The Aphantasia is a special form of visual agnosia and corresponds to the complete inability to voluntarily call up visual images. The clinical picture is probably due to brain defects. So far there are no therapies.
What is Aphantasia?
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The subconscious and conscious of the person work through mental images. Visualization is a basic process of cognition. Cognitive visualization processes arise through a network of different brain regions, especially through the areas of the parietal, frontal, temporal and occipital lobes. For cognitive visualization, stored memories are crucial, which call the corresponding images into consciousness.
For example, if you read a novel, you usually see the situations described in your mind's eye. The ability to cognitive visualization is individual to a certain extent. The absolute inability to such a visualization and thus the complete absence of imagination 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.
The term was used by him to describe a hypothetical state. He was referring to the description of a 65-year-old man who allegedly lost his imagination after undergoing heart surgery. After Zeman's statements were published, more than 20 people who describe themselves as Aphantasia patients came forward.
causes
Adam Zeman and his colleagues have linked aphantasia to soul blindness or visual agnosia. This is a disruption in the processing of visual stimuli caused by damage to the visual center. This visual center is located in the occipital lobe and lets visual agnostics no longer recognize objects and faces, although they can see the objects clearly.
Most visual agnosia patients can at least roughly describe objects based on their visual memory. Patients of the hypothetical aphantasia would not be able to do this. Aphantasia would thus be a special form of visual agnosia and at the same time could be described as the most extreme type of soul blindness. The reason for the absolute inability to visualize is assumed by the first person to describe it as a serious defect in the brain regions involved.
It has not yet been clarified whether genetic factors such as hereditary mutations or external factors such as exposure to toxins favor absolute aphantasia. Some of the apparent Aphantasia patients reported having had the symptoms since birth. Others attributed the onset of the disease to a dramatically traumatic event in their life, such as the death of a loved one. The congenital form of Aphantasia probably differs so much from the acquired form that different diseases must be assumed.
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Aphantasia patients can see, but despite their ability to process stimuli visually, they have no ability to arbitrarily call up images from their visual memory or their cognitive imagination. This relationship means that those affected cannot visualize situations, objects or living beings on the basis of a pure description.
Some of the patients feel excluded from professions such as architecture because they cannot imagine the end product of the work. Many say that descriptive texts are fundamentally meaningless to them. Still others cannot remember the appearance of their partners or deceased family members and suffer greatly from this connection. Most of the patients are absolutely unable to relive moments they have already lived through in their imagination.
Often those affected describe a feeling of isolation and loneliness accompanied by symptoms. The night dreams do not seem to be affected by Aphantasia. Most of the patients say that they cannot just imagine what is thought. The visualization of what is thought corresponds to a conscious visualization. The visualization in the dream is a visualization of the subconscious. The apparent decoupling of unconscious and conscious visualization suggests that the cause of aphantasia is a defect in a brain area that is particularly active when awake.
diagnosis
So far, the medical history is the only means of diagnosing aphantasia. So far, the diagnosis can only be suspected. There are no diagnostic means. Since the anamnesis is based on subjective descriptions by the patient, an objective diagnosis is currently impossible.
Complications
As a rule, there are no special medical complications with aphantasia. Through the Aphantasia the patient cannot or only to a very limited extent imagine pictorial things and processes. Aphantasia can occur completely differently in many people, with this symptom there is no measure by which the severity can be defined.
Usually, the patient cannot visualize mental images or imagine events. This mostly leads to a limited ability to think. However, people with Aphantasia can lead a completely ordinary life with no other restrictions. They may not be able to perform certain artist professions or may not remember what happened very well.
Often those affected find it relatively difficult to describe events from the past. Aphantasia is largely unexplored, so there is no treatment for this symptom. It can be congenital or occur after an accident. With strong characteristics, spatial thinking and imagining is not easily possible.
In everyday life, this does not lead to any particular complications. Also, the life expectancy of people with aphantasia is no less than that of healthy people. In most cases, those affected are not aware that they are suffering from aphantasia.
When should you go to the doctor?
An aphantasia does not necessarily have to be clarified by a doctor. However, anyone who suspects they have no visual imagination should seek medical advice. Although there is still no effective treatment method, the lack of imagination can be compensated for by therapeutic measures. Whether this is necessary depends on whether it is a congenital or a developed aphantasia and how pronounced the phenomenon is.
Ultimately, the person concerned has to decide for himself whether and to what extent the Aphantasia reduces 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 doctor.
Possibly it is just a side effect of a certain drug or 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 person concerned can no longer learn properly or carry out the activities at work, medical advice is required.
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Treatment & Therapy
Since Aphantasia has so far been more of a hypothetical idea than an objectively real disease, there are no options for therapy so far. Causal therapies, for example, can only be developed once the causes have been clarified. Symptomatic therapies in Aphantasia would presumably include cognitive training that activates and promotes visual imagination. If a defect in the brain is actually causing the disease, such training could probably still relieve the symptoms.
Stroke patients are able to rehabilitate in spite of irreversible brain damage by getting healthy brain regions to take over tasks from the damaged regions by frequently repeating certain processes. According to this principle, Aphantasia patients could, for example, train daily visual memory of certain objects or faces under professional guidance.
Under certain circumstances, electrical stimulation of the defective brain region would also be considered as a therapy option. Since the aphantasia after a psychological trauma cannot be the same disease as the congenital or the physically conditioned aphantasia, these patients are probably treated in a completely different way. A processing of the triggering psychological trauma in psychotherapy can presumably remove the blockade of ideas for these patients.
Outlook & forecast
Aphantasia has an unfavorable prognosis. According to current scientific knowledge, the disease is neither treatable nor curable.
There is a defect in the brain tissue that cannot be repaired with current medical research results. Within some therapeutic approaches, there is also an increased risk that additional brain tissue will be damaged. This would lead to an immediate deterioration in the general welfare and trigger new disturbances or impairments. This threatens the patient with 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 there is no cure for this condition, 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 well-being, the sick person has psychotherapeutic approaches available.
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 sick person to achieve an improvement in the 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 fulfilled life despite impairments.
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Aphantasia cannot be prevented so far because research has not progressed far enough.
Aftercare
One goal of follow-up care is to prevent the disease from recurring. According to the current state of science, this cannot be done with an aphantasia. It is considered incurable. The cause is a defect in the brain tissue. This can be innate or caused by an accident.
Nevertheless, follow-up care can be useful to prevent complications and provide the patient with everyday support. In practice, the wish of the person concerned is decisive for this. Aphantasia is not a life-threatening disease. It is only advisable to see a doctor if the quality of life suffers.
The attending physician can order psychotherapy for this. This should 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 using introductory tests.
Those affected do comparatively poorly here compared to other test persons. In addition, subjective description is an essential diagnostic tool. So far, there are no clear and objective methods of determining this. Some scientists assume that electrical stimulation can treat brain areas positively. So far, however, this has been an experimental field.
You can do that yourself
Various online tests and diagnostic methods can be used if Aphantasia is suspected. If this shows that the imagination is actually severely restricted, a doctor must be consulted. He can determine whether it is a congenital or a psychological or disease-related aphantasia and suggest a suitable therapy.
In the case of an illness-related aphantasia, as it occurs in stroke patients, for example, the power of imagination can be strengthened by regularly repeating certain processes and thus raised to the original level in the long term. Additional exercises to strengthen visual memory and, more generally, the imagination can be performed under professional guidance or at home. 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 in lifestyle. A congenital phantasia must be accepted by those affected. Treatments such as cognitive training or electrical stimulation can likely relieve symptoms but not fully restore imagination. Dealing with the disease can be learned through appropriate specialist reading and discussions with specialist doctors.
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