On the edge of consciousness

The Express Tribune explores what the human mind can experience while gasping for breath

Nabil Tahir/Rabeea Saleem January 16, 2022
Design: Mohsin Alam


In November, a video clip went viral on social media, which showed Sajid Ali Sadpara, the son of iconic Pakistani Mountaineer Ali Sadpara, being tied up in ropes, and brought down by his comrades during his expedition at Mount Everest in Kathmandu, Nepal. Sajid and French mountaineers were on the expedition to explore a new route from Base Camp one to Camp two.

The High Commission for Pakistan in Nepal then coordinated Air Rescue of Sajid Sadpara, who was said to be suffering from mental health conditions, from Everest Base Camp to Kathmandu. His condition most likely was due to a condition referred to as high altitude cerebral edema (HACE) , or brain swelling, caused by an increase of pressure in your head that may restrict blood flow and oxygen to the brain, resulting from the physiological effects of traveling to a high altitude.

According to Sajid, they planned to cover the two-day route in one day. “When we reached 5000m, I was left low on oxygen and started behaving abnormally. It didn’t hit me at once. I was getting normal and then abnormal again. The fellow climbers helped me in getting me back to the base camp,” he said.

Sajid, who has climbed multiple times, explaining the reason, told The Express Tribune that various factors contributed to his condition. “Smoking affects your climbing. It was my fault that I smoked before climbing. I am not a regular smoker but occasionally do. Then as we were used to the local Pakistani food, I could not digest the food that we got there. Then we gained height quickly and didn’t take the required rest to make it to the camp two in a day instead of two,” he said.

He said he faced a similar issue during his K2 expedition back in 2018. “That was not that intense, and this was the worst one. I was not acting normal until I got to the hospital and the treatment started,” said Sajid, who was admitted for five days before recovering and getting discharged to travel back to Pakistan.

He added that it was his luck that he faced this at the height of 5000m. If it had been above 8000m, then he might have lost his life. “When you reach above 8000m, there is not much energy left in you or your fellows to take you back down. You often get lost on the way back as your mind is not working properly, and you see different things that lead you to death,” said Sajid, who lost his father Ali Sadpara along with two of his companions during their winter summit of the mighty K2 in February 2021.

Brush with Hypoxia

In an appalling incident last week, 22 tourists lost their lives after being trapped overnight in a snowstorm-induced traffic jam in Murree. While most deaths might have been caused by hypothermia, carbon monoxide poisoning is another possibility. Carbon monoxide is an odourless gas which is produced by the incomplete combustion of carbon fuels, including inadequately ventilated heaters and car exhausts. CO poisoning causes hypoxia, cell damage, and death so many people probably died of suffocation in their cars from exhaust fumes generated by drivers running engines to keep warm.

A mountaineer and visual storyteller, Sa’ad Mohamed, shared his experience of having low oxygen at a high altitude, a condition medically referred to as high altitude Hypoxia, during a climb.

“You will be in the middle of snow at -20 degrees, but if your brain tells you that you are at home or at a beach, then you will start taking your clothes off and eventually die. This happens to a lot of climbers. The rational decision-making power is affected, and the person is not able to decide what is right for him and end up taking his life,” he told Express Tribune.

He added that when fatigue combines with hypoxia, the chances of psychosis being triggered are greater. Mohammed, while sharing his own experience said that when he was at the 7027m high peak Spantik, he made some mistakes that a climber should never make and was very close to taking his own life.

“I was with two other climbers during the ascent at Spantik and established a camp at 5050m. The camp was for two, but we slept with three people in it. After going to sleep at 8 pm, I woke up at 12 am as I was hungry. I made jelly and ate that. When I came back inside the camp, there was no space left for me, but I tried to fit in but didn’t have a good sleep,” he said.

“When we woke up and as I didn’t have my sleep and was tired so I began to say strange things that there should be a standard of climbing and all although it was my fault that I didn’t have a good sleep. Anyhow, we started climbing, and in the middle of the next camp, I slept on the rock. I had no idea where I just saw rock and slept on it. When I woke up, my nose was black with sunburn,” he shared.

The timings of ascent and descent are crucial. You have to make the summit push and then come back to the camp on time to avoid harsh climatic conditions. Mohammed and his partners went for the summit push from their camp three that they had established at 6000m. “We left for the summit at 12 am and faced a storm in the middle and reached the summit. We stayed there for about 30 minutes and then started the descent. Usually, the camp is established at 6300m, but we did at 6000m, so we had to travel extra, and in the middle we also lost the rope and the way back to the camp,” he said, adding that it was already 24 hours since they had left.

“So we decided to descend in the morning and stay the night. We had to dig and cover ourselves to control the temperature; otherwise, we would die in the storm,” said Mohammed, who at that time was struggling with extreme exhaustion and tiredness.

“When we were inside the camp in the middle of the snow, my brain was telling me that there are trees outside and I can go and take shelter under it. Whereas there are no trees after 3000m. At that time, if I had stepped out, I would have died,” said Mohammed, adding that the climber should never over exert himself or if the climber had faced some trauma before, then it becomes even more challenging to control the ramblings of his mind.

He also shared another incident during his first climb in 2006 at the 6000m Manglik Sar. He started climbing, and due to extreme exhaustion at the 5500m, had to turn back at the camp established at 4800m. Due to losing height rapidly, Mohammed was not able to keep himself sane.

“Inside the camp, I thought that the people who were with me misguided me, and the way up was from the other side. During the wait inside the camp, I heard the sounds that my brain wanted me to hear. I heard the sound of a 4 by 4 car outside the camp waiting for me to take me home. I was telling myself that these were just the sounds inside my brain. This happens when you are exhausted on the mountain in the presence of low oxygen and atmospheric pressure. It might seem like you are sitting inside your home and thinking why you are wearing these clothes and start to take them off. If I had opened the zip of the tent and seen a jeep outside, I would have been gone,” he said.

He further said that when the other climbers came back after the summit, the others usually congratulate them, but I was complaining that they didn’t do the right thing with me. “We then started going down. I couldn’t walk straight and then fell down at 4300m. A total blackout. I don’t remember what happened for a full 24 hours after that. The memory is lost. I was told that I was carried down to the base camp,” he said, adding that the climbers should never exhaust themselves and keep their oxygen levels stable.

From hallucinations to near death

Brain oxygen deprivation can result in hallucinations, delusions, and ‘near-death experiences.’ These experiences are due to oxygen deprivation and elevated levels of carbon dioxide — a gas that is toxic in high concentrations — in the blood. These near death experiences can include movement towards a bright light or a tunnel, feelings of peace and joy, and profoundly spiritual moments including witnessing a presence that is not there. Throughout history, there have been many accounts of this sensed presence in people who have reached the limits of human endurance.

Anthropologists and psychologists have realised that cultural expectations shape the way people pay attention to their sensory experience. These different patterns of attention may be responsible for differing experiences of psychosis and are referred to as the ‘cultural conditioning’ of hallucination experience. Cross-cultural studies have revealed that Muslim patients with psychosis would often have hallucinations related to jinn, ‘shaitan’ and religious beliefs. Rural Africans are more likely to hallucinate about ancestor worship; Christians are more likely to hallucinate about Christ, Mary, and Satan besides confirmed or questioned Church dogma. This indicates that the visions are quite vulnerable to expectations and suggestions.

The Third Man Factor

Another peculiar phenomenon reported throughout history is called the ‘Third Man Factor,’ which is the perception of a ‘sensed presence’ that appears to people who have reached the absolute limits of human endurance.

One of the earliest accounts is that of Ernest Shackleton's Antarctic expedition in 1916. The team's boat was trapped in ice and they were forced to make a grueling journey across mountain ranges and glaciers to a whaling station in Stromness Bay. Shackleton later wrote: "I know that during that long and racking march of thirty-six hours over the unnamed mountains and glaciers, it often seemed to me that we were four, not three."

Later, the poet T.S. Eliot read Shackleton's account of a mysterious ‘fourth’ man and took some poetic license with the idea, including it in his famous poem, The Waste Land. He turned Shackleton's fourth into a third — and this is where the phenomenon gets its name:

Who is the third who walks always beside you?

When I count, there are only you and I together

But when I look ahead up the white road

There is always another one walking beside you

Gliding wrapt in a brown mantle, hooded

I do not know whether a man or a woman

—But who is that on the other side of you?

Phantom companion

This sensed presence is a perceptual occurrence in people who are the edges of human endurance. In his book, The Third Man Factor, John Geiger documents this effect in mountain climbers, solo sailors and ultra endurance athletes. He lists conditions associated with it: monotony, darkness, barren landscapes, isolation, cold, injury, dehydration, hunger, fatigue and fear. Sleep deprivation is a commonly associated factor as well.

In 1933, British explorer Frank Smyth almost became the first person to reach the summit of Mount Everest. The journey to the top of the mountain was arduous and nearly disastrous; his entire hiking party had fallen back, unable to make it through the sweeping wind, snow, ice and low oxygen. Smyth continued, but never made it to the top — he missed it by 1,000 feet.

Eliot was struck by the idea, that “a party of explorers at the extremity of their strength, had the constant delusion that there was one more member than could actually be counted.”

Later, writing in his diary, Smyth described sensing a phantom companion that scientists commonly refer to as the "Third Man Factor." He recounted how at one point on the ascent, he reached into his pocket, pulled out a slab of Kendal mint cake, broke it in half and turned around to give the other half to a companion. But there was no one there: "All the time that I was climbing alone, I had a strong feeling that I was accompanied by a second person. The feeling was so strong that it completely eliminated all loneliness I might otherwise have felt."

This condition is largely reported by mountain climbers, solo sailors, survivors of shipwrecks, and polar explorers but the Third Man can appear elsewhere as well. Historically, this third presence intervenes at a critical point and acts as a guardian or saviour to give people that extra push to not give up.


The science behind it

Sensory deprivation or perceptual isolation occurs when there is an absence or reduction from one or more of the senses. When the outside world is cut away completely, the neuron receptors that pick up sensations from the world are closed, and another pathway opens to allow some sort of sensations to still make their way into the brain centers. Thus, the lack of stimulation causes imagined or unreal sensations to be projected into the subject's thoughts which may appear as hallucinations.

Most of the time this presence is observed in the state of delirium and is discounted as hallucination. Then how come are people able to hear such clear instructions given by these presences in moments where they need it the most? Some psychologists posit that this is the body’s fight and flight response with the survival mode kicking in.

The similarities between these experiences on mountains and their appearance in contemporary mountaineers suggest that exposure to altitude or extreme weather conditions might affect functional and neural mechanisms, manifesting in the experience of a presence. Different functions relying on brain areas such as the temporo-parietal junction and the prefrontal cortex have been suggested to be altered in altitude. Moreover, acute and chronic hypoxia significantly affect the temporo-parietal junction and the prefrontal cortex and both areas have also been linked to altered own body perceptions and mystical experiences.

Various factors associated with mountaineering like social isolation and extreme cold may also lead to prefrontal lobe dysfunctions such as low resistance to stress and loss of inhibition.

In laboratories, scientists have been able to elicit hallucinations by stimulating certain parts of the brain. Penfield reproduced such experiences by electrical stimulation of the temporal lobe cortex. We have found that similar hallucinatory experiences may arise from subcortical stimulation of the temporal lobe.

Divine intervention or survival instinct?

In all these stories, these presences did not have definite identities or personal import and did not communicate verbally. In most instances, the presences were imbued with some emotional quality, usually protective and guiding in nature. Since these abnormal experiences occurred beyond the range of sensory perception, Macdonald Critchley, a British neurologist, referred to them as extracampine hallucinations in his book Divine Banquet of the Brain. These hallucinations are defined as false perceptions that occur outside the limits of a person’s normal sensory field.

Since the syndrome was first clinically documented in the 1940s, psychologists have postulated various triggers and explanations ranging from coping mechanisms, perceptual disorders caused by sensory deprivation, extreme fatigue and boredom, to an evolutionary adaptation. Some people can perceive these presence as a benevolent being while for others it might provide them psychological comfort to give a boost in the survival stakes.

Sydney-based clinical psychologist Dr Lissa Johnson has successfully encouraged trauma victims to “cultivate inner characters,” lending imagined support and comfort through internal dialogue in times of need.

She says she finds it “very powerful in therapy”, but also sees a parallel with the third man syndrome, where the “psyche could rise to the occasion and fulfil a need for external assistance”. Instead of talking to oneself, Dr Johnson believes, “imagery is emotionally more powerful than language”.


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