Strange tales of the mind 1: Double Trouble and the Harbinger of Death
Imagine for a moment reader, that you awaken one bright morning and as your eyes slowly acclimatise to the intrusive glare and warmth of the sun, a familiar figure stares down at you. With mounting horror you see that the alien figure bears every resemblance to your own self. With the slightest of efforts you can switch between the self which is currently lying down still adjusting to this apparent nightmare, and trade places with the figure who stands over the bed…brace yourself for heautoscopy!
There is a quote from the Sherlock Holmes stories which we may want to bear in mind for this strange tale —
“life is infinitely stranger than anything which the mind of man could invent.”
There are no truer words to go along with this strange tale of a man who meets his disembodied self.
Patient M and a brief overview of his medical history
To begin, is to start at the beginning, and in this patient’s case we need to start at age 15 (Brugger at al, 1994). That is when the seizures began, that is when he would lose control and whatever he had been holding in his right hand would drop to the floor. Accompanying these episodes M also experienced bouts of deja vu usually about twice a day. These seizures initially termed ‘complex focal seizures’ are now known as ‘focal onset impaired awareness seizures’ (epilepsy.com, 2022) which is quite a mouthful.
Some characteristics of these seizures include:
1. Typically last 1 to 2 mins
2. May include automatisms “lip smacking, picking at clothes, fumbling”
3. Occurs in one side of the brain
The 15-year-old M (M my own patient nomination) (Brugger et al, 1994) had to suffer these seizures up to three times a day, and things seemed to worsen with age. At age 17, M was found to have a lesion within an area of the brain called the mesiobasal temporal lobe. This was a tumour and was surgically removed. Prior to this the patient had been receiving anti-convulsant drugs to try and suppress the debilitating seizures.
Meeting the Spectre
M had suspended taking phenytoin (an anti-seizure medication) and had been drinking beer during the morning when the heautoscopic incident occurred. M wasn’t to be found until the evening, dazed and confused he had a startling narrative for the doctors who were to treat him.
M had gotten out of bed, but had been seized by a spell of dizziness. Stumbling, M turned around and glanced at the still sleeping figure of himself. Anger took control, knowing that if he couldn’t wake himself, he would be late for work. In M’s words:
“this guy who I knew was myself and who would not get up and thus risked being late at work”
Dread provoked the strongest reaction and M took to yelling at himself which still lay within the seductive comfort of slumber. Seeing no reaction just enraged M further, and he became convinced that the only way to awaken the idle alter ego was to submit to more drastic measures. Yelling gave way to shaking and finally to vigorous jumping upon the still dozing figure.
During this period of ranting, a grotesque fancy took hold. M frequently felt himself changing places with the figure of himself lying within the comfortable confines of the bed. A terrible schism was occurring; a terrifying fantasy and splitting of the self into two distinctive and physical forms. If M could switch so effortlessly between the two forms of himself, it raised the natural question as to which one was in fact the real him? The two forms were uniform in personality and temperament, neither could be associated with distinctive personalities and thus was not a form of the enigmatic disorder DID (disassociative disorder). Rather, it appeared to be two physical forms which were separated, and it was the mind of M which found it impossible to decide within which shell to find permanent residence.
When M’s mind returned to the abode of the figure lying within the bed, he felt himself to be perfectly awake, only paralysed not only by physical considerations but also by the mortal dread provoked by the beating inflicted by the other self which stood over him.
Reader — what would you do? Your sense of self is called into question. Two selves at war, each clamouring for the unification of the whole. What is there to be done, when a crack appears within the sense of self, and one falls prey to the disembodied self?
M made a choice…there could only be one way to unify the fractured self. One way to secure the tethering of each individual body back under the ownership of one mind.
The window, the world of reality lay beyond the entrapments of the bedroom, M knew what he had to do. If the figure in the bed would not unify itself to his body, he would scare it into action or else force unification by leaping out of the window. One way or another the waking nightmare had to come to an end.
In M’s words:
“this really desperate action would frighten the one in bed and thus urge him to merge with me again”
The next thing M remembered was waking up in pain within the sanctuary of the hospital bed.
Heautoscopy
The medical and psychiatric term ‘heautoscopy’ finds its etymology from two Greek words meaning ‘itself’ and ‘viewing’ or ‘observation’ (Wikitionary, 2022). Research finds that this is a condition where epilepsy has a “parietal or temporal foci” meaning that the the seizures have their origin point within the parietal or temporal lobes of the brain.
Perhaps the worst facet of heautoscopy is the overwhelming sense of despair which can accompany the experience. The authors hypothesise that this is due to an hyperactivation of the limbic region of the brain. This strange feature of heautoscopy and the oft terrible morose feelings which accompany the experience, may explain its representing a harbinger of death in folklore. Suicide is not unknown to be related to these grotesque episodes.
A final word
The line between madness and sanity is but a fine and delicate strand of cotton upon which we all walk. At any moment, tumours, infections and seizures threaten to rob us not only of the relationships we cultivate but the very sense of a safe and secure self which we too often take for granted.
Empathy is a quality of placing ourselves within the life and experiences of another. It is a temporary sacrificing of ourselves to understand the motivations and the perspective of someone else. Cases like these, are not just fodder for idle curiosity. If we approach carefully this story, we find M has a lot to teach us about the nature of self, its loss and subsequent rebirth. There are lessons here, to love and respect the struggles that another person endures, not just because it’s the right thing to do — but that we acknowledge that nothing divides us but a fine strand of cotton that may break from beneath our feet at any moment.
References:
Brugger P, Agosti R, Regard M, et al (1994) [PDF] ‘Heautoscopy, epilepsy, and suicide’ in The Journal of Neurology, Neurosurgery, and Psychiatry available at: https://jnnp.bmj.com/content/jnnp/57/7/838.full.pdf (Accessed 22/03/2022)
Epilepsy (complex focal seizures): ‘Focal Onset Impaired Awareness Seizures (complex partial seizures)’ [Online] available from: https://www.epilepsy.com/learn/types-seizures/focal-onset-impaired-awareness-seizures-aka-complex-partial-seizures (Accessed: 22/03/2022)
Heautoscopy etymology: ‘heautoscopy’ Available at: https://en.wiktionary.org/wiki/heautoscopy (Accessed: 22/03/2022)
