Phantom satellites, the smell of food, car noise: at high altitude, climbers' senses are often deceived by some strange illusion. Doctors consider these symptoms to be a special type of psychosis that occurs separately from the classic altitude sickness.
Phantom satellites, the smell of food, car noise: at high altitude, climbers' senses are often deceived by some strange illusion. Doctors consider these symptoms to be a special type of psychosis that occurs separately from the classic altitude sickness.
He appeared suddenly. As if out of nowhere. Jeremy Windsor exchanged a few encouraging words with a man who introduced himself as Jimmy, then walked slowly on. Here, at an altitude of 8200 meters, while climbing the southeastern slope of Mount Everest, there is no desire to waste oxygen on conversations. For the rest of the day, the American climber Windsor saw with the peripheral vision of his companion, always a few meters behind, behind his right shoulder. Later, during the descent, Jimmy disappeared as suddenly as he appeared. It was only when Windsor returned to the camp below that he realized that there really was no Jimmy.
“What Jeremy Windsor described in 2008 is typical,” says Katharina Hüfner, a neurologist and psychiatrist at the University Hospital Innsbruck. Together with Hermann Brugger, director of the Bolzano High Altitude Emergency Medicine Institute, she researched 83 reports from climbers. Scientists in Italy and Austria have studied descriptions of this phenomenon from the records of such great climbers as Hermann Buhl and Reinhold Messner, the testimony of the writer Jon Krakauer, and other lesser known climbers.
As climbers are “chased,” they begin to interact with imaginary people, hear the noise of cars or music, see colorful stars, or change their route to get to a mountain hut, which they think is in front of their eyes.
Until now, scientists have attributed hallucinations such as Jeremy Windsor's "third person syndrome" to organic causes, primarily the well-known and life-threatening cerebral edema caused by rapid ascent to altitude, as well as dehydration and infections. The first symptoms of acute altitude sickness are severe headache, dizziness, or imbalance. But in a good quarter of the reports now investigated, climbers described only psychosis without any accompanying physical symptoms.
“We found that there is a group of symptoms that are purely psychotic, which means they are related to height, but not related to cerebral edema or other organic factors,” explains Brugger. Innsbruck scientists call this phenomenon "isolated psychosis due to altitude." This new form of the disease usually manifests itself at an altitude of 7,000 meters, Hüfner continues, but it can develop at the “normal alpine” altitude of 4,000 meters.
After the study was published in the specialized journal Psychological Medicine, many climbers approached the authors. 52-year-old Italian mountaineer Sergio Zigliotto has also gained experience that confirms the scientists' thesis. “It was one in the morning. I just left the fourth camp at Manaslu, climbed about 200 meters and ended up at an altitude of 7600 meters, - he says. - Then I got the feeling that I was on a hike at home in Trentino. I saw the forest, then at home, just like those in my house. Then I even smelled of food, and I talked to someone in Italian about my frozen feet. " Although Zillotto was extremely emaciated, he did not show any painful physical manifestations. “There were definitely no signs of altitude sickness, just these visions,” he says. His fellow mountaineer had a similar experience in the same ascent at 7,500 meters, according to Zillotto. “He is from Tuscany and has seen the Tuscan hills. In the Himalayas! " For some time on the icy height his friend was "accompanied" by a dog.
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The authors of the study, 65-year-old Brugger and 41-year-old Hüfner, are avid climbers themselves. For many years, in conversations with friends such as the Italian extreme climber Hans Kammerlander, they heard about phenomena and hallucinations at high altitude. Then, during joint ski mountaineering in Tajikistan, they decided to conduct scientific episodic observations.
“As is often the case, the best ideas come over a beer by the campfire,” says Hüfner. First of all, the fact that the manifestations of psychosis completely disappeared during the descent and the climbers returned to the camp below physically healthy, made it clear that we could talk about a separate new disease not related to altitude. “The fact that the mountains are insanely beautiful, we both always knew, - continues Hermann Brugger, - but we did not know that they could plunge us into madness.”
The cause of high-altitude psychosis is unclear. “We have no confirmed data,” Brugger says. - Of course, factors such as lack of oxygen, cold, degree of fatigue and the climber's feeling that he was completely alone with himself can influence. It is important for future research that apparently no health consequences of this psychosis have been diagnosed. “This allows us to more accurately study temporary psychoses in otherwise perfectly healthy people,” says Katharina Hüfner. This can provide important information for understanding mental illnesses such as schizophrenia.
The results of the study are also important because they shed light on the unexplained causes of accidents in the mountains. It is clear that this syndrome increases the risk of an accident. For example, the famous Slovenian climber and doctor Iztok Tomazin reported a case that occurred in 1987 in the Himalayas, at the 8167 meter high Dhaulagiri peak. Thomasin recalls how, during the ascent, he left the route and heard the voices of the "guides" who urged him to jump off a sheer cliff 2,000 meters high in order to get to a "flat, safe surface." At the last second before the jump, the thought occurred to him: what if the guides are wrong? Then he made a test jump on a rock ledge located two meters below. Feeling the pain of the injury, he was able to correctly assess the situation, the "voices of the guides" fell silent,and he resumed his search for the correct route.
This is the practical value of the research. “Extreme climbers need to be aware that there is an isolated high-altitude psychosis, that it appears without any other signs of illness, and that it is temporary,” says Brugger. The number of unreported accidents and deaths associated with these cognitive impairments can be very high. Suddenly irrational and inexplicable erroneous actions of climbers at high altitude appear in a different light. “In order to reduce the number of accidents, it is very important to disseminate cognitive treatment strategies that climbers themselves or with a partner can apply directly in the mountains,” says Katharina Hüfner. This includes simple questions to ask your partner to test their perception of reality, for example:"Do you see this person too?" or "Do you hear what I hear?"
In May at Everest Base Camp, scientists want to work with several Nepalese doctors to examine numerous climbers before and after climbing the routes. The goal, among other things, is to find out how often the disease occurs, to collect the immediate impressions of the sick and to classify them.
Starting next year, it will be somewhat easier for mountain doctors to obtain data. In Bolzano, in early 2019, the Institute of High Altitude Emergency Medicine will open the terraXcube, the largest climate chamber in the world. Brugger is very enthusiastic about opportunities. “We will be able to place up to 15 people in the conditions prevailing in the death zone in the Himalayas: oxygen content as high as 8000 meters, minus 40 degrees, gusts of hurricane winds.” Then physicians in the laboratory can also simulate the conditions under which high-altitude psychosis occurs. “Let's bring madness to Bolzano,” says Brugger.
Stefan Wagner