After having met the “Third Man” on Putha Hiunchuli (in 2011)

I have experienced it myself. It happened in fall 2011 during my failed summit attempt on the 7,246-meter-high Putha Hiunchuli in western Nepal, somewhere above 7,000 meters. My teammates were out of reach, I was fighting my way up alone, physically and mentally at the limit. “Please!,” I suddenly heard Pemba Nuru, one of our two Climbing Sherpas, say behind me. “Please what?,” I asked and turned around. But nobody was there. Strange. Scientists call the phenomenon the “Third Man”. Descriptions of such hallucinations abound in expedition reports from the highest mountains in the world. Psychiatrists of the Medical University of Innsbruck and emergency physicians of the private research center “Eurac Research” in Bolzano have now examined about 80 such descriptions from alpine literature and discovered, according to their own information, a new disease: the “isolated high-altitude psychosis”.

Seven out of eight

So far, high altitude physicians have assumed that organic causes are responsible when altitude climbers suddenly see and hear people or perceive odors that are actually not there. The researchers from Austria and South Tyrol, however, found out that “there is a group of symptoms which are purely psychotic, that is, they are related to altitude but not to a high-altitude cerebral edema or other organic factors such as dehydration, infections or organic diseases”, explains Hermann Brugger, head of the Institute for Alpine Emergency Medicine in Bolzano. Brugger had found in an earlier study that seven out of eight world-class climbers who reached altitudes above 8,500 meters without bottled oxygen had hallucinatory experiences.

Almost jumped

Dhaulagiri

The good news of the new study: The pure psychoses in high altitude are only temporary and do not leave any consequential damage. The bad news: On the mountain, they can endanger the climbers. Thus the Slovene Iztok Tomazin, one of the authors of the study, describes a hallucination he himself had during a summit attempt on the eight-thousander Dhaulagiri in December 1987. Several (fancy) mountain guides had advised him to jump down the East Face telling him that in few seconds he would be on a flat, safe place 2,000 meters lower and this would solve all his problems. “I almost jumped and this would have meant death with a 100% chance,” writes Tomazin. But then he reflected and made a test: He jumped only two meters deep to a small ledge. The pain he suffered opened his eyes, that maybe it would not be such a good idea to jump down the whole wall.

Further research in Nepal

“There are probably unreported cases of accidents and deaths due to psychosis,” says emergency physician Brugger, adding that therefore it is important to inform extreme climbers about the possibility that hallucinations can occur. In addition, they should be given strategies on how to deal with the “Third Man” without being endangered, says Katharina Hüfner, psychiatrist at the Medical University of Innsbruck. Next spring, the scientists want to continue their research along with Nepalese doctors in the Himalayas. Among other things, they want to find out how often these psychoses occur at high altitude. “The highest mountains in the world are incredibly beautiful,” says Hermann Burger. “We just did not know that they can drive us mad.”