Avi Ohry
Tel Aviv, Israel

In what may be justifiably described as the “third man factor syndrome,” some people may experience the hallucination that another person is present with them in the room. The long-term war correspondent Sebastian Junger described such a phenomenon when, during an emergency surgery for a ruptured aneurysm, he had imagined that his long deceased father was with him during the entire operation so that he was never alone.¹

I had a similar experience as a prisoner of war for five weeks in an Egyptian jail, which I have described in The Lancet^2,3:

…enduring isolation, deprivation, hunger, thirst, long sleepless periods, interrogations, and mock executions. The single most unforgettable event of that time was [hallucinating] being visited by my new wife and my closest friend from medical school. I vividly remember how suddenly they “disappeared” when the guard-interrogator arrived, and could not understand how they managed to enter the jail safely and how they escaped.²

The eminent British neurologist MacDonald Critchley called the phenomenon “the idea of a presence,”⁴ which I continued to explore:

After repatriation to Israel, I began to read about my experience. In Critchley’s 1979 article, one can find Eliot’s poem and a full description of “the idea of a presence”, with its differential diagnosis. Our research on the late effects of captivity broadened our understanding of the psychological and physiological aspects of this extreme situation.

Most probably, Alexander Selkirk (1676–1721), who was immortalized in Daniel Defoe’s Robinson Crusoe, had experienced such a “presence” while being alone for more than four years.²

Later, I and other collaborators wrote⁵:

Guided by the notion that people search for compensation in lack of companionship, we scrutinized testimonies of former POWs for accounts of hallucinatory experiences. A narrative analysis was utilized in an attempt to understand the meaning of the hallucinations for the POW. Findings reveal that benevolent figures and concomitant acts of care are exhibited in war captivity hallucinatory experiences. Thus, it is argued that the content of such hallucinations may be protective. These findings are discussed in light of the literature concerning peritraumatic dissociative experiences. In addition, attachment theory was suggested as a plausible framework for understanding these findings.

The Canadian geographer John Geiger interviewed me and other survivors of extreme situations about our “third man factor” experiences.⁶

Rarely, clinicians encounter a different kind of presence. I and others described⁷ a rare and peculiar “duplicate limb sensation” in a patient with acute traumatic tetraplegia. The possible causes were a petit mal seizure, drug side effects, altered drug metabolism, wishful thinking or a phantom-like phenomenon, sequelae of head injury, or the end result of sensory deprivation and cognitive malfunction after a long hospital stay.

 References

1. Egan E. Live from the brink of death. New York Times May 27, 2024: 13.
2. Ohry A. Extracampine hallucinations. Lancet 2003;361(9367):147.
3. Ohry A. Recollections of war and captivity. Lancet 2023;402(10417):206.
4. Critchley M. The idea of a presence. In: The divine banquet of the brain. New York: Raven Press, 1979.
5. Stein JY, Crompton L, Ohry A, Solomon Z. Attachment in detachment: The positive role of caregivers in POWs’ dissociative hallucinations. J Trauma Dissociation 2016;17(2):186-98. 
6. Geiger J. The Third Man Factor. Toronto: Viking Canada, 2009.
7. Ohry A, Gur S, Zeilig G. “Duplicate limbs” sensation in acute traumatic quadriplegia. Spinal Cord 1989;27(4):257-60.