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David Luke Department of Psychology, Social Work and Counselling University of Greenwich, London, UKPhone: +44 208 3319957 E-mail: d.p.luke@gre.ac.uk

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In a recent article in this journal, Dos Santos et al. (2018) report a case of ayahuasca use by a man with aphantasia. This account is the first such report of the use of a psychedelic agent by someone with aphantasia. Surprisingly, the case, SE, reported an improvement in their visual imagery following one particular instance of ayahuasca use. In support of Dos Santos et al.’s (2018) favored psychological explanation for improvement and their suggestion that SE’s aphantasia was acquired rather than congenital, this letter reports on a case study of an individual with apparent congenital aphantasia who has experienced no visual imagery, despite reported having excessively smoked N,N-dimethyltryptamine. It is proposed that the theoretical distinction between acquired and congenital aphantasia be further explored with regard to the use of psychedelics. In addition, further research with psychedelics should include self-report measures that can index aphantasia, such as the Vividness of Visual Imagery Questionnaire, as well as behavioral tasks, such as those measuring binocular rivalry.

Abstract

In a recent article in this journal, Dos Santos et al. (2018) report a case of ayahuasca use by a man with aphantasia. This account is the first such report of the use of a psychedelic agent by someone with aphantasia. Surprisingly, the case, SE, reported an improvement in their visual imagery following one particular instance of ayahuasca use. In support of Dos Santos et al.’s (2018) favored psychological explanation for improvement and their suggestion that SE’s aphantasia was acquired rather than congenital, this letter reports on a case study of an individual with apparent congenital aphantasia who has experienced no visual imagery, despite reported having excessively smoked N,N-dimethyltryptamine. It is proposed that the theoretical distinction between acquired and congenital aphantasia be further explored with regard to the use of psychedelics. In addition, further research with psychedelics should include self-report measures that can index aphantasia, such as the Vividness of Visual Imagery Questionnaire, as well as behavioral tasks, such as those measuring binocular rivalry.

In a recent article in this journal, Dos Santos, Enyart, Carlos Bouso, Pares, and Hallak (2018) report a case of ayahuasca use by a man with aphantasia, a condition characterized by reduced, or in this case, absence of visual mental imagery (Zeman, Dewar, & Della Sala, 2015). This account is the first such report of the use of a psychedelic agent by someone with aphantasia. Surprisingly, the case, SE, reported an improvement in their visual imagery following one particular instance of ayahuasca use in which vivid internal (i.e., with eyes closed) visual imagery of a personal emotional nature was experienced. Furthermore, SE believed that the visual imagery apparently induced by the ayahuasca was related to a psychologically difficult period in his childhood when his father had left, and that this childhood experience was possibly related to his aphantasia. Strikingly, SE further claimed that the ayahuasca experience had enabled him to experience visual imagery, albeit minimally. The authors posit as their favored explanation that SE’s aphantasia is psychological in origin, thereby suggesting that it qualifies as a form of blindsight or perhaps a functional neurological disorder, and that it was remedied through ayahuasca use by the emotional resolution of his psychological concerns regarding his father.

In support of Dos Santos et al.’s (2018) favored psychological explanation and their suggestion that SE’s aphantasia was acquired rather than congenital, this letter reports on a case study of an individual with apparent congenital aphantasia who has experienced no visual imagery, despite reporting having excessively smoked N,N-dimethyltryptamine (DMT) – typically considered to be the most imagery-inducing chemical component of ayahuasca (e.g., McKenna, 2004).

During the course of conducting ongoing experimental field research with experienced DMT users in London, the present author encountered Humphrey Earwicker (HE, a pseudonym), a 39-year-old male, who had self-diagnosed himself with aphantasia aged 19 having read Aldous Huxley’s The Doors of Perception, and identifying with Huxley’s own aphantasia. Extraordinarily, HE had reportedly used DMT over 1,000 times since 2013 (most often in the form of changa, at various doses). It is possible that HE’s extensive use of DMT is attributable in part to the lack of visual mental imagery he experiences when taking the otherwise highly imagery-inducing drug and possibly the reduced concomitant intensity of the drug.

As part of the field research, HE vaporized and inhaled 55 mg of what looked and smelled like plant-extracted DMT (his own supply) and apparently had a full “breakthrough” DMT experience in the presence of the author and his research assistants. He reported an experience with a maximum intensity of 10 on a scale of 1–10 (from normal state to the most intense) for the initial period of a 10-min psychedelic experience, conforming to a typical breakthrough dose as identified by ongoing laboratory research with injected DMT (Timmermann et al., 2018) and field-based research by the author (currently incomplete) with inhaled vaporized DMT. The author has little doubt that this was a full DMT breakthrough experience as HE immediately reported exotic mystical phenomena, extreme intensity, and the encounter with (unseen in this case) numinous entities during the experience, consistent with high-dose DMT experiences (Strassman, 2001; Strassman, Qualls, Uhlenhuth, & Kellner, 1994). However, as with HE’s ordinary and prior DMT-induced mental phenomena, he did not experience visual imagery, although he experiences other DMT-induced mental phenomena (such as sensed presence, awe, somatic bliss, semantic associations, depersonalization, etc.).

Following the DMT experience, HE was interviewed about his aphantasia and administered the Vividness of Visual Imagery Questionnaire (VVIQ; Zeman et al., 2015) and scored the lowest possible value of 16 (out of a range of 16–80) qualifying him as having “no visual imagery,” as compared to SE who scored 30 (“minimal imagery”) following his ayahuasca experience, but whom previously had also scored 16. Unlike the case of SE, HE reports that his aphantasia was lifelong and that he had never experienced visual mental imagery, including in dreams, even during his earliest childhood. These findings cumulatively suggest that HE’s condition is congenital (see also Zeman et al., 2015), not psychologically or otherwise acquired. Indeed, Dos Santos et al.’s (2018) case of “treatable” aphantasia appears to be novel in the literature on aphantasia, and probably belongs to the classification of acquired (Bartolomeo, 2002; de Vito & Bartolomeo, 2016; Zago et al., 2011) rather than congenital aphantasia.

Notwithstanding the possibility that HE’s aphantasia is functional (psychogenic) but that his extensive and intense psychedelic experiences have not led to its reversal, I propose that his aphantasia has lifelong biological origins and is not susceptible to change even after ingesting extremely potent psychedelic agents such as DMT on multiple occasions. By contrast, SE’s aphantasia, not being lifelong and apparently at least partially reversible, appears to be functional and therefore susceptible to changes via the use of DMT (in ayahuasca), probably through an at least partial psychological resolution of the inducing childhood trauma. That SE’s first adult experience of visual imagery was coupled by an engagement with the childhood experiences that possibly precipitated his aphantasia and led to his reduction of the syndrome further attests to this supposition.

It is proposed that the theoretical distinction between acquired and congenital aphantasia be further explored with regard to the use of psychedelics. In addition, further research with psychedelics should include self-report measures that can index aphantasia, such as the VVIQ, as well as behavioral tasks, such as those measuring binocular rivalry, which appear to be able to distinguish those with and without aphantasia (Keogh & Pearson, 2017). Furthermore, neuroimaging comparisons of those with suspected acquired and congenital aphantasia might also prove insightful.

Conflict of interest

The author declares no conflict of interest.

References

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  • McKenna, D. (2004). Clinical investigations of the therapeutic potential of ayahuasca: Rationale and regulatory challenges. Pharmacology and Therapeutics, 102(2), 111129. doi:10.1016/j.pharmthera.2004.03.002

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  • Strassman, R. (2001). DMT: The spirit molecule. Rochester, VT: Park Street Press.

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    • Search Google Scholar
    • Export Citation
  • Zeman, A. , Dewar, M. , & Della Sala, S. (2015). Lives without imagery – Congenital aphantasia. Cortex, 73, 378380. doi:10.1016/j.cortex.2015.05.019

    • Search Google Scholar
    • Export Citation
  • Bartolomeo, P. (2002). The relationship between visual perception and visual mental imagery: A reappraisal of the neuropsychological evidence. Cortex, 38(3), 357378. doi:10.1016/S0010-9452(08)70665-8

    • Search Google Scholar
    • Export Citation
  • de Vito, S. , & Bartolomeo, P. (2016). Refusing to imagine? On the possibility of psychogenic aphantasia. A commentary on Zeman et al. (2015). Cortex, 74, 334335. doi:10.1016/j.cortex.2015.06.013

    • Search Google Scholar
    • Export Citation
  • Dos Santos, R. G. , Enyart, S. , Carlos Bouso, J. , Pares, O. , & Hallak, J. E. C. (2018). “Ayahuasca turned on my mind’s eye”: Enhanced visual imagery after ayahuasca intake in a man with “blind imagination” (aphantasia). Journal of Psychedelic Studies, 2(2), 14. doi:10.1556/2054.2018.008

    • Search Google Scholar
    • Export Citation
  • Keogh, R. , & Pearson, J. (2017). The blind mind: No sensory visual imagery in aphantasia. Cortex, 105, 5360. doi:10.1016/j.cortex.2017.10.012

    • Search Google Scholar
    • Export Citation
  • McKenna, D. (2004). Clinical investigations of the therapeutic potential of ayahuasca: Rationale and regulatory challenges. Pharmacology and Therapeutics, 102(2), 111129. doi:10.1016/j.pharmthera.2004.03.002

    • Search Google Scholar
    • Export Citation
  • Strassman, R. (2001). DMT: The spirit molecule. Rochester, VT: Park Street Press.

  • Strassman, R. J. , Qualls, C. R. , Uhlenhuth, E. H. , & Kellner, R. (1994). Dose response study of N,N-dimethyltryptamine in humans. II. Subjective effects and preliminary results of a new rating scale. Archives of General Psychiatry, 51(2), 98108. doi:10.1001/archpsyc.1994.03950020022002

    • Search Google Scholar
    • Export Citation
  • Timmermann, C. , Roseman, L. , Williams, L. , Erritzoe, D. , Martial, C. , Cassol, H. , Laureys, S. , Nutt, D. , & Carhart-Harris, R. (2018). DMT models the near-death experience. Frontiers in Psychology, 9, 1424. doi:10.3389/fpsyg.2018.01424

    • Search Google Scholar
    • Export Citation
  • Zago, S. , Allegri, N. , Cristoffanini, M. , Ferrucci, R. , Porta, M. , & Priori, A. (2011). Is the Charcot and Bernard case (1883) of loss of visual imagery really based on neurological impairment? Cognitive Neuropsychiatry, 16(6), 481504. doi:10.1080/13546805.2011.556024

    • Search Google Scholar
    • Export Citation
  • Zeman, A. , Dewar, M. , & Della Sala, S. (2015). Lives without imagery – Congenital aphantasia. Cortex, 73, 378380. doi:10.1016/j.cortex.2015.05.019

    • Search Google Scholar
    • Export Citation
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226
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Scopus
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0,9
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2020  
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Journal of Psychedelic Studies
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