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Notes for the Faint of Heart

My name is Jon. I’m a fainter.
My fainting habit began in 1971 when, during the washing-machine slosh of a surfing wipeout, my board’s tail smacked my forehead. I stanched the bleeding with an index finger and ran to the nearest lifeguard tower, where a grimacing lifeguard bandaged my wound. He said I’d probably need stitches and that I should get to a hospital soon. My mother was supposed to pick me up in an hour. So knowing that my life was not in danger and being only 12, I decided to wait for her.Two hours passed before my mother and I were sitting in the emergency room of Kaiser Permanente Hospital. Still, I was fine. As a nurse removed my bandage, I boasted that I was looking forward to explaining the origin of my future scar.

Then it happened.

Sweat beaded on my forearms. My stomach imploded. My skin turned green. Breathing became a chore, my eyes rolled back, my knees buckled. Barely conscious, I sat on the hospital floor and stared at the colored flecks decorating the linoleum tiles. I have since become intimate with several hospital floors.

I have also endured dozens of other faints. I fainted when I took the blood test for my marriage license. I fainted when I had my ear pierced. I fainted three separate times while volunteering on the pediatric ward of a hospital. I fainted when I saw my brother lying in a hospital bed. I fainted four separate times while dentists — one of whom was named Dr. Payne — probed my mouth. I fainted when a waiter in Spain graciously attempted to clean another surfing wound. I fainted who knows how many times after breaking a finger in a skateboarding accident. I fainted watching my daughter get a shot. I could go on, but I’m getting queasy.

Over the years, I have come to regard my fainting as more of a curiosity than a liability. At the first drop of cold sweat, the first stomach flip, I attempt to hover above my body and watch. But before I can reach my observation post, I must comfort the people around me, who, be they lifeguards, waiters or nurses, invariably feel more concern than I do. Frequently, the opening ritual also requires that I wave off smelling salts, which make me feel worse than fainting. Then, if I am lucky, I can concentrate on the details, which are as slippery as the particulars of a dream.

Accident victims often recount how life switched into slow motion, how the moving picture became a series of individual frames. Imagine going through a similar accident repeatedly. I can anticipate specific frames. Dizzily searching for an untrafficked patch of floor or a vacant chair to plop down on. Cupping my face in my hands. Feeling the sting of salty sweat on my upper lip and wrists. Gulping air. Hearing nothing but a hum. Looking at my paste-colored skin. Relentlessly, torturously, reconstructing the triggering event. Anticipating the first chill that, like a fever breaking, signals the faint has ended.

But no matter how much I study my faints, I still do not understand them. My only conclusion is that the human body works in mysterious ways. Some people sneeze at sunlight. Some yawn when they see others yawning. Some peal with laughter when the soles of their feet are lightly touched. Some faint from simply standing in line or the dread of fac- ing the truth. And some, like me, faint at the sight of a little blood.

In an attempt to come to grips with my own weird condition, I set out to better understand the phenomenon of fainting. Along the way, I talked to doctors, psychologists and researchers. I interviewed swooners, passers-out and deadaway fainters. I was hoping that by staring the strangeness square in the eye, I might learn to control my own fainting or at least shed a little light for others. I knew the road would be unsettling, but I was determined not to take this lying down.

On the evening of May 2, 1991, hundreds of parents and students gathered at the West Springfield High School auditorium to explore the mysteries of fainting. A few dozen of the 2,196 students who attended the Fairfax County school had suddenly begun fainting, some of them repeatedly. Then a student died in her sleep. Her death was eventually found to be unrelated to the fainting episodes, but at the time of the meeting, the coroner had no explanation. That spring evening, many people had an explanation for all of the weirdness: The recently renovated school buildings were somehow responsible. A panel of school and health officials floated a few explanations of their own as to why the school should not be closed forthwith.

Emotions roiled. A parent asked everyone whose children recently had had health problems to stand up. Half of the room rose. A student told the gathering that his class wouldn’t have to worry about their 10-year reunion — they wouldn’t be around.

“It was the culmination of a lot of frustration,” says Jane Stottlemyer, who at the time had just finished her term as president of the Parent Teacher Student Association and had a daughter in the 12th grade. “When you’re dealing with the unknown, it’s a very scary thing.”

Carl Armstrong, an epidemiologist from Virginia’s Department of Health, attempted to explain to the fiery crowd why people faint, describing a bedazzling array of situations that cause syncope, the medical name for fainting: People with diabetes faint when the amount of sugar in their blood drops too low. Kids in marching bands tumble from standing too long in one place. Patients faint when tubes are stuck down their throats. Some folks faint from hyperventilating or drinking too much alcohol. Heat, crowding and emotional events also can bring on fainting, as can some medications, chemicals, brain lesions, heart problems, coughing and urinating.

Armstrong also pointed out that some people fake faints, either because they’re short a few marbles or because they want sympathy so they can, say, leave school early.

Though most faints occur because the brain is running low on oxygen, Armstrong painstakingly explained to the crowd, they can be further categorized into anatomically tidy divisions, including too little blood entering the right side of the heart or too little exiting the left. But the parents had not come to learn about the vagaries of fainting, a condition that seemingly can be caused by anything. They wanted answers and action, which they hotly let Armstrong and the other panelists know.

“It was difficult to calm people down enough to speak rationally about the problem,” Armstrong recalls.

Rationality eventually carried the day at West Springfield. The school hired indoor air-quality consultants who came in and measured ventilation rates and levels of carbon dioxide and humidity in individual classrooms. They took air samples back to the lab, where gas chromatography machines and flame ionization detectors hunted for volatile organic compounds. They checked out the custodial supplies, pesticides and renovation materials used at the school. They found a few problems. But nothing accounted for the fainting.

The school system then brought in a team of physicians who specialized in epidemiology and occupational health. The physicians documented every fainting case from February 1990 through June 1991 and came up with fascinating facts: Only 26 students truly passed out, though they fainted a total of 138 times; 25 of the 26 were female; five of them reported between 13 and 33 faints each; and most faints happened in the cafeteria and the auditorium, though Room 203 and the gym also had more than their fair share.

The hard facts melted away, however, when the experts tried to explain the episodes. In the final report issued by the doctors, they devoted several pages to possible sociodynamic causes. Maybe it was mass hysteria, an outbreak of which once swept through a British school, leading 60 teenage girls to faint more than 400 times. Maybe it was the ever-threatening cumulative stress syndrome. Maybe it was a behavioral contagion: Ambulances, lights flashing and sirens blaring, came three separate times in a single day to treat fainters. Or maybe, just maybe, the fainting epidemic was sparked by the Persian Gulf War. Cautioning that the war hypothesis was speculative, the doctors nonetheless found it “highly suggestive” because the number of fainting episodes peaked during that time.

The doctors didn’t say it of course, but all of the studies revealed only one answer to the curious fainting at West Springfield: Nobody knows.

What we do know, however, is that the first months of the fall semester have been faint-free, and hopes are high that the fainting demon finally has been exorcised. Jane Stottlemyer, now a member of a committee that monitors health at West Springfield, recently received phone messages from TV people wanting to know if parents might be interested in having their story broadcast to the nation. She did not return the calls.

The show was “Unsolved Mysteries.”

Iam more fortunate than the fainters at West Springfield High. After I start my personal investigation, it only takes a few days of sifting through medical journals before I’m walking down the road to recovery.

My name is Jon. I’m a blood-injury-illness, or BII, phobic fainter.

There are few experts on what is known as “emotional fainting,” or “vasovagal syncope,” brought on by BII phobia, and the few who exist agree that the phenomenon has not received the attention it deserves. “Most people who have it do not come in for treatment,” says Bruce Thyer, a professor of social work at the University of Georgia who has published widely on BII phobia. “It’s a very common condition, I imagine, but people tend to shrug it off as, ‘Well, it’s just a bothersome part of me.’ ”

BII phobia is cousin to other “simple” phobias, like fear of flying, spiders, heights and dogs. Yet, oddly, BII is the only known phobia that is connected to fainting.

According to Thyer and others who have researched the subject, BII phobia may be linked to survival and evolution itself. One fairly silly-sounding theory holds that as long as there are humans who become revolted by blood, humankind will not exterminate itself. Another hypothesizes that BII phobia is a form of playing dead, a response that many creatures, fearing injury or death, use to make their predators lose interest.

A more persuasive evolutionary argument takes into account the physiology of BII phobia. Say you have a BII phobic man who cuts his finger while dicing onions. When he sees the cut, his heart rate and blood pressure rocket in a classic fight-or-flight response. But then, abruptly, his heart rate and blood pressure drop — and so does he. The reason such “biphasic” reactions persist evolution-wise may be that the drop in blood pressure and lying still decrease the loss of blood, increasing the chance of survival.

“Fainting is probably an evolved adaptive response that has gone a little bit awry,” says Thyer. “If you show gory things to normal people who don’t faint, you get the same biphasic response; it’s just not as great an amplitude. I suspect there is nothing that could be called uniquely psychopathological in people who faint at the sight of blood.”

While I draw much comfort from the notion that I am not uniquely psychopathological, I am interested in understanding why I faint. Psychologist Ronald Kleinknecht, a professor at Western Washington University in Bellingham and author of Mastering Anxiety, has done a great deal of research on categorizing fainters. “There are fearful and non-fearful fainters and there are fearful non-fainters,” says Kleinknecht. “I’ve worked at clarifying the relationships.”

The study of fear and fainting requires an unusual tool chest. Kleinknecht often relies on the Interpersonal Reactivity Index, a 28-item scale assessing empathy. The Fear Survey Schedule asks subjects to rate their fear of blood, needles, corpses and the like. Then there’s the Anxiety Sensitivity Index, the Faint Scale and the Avoidance Scale. My favorite is the true-false Mutilation Questionnaire, which asks subjects to consider such statements as “watching a butcher at work would make me anxious,” “I could not remove the hook from a fish that was caught,” “it would be interesting to see the action of the internal organs in a living body,” “watching people use sharp power tools makes me nervous,” and “I would feel some revulsion looking at a preserved brain in a bottle.”

In one study of 103 psychology and sociology students who had a history of fainting, Kleinknecht found that he could divide fainters into three groups. “Relief” fainters feel anxious or afraid before they faint, but do not actually faint until the threat has passed. “Escape” fainters are, for social or physical reasons, unable to flee, and so they faint while in the presence of the blood-injury stimuli. “Essential” fainters have no identifiable fear of blood or injury, but still faint.

It turns out that I’m a combo essential-relief type, who typically has what Kleinknecht would describe as “near faints,” because I rarely lose consciousness. “In your case, I wouldn’t say it was a phobia,” Kleinknecht offers, noting that phobics feel fear and avoid certain situations because of it.

“What about a person who avoids donating blood?” I ask Kleinknecht.

“I wouldn’t call that a phobia,” he says. “I would call that simply adaptive.”

And what about a person who cuts his forearm, I ask, “and doesn’t go get treated because he’s afraid of getting a tetanus shot?”

“That’s getting a little bit closer,” says Kleinknecht.

So let’s assume it is a phobia. Does it have roots in my childhood? Plenty of children observe horrific scenes without developing a fainting habit. A few studies, one conducted by Kleinknecht, suggest that there may be a genetic link. In Kleinknecht’s survey of 103 fainters, he found that in two-thirds of the cases, at least one parent had a history of fainting. Surprisingly, only 24 percent of the female children and none of the male children knew their parents were fainters.

By coincidence, shortly after I finish reading the Kleinknecht survey, my father phones. I have no idea whether either of my parents has ever fainted, nor can I remember ever discussing my little lapses of consciousness with them. Yes, my father says, he fainted when he was 15. He had gone to the hospital to visit a friend who had typhus fever. When my father turned the corner into his friend’s room, he could not stomach the sight of the pale boy, who had lost much of the hair on his head.

“I just gave a look and started to faint,” my father says. “I left without talking to him.” Though my father cannot remember fainting again, he says he blocks out bad memories and confides that, to this day, he avoids visiting people in hospitals whenever possible.

Not by coincidence, my mother phones a few minutes later. She too remembers fainting once.

“It was at the blood test for my marriage license,” she says.

Few BII fainters ever seek therapy, and not just because they shrug off that bothersome part of their makeup. Many learn to “actively cope” with their problem.

My name is Jon, and I am, in fact, a blood-injury near-fainter (essential-relief type) who actively copes.

With us active copers, as long as we are participating, everything is fine. When my daughter had blood drawn, for example, I stroked her head and whispered sweet nothings as she lay on the doctor’s table. The nurse had trouble finding a good vein, so another nurse and a doctor came in, leaving little room for me. I took my seat and, wham, the sweat started leaking, the stomach started doing half gainers.

“Many other people describe similar things,” says Kleinknecht, who classifies an active coper as a type of relief fainter. “The minute they stop being active and reflect on it, then they’ll go.”

Fainters, says Kleinknecht, also can control their fainting by “construing” situations differently. “There was a fellow swimming at the beach with some friends,” says Kleinknecht, sounding like one of the brothers Grimm. “He had gone out further than the rest to where there were some old pilings. He climbed up and out of the water. Then he lost his grip. There were a bunch of barnacles on the piling. He knew he was cut from sliding on the barnacles. He also knew if he saw himself bleeding he would faint. So he kept his head up, swam into shore, ran up the beach to where his friends were, then looked down at himself and fainted. He knew his pattern. He knew that once he looked he was gone.”

Typically, therapists only hear from BII fainters when passing out interferes with their lives — a woman who has put off pregnancy because she is afraid of giving birth, or, maybe, a man who wants to coach his wife through childbirth. Medical students who can’t make it through a shift. People with rotting teeth who have not been to the dentist in 10 years. People who “go” when they hear the wail of a siren, a gruesome newscast, a pastor reading from the Book of Martyrs, or the word “blood.”

Because fainting occurs when the heart rate drops, therapists have begun to teach patients how to increase their heart rates. One 1976 study showed that faints could be prevented if BII phobics concentrated on past insults to make themselves feel angry, a sure booster of heart rates. A more popular technique is “applied tension,” in which patients learn to raise their heart rates by rhythmically flexing the large muscles in their legs and arms.

But therapists primarily treat BII phobia the same way they treat other phobias: desensitization through exposure. “There is a general principle that with more and more exposure to the feared stimulus, the effect wears off,” Kleinknecht says. “The issue with blood-injury is that you typically faint before you get the amount of exposure you need.” This leads Kleinknecht and his ilk to some creative techniques.

Thyer begins his therapeutic regimen by interviewing patients to learn what, exactly, induces each person’s faints. Thyer then asks patients to arrange their “anxiety-evoking stimuli” into a hierarchy, “from things guaranteed to set them off to things that are more iffy.” He has them decide which stimulus on the hierarchy they would like to be exposed to first, encouraging them to select the highest one they can handle.

Take the patient who says she can just barely stomach watching gory movies. Thyer pulls out a color videotape of a real surgery done on a human and fast-forwards to the most graphic section. He has the woman stretch out on a couch and elevate her feet, a position that makes it difficult to faint. He plays the tape, asking her to shut her eyes and simply listen. He plays the section again, having the woman blink her eyes. He repeatedly plays the tape, having her keep her eyes open longer and longer. Once she can view the entire section, he has her lower her feet and watch it. Then she views the tape sitting in a semi-upright position, then upright, then standing. He leaves the room and lets her observe it standing alone.

“If you do it gradually enough and you’re encouraging and supportive,” says Thyer, “people will do all sorts of ghastly things.”

Had I met Bruce Thyer or Ronald Kleinknecht when I was 20 years old, I might be a doctor today. I am not certain that would be a good thing for either me or my patients, but the fact remains.

Premed training at my school required aspirants to volunteer at the university’s hospital. I chose the pediatric ward, where I helped feed and cheer the kids. The first time I fainted, I was wheeling a girl with cancer to her radiation treatment. The second time was when I saw a kid named Duncan who had been in a motorcycle accident. The third time, I was bottle feeding an infant who was hooked up to a life-support system. A nurse happened to walk in and see me lying on the ground, the baby still in my arms. “You do not belong here,” she said. She was right. I never returned.

I have not let fainting decide my fate again. I go to the dentist and doctor. I visit people in the hospital. I coached my wife while she gave birth to our daughter.

I also have gone through self-designed exposure therapy. I once sat in on an autopsy. I closely witnessed emergency rooms for a handful of stories. I spent half an hour watching a Philadelphia butcher wield his cleaver. While working as a diabetes educator, I injected myself with a saline solution and regularly pricked my fingers to check my blood sugar levels.

But there is one thing I have long avoided. It is perched at the top of my hierarchy. Just thinking about it makes me swallow hard: donating blood.

A LARGE MAN WEARING A NATIONAL Park Service uniform is lying on a thickly cushioned table that is covered with red and black Naugahyde. The man is at the Drew Blood Center, the Red Cross outpost in Foggy Bottom, and a nurse is holding a sheathed needle next to his outstretched arm. “It’s sharp,” she teases him.

“If it’s too sharp, I’ll holler,” he threatens.

“Holler and you’ll make me nervous,” she says.

The nurse finds a vein and slides the needle in.

A man lying perpendicular to the Park Service employee says, “I didn’t hear any screams. I feel safe. I guess I’ll stay.”

I am having second thoughts. But that is what my latest round of exposure therapy is all about. I am going to watch people donate blood this morning until the second thoughts fade into third thoughts and fourth thoughts and fifth thoughts, and then, when all my thoughts have evaporated, I too am going to donate. I too will then walk with an escort to the “canteen,” passing a bulletin board filled with Polaroids of donors who have given more than 100 times. I too will sit and enjoy a cold cup of orange juice and a few molasses cookies, chatting with my neighbors who will be similarly swelled with a sense of goodwill. Then I too will paste a sticker to my shirt that reads, “Be nice to me, I gave blood today.”

After two hours of desensitizing myself to the needles, odors and other things, I am ready. My nurse, Vadetta Matthews, is a champ. The needle goes in with little more than a burn. Everything is going swell. Here I am, donating blood. The Red Cross people told me they’re short on blood right now too. Maybe I’ll begin to do this regularly, even get a Polaroid up on that corkboard.

Then it happens. The cold sweat. The fluttering stomach.

Matthews notices that I am fading. She pulls out my pillow and accordions my legs so that my knees are raised.

“I’m fine,” I say.

“I know,” she says, placing a wet paper towel on my forehead and another on my chin. “Two more minutes.”

Two more minutes. I joke with the woman lying perpendicular to me. Two minutes is a long time.

“One more minute,” says Matthews. “You look great.” Looks are deceiving.

Before I know it, it’s all over. I feel better almost immediately and want to jump up and run for the door. I try to impress upon Matthews how everything’s swell, but she’s having none of it. She makes me sip orange juice lying down and wait a good 15 minutes before escorting me to the canteen, where a sign pronounces, “Thank You! Your next eligible date to donate is: Sept. 13th 1991.”

I have cookies and a cup of coffee, finding that two of the other donors sitting at the canteen also had felt queasy. Because I am a first-timer, I receive a packet of pamphlets that, among other positive things, tell me, “You have just joined a very special and select group — one that only 5 percent of the population belongs to!” I also have a red plastic drop of blood pinned to my lapel. I say my goodbyes.

“See you next time,” says Matthews.