The 12 O'Clock High Syndrome is from encountering something that interferes with, or conflicts with the player's sub. That would generally be an AI sub that still has any "player" parts on it. You do not have to "see" that sub, only that it is within rendering range (roughly just beyond the horizon). It is also possible to induce any one of a number of maladies upon yourself at just about anytime though, if you do much shelling out to Windows - computer resources and game scenario dependent, of course...
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