The Blood Transfusion Taboo of Jehovah's Witnesses

[Social Science & Medicine 31(4)1990, pp 515-523]
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     [Thomasma, D.C. & P.A.Marshall (eds) Clinical Medical Ethics. Cases and Readings Lanham MD, University Press of America, pp 678-682]

Abstract

 Jehovah's Witnesses are not allowed to accept a blood transfusion. According to the Watch Tower Bible and Tract Society this therapy is a transgression of divine precepts. Additionally, in the judgement of the believers, secular proof is abundant these days; to them AIDS is a powerful justification to abstain from blood.

Founded on the work of the anthropologist Mary Douglas, it is argued that the rejection of this medical therapy is based on perceptions of pollution and purity inherent in the Watch Tower Society's ideological concept of anti-worldliness. Rooted in the movement's pre-war opposition to vaccination the implementation of the taboo was triggered by the prevailing social-political climate surrounding the Society during the Second World War, resulting in this intriguing and controversial religious pro­scription. For the community of Jehovah's Witnesses the blood transfusion taboo still functions as a significant mechanism of sectarian boundary maintenance.

  Key Words:

  Jehovah's Witnesses; blood transfusion; AIDS; boundary maintenance.

  Introduction

Part of the underlying tension between religious healing and secular medicine can be found in particular within non-mainline Christianity. Certain biblical doctrines as interpreted by followers of particular religious groups, were, and still are, at odds with established medical practice, creating "a degree of tension between the medicine of the soul and the medicine of the body" (1). Accordingly members of Christian Science hold that their faith is "a panacea (...) and the only real remedy for sin, disease and death" (2). Rather than consult secular physicians, orthodox believers would prefer to seek healing from the movement's practitioners. Faith healing or the conviction that the supreme being punishes the sinner by sending illness, thus causing them to reject "worldly" health care, can be found among conservative Pentecostalists within the Holiness Church (3,4). Similarly, based on the Mathian verse "persons in health do not need a physician", fundamentalistic groups within the Dutch Reformed Church in the Netherlands refused to have their children vaccinated against poliomyel­itis in the 60s and 70s, as well as during an eruption of the measles in February 1988 (5).

Perhaps the best known example of this general phenomenon is the blood transfu­sion refusal of Jehovah's Witnesses. Promulgating the rule in 1945, the Watchtower Bible and Tract Society (hereafter "the Society"), generated one the most controversial issues on the interface of religion and health care. Based on Genesis 9 verse 4, Leviticus 17 verses 11 and 12 and the Pauline New Testamentary reiteration in Acts 15, the Society declared that, irrespective of the mode of consumption, the eating of blood was an unscriptural practice (6,7). Besides the array of scriptural references the Witnesses have at their disposal legitimizing the regulation, they feel heavily sup­ported by extra-doctrinal arguments. The second part of the 80s provided them, from their point of view, with a powerful secular ally: AIDS emerged as a macabre confirmation of the doctrine.

  The first part of the present paper explores origin, development and the arguments used to justify the prohibition. The second part offers a functionalist analysis of the doctrine. It appears legitimate to wonder why, of the wide range of possible interpre­tations of divine precepts, the Society has formulated this extended exegesis of the rule to abstain from blood. However, the anthropologist searches for the taboo's implicit meaning, trying to explain an idiosyncrasy within the context of a specific religious system. So, going beyond doctrine, the questions that must be raised are: why was the rule promulgated in 1945 and not earlier (since blood transfusion was already in use at the beginning of this century) and what is its function within the community of believers? In order to grasp meaning and function of the doctrine, it appears useful to apply the concepts of purity and pollution as formulated by the anthropologist Mary Douglas (8).

As far as I can tell, the blood transfusion doctrine is unique. I found no evidence in ethnography or medical anthropology of an identical taboo (9)

  Origins, Development and Justification

  Prior to its prohibition of blood transfusion, the Society had objections to another medical treatment, namely, vaccination and inoculation. To be sure, this disapproval was never framed in an official doctrine based on biblical articles of faith and prom­ulgated like the ruling on blood, but the practice was vehemently discouraged. This position emerges most clearly during the 30s in The Golden Age, one of the prede­cessors of Awake!. A quote may illustrate this:

Thinking people would rather have smallpox than vaccination, because the latter sows the seed of syphilis, cancers, eczema, erysipelas, scrofula, consumption, even leprosy and many other loathsome afflictions. Hence the practice of vaccination is a crime, an outrage and a delusion

The treatment was further described as "defiling", "devilish" and "influencing the criminal tendencies of the present generation" (10), expressions similar to those uttered by resisters of compulsory vaccination in 19th century Britain and Holland (5,11). In some instances, letters from readers pointed to the biblical foundation of the evil of inoculation, referring to the appropriate text in Leviticus in which the inter­mingling of animal matter with human blood is prohibited (12). Besides the perceived dangers of vaccination and inoculation, the markedly cynical writings also breathe of an antagon­istic attitude towards the medical profession, the pharmaceutical industry, and, above all, the state as an active agent which compels its citizens to have them­selves vacci­nated. It is doubtful whether this doctrine enjoyed large support. In one of the first studies of the Witnesses, undertaken in the early 40s, it is noted that the majority of the adherents would accept medical services (13). Also indicative may be the case of the approximately 4300 American Witnesses who were in prison as conscientious objectors during World War II (14). According to Macmillan, member of the Society's leadership, only a small minority concentrated in one prison refused to submit to the vaccinations compulsory for all inmates. It was only after his inter­vention convincing them there were no scriptural objections that they complied. Of interest, however, is Macmillan's argument for the prisoners refusal. In his autobi­ography (one of the few eulogies on the Jehovah's Witnesses which have not been published by the Society), he notes "(...) our boys (...) considered [vaccinations] the same as blood transfusions (...)" (15,16). As the doctrine on blood had yet to be promulgated his assertion may exemplify the psychological repression of obsolete doctrines or unpopular policy and subsequent reinterpretation into acceptable and plausible ideological statements; a mechanism not uncommon among Jehovah's Witnesses and adherents of similar religious groups. In the Society's own official historiography this particular event has been omitted (17). Furthermore, as noted by Penton, it is not entirely clear whether the aversion against vaccination represented the Society's viewpoint in general or rather a personal grudge of Woodworth, the editor of Awake! (18). Macmillan's explanation may therefore reflect the possible disagree­ment among the Society's leadership among this specific issue. After 1945 the animosity against vaccinations disappeared from the reading matter, but until the 60s it was still considered an act of pollution of blood and body (19).

  The origins of the ruling on the use of blood are somewhat obscure. To be sure, the Society promulgated the doctrine in 1945, but that was not the first time the matter was brought up. As early as 1939, Rutherford, the then president, wrote that 'life is in the blood and that the blood must not be eaten', in answer to a letter of a Witness who wondered if the eating of pork was scripturally allowed (20). Blood transfusion was not mentioned: a year later he even seemed to be in favour of it (21). According to Penton the matter did not rise until 1937, the year in which the first large-scale blood bank was established in Chicago, but the author does not elaborate on the Society's reaction (18, p. 153). Then, in the Dec. 22, 1943 edition of Consolation, Awake!'s immediate predecessor, a short article mentioned the development of a serum against meningitis, which includes horse blood. The writer concluded that "the divine prohib­ition as to the eating or partaking of blood does not appear to trouble the 'scientists'". About that time, at the other side of the Atlantic, a Jehovah's Witness, inmate of the women's concentration camp Ravensbrück in Nazi-Germany, one day approached her warden, announcing that the eating of blood-sausage was a violation of the scriptures. According to Deuteronomy 12:24, she declared that "the blood should not be eaten, but should be poured upon the ground as water". So, from now on, she and her fellow believers would abstain from this food, in spite of the alarmingly low rations. This time, even for the cohesive group of Witnesses, things were being pushed too far: according to the warden's eyewitness account, only 25 out of the 275 detained Witnesses followed their inspired "sister". (22)

Nevertheless, The Watchtower of July 1 1945 introduced the prohibition. Ironically, two months later, the Dutch edition of Consolation states:

God never issued provisions prohibiting the use of medicines, injections or blood transfusion. It is an invention of people who, like the Pharisees, leave Jehovah's mercy and love aside (23).

  This notorious quote, often used by the movement's (Dutch) adversaries as proof of doctrinal inconsistency, did not emanate from the Society's headquarters in New York, but was written by its regional editor, who, apparently, was unaware of the new doctrine: a situation unthinkable today and probably a result of post-war com­munication breakdowns. During the late forties, the Society hardly paid any attention to the new ruling. From 1949 onwards, some back-up material was published, such as the statement by a homeopathic physician, who warned that "complications and chronic conditions follow as a rule those who live long enough to pay the penalty of such repugnant measures" (24). Also, readers started to ask questions about the prohibition. One of them, apparently worried about one of its implications, was reassured by the editorial staff that "human copulation for the reproduction of man­kind cannot be viewed as a blood transfusion from the male to the female". According to another reader, the element of "greed", indissolubly bound up with the biblical injunction of blood eating, is absent in transfusions. "How can you say this", was the Society's reply, "For when a doctor tells a patient that he must have a blood transfu­sion or else he cannot get well and live, what does the doctor create in the patient but a greed for the blood of another human creature?" (25): Hence the theme of patient as vampire emerged, as noted also by Tannahill, and the preamble for the regularly used parallel of blood transfusion with cannibalism (26).

Until the mid-fifties the issue received only marginal attention in the Society's publications, measured by the number of articles covering the taboo. According to the Society's subject index, during 1946 and '47 nothing appeared in its literature. In 1948 and '49 only four editions paid attention to the issue. In contrast, in 1971 the subject was covered in 16 editions. Gradually, the medical world was confronted with the doctrine, resulting in an increasing tension between two value systems. An extreme example is that of the father and two brothers of a victim of an automobile accident in Texas in 1952, who kept guard in her hospital room to prevent doctors from giving a transfusion, in spite of the fact that the patient herself was not a Witness (16, p. 187). From the medico-legal angle an important ethical problem arose: was the Hippocratic oath more important than individual religious freedom? In particular, attention was paid to the element of "forced" transfusions as imposed by court orders. In fact, questions were raised of a persons's constitutional rights, resulting in extensive legislative debates (27,28). Besides, the medical profession was challenged to adapt its skills and technology to a clientele who refused to accept a treatment that had hitherto hardly been questioned. The doctrine unlocked considerable upheaval within as well outside the Witnesses's community. Particularly in the case of minor's whose parents refused to consent to the administering of possibly life-saving blood, emotions ran high; more often than not parental authority was temporarily divested by state agencies, to be followed by the forbidden treatment. Reports such as the transfusions forced upon twelve infants in Canada, who were returned dead to their families resulted in bitter legal debates, as the parents were convinced that the transfusions had caused their children's death (29). Conversely, many press reports voiced the feelings of society at large, appealing to the fundamental values of parental love and care. Not surprisingly, the Witnesses felt they were under siege. The more outside resistance increased, the more vehemently the Society's defense. Opposing doctors were labelled "bloodthirsty physicians", the divesting of parental authority was compared with the "recruitment of the Hitler Youth", while one of the Society's legal counsels qualified the forced transfusions in Canada as a form of "rape" (30; 18, p. 154).

Until 1960, violation of the injunction had supernatural consequences only. "We will not take any spiritual action against anyone", replied the Society to those who dis­agreed (34). The offender eventually had to stand trial before God. Even an "anointed sister", member of the elite of the 144,000 chosen, who had accepted a blood transfu­sion, did not face expulsion from the Society (31). All that was to change. In the "Questions from Readers" part in the Jan 15, 1961 edition of The Watchtower, it was stated that the taking of a transfusion would be followed by excommunication (in the Society's jargon "disfellowshipping"). If the offender would refuse to acknowledge his transgression or would persist in accepting or donating blood, he would be considered "a rebellious opposer and unfaithful example to fellow members" and therefore should be cut off from them. It is likely that this rigid measure was taken in view of the increasing application of blood transfusions. During the sixties medical science had progressed rapidly, in particular in the field of cardiac technology. Open heart surgery was brought into American homes via live TV-broadcasts and within a few years heart transplantations would become a fact of life. What these new methods, to overcome hitherto fatal disorders, needed were, first and foremost, blood. From that time on, the Society paid more attention to the matter. Long articles, in which the doctrinal foundations were highlighted and reiterated, possible dangers of the therapy, stories in which Witnesses miraculously survived drastic surgery without transfusions and descriptions of perceived maltreatment, filled the pages of the magazines.

It is beyond the aim of the present paper to describe in detail how the ruling vacillated through the late 50s and 60s, in particular if applied to specific cases. Questions like "can one take medicines containing blood products, should a Witness surgeon give a blood transfusion (in the Netherlands a Witness hospital physician solved this dilemma by opting for laboratory research in order to avoid any possible participation in blood therapy)?, can a chicken be fed by products containing blood substances", etcetera, appeared in the "Questions from Readers" pages of The Watchtower. One example, taken from a former Society's top-official experiences, may illustrate the rather fluid character of the rule. Hemophiliacs, inquiring on the permissibility if they could accept medication of blood fractions were told that "(...) to accept such blood frac­tions one time could be viewed as not objectionable (...) but to do so more than once would constitute a "feeding" on such blood fractions and therefore be considered a violation (...)". (38). Autologous blood transfusion is also forbidden unless the patient's blood continues to circulate through an external surgical device. Prior storage of one's own blood is not allowed by way of "On the earth you should pour the blood out as water" (Deuteronomy 12:16). Nowadays, the ruling's derivatives are more or less left to the individual. The Society has withdrawn from the exegetic casuistry concerning the use of blood products and its wide variety of applications, appealing instead to the Witness's conscience; cases that are not clear cut are in unprecedented "grey area", an indistinct doctrinal territory within an otherwise absolutistic ideologi­cal system. Besides, the research involved in checking the purity of products is "not the responsi­bility of the Christian, for, doing that, it would give him less time to preach" (33).

Although the Society's primary justification for the doctrine is based on biblical exegesis, an array of secular arguments usually accompany the scriptural ones. Prior to the outbreak of AIDS the amount of medical objections was rather limited. Errors can be made in administering an incompatible blood type and the receiver can be infected by hepatitis,  malaria and syphilis. A considerable factor in the Society's abhorrence has been (and still is) the practice of some commercial blood banks. For example, in his description of the life style of an American skid row population, the urban ethno­grapher Spradley reports that "making the blood bank" provides a signifi­cant way to obtain alcoholic beverages. According to one of his informants "it is usual to drink some wine before donating blood in order to avoid too much shaking and to calm the nerves". In case the individual has no means to purchase the liquor in advance, the blood bank provides an advance, to be subtracted from the revenues of the donation (34). The Society's magazines regularly mentioned similar occurrences, yet, statistical­ly, such reports were hardly significant. certainly not within the context of the Western European situation in which blood donation is usually a free gift: Altruism and life-saving are easy competitors for insignificant casualty rates. This draws attention to the Society's decision making which is primarily an American affair.

Besides the perceived hazards for physical health, as emanating from the exploita­tion of the penurious urbanites, the Society was convinced that blood transfusion would incur mental contamination. So until the 70s the Society frequently defended its policy by arguing from the perspective of the humoural physiology. The following quote provides an example:

Some say blood transfusions are harmless. Do you believe that? For 40 years K. was known as an honest man. Then he was given a blood transfusion after a fall. "I learned the donor was a thief" K. told police. "When I recovered I found I had a terrible desire to steal". And steal he did. He confessed to stealing ,10,000 in six robberies in three months. K. threatened to sue the doctor who arranged the transfusion, if he receives a severe sentence for his thievery.

To stress the imaginary danger of contagion with less enviable psychological donor traits, in conformity with the biblical adage "the soul of the flesh is in the blood", the Society regularly quoted from a type of literature which in medical circles would probably be considered controversial. So, according to the book "Who Is Your Doctor and Why?":

blood contains all the peculiarities of the individual from whence it comes. This includes hereditary taints, disease susceptibilities, poisons due to personal living, eating and drinking habits...The poisons that produce the impulse to commit suicide, murder, or steal are in the blood.

In the same edition, a Brazilian medical journal was quoted, according to which: "Moral insanity, sexual perversions, repression, inferiority complexes, petty crimes - these often follow in the wake of blood transfusion". It is important to note how the Society stresses the perceived quality of blood through this negative characterization of the donor. If he is not a criminal, then at least there exists a social distance from the receiver. It is mentioned, for example, that Witnesses will try to protect their children from taking strange blood. And in spite of the fact that the donor may be a respect­able member of the family, leading an immaculate life, the danger still looms. To make things worse, however, the donor usually is an unknown person, perhaps even a convict of a penitentiary or an alcoholic, as the Society reports (35). With even more horror the Society refers to the use of cadaver blood for transfusion purposes, a method in vogue in the Soviet Union during the thirties (36).

The Society has no need to revert to these arguments any more. Obviously, the more widespread blood transfusion was applied, the more adversely medical side-effects became known. The old humoural physiology, presented in the 1961 brochure Blood, Medicine and the Law of God has been omitted in the updated version pub­lished in 1977 and been replaced by more sophisticated, although still highly selective refer­ences. During the late 70s and 80s the provocative rhetorics have gradually been replaced by a tone of accommodative restraint, which, for example, emerged in the publication of the viewpoint by the Society's medical staff in The Journal of the American Medical Association (37)

The last part of this decade provides the Witnesses with an even more powerful argument: AIDS has become the ideal case to convince the outside world that the doctrine is legitimate. The macabre relationship "Blood transfusion - AIDS", as back-up argument to the primordial scriptural semantics, facilitates the Society's justifica­tion for the rule. Also, recent medical discoveries have demonstrated that contro­versies now surround the once hardly questioned efficacy of blood transfusion (38). Special editions of Awake! quote medical experts who agree with the Witnesses in their refusal of blood transfusions, as well as scientific articles in which the hazards of the treatment are highlighted (39). Whether the disease and other recently discovered possibly adverse medical effects diminishes the controversy among the general public, is less clear. For example, in the Netherlands, during spring 1989, a TV-station reported the case of a Witness who died as a result of blood refusal during obstetrical surgery. The program definitely exuded an atmosphere of antagonism towards the prohibition. Not in the least this was probably due to the reaction of an official of the Society's Dutch branch office who asserted that ultimately the decision to refuse blood has to be made by the individual, thereby disclaiming any responsibility on the part of the Society. Similarly, the day after a broadcast of a recent TV-discussion, in which Witnesses defended their point of view, those engaged in house-to-house calls received several scornful remarks. Apparently the majority of medical personnel usually respects the patient's conviction (40). A leading Dutch anesthesiologist, though, confronted with a fatal surgery as a result of blood refusal, formulated the dilemma pithily: "It's their conviction, but they do it under my nose".

For the individual believer the doctrine appears to be of minor importance. Although systematic data collection is still in progress, my fieldwork impressions among the Witnesses do not show a particular concern with the rule. Surely the doctrine is not experienced as profoundly as the Kosher dietary laws among orthodox Jews, consider­ing them "conditions for holiness over against profanity and pollution" (41). After all, the major part of the adherents will never directly be confronted with the prohibition. New members know they have to accept the doctrine before they are allowed to gain access in their new religious environment. In order to establish the ideological suitabil­ity for entrance, the candidate has to prove agreement with the Society's theology. In addition to an evaluation of the prospective member's general conduct and attitude based on a recruitment and resocialization phase which may vary from a few months to several years, congregation elders examine the neophyte by way of an oral test. These so-called 124 "baptismal questions" cover the entire doctrinal corpus and include several items on the blood issue (42). If the elders are convinced that the candidate will accept the new belief system, the subsequent rite de passage through baptism initiates the inductee into the status of "full-fledged minister". Proselytizing activities then become the most important visible "cognitive commit­ment" indicator (43). The blood transfusion matter manifests itself in the background only: the Witness has to fill out a codicil in which it is declared that the bearer of this document will not accept a blood transfusion. Alternatives like dextran or hetastarch are allowed. Further, medical personnel will be discharged of any responsibility for the consequences resulting from this refusal. Except during July and August 1988, when the Society's brochure Jeho­vah's Witnesses and the Question of Blood was discussed world-wide among the more than 3 million Witnesses, the annual renewal of the codicil will be the only ritual confrontation with the doctrine, thus constituting another proof of cognitive commit­ment.

On the weekly Sunday gatherings, during which topics from he Watchtower are lectured, the matter is sparsely discussed. After all, from the secular point of view, the hazards of refusal have diminished. Medical technology has found alternatives for those refusing blood, not in the least as a result of the guinea-pig position of the Witnesses: how to do major surgery without blood transfusion has been (and still is) a topic for a considerable amount of papers in medical literature (28,44). In spite of future divine judgement and medical alternatives, whether the Witnesses will persist in a refusal at the crucial moment, in particular if their children are endangered and in need of a transfusion, is a matter of which some are not entirely confident. "Only that moment will show if I am really committed to Jehovah", is a standard reaction of the doubters. Some have bitter memories of the moment when their authority was tempor­arily divested in order that their child received a transfusion. Yet, others confided to me they felt relieved to be deprived of the ultimate responsibility for life and death. According to dissident sources Witnesses accept blood transfusions. This was con­firmed to me by medical authorities although the magnitude seems limited. It is only when one of the fellow believers is in a physical condition that requires the therapy that some tension in the congregation is noticeable, though the matter will not be on the agenda of the service. Particularly if there is pressure from hospital staff upon a Witness to accept a transfusion, congregation elders and other senior members will assist the patient and immediate relatives in order to reduce all possible doubts. Simultaneously, to the physicians in attendance, they elucidate the Society's viewpoint on this matter, thus providing a protective shield between doctrinal imperatives and secular temptation. It is during such dramatic events and, even more, when the outside world takes offence, that ranks close.

Discussion

Unlike the objections raised against medical treatment, uttered by certain members of the religious groups exemplified in the introduction, the Society's present objection against blood transfusion and previous aversion against vaccination are not founded on divine providence or the availability of alternatively spiritual methods. Pollution, in particular in the context of compulsion, appears to be the key word through which the antagonisms can be understood. As far as vaccination was concerned, the objections appear to have been founded on the perceived polluting characteristics of the sub­stances: the introduction of evil humours into one's system, a conception similar to the argument for vaccination refusal in 19th century Britain (11, p. 162)

But above all, it was the compulsory character of vaccination that rubbed the Society the wrong way. Stressed particularly in the pre-60s, in the Society's theology, the state and industrial corporations embody Satan, whereas no good could come from academic professionals. These ideological adversaries, in the shape of public health authorities, the pharmaceutical industry and the medical profession, compelled its citizens to take an evil drug. As Smith notes: "Compulsory vaccination represented a new, and for many people, the first, intrusion into the family of state authority (...) raising funda­mental issues about authority and morals" (11, p. 159,161). To be sure, in the US state vaccination had caused a considerable number of casualties during the first decades of this century and some medical authorities held extreme views on the eradication of germs. The Old Testament scriptural back-up, brought out at a later stage, only emphasized the polluting aspects of vaccination, thus reiterating the importance to distance oneself from secular dirt: to reject vaccination was part of rejecting the world. The opposition against vaccination never received the aura of divine sanctioning. After all, in certain cases, public health was involved. Besides, as noted previously, it is questionable if the opposition was unequivocally supported by the Society's leadership.

If vaccine and inoculant are perceived to pollute the receiver, the same can be said about blood. Ubiquitously, blood has a disquiet cultural connotation, specifically within the religious domain. "Blood is perceived as being simultaneously pure and impure, attractive and repulsive, sacred and profane; it is at once a life-giving substance and a symbol of death" (45). Its metaphorical importance has been widely documented in the ethnographic literature. Blood points to group identity, it is the idiom of kinship, which in its turn constitutes the elementary fabric of social organiz­ation. Alliances between groups or individuals or between their deities are often established by a covenant in which blood plays a crucial role. In present-day western societies, its importance is obvious from proverbial expressions like "'blood will tell', "blood is thicker than water", etcetera, let alone the sinister applications in racial ideologies. The closed character of the Indian caste system, for example, is based on the idea that parental blood is transferred to the offspring: the purity of a caste is defined by the purity of the blood of each individual member. Pollution of an individual's blood means a stain on the whole caste (46). Related to our subject-matter, a blood transfusion in India is a family affair: a patient accepts blood only from his next of kin. This cultural concept of blood pollution may have been the reason behind the murder of two English medical students who transfused their own blood to a patient in an Indian operating theatre (47).

In the Society's blood transfusion doctrine, this consanguinity aspect plays a partial role. As shown above, the Society often stressed the questionable characteristics of the donor category, transferring its evil qualities into the believer's bodily system. Recep­tion meant individual, and accordingly, group pollution. The analogy with the Indian caste is obvious. However, a significant flaw emerges: why is transfusion among Witnesses not allowed? It should be noted that defection among the Society's adherents is considerable (15,26,38,57). In the view of the Society, apostate members belong to the realm of Satan. Though the transfusion might have been life-saving, the thought of a believer who once received blood from someone who is now in the devil's category, is almost an obscenity within the Society's ideological schemes. Insiders, thus, can also defile, so a absolute prohibition is the most secure defense for spiritual pollution.

Even more important for our discussion is the entwined relationship between blood and war. It points to the socio-historical setting in which the doctrine emerged. Blood transfusion had a definite martial component. World War I had been the first large-scale test-case for blood transfusion, followed by the Spanish Civil War. Surely the Society regards the labeling of Jehovah's Witnesses as "pacifists" a defilement (48), but the army is considered an odious institution at the disposal of a reprehensible state authority. When, during World War II, the American population was regularly incited to donate blood for its injured soldiers, it is imaginable that this patriotic climate, ideologically anathematized by the Society, provided the breeding ground on which the prohibition crystallized. To put it bluntly: blood donation was considered an act of sacrifice to a false deity. In this way blood transfusion was part of nationalistic manifestations like flags, national anthems and armies. To make things worse, other adversaries like politicians, the established churches and the world of entertainment participated in the blood donation campaigns, rendering the act even more loathsome (49), to be compared with one of the explanations of the Jewish pork taboo: Pork is impure because the hostile Canaanite neighbours eat it.

The above may explain the choice for this specific taboo, but not the reason to implement it. To explore this question, I will turn to the thought-provoking theoretical framework of Mary Douglas. A central theme in Douglas's work is the relationship between symbolic and social order in different cultural systems. In her seminal study Purity and Danger she presents a thought-provoking analysis of the symbolic meaning of pollution. Departing from Durkheim's view that religion expresses social experi­ence, Douglas hypothesizes that rituals of pollution mirror concerns of the social order, creating "unity in experience" and providing "positive contributions to atone­ment" (8, p.2). For Douglas, the human body mirrors the surrounding society and as such symbolizes social structure. The body's orifices and emissions are society's margins, representing points of entry or exit to social units. Social dangers, threaten­ing the structure, are reflected in the polluting bodily orifices and substances. Basing her assertions mainly on ethnographic material from India she connects the elaborate purification rituals of specific castes with their perceived minority position within the system of Hindoo castes. Also the Israelites seem to conform to the hypothesis in view of the relationship between their status as a "hard pressed minority" and "their care for the integrity, unity and purity of the physical body", thus considering "blood, pus, excreta, semen, etcetera" as polluting substances (8, p.124; 50). As such, rules of pollution and purity are instrumental in creating structural boundaries around group members and "(...) expected to be found in situations were the social order is threatened" (51).

It is exactly this situation in which the Jehovah's Witnesses found themselves when the doctrine was promulgated. For the Witnesses World War II marked the climax of their persecution when in Nazi occupied Europe they were put in concentration camps. This had already been preceded by opposition in other parts of the world during the 30s. Because of the Society's ideological rejection of state authority, the Witnesses were harassed for their alleged anarchistic, communist or whatever perceived extrem­ist political stance. Since, the refusal to salute the flag, not to sing the national anthem, to oppose the established churches and to be a conscientious objector are, in a patriotic atmosphere, obvious indicators of deviant social behavior. Add to that the fierce opposition they encountered as a result of their contentious missionary zeal and the picture emerges of a religious minority to be regarded as the most persecuted group of Christians in the twentieth century (18, p. 130).

Though specific local hostility may have contributed to the sect's cohesion on a regional or national level, and the recognition that fellow believers were in more or less comparable trouble elsewhere, it is not clear whether the Society as a world wide movement was a cohesive unity. It is conceivable that external threat, more than internal theology, supported the mutual solidarity among members. Surely the act of proselytizing was an ideological necessity welding people together, but it lacked the sacral symbolism that divides the pure from the impure. In the terminology of Douglas, the element of "holiness" was lacking (8, p.49). "Holiness", or its Hebrew original meaning "to set apart" was needed in order to re-establish the movement's universal collective identity: a clear doctrine of purification, connoting a rule of mental and physical hygienics was called for. Blood was decided upon. That is to say, the complete avoidance of it. In that way it is functionally analogous with the Jewish dietary laws: its observance means an encounter with the supreme being. As such, rules of pollution and purity are instrumental in creating structural boundaries around group members. And, the more distinctive when formulated into divine precepts, the clearer the dividing lines between the faithful and those excluded (52). For the faithful, the relinquishing of this possibly life-saving medical therapy can be con­sidered a sacrifice as part of the price of membership, thus increasing motivation to remain participant (43, p. 505). The annual renewal of the codicil can partially be considered a test of their cognitive commitment. For the inductee the prohibition can also be considered a barrier prior affiliation. Not until the recruit's motivation is at its maxi­mum full membership is possible (53). In that way the rule functions as one of the Society's selection criteria: Its endorsement by the individual far surpasses non-committal membership. It is unlikely, however, that the majority of the recruits deal with this specific issue at great length. After all, cognizance of the doctrine is only one part in a  usually protracted introductory period. For it is more than doctrinal attraction that ties an individual to a religious movement: the emotional dimension may play an even more important role than the cognitive. In Kanter's scheme this component underlies the community's "cohesion commitment": "(...) the attachment of an individ­ual's fund of affectivity and emotion to a group" (43, p. 507). Numerous studies have pointed to the individual's affiliated networks as the primary sources of recruitment to sectarian groups (54). The new member enters an inner circle in which emotional bonds will be established and reinforced. It is when the outside world takes offence at the blood doctrine that the solidarity of the group becomes visible. As such the blood transfusion has an important secondary function: the opposition reinforces the Witnesses's internal cohesion by distinguishing even more clearly between purity and pollution. The Society's abhorrence of blood also emerges in the annual celebration of the Lord's Supper: the drinking of the wine, symbol of Jesus's blood, is only reserved for the remainder of the elect 144,000. For 1989 that meant 0,2% of the Witnesses. In that way the old church maxim "Ecclesia abhorret a sanguine" applies, in the most literal sense, to the Society.

  Conclusion

In the 50s Werner Cohn characterized the Jehovah's witnesses as a proletarian movement: a social category not participating in societal institutions. In order to show this social estrangement, such movements had "separation rites" at their disposal: "demonstrative practices by which the proletarians set themselves apart from everyone else" (55). Though this is not the place to argue about Cohn's use of the adjective "proletarian", his observation of the creation of social boundaries is relevant. World rejection, a major ideological characteristic of the Watch Tower Society, appears to be at the root of the prohibition of blood transfusion among the Jehovah's Witnesses. For the Jehovah's Witnesses purity means to be separate from the outside, "the world". "The world" is the major part of mankind with exception of the Witnesses (7, p. 427). An array of biblical references indicate that "true Christians", though living in "the world" performing their daily human activities are not part of "the world", the classic sectarian position as noted by Beckford. (56) For analytical purposes, secular anti-institutionalism and inter-group purity are the rule's two components. The former is rooted in the Second World War, being part of the patriotic complex which already included the state, flag, army and church. The latter seems to have its origins in the Society's pre-war opposition to vaccination: Blood transfusion emerged as a similar act of pollution. The important difference, however, was the rule's radius: it only afflicted individual group members. Public health was not at stake. Furthermore, as in the case of compulsory vaccinations, here also the arch-enemy state intruded into the private domain of the family or the individual by forcing the polluting treatment on the victim.

Since its promulgation in 1945, the scriptural base of the taboo has not changed, in contrast to its implementations and additional, secular arguments. The amount of attention the Society paid to the subject seems directly related to its rate of application in medical practice, where it initially encountered little tolerance. Eventually, doctrinal imperatives were more or less forced to find a compromise with societal acceptation, in particular concerning the ruling's derivatives concerning blood in food and medical products. This more or less conforms to Beckford's remark that the justification on certain doctrinal views was a response "(...) to requests for assistance from individual Jehovah's witnesses". As such, the decision making process may partly have been inspired by "(...) the defending and promoting [of the Society's] interests", character­ized by "ad hoc responses to immediate problems without an underlying rationale". Tactics and strategy may have prevailed over principle (56, p. 59). These dialectics between legalistic dogmatism and adherents's commitments may have been the reason that the pre-war vaccination objection never received the aura of divine sanction. The same process created the rather unique "grey area": a doctrinal territory on which the Witness had to decide personally. The same applied to the so-called "1975" prophecy: the Society left it to the individual believers to accept or reject the possibility of an apocalyptic event in that year (57). In spite of these less stable features, the central issue stands its ground through its complementary function. The rule demarcates the believers from the non-believers thus being one the most salient identity markers. Its controversial character contributes to the internal solidarity, since the enemy is an indispensable ingredient of the survival of any millennial movement.

Although, since the 50s the Society's attitude towards the outside world has evolved from a rigid "anti-worldliness" to a moderate "world-indifference" (56, p. 47,48), "the world", though still anathema, is a millenarian prerequisite: it must exist to show how evil it is. Simultaneously, as a consequence of some adverse effects of blood transfu­sion the Society is eager to quote assenting opinions from the hostile external world. And, ironically, even apostate members, actively engaged in opposing the sect, still abhor blood transfusion. As one stated:

Most Witnesses can forgive adultery, smoking, bad business practices, and above all drunkenness, but they find it virtually impossible to forgive the ban on blood and apostasy. (...) the idea of taking blood is still dreadfully abhorrent to me. I know how an orthodox Jew must feel when asked to eat pork or shellfish (59).

It is highly improbable that the Society will quote this phrase, in particular the source, in its magazines. After all, the ultimate enemy is needed for contrast, not consent.

  Acknowledgements.

  A condensed version of this paper was read at the 1989 Annual Meeting of the Association for the Sociology of Religion, San Francisco, USA. The author extends his gratitude to his colleagues at the Dept. of Anthropology, in particular to Walter van Beek.

  References

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2.      Wilson B.R. Sects and Society p. 128,129. Heinemann, London, 1961

3.      Numbers R.L. and Sawyer R.C. Medicine and Christianity in the Modern World. In Health/Medicine and The Faith Traditions (Edited by Marty M.E. and Vaux K.L.), p. 153. Fortress Press, Philadelphia, 1982

4.      Redlener I.E. and Scott C.S. Incompatibles of Professional and Religious Ideology: Problems of Medical Management and Outcome in a case of Pediatric Meningitis. Soc. Sci. Med. 13B, 89-93, 1979

5.      Douma J. and Velema W.H. Polio: Afwachten of Afweren. Bolland, Amsterdam, 1979

6.      The Watchtower, July 1, 1945

38.    For example, it is assumed that a relationship exists between the administering of donor blood during cancer surgery and the tumor's metastasis. Ned. T. Geneesk. 131, 1255-1257, 1987.

39.    Awake!, Apr. 22, 1986; Oct. 8, 1988 Dutch ed.

40.    Weinberger M. et al. The Development of Physician Norms in the United States. The Treatment of Jehovah's Witness Patients. Soc. Sci. Med. 16, 1719-1723, 1982

41.    Levin J.S. & Vanderpool H.Y. Is Frequent Religious Really Conducive to Better Health?: Toward an Epidemiology of Religion. Soc. Sci. Med. 24, 596, 1987

42.    Organized to Accomplish Our Ministry p. 190-191 WBTS, New York, 1983 Dutch ed.

43.    Kanter R.M. Commitment and Social Organization: A Study of Commitment Mechanisms in Utopian Communities. Am. Sociol. Rev., 33, 500, 1968

44.    Jarvis G.K. and Northcott H.C. Religion and Differences in Morbidity and Mortality. Soc. Sci. Med. 25, 819, 1987

45.    Roux J. Blood. In The Encyclopedia of Religion Vol. 2, p. 254

46.    Östör A. Concepts of Person: Kinship, Caste and Marriage in India p. 13-15 Harvard University Press, Cambridge MA, 1982

47.    Saunders J.B. A Conceptual History of Transplantation. In Transplantation (Edited by Najarian J.S. & Simmons R.L.) p. 11 Urban & Schwarzenberg, Munich, 1972

48.    The Watchtower, Apr 1, 1951, p. 99 Dutch ed.

49.    Awake!, Aug. 8, 1950

50.    One wonders if there is any relationship between these remarks and the opposition of the residents of Jeruzalem's orthodox quarter Mea Shearim against a governmental anti-poliomyelitis vaccination campaign, as shown by a picture in a Dutch newspaper in October 1988. According to several scholars on Chassidism, there is no foundation in the Mosaic Law whatsoever justifying this protest.

51.    Douglas M. Implicit Meanings. Essays in Anthropology, p.55 Routledge & Kegan Paul, London, 1975

52.    Caplan L. Introduction. In Studies in Religious Fundamentalism (Edited by Caplan L.) p. 15 MacMillan, London, 1987

53.    Borhek J.T. and Curtis R.F. A Sociology of Belief p. 99 Wiley, New York, 1975.

54.    To mention one example: Stark R. and Bainbridge W.S. The Future of Religion ch. 14. University of California Press, Berkeley, 1985

55.    Cohn W. Jehovah's Witnesses as a Proletarian Movement. The American Scholar, 24, 283, 1955

56.    Beckford J.A. The Trumpet of Prophecy. A Sociological Study of Jehovah's Witnesses, p. 56 Basil Blackwell, Oxford, 1975

57.    Singelenberg R. "It Separated the Wheat from the Chaff": The "1975" Prophecy and its Impact among Dutch Jehovah's Witnesses. Sociological Analysis 50, 23-40, 1989

59.    Penton, personal communication

© Richard Singelenberg. May not be reprinted without permission.