Lost Soul hides behind Isaac's back, so shooting left will cause Lost Soul to be on your right side and vice versa.
Also, if Isaac is moving right but shooting left, then his hitbox will completely absorb Lost Soul's hitbox, making it significantly harder for enemies to hit it.
Lost Soul originates from the Antibirth mod. In Antibirth, multiple copies of the item would grant multiple familiars.
Bugs[ | ]
Bug!
If Lost Soul is killed before the segment with Mother's Shadow, it will respawn after Isaac returns to the normal floor.
Bug!
Swapping Lost Soul for another item as Tainted Isaac and picking it back up again will cause it to respawn if it died previously. This can also be accomplished with Butter!.