It is now thought that a substantial number—perhaps a third—of all cases of autoscopy may be associated with schizophrenia, and even cases of manifestly physical or organic origin may be sensitive to suggestion. T. R. Dening and German Berrios described a thirty-five-year-old man whose apparitions were related to temporal lobe seizures following a head injury. The man said that he had once seen his ties hanging up as a rack of snakes, but when asked whether he had any outright hallucinations or autoscopic experiences, he said no. A week later, he came in for another appointment in a state of some excitement, for he had now had an autoscopic experience:
He had been sitting in a café, when he was suddenly aware of an image of himself, about 15–20 yards away, looking in through the café window. The image was dark and looked like him at the age of nineteen (when his accident occurred). It did not speak and probably lasted for less than a minute. He felt amazed and uncomfortable, as though physically struck, and he felt he had to get up and leave. It is difficult not to suppose that the timing of this episode was influenced by the questions asked by the psychiatrist in the previous week.
While most examples of autoscopy are fairly brief, long-lasting autoscopy has also been recorded. Zamboni et al. provide a detailed description of this in a 2005 paper. Their patient, B.F., was a young woman who developed eclampsia in pregnancy and was comatose for two days. As she started to recover, it was evident that she was cortically blind and had a partial paralysis on both sides as well as an unawareness of her left side and of the left side of space, a hemi-neglect. With further recovery, her visual fields became full and she could discriminate color, but she was profoundly agnosic, unable to recognize objects or even shapes. At this stage, Zamboni et al. wrote, their patient first started seeing her own image as if reflected in a mirror, about a meter in front of her. The image was transparent, as though it were set “in a sheet of glass,” but a bit blurry. It was life-sized and consisted of a head and shoulders, though if she looked down, she could see its legs, too. It was always dressed exactly like her. It disappeared when she closed her eyes and reappeared the moment she opened them (although, as the novelty wore off, she was able to “forget” the image for hours at a time). She had no special feelings for the image and never attributed any thoughts or feelings or intentionality to it.
As B.F.’s agnosia disappeared, the mirror image gradually faded, and it had vanished entirely by six months after the original brain injury. Zamboni et al. suggested that the unusual persistence of this mirror image may have been associated with her severe visual loss, along with disturbances of multisensory integration (visual, tactile, proprioceptive, etc.) at higher levels, perhaps in the parietotemporal junction.
An even stranger and more complex form of hallucinating oneself occurs in “heautoscopy,” an extremely rare form of autoscopy where there is interaction between the person and his double; the interaction is occasionally amiable but more often hostile. Moreover, there may be deep bewilderment as to who is the “original” and who the “double,” for consciousness and sense of self tend to shift from one to the other. One may see the world first with one’s own eyes, then through the double’s eyes, and this can provoke the thought that he—the other—is the real person. The double is not construed as passively mirroring one’s posture and actions, as with autoscopy; the heautoscopic double can do, within limits, whatever it wants to (or it may lie still, doing nothing at all).
“Ordinary” autoscopy—such as Linnaeus and Lullin experienced—seems relatively benign; the hallucination is purely visual, a mirroring which appears only occasionally, has no pretensions to autonomy, no intentionality, and attempts no interactions. But the heautoscopic double, mocking or stealing one’s identity, may arouse feelings of fear and horror and provoke impulsive and desperate acts. In a 1994 paper, Brugger and his colleagues described such an episode in a young man with temporal lobe epilepsy:
