Could Aphantasia, A Newly Recognized Condition Of A Blind Mind’s Eye, Have Psychological Roots?

Try to picture a sunrise, the beach, or the ocean. Seems easy, right? But this is impossible for people who have a rare condition of absent voluntary imagery — they are unable to picture things in their mind’s eye. The condition was recently named “aphantasia,” the opposite of “phantasia” – the classical Greek term for imagination.

Most of the few people who have been identified by scientists to have aphantasia seem to have been born with it, and researchers hope to use neuroimaging to find clues in the brains of those affected. But in a new commentary, two researchers suggest that a psychogenic form of the condition may exist as well.

The first case that eventually led to recognizing aphantasia was actually in a man who acquired it following a routine procedure to have his clogged heart arteries treated. In 2005, the 65-year-old building inspector went to see Adam Zeman, a neurologist at the University of Exeter Medical School in the UK, to discuss the sudden, unusual problem. The man, referred to as MX, had lost his ability to generate visual images following the heart treatment. His imagination had become “blind.” Even his dreams had lost their visual content.

MX’s subjective report was corroborated by evidence from fMRI scans that showed activation in his visual brain areas was markedly lower than that of control subjects during mental imagery. Zeman and his colleagues reported the case in 2010.

After the case was covered in the popular press, 21 people with similar symptoms contacted the authors of the original paper. But, unlike in the case of MX, the imagery impairment in those people was congenital. They were born with a blind mind’s eye.

A survey of this group of people showed that their experiences were indeed similar, suggesting that aphantasia, still unnamed at the time, was a true condition.

In the new commentary published last week in Cortex, other researchers pointed out that an acquired form of the condition has also been observed in populations of patients with psychiatric symptoms. They suggest that, while some cases of the condition may stem from brain injuries, other instances may have psychological roots. In such cases, “loss of visual imagery accompanies dissociative disorders often associated with anxiety and depression,” said commentary co-author Stefania de Vito, of Université Pierre et Marie Curie in Paris.

For example, as de Vito and her colleague noted, in 1906, Portuguese neurologist António de Sousa Magalhães e Lemos described a case of the condition in a woman with a history of recurring hysterical crises as well as symptoms of anxiety and depression. In another case, French neurologist Jules Cotard described two patients with severe anxiety and depression, who also lost the ability to conjure mental images. One of them even developed what is now known as Cotard delusion, which caused him to believe he was dead.

In 1883, a report in Le Progrès Médical described the case of Monsieur X, who experienced loss of imagery that at the time was attributed to a hypothetical circumscribed cerebral lesion. But they noted that, around the onset of his disorder, he also experienced symptoms of mental alienation. “I observed a drastic change in my existence that obviously mirrored a remarkable change in my personality. Before I used to be emotional, enthusiastic with a prolific imagination; today I am calm, cold and I lost my imagination,” the patient wrote to the authors of his case report. Interestingly, Freud, who personally examined Monsieur X suspected that he had neurosis, point out the authors of the new commentary.

In 1898, the French philosopher Ludovic Dugas reported a case of depersonalization, whose onset coincided with the occurrence of inability to visualize an absent person. And, in 1960, the Italian psychiatrist Gian Carlo Reda described four people whose loss of visual imagery occurred in the context of anxiety attacks, depression and depersonalization.

The authors of the new commentary therefore propose there may be two categories of patients with acquired loss of imagery: those whose condition has an organic, neurogenic basis, and those with its functional form, one related to psychological factors. A third category, in which organic and functional factors overlap, is also possible.

“Therefore, an impairment of the ‘mind’s eye’ may be linked to heterogeneous variables, which need to be properly kept into account in future investigations,” the researchers wrote. “Cases of ‘aphantasia’ should receive not only neuropsychological and neuroimagery assessments, but also psychopathological examination.”


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