vomiting and eating problems, from which it can be deduced that the untreated anorexia had worsened.

At this point, Elena’s physical and mental condition deteriorated rapidly. However, in November 1921, a change occurred following a new appearance by Saint Rita who “lovingly puts a hand on her stomach”, informing her the suffering would soon finish. Her general health improved markedly from this moment on, and the patient “miraculously” regained control of her arm. Thus began a long period of “imposing” visions of the Saint of Cassia that would last until 1923. As of March that year “Elena Aiello suffered no type of ailment that required medical help” (Bianchi 1926).

Hematidrosis and Sores

On the first Friday of March 1923 - the first Friday of Lent - Elena Aiello complained of a severe headache. According to her testimony, she also had a vision of Jesus Christ placing his crown of thorns on her. Blood then began to ooze from her forehead. The event lasted three hours together with a psychic situation of ecstatic trance. This took place before numerous witnesses and, once finished, the nun returned to normal, rising the next morning in perfect health. The same phenomenon would be repeated every Friday of Lent, with particular intensity on Good Friday - the Christian holiday commemorating the crucifixión of Jesus -. It would then not occur for another year (Giuliana 2011).

The first sores or ulcerations appeared during the final episode of blood sweating on Good Friday of the following year, 1924, being particularly intense on this date. The lesions appeared on the knees and feet. Doctors collected between 4 and 5 cc. of blood sweat, which flowed in repeated phases of five minutes duration, for a histological examination that was normal, except for the expected presence of anemia (Figure 4). They also looked for epithelial lesions on the scalp but none were found (Bianchi 1926). The sores were presented as follows:

Figure 4.

Elena Aiello, already in maturity, during one of her episodes of hematidrosis and ecstatic trance (Source: Google Images).

On the dorsal part of both feet corresponding to the upper third of the space between the second and third metatarsals, we observed two continuous, almost identical circular lesions, both the size of a penny, with slightly jagged margins and a bright red background, with very little liquid secretion. On the soles of both feet, we noticed two more lesions, smaller than the first. […] Identical lesions we could barely see due to the patient’s reluctance are found on the anterior face of the ends of the knee. […] Tactile and thermal sensitivity disappeared in most of the body surface. The patient feels no contact of various objects nor pinpricks, cold nor heat (Fabrizio and Turano 1925).

Shortly afterwards, Elena Aiello with no treatment of note overcame the supposed cancer, as well as the shoulder ailment. As she explained,

On the night of May 21, 1924, I received a vision from Saint Rita. She told me: ‘Tomorrow, after rosary, come to my image and I will heal you’. Anxious as well as comforted, around three in the afternoon, after saying the rosary with some of my sisters and friends, helped by Emma, I moved to the divan and approached the image. I prayed and then felt light and free in my movements. I rose with intimate joy, seeing the others in a state of shock, I told them: ‘I’m cured’. I went to the balcony and, seeing Mother Superior Valentina Vercillo, I instinctively exclaimed, raising my arms, ‘Look I’m cured’ (Spadafora 1964).

The 1925 Meeting and Diagnosis

A Brief Discussion

The reasons why Vincenzo Bianchi and Elena Aiello met are unclear. The fact is that such contact occurred throughout Good Friday 1925, during the most severe episode of blood sweating. After a brief initial examination by the doctor, the following dialogue took place:

BIANCHI: Are you suffering a lot?

AIELLO: Yes, very much.

B: And where?

A: On the head… the crown of thorns… God, such pain…

B. And who put it on you?

A: Jesus.

B: And why?

A: For the redemption of my sins and those of the human race…

B: But have you really seen Jesus?

A: Yes… Yesterday… (Bianchi 1926).

Bianchi then proceeds to examine the patient, although only superficially due to the woman’s constant complaints and the subsequent reluctant intervention of witnesses and relatives. He extracted a series of impressions enabling him to sketch a general clinical picture (Bianchi 1926):

• Wailing, writhing and shaking (especially in the trunk area).

• State of ecstatic trance with constant muttering of incomprehensible words.

• Anesthetic body surface, except in the bleeding region of the forehead and in stigmata of hands.

• Extensive hair loss during bleeding episode.

• General corroboration of that previously described by doctors Fabrizio and Turano.

Bianchi, intrigued by the peculiarities of the case, undertook his own particular investigation, ruling the patient had been psychologically unstable since preadolescence, with a hysterical disorder aggravated by religious extremism, “[to which perhaps it should be added] among other phenomena, that of simulation, given that a braid of hair had fallen that had possibly been cut off beforehand” (Bianchi 1926). In his opinion, the stigmatic process, induced psychosomatically, would occur as follows:

PHASE 1: Passionate mystical orientation of the subject (basic personal condition).

PHASE 2: Monotheism – or the belief that there is only one true God - and somnambulism as conditions prior to appearance of stigmata.

PHASE 3: Hallucinations of religious content symbolising where stigmata would appear in the anatomy.

PHASE 4: Progressive elevation of the spirit towards fusion with “the divine”, or belief in a “descent of the divine” towards the creature in which it manifested (sublimation and ecstatic mental state). As was defined then, “sublimation” is a mature type of defense mechanism, in which socially unacceptable impulses or idealizations are transformed into socially acceptable actions or behavior, possibly resulting in a long-term conversion of the initial impulse (i.e. Freud 1961). In this case, as a religious trance manifestation.

PHASE 5: Generalised hysteria.

Thus, the psychiatrist concluded that Elena Aiello had a marked mystical personality orientation that would translate into strong emotionality and progressive disintegration of identity. This would explain symptoms like psychogenic anesthesia – or or attenuated pain caused by a mental or emotional conflict -, mutism and, in general, configuration of a particular state of mind equivalent to “war neurosis”. To support his diagnosis, Bianchi turned to the classics: Gullerre, Beaunis, Bernheim, Babinski, Pitres, Portigliotti, Tischner, Richet, de la Tourette, Freud, Morton-Prince, Campion, etc (Bianchi 1926). In his opinion, the perfect example of the patient´s general state would be that of Indian fakirism - In Western Europe, from travel books of XVII and XVIII centuries, there was the idea that a fakir was essentially someone who performed seemingly magical or superhuman challenges of physical and mental endurance, before an audience (Dobe 2015) -. The medical-psychiatric cause of phenomena like hematidrosis or stigmata was still unknown. However, Bianchi did not believe these could be deemed supernatural or miraculous, as they could well be explained by suggestion or mere simulation.

In mystics suffering hysteria, owing to their intense and prolonged emotional state, favourable conditions exist for these dystrophies to occur, which are the reflection of conscious representations of emotion. The interpretation of the phenomenon therefore, remains biologically hypothetical. It is preferable to declare this, instead of searching for other hypotheses which have no basis in provable facts. In Bianchi’s opinion, to the old way of considering suggestion, at that day were possible add knowledge of another integrating element of emotion, such as the sympathetic-endocrine (Bianchi 1926). Nevertheless, there are no more additional references to this idea in his published inform, so, because the lack of other resources or references, is difficult to determine what exactly he intended to explain.

CONCLUSIONS

Despite a lack of cases which prevent consistent research on this subject which would keep it in the realm of medical rarity, the phenomenon of hematidrosis is transcultural and can occur in diverse circumstances and contexts, and does not appear to be explained solely from strictly religious variables. The same might be said for stigmata. Authors like Patel and Mahajan (2017) indicate that blood sweating is closely connected to extreme stress, though the exact etiology of the process is still unknown. It could be considered, as Bianchi did in the Aiello case, as some sort of self-induced neurotic disorder of a psychosomatic nature.

Consequently, it would be a systemic event, of a psychogenic nature related to overexertion or other organic conditions related to mucosal bleeding. Some subjects could sweat blood due to rupture of capillaries surrounding the sweat glands in moments of high anxiety, which would pose a problem of hematofolliculohidrosis (Biswas et al. 2013). The truth is that stigmata, often linked to this clinical condition, sometimes repeatedly appear in people with high neuroticism and therefore, might form an intrinsic part of the case described. The scarcity of known authentic cases, together with the reluctance of potential patients to undergo in-depth examinations, which prevent systematic observation of the ailment, have impeded deeper understanding of the subject.

As for the Monaca Santa, after occasional contact with Dr. Bianchi, she would never again be subjected to further medical examinations, despite the clinical event occurring again and even worsening over the years, presenting with severe chronic anorexia. This is how she herself explained it so dramatically in 1949:

For four years I have not eaten [sic.]. Only occasionally taking a glass of milk or water and some sugar. The sores on the hands and feet appear again on Fridays and then close instantly. On Good Friday 1948, a bloody cross appeared on my chest for the first time. I put on a handkerchief with nine hearts and a cross printed on the middle of it. A cross appeared on my left forearm on August 8 of this year, 1949 (Napoli 1978).

The Aiello case seasoned with the mystical “gift” of prophecy, would eventuallly become one of almost 300 episodes of stigmatised persons that the Catholic Church has recognised as “authentic”, in the sense of “saints”, just like the spectacular event of the famous Padre Pío (Royo 1982). Elena would be beatified by Pope Benedict XVI on September 14, 2011, and several miracles have since been attributed to her. Paradoxically, the criterion for determining the “sanctity” of this condition is particularly elusive from a purely religious approach, to the degree that, given certain conditions, it could be considered that “these wounds [referring to stigmata] can occur by natural causes (autosuggestion, hypnosis, fraud), the devil, or by supernatural powers. [Similarly, blood tears or blood sweat] can be caused by the devil, or be the effect of some physical or psychic pathology” (Aumann 2002).

Regarding the history of psychiatry, and in strictly historiographical terms, it is quite remarkable that all hagiographic texts extolling the figure of Elena Aiello, in the rare case of resorting to medical testimonies to document the life of the nun, usually refer to the “nice” part of the medical history prepared by doctors Fabrizio and Turano, but never the case study proposed by Vincenzo Bianchi, which for decades seemed not to exist and ended up falling into complete oblivion. The controversial rising fame of Elena Aiello as miracle woman, who even wrote prophetical letters to Benito Mussolini (1883-1945), Franklin D. Roosevelt (1882-1945) or the King George VI of England (1895-1952), provoked to this silence (Rossi 2018).