Aphantasia is a special form of visual agnosia and corresponds to a complete inability to recall visual images at will. The clinical picture is thought to be due to brain defects. Therapies do not yet exist.
What is aphantasia?
The human subconscious and conscious mind work through mental imagery. Visualization is a basic process of cognition. Cognitive visualization processes arise through a network of different brain regions, such as primarily the areas of the parietal, frontal, temporal and occipital lobes. For cognitive visualization, stored memories are crucial, which call corresponding images into consciousness. For example, a person reading a novel usually sees the situations described in his or her mind’s eye. The ability for cognitive visualization is individual to a certain degree. The absolute inability to visualize in this way, and thus the complete absence of an imaginative faculty, is called aphantasia. Professor Adam Zeman of the University of Exeter Medical School introduced the term in 2015 as part of a study on soul blindness. He used the term to describe a hypothetical condition. He was referring to a 65-year-old man with the description who had allegedly lost his ability to imagine after undergoing heart surgery. After Zeman’s comments were published, more than 20 people came forward to describe themselves as having aphantasia.
Causes
Adam Zeman and his colleagues have linked aphantasia to soul blindness or visual agnosia. This is a disorder in the processing of visual stimuli caused by damage to the visual center. This visual center is located in the occipital lobe and causes visual agnostics to fail to recognize objects and faces, even though they can see the objects clearly. Most patients of visual agnosia can describe objects at least approximately based on their visual memory. Patients of hypothetical aphantasia would not be able to do so. Thus, aphantasia would be a special form of visual agnosia and at the same time could be described as the most extreme type of soul blindness. As a cause for the absolute inability to visual imagination, the first describers assume a serious defect in the brain regions involved. Whether genetic factors such as hereditary mutations or external factors such as exposure to poisons promote absolute aphantasia has not yet been determined. Some of the apparent aphantasia patients reported suffering from the symptoms since birth. Others attributed the onset of the disorder to a drastic traumatic event in their lives, such as the death of a loved one. It is likely further that the congenital form of aphantasia differs from the acquired form to the extent that different diseases must be assumed.
Symptoms, complaints, and signs
Patients of aphantasia can see but do not possess any ability to retrieve images from their visual memory or cognitive imagination at random, despite their ability to process visual stimuli. This relationship results in the inability of affected individuals to visualize situations, objects, or living things based purely on description. Some of the patients feel excluded from professions such as architecture because they cannot visualize the end product of the work. Many state that descriptive texts are fundamentally meaningless to them. Still others cannot remember the appearance of their partners or deceased family members and suffer greatly in this context. Most of the patients are absolutely unable to relive moments they have already lived through in their imagination. Often the affected persons describe accompanying symptoms of a feeling of isolation and loneliness. Nocturnal dreams do not seem to be affected by aphantasia. Most of the patients declare that they are only unable to imagine what they have thought. Visualization of thought corresponds to conscious visualization. Visualization in dreams is a visualization of the subconscious. The apparent uncoupling of unconscious and conscious visualization suggests as the cause of aphantasia a defect in an area of the brain that is particularly active in the waking state.
Diagnosis
To date, history is the only means of diagnosing aphantasia.So far, the diagnosis can only be made on suspicion. There are no means of confirming the diagnosis. Since the anamnesis is based on subjective descriptions by the patient, an objective diagnosis is currently impossible.
Complications
No particular medical complications usually occur with aphantasia. Aphantasia causes the patient to be unable to imagine pictorial things and processes, or to imagine them only to a very limited extent. Aphantasia can occur in many people in completely different ways; there is no measure by which the severity of this symptom can be defined. As a rule, the patient cannot visualize mental images or imagine events. This usually results in impaired thinking ability. However, people with aphantasia can lead a completely ordinary life without further limitations. They may not be able to perform certain artistic professions or remember events very well. Often, those affected also find it relatively difficult to describe events from the past. Aphantasia is largely unexplored, so there is no treatment option for this symptom. It can be congenital or occur after an accident. In severe manifestations, spatial thinking and imagining is not readily possible. In everyday life, this does not lead to any particular complications. Also, the life expectancy of people with aphantasia is not less than that of healthy people. In most cases, those affected are not aware that they are suffering from aphantasia.
When should you see a doctor?
Aphantasia does not necessarily need to be cleared by a doctor. However, those who suspect they have no figurative imagination should seek medical advice. Although there is no effective treatment method to date, therapeutic measures can compensate for the lack of imagination. Whether this is necessary depends on whether the aphantasia is congenital or developed and how pronounced the phenomenon is. Ultimately, the affected person must decide for himself whether and to what extent the aphantasia limits the quality of life. However, an initial consultation can remove uncertainties in dealing with the rare phenomenon and point out therapy options. Aphantasia after a stroke or other illness should be discussed with the responsible physician. It is possible that it is merely a side effect of a certain medication or that the aphantasia has psychological causes. A doctor should be consulted at the latest when the phenomenon affects the quality of life. For example, if the affected person can no longer reasonably learn or perform activities at work, medical advice is needed.
Treatment and therapy
Because aphantasia has so far been a hypothetical idea rather than an objectively real condition, no options for therapy exist to date. Only with clarification of the causes, for example, can causal therapies be developed. Symptomatic therapies for aphantasia would probably include cognitive training that activates and enhances visual imagination. If, in fact, a defect in the brain causes the condition, such training could still presumably alleviate symptoms. Stroke patients are capable of rehabilitation despite irreversible brain damage by getting healthy brain regions to take over tasks from damaged regions by repeating certain procedures frequently. Following this principle, aphantasia patients could, for example, train daily visual recall of certain objects or faces under professional guidance. In some circumstances, electrical stimulation of the defective brain region would also be considered as a therapeutic option. Since aphantasia following psychological trauma may not be the same condition as congenital or physically induced aphantasia, these patients are likely to be treated in an entirely different way. Thus, reappraisal of the precipitating psychological trauma in psychotherapy can presumably unblock the imagination for these patients.
Prospect and prognosis
Aphantasia has an unfavorable prognosis. The condition is not treatable or curable according to current scientific knowledge. There is a defect in the brain tissue, which is not repairable with current medical research.Within some therapeutic approaches, there is additionally an increased risk that further brain tissue will be damaged. This would lead to an immediate deterioration in general well-being and trigger new disorders or impairments. Thus, the patient is at risk of a life-threatening condition. Without treatment or therapy, the physical state of health does not normally change. An increase in symptoms is therefore not to be expected in the course of further life. Since this condition cannot be cured, the treatment plan focuses on improving the sequelae of aphantasia. These mostly relate to the patient’s psyche. In order to maintain the zest for life and optimize the well-being, psychotherapeutic approaches are available to the sufferer. In therapy, the patient’s self-confidence is strengthened, cognitive patterns are questioned, and how to deal with the disease is discussed and trained. This helps the patient to achieve an improvement in quality of life in everyday life and to face the daily challenges more optimistically. With a mental strength, it is often possible to have a fulfilling life despite impairments.
Prevention
Aphantasia cannot be prevented so far because research on it is not advanced enough.
Aftercare
One goal of follow-up care is to prevent the recurrence of the disease. However, according to current scientific knowledge, this cannot be done in the case of aphantasia. It is not considered curable. The cause is a defect in the brain tissue. This can be congenital or result from an accident. Nevertheless, follow-up care can be useful to prevent complications and to provide the patient with everyday support. In practice, the wish of the affected person is decisive for this. Aphantasia is not a life-threatening condition. Only if the quality of life suffers, the way to the doctor is advisable. The treating physician can order psychotherapy for this purpose. This is intended to provide cognitive support in everyday life. Self-confidence can also be strengthened in this way. According to current scientific knowledge, drug treatment is not effective. Aphantasia is diagnosed by means of performance tests. Aphantasia sufferers perform comparatively poorly here compared to other test persons. In addition, subjective description is an important diagnostic tool. So far, there are no clear and objective methods for diagnosis. Some scientists assume that electrostimulation can positively treat brain areas. However, this is an experimental field to date.
Here’s what you can do yourself
If aphantasia is suspected, various online tests and diagnostic methods can be consulted. If this reveals that the imagination is indeed severely limited, a doctor must be consulted. He or she can determine whether the aphantasia is congenital or caused by a mental illness or disease and suggest a suitable therapy. In the case of disease-related aphantasia, such as occurs in stroke patients, the imagination can be strengthened by regularly repeating certain sequences and thus, in the long term, restored to its original level. Under professional guidance or at home, further exercises can be performed to strengthen visual memory and, more generally, the imagination. In the case of psychologically induced aphantasia, the triggering psychological trauma must be treated within psychotherapy. Possible self-measures include a change of environment or a change of lifestyle. Congenital phantasia must be accepted by the affected person. Treatment measures such as cognitive training or electrical stimulation are likely to alleviate symptoms, but may not fully restore imagination. Coping with the disorder can be learned, for example, through appropriate specialist reading and discussions with specialists.
