Trigger Warning: This story contains content about suicide.
I suffer from mental illness, specifically depression, panic, and anxiety. All were well managed until the fall of 2021 when I experienced six weeks of the worst bout of acute panic and anxiety of my life. During this event, I also suffered from intrusive thoughts, which had never happened to me before. I was both surprised and terrified, as I didn’t think you could have intrusive thoughts without imagery. I was wrong.
How Can You Have Intrusive Thoughts Without Imagery?
Like myself, many people with aphantasia—the inability to visualize or create mental images—often get asked, “If you can’t visualize, how do you even think?” I was asked a similar question about having intrusive thoughts. “You have aphantasia, right? So how can you have intrusive thoughts without imagery?” It seems implausible to visualizers to have thoughts, intrusive or otherwise, without imagery.
Believe me, we can.
I was in bed sleeping. I awoke with a start, already in a state of panic. This is called nocturnal panic. As if the symptoms weren’t bad enough: racing heart, rapid breathing, trembling, chills, sweats, etc., the inevitable sense of doom one feels during a panic attack turned into a litany of intrusive thoughts tumbling out of my psyche.
“This is never going to end.”
“If this doesn’t end, will I hurt myself?”
“How will I hurt myself? Will I kill myself?”
“I could end it all, you know. Just get up, go to the bathroom, and swallow all the pills.”
“Why are my hands shaking? Am I going insane?”
“Is this what insane feels like?”
“They’re going to have me committed.”
“I’ve hurt my family enough.”
… and so on. There was no visual component to these thoughts. In fact, I was sinking into a pitch-black abyss, with no light and no sound—other than the thoughts in my head. Loud. Insistent. Brutal. Convincing. Terrifying.
Just like aphantasics have memories without imagery, so, too, do we have intrusive thoughts without imagery. For memories, my experience is one of feeling versus seeing. During recalled events, I may feel happy, sad, joyful, gleeful, annoyed, angry, depressed, silly, etc. These may be accompanied by somatic (of or relating to the body) responses: tears of joy, tears of sadness, clenched jaw, furrowed brow, increased heart rate, light-headedness, smiling, frowning, etc.
An aphant can experience everything a visualizer can when it comes to memory recall. All that’s missing is the visual component.
The same holds true for intrusive thoughts without imagery.
Remember, I had just been awakened by panic, so I was already suffering the human brain’s autonomic response to perceived danger: racing heart, rapid breathing, trembling, chills, sweats, etc. On top of that, I felt doubt, shame, terror, guilt, weakness, despondency, and defeat, along with every imaginable somatic sensation that goes with it, just as a visualizer might. All that was missing was the visual component.
You Don’t Need Imagery to Experience Suicidal Ideation or Intrusive Thoughts
After a long recovery that included medication and 18 months of therapy, and having experienced thoughts of suicide in 2012, I wanted to better understand what I had been through and how it was different from my past experience.
As I’ve come to understand it, when thinking about self-harm or suicide, it’s considered suicidal ideation. These thoughts are cognitive insomuch as you know you’re thinking about them. Intrusive thoughts are almost involuntary and, most certainly, irrational. Despite how much I wanted to live, to get back to a normal, panic- and anxiety-free life, my psyche had other ideas. Remember I mentioned thoughts that came tumbling out? My thoughts were rapid-fire, disjointed, comprehensible noise.
“Is this what insane feels like?”
“Are they going to have me committed?”
These were very irrational thoughts.
Still, some of my intrusive thoughts had aspects of suicidal ideation, which can happen.
“How will I hurt myself? Will I kill myself?”
“I could end it all, you know. Just get up, go to the bathroom, and swallow all the pills.”
These thoughts were different from my experience in 2012. There was little to no cognition involved. Comprehension? Yes. Cognition? No. I understood what my thoughts were saying, but there was no forethought.
Thanks to my ever-supportive husband, I was able to pull myself out of both the panic and the intrusive thoughts that night.
I later came to understand and appreciate that regardless of the fact that I had intrusive thoughts without imagery, they were equally disturbing and disruptive to my well-being and needed just as much attention in the way of mental illness support.
Thoughts About Aphantasia and Mental Illness
My experience with acute panic in 2021 left me in a fragile, traumatic state. The triggers were varied, whereby I relived the experience many times during months of recovery, somatically and, oftentimes, through auditory imagery.
There is no hard and fast rule nor indisputable evidence that states people with aphantasia can’t or don’t experience disruptive symptoms—like intrusive thoughts—associated with mental illness. One need only Google “aphantasia and PTSD” to see this. Scientific studies show mixed results. See Aphantasia and psychological disorder: Current connections, defining the imagery deficit and future directions and Fewer intrusive memories in aphantasia: using the trauma film paradigm as a laboratory model of PTSD as examples. There are also a myriad of personal accounts of people who experience flashbacks and flashforwards, sometimes with, sometimes without imagery. In this regard, I believe people with aphantasia are no different from visualizers.
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If you or someone you know is thinking about suicide, please consult these Suicide Hotlines and Prevention Resources.
Feature image by Pavel Danilyuk on Pexels.com
Cascading Insights 
I think of my anxious thoughts in terms of “dominos” – one negative thought tends to set off another, which sets off another, and another… sometimes you have to say STOP. (Although sometimes easier said than done). Hope you’re travelling ok today. Linda x
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Hi Linda. That’s a great analogy – dominoes. Intrusive thoughts are very much like that. It’s so hard to reel them in once they start multiplying. It definitely helps to have some strategies. Are you a visualizer? Or do you have aphantasia, like me? Thanks for taking the time to comment. Liana
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I’m a trained architect and currently doing my PhD on metaphors – I would be in so much trouble if I couldn’t visualize things!! I can’t even imagine what it would be like for you!! Scary, and yet I’m somehow just a little fascinated… Linda x
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Hi Linda. Don’t underestimate the non-visualizers when it comes to vocations or studies that would otherwise be deemed unlikely or unfeasible for them. 😊 I know an aphant who studied ASL (American Sign Language) and became an ASL interpreter. Then there’s Disney animator Glen Keane, the Oscar-winning artist behind such Disney classics as The Little Mermaid (1989), was once described by as “one of the best animators in the history of hand-drawn animation.” No small feat when you can’t visualize. We aphants have strategies, some known to us, others not – our brains simply compensate – to overcome or sidestep the need to visualize. Me, for instance, I write fiction. I think in words, rather than pictures. To me, having pictures or video streaming images in my head all the time is scary. Still, it would be nice to have sometimes 😉
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You’re right, I apologise for making generalisations! Especially bad of me as I’m trying to advocate for more understanding for chronic pain people. Sometimes I think it’s the ‘compensation’ strategies that we utilise that are actually our secret super powers. Linda x
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No problem at all. 😊 We aphants often get questions like, “If you can’t visualize, how do you even think?” Well, obviously we think. 😏 It’s curiosity and openmindedness that’s the key. I LOVE that you said “super powers” because I didn’t realize I had them until I discovered I’m an aphant. 💪🏼 Is your reference to chronic pain with regard to migraines?
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Migraines are the thing that ‘stole’ everything for a couple of years – but I’m building myself back up. But there’s plenty of other glitchy things about my old bod, like a dodgy hip and a sore shoulder that won’t mend. The problem with pain-brains is they seem to get conditioned to seek it out everywhere, always 🙃 PS – glad you’ve figured out how to think – people – honestly! (I get “why do you always look so tired when you spend so long in bed?”) If you don’t laugh, you’ll cry! 🤣
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I can relate. Not with pain-brain (never heard that term before), but with the old bod. Thanks for sharing your insights with me. Liana
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Always welcome! xx
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A quite remarkable piece. I am an autism, and tried explaining the issues I had some years ago regarding a malfunction in my memory, recall—whole periods of my life and learning.
I was always able to access vast memory resources, cross-reference them and never really understood how it worked, because I didn’t really need to.
When my ability to SEE things—I think it’s trauma related, or despair— I found I couldn’t remember or recall or use, essentially a lifetime of work and learning which I thought would’ve been the type of long-term, embedded memory, safe from distortion or the type of short-term, throw-away stuff we lose every day.
But area I was considered expert in, seems out of reach. I recognise it if I come across it, but independently, it feels gone.
I don’t have the skills to organise my experience without intricate visual filing.
This is revelatory. A beautiful piece of writing. Thank you.
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Hi Just D. Thank you for taking the time to comment on my article about intrusive thoughts without imagery. I’m glad that it resonated with you in some way. Do you think you have aphantasia? Do your memories have visual components? Again, thank you for your feedback.
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I’ve never heard of it—the condition, yes. I’m pretty sure I remember Talia Lavin describing it. Everything I used to do was visual in nature, but it’s not something II thought about until it started to break. It’s something I ought to think about. I have a huge period of time which is blank, if I try to recall, beyond incoherent fragments and what is visual, feels recreated. I’ve spoken to doctors about it but it’s such an unusual feeling.
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