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
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