The silent companions

In Moby Dick, Herman Melville wrote:

'At last I must have fallen into a troubled nightmare of a doze; and slowly waking from it – half steeped in dreams – I opened my eyes, and the before sunlit room was now wrapped in outer darkness. Instantly I felt a shock running through all my frame; nothing was to be seen, and nothing was to be heard; but a supernatural hand seemed placed in mine. My arm hung over the counterpane, and the nameless, unimaginable, silent form or phantom, to which the hand belonged, seemed closely seated by my bed-side… I knew not how this consciousness at last glided away from me; but waking in the morning, I shudderingly remembered it all, and for days and weeks and months afterwards I lost myself in confounding attempts to explain the mystery. Nay, to this very hour, I often puzzle myself with it.'

Someone is there; at your side, or just behind you. A feeling of a person or agency, without being heard or seen. It is a felt presence, one of the most unusual experiences a person can have, and yet also a feeling that will be familiar to many. Sometimes referred to as sensed presences or extracampine hallucinations, such experiences are described in a wide variety of sources and contexts, including survival situations, bereavement, sleep paralysis, and neurological disorder.

In the above passage, Melville describes a felt presence on waking from sleep. A range of unusual experiences occur in the no-man's land between sleep and waking, usually including short bursts of speech or visions in the transition to sleep (hypnagogic hallucinations) or fragments from dreams on awakening (hypnopompic hallucinations) (Jones et al., 2009). Felt presences in particular are a common feature of sleep paralysis. This is a phenomenon that will occur to one third of the population at some point in their lives (Cheyne & Girard, 2007; see also tinyurl.com/jscf0809), in which the awakening from sleep is accompanied by muscle paralysis and breathing problems. During paralysis many people describe the intense feeling of someone or something being in the room, often with a distinct location, occasionally moving towards them, in some cases pushing down on the person's chest, and provoking a strong sense of dread. Folk accounts of visits by demon-like nightmares, incubi and succubi are thought to derive from such sleep paralysis experiences (Adler, 2011).

More benevolent presences are also reported, however, with perhaps the most common examples coming from people who have recently been bereaved. In a review last year, Castelnovo and colleagues (2015) reported that up to 60 per cent of cases of bereavement are associated with some kind of hallucinatory experience, of which 32–52 per cent were felt presences. Strong feelings of loved ones still being present are often described in the first month of bereavement, but they can in some cases persist for many years. In contrast to sleep paralysis, the presence experienced is typically associated with comfort and longing rather than any sort of malevolent intent.

Similarly benevolent experiences are also reported by people in extreme survival situations. Known collectively as 'Third Man' experiences (see box, over), accounts of guiding or accompanying presences in polar treks, mountaineering expeditions, sea accidents and natural disasters are numerous. The presences described are usually human-like, close by and feel like they share an affinity with the person experiencing them. Occasionally they are associated with sounds or words (Geiger, 2010, p126), or vague visions, such as a shadow or outline, but more commonly such presences are described without any sensory correlates. Like other presence experiences, though, the Third Man usually takes up a distinct spatial location, in some cases appearing to lead those in peril to safety.

The other common contexts in which presences occur are various neurological and psychiatric diseases, such as Parkinson's disease (PD) and Lewy body dementia, and following traumatic brain injury. Sensations of presence are a frequent feature of PD with one recent study reporting a 50 per cent prevalence rate (Wood et al., 2015). Presence experiences in PD are usually experienced without particular affect or intent, and they are reported as being felt alongside or just behind the patient (Fénelon et al., 2011). They are sometimes referred to as extracampine hallucinations, although strictly these refer to subtly different phenomena; following Bleuler (1903), extracampine hallucinations refer to unusual sensory experiences that go beyond the possible sensory frame; for example, one might describe seeing something occur behind you, or feeling a distant object move over your skin. Sensed presences, in contrast, are usually defined as having no clear sensory phenomenology (Sato & Berrios, 2003) and yet still feeling like a perceptual state (as opposed to a belief about someone being present, for example).

What's going on?

Despite coming from such different contexts, the overlapping phenomenology of presence experiences raises the intriguing question of whether some underlying cognitive and neurological mechanisms may unite their occurrence. There are broadly three main hypotheses that attempt to explain felt presence: body-mapping, threat, and social representation (see Cheyne, 2011, for a review).  

The most common interpretation of presence experiences is that they represent some kind of disruption to the internal mapping of one's own body. Along with presence experiences, survival scenarios are associated with a variety of autoscopic phenomena, such as out-of-body experiences or seeing one's own doppelganger. Given that felt presences in such situations often feel like they are linked to the person having the experience, it has been suggested that they may be a projection of one's own body-map, prompted by extreme conditions and stress (Brugger et al., 1997).

This idea is supported by evidence from neuropsychology and neurostimulation. Presence and autoscopic experiences can follow damage to a range of brain regions, but are often prompted by lesions to areas associated with interoception and body position, such as insular cortex and the temporoparietal junction (TPJ) (Blanke et al., 2008). The experience of a close-by presence can also be elicited by electrical stimulation to the TPJ, suggesting a key role for that region in the representation of presence (Arzy et al., 2006).

One thing that a body-mapping account misses out is the role of affect in presence experiences. In particular, presences during sleep paralysis are experienced as strongly negative phenomena, prompting fear and distress in the sleeper and involving the perception that the entity in the room has untoward intent. Based on this, Cheyne and colleagues (e.g. Cheyne & Girard, 2007) have argued that sleep paralysis presences in particular may result from the mistaken detection of threat in the environment. Specifically, they suggest that the experience of waking while paralysed, and the continuation of REM-state brain activity related to dreaming, prompts a threat-activated vigilance system that provides the feeling of malevolent presence.

Finally, Nielsen (2007) and Fénelon et al. (2011) have described the experience of presences as a social hallucination (i.e. a kind of pure perception of social agency, divorced from its ordinary sensory correlates such as a face or voice). While presences vary in body position and emotional affect, they very often feel like they have a specific identity with its own agency (irrespective of whether that identity is actually known to the perceiver), suggesting the involvement of social-cognitive processes. Fénelon et al. (2011) argue for this by pointing to the common occurrence of presences with known and familiar identities in PD, which in many cases will be people who have just left a scene (what they term 'palinparousia'). Similarly, in presences following bereavement, the persisting identity of the perception is a clearly crucial part of the experience.

Of these three explanations, the body-mapping theory has perhaps the most evidence to date, but accounts emphasising the social, agentic and affective elements of presences are also likely to be crucial. Understanding how comforting presences can occur in grief while terrifying presences haunt sleep paralysis will depend on further examination of what drives such vivid alterations and dissociations to the mappings of self and other. And in addition to this, each may also have something to say about another unusual phenomenon: hearing voices.

'Sometimes you just know he's there'

Hearing the Voice is an interdisciplinary research project at Durham University funded by the Wellcome Trust. It was created in 2012 with the aim of investigating the phenomenology of hearing voices that no one else can hear (sometimes known as auditory verbal hallucinations). At one of its first research meetings, a voice-hearer, Adam, described the voice that he heard in the following way: 'You know, sometimes he doesn't even have to say anything; sometimes you just know he's there'. That is, the 'voice' that Adam often heard speaking could somehow be perceived, even when it was silent; as if it had an identity or agency that could be present without its 'usual' sensory form as a heard object.

Interpreting the phenomenology of this apparently paradoxical experience has to be done carefully. Voices without sound do in fact have a long psychiatric history – Bleuler (1911/1950) made reference to such 'soundless voices' in his original descriptions of hallucinations – but usually these denote specifically verbal or linguistic experiences that lack an auditory phenomenology. Instead, Adam's description of a voice-identity, that just happened to be silent, seems closer to Nielsen's (2007) idea of a purely social representation: in other words, a felt presence.

Although this kind of experience is not necessarily a frequent part of how voice-hearers describe their experience, it is also not a one-off. Anecdotally voice-hearers will talk about their voices being present without speaking, taking up spatial positions even when silent, and in some cases 'looking' at the world alongside the voice-hearer. In the Hearing the Voice phenomenology survey published last year (Woods et al., 2015), 69 per cent of a sample of 153 voice-hearers described their voices as being characterful or having a distinct personality, while 66 per cent associated their voices with unusual bodily sensations or changes. And in some cases, descriptions of presence were explicitly made:

I have never encountered anyone with as powerful a presence as my voices. They are loud and feel enormous. …They feel very much here when I hear them.

In these cases, the idea of a voice not just being an auditory experience, but also one with a social and agent-like presence becomes much more tangible (Alderson-Day & Fernyhough, in press).

Thinking about hearing voices in this way is not necessarily new. Bell (2013) and Wilkinson and Bell (2016) have argued for social representations being key to understanding how voices are experienced and persist over time; various psychotherapeutic approaches focus on the social relations that voices seem to create (e.g. Hayward et al., 2011), and the Hearing Voices Movement itself has long argued for an understanding of the experience that involves interaction with voices as meaningful entities.

What research on felt presence has to offer is a comparative perspective on how feelings of agency and accompaniment could come about in similar ways, albeit in very different scenarios. For example, the involvement of the TPJ in presence experiences overlaps with evidence from voice-hearing: the posterior section of the superior temporal gyrus, extending up into the TPJ area, is often implicated in fMRI studies of hallucination occurrence (Jardri et al., 2011); the TPJ is a target for neurostimulation in the treatment of problematic voices (Moseley et al., 2015); and there is evidence of resting connectivity differences in the same area in voice-hearers (Diederen et al., 2013).

The TPJ is a multimodal area that is both anatomically and functionally diverse, so clear overlaps between voice and presence experiences are yet to be established. Nevertheless, for such phenomenologically unusual experiences, any clues that may shed light on overlapping or similar cognitive and neurobiological mechanisms are important to consider. And feelings of presence arguably provide a wealth of such clues: understanding the Third Man provides a model for how one's own body could create the feeling of another; explanations of sleep paralysis highlight the role of negative affect and threat in driving unusual experiences; while the presences that follow bereavement provide examples of how identity without form can persist over time. Taken together, accounts of presence show us the 'others' that we carry with us at all times, the silent companions whose visits can either guide or haunt; support or confuse, comfort or terrify.

Box Text: Spirits, magnetic fields and extrasensory perception

Unusual feelings of presence have always been associated with similarly unusual or unorthodox interpretations. Some presence experiences appear to share qualities with the feeling (and subsequent discovery) of being stared at; a phenomenon argued to be a real faculty of perception by some (Sheldrake, 2005), but without any strong empirical basis (e.g. Colwell et al., 2000). Persinger and colleagues (e.g. Booth et al., 2005) have argued that felt presences can occur as a result of changes to the earth's magnetic field, although such effects seem likely to arise from participant suggestibility (Granqvist et al., 2005). Finally, some psychotherapists and spiritual healers consider presences to be evidence of an entity that must be persuaded to depart its host; a controversial approach known as 'spirit release' therapy (Powell, 2006).

Box Text: Shackleton's 'Third Man'

The 'Third Man' factor takes its name from The Waste Land by T.S. Eliot.  
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?

Eliot's description was based on his memory of reading about one of Ernest Shackleton's Antarctic expeditions. Referring to the lines in his notes on The Waste Land, he wrote 'it was related that the party of explorers, at the extremity of their strength, had the constant delusion that there was one more member than could actually be counted'.

While for the poem Eliot specifically chose two travellers and a companion, in fact the third man was number four: the story that Eliot recalled came from the experiences of Shackleton, Tom Crean and Frank Worsley when they crossed South Georgia during the Imperial Transantarctic Expedition in May 1916. Following the loss of the Endurance to pack ice, the expedition had decamped to the harsh and inhospitable Elephant Island. Shackleton and five others then crossed 800 miles of the Southern Ocean in an open lifeboat in an attempt to reach help for the rest of the crew, with Crean, Shackleton, and Worsley making the final journey across the interior of South Georgia itself. During their 36 hour trek to the north coast of the island, all three men were convinced that they were accompanied by a fourth on their journey. As put by Worsley: 'I again find myself counting our party – Shackleton, Crean, and I and – who was the other? Of course, there were only three, but it is strange that in mentally reviewing the crossing we should always think of a fourth, and then correct ourselves' (Thomson, 2000).

Meet the author

'This piece was developed from a Guardian article, 'The strange world of felt presences', that I wrote with David Smailes (Leeds Trinity University): see tinyurl.com/ozptw8e. I joined the Hearing the Voice project at Durham University three years ago, and through that I've been lucky to have the opportunity to speak to a number of voice-hearers and clinicians about what it's like to have the experience. One thing that kept coming up was a sense of many "voices" having a strong sense of character or identity – including, in some cases, a feeling of presence. This is important because it has implications for cognitive and neuroscientific research on voices – which has often focused more on speech and language – and reflects a number of popular therapeutic approaches to managing unpleasant voices. Since then I've been interested in exploring the ways in which unusual experiences might relate to inner speech, dialogue, and social cognition.'

Dr Ben Alderson-Day is a Research Associate in the Department of Psychology at Durham University
[email protected]

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