imaginal neglect

When Dr. Paulo Barolo first encountered patients in Rome over 30 years ago who couldn't describe the left side of familiar places from memory, he stumbled upon a mystery that would define his career. These weren't people with damaged memories - they were patients whose brains had somehow lost access to half their mental images, revealing something profound about how visualization actually works in the human mind.

Today, as a researcher at the prestigious Paris Brain Institute, Barolo's work bridges the gap between rare neurological cases and the millions of people worldwide who experience aphantasia - the inability to form mental images. His discoveries challenge everything we thought we knew about the "mind's eye" and offer new hope for understanding consciousness itself.

The Patients Who Forgot Half Their Memories

It started with a condition called "representational neglect" - patients with right hemisphere strokes who would bump into objects on their left, ignore food on the left side of their plates, and remarkably, omit left-sided details when describing familiar places from memory.

The classic case involved Milanese patients describing the famous Piazza del Duomo, the square surrounding Milan's cathedral.

"They forgot to mention all the left-sided details from memory," Barolo explains, even though these were places they'd known intimately before their strokes.

But here's where it gets interesting. When Barolo studied similar patients in Rome, he discovered something the Milan researchers had missed:

"Only a minority of patients with visual spatial neglect also have neglect in their visual mental imagery - only about a third of them."

This meant the explanation couldn't be as simple as losing the left part of mental space. Something more complex was happening.

The Control Experiment That Changed Everything

The breakthrough came through an elegant experiment. Researchers asked patients to imagine standing in the same familiar square but from the opposite direction - as if they'd just exited the cathedral instead of approaching it.

The results were startling:

"The patient said to describe what they described before but now they forgot to describe what they had described before - the former right part which was now the left part of their mental image."

This proved the memories were intact.

"It shows that the information, the memory, is still present but not perceptible," Barolo notes. "Information is there but it is not accessed in a fashion to permit explicit description."

The implications were profound: these patients hadn't lost their memories - they'd lost access to them from certain mental perspectives.

From Rome to Paris: The Patient Who Saw Everything Differently

Moving to Paris 30 years ago, Barolo encountered another case that would reshape his understanding of mental imagery. A patient had suffered two symmetrical strokes affecting the pathways between early and high-level vision.

The damage was devastating: she couldn't recognize objects (agnosia), saw the world in shades of gray (achromatopsia), couldn't recognize faces (prosopagnosia), and couldn't read (alexia).

Yet something extraordinary remained intact.

"Despite all these deficits, she had perfectly preserved visual mental imagery," Barolo recalls. When asked which red was darker between cherries and strawberries, "she could very well picture cherries and strawberries, visualize cherries and strawberries in her head. She told me that she could see very clearly in her mind cherries and strawberries."

This single case shattered the dominant theory of mental imagery.

The Great Imagery Debate

For decades, psychologists had battled over how mental imagery works. Steven Kosslyn at Harvard argued that mental images were built in the brain "exactly like real visual images starting from V1" - the primary visual cortex. This quasi-visual processing gave mental images their visual character.

Zenon Pylyshyn disagreed, arguing that "everything in the brain is symbolic, it's not pictorial" - that mental imagery relied on propositional, symbolic, non-pictorial code.

Barolo's patient proved both were partially wrong.

"We know that her primary visual cortex was disconnected from more anterior stages of processing," yet "her visual mental imagery was perfect. She must have used different brain structures than the primary visual cortex to visualize her mental images."

The 7 Tesla Revolution

To settle the debate definitively, Barolo's team at Paris performed something unprecedented: ultra-high-field 7 Tesla fMRI studies of mental imagery with "unmatched resolution to visualize the living human brain."

Their meta-analysis of all previous neuroimaging studies, combined with their own high-resolution scans, revealed the truth:

"Early visual cortex is not used at all during this kind of test - the tests of visual mental imagery."

But imagery wasn't purely symbolic either.

"We did see high-level visual regions, more anterior in the temporal lobe, which were activated by this kind of questions."

Mental imagery uses late, high-level vision - not early vision.

The Aphantasia Connection: Same Brain, Different Experience

When Barolo's team studied people with aphantasia using the same 7 Tesla technology, they made a surprising discovery. Asking questions like "which red is darker between strawberries and cherries," they found aphantasic individuals could answer just as easily as typical visualizers.

"We were actually surprised to find that people with aphantasia could answer easily this kind of questions," Barolo admits.

Even more intriguingly, brain scans showed aphantasic people activated "exactly or more or less exactly the same brain network" as typical imagers when processing visual questions.

The difference wasn't in which brain regions activated - it was in how they coordinated.

The Connectivity Problem

Using functional connectivity analysis - examining how different brain regions activate together over time - Barolo's team uncovered the key difference.

In typical visualizers, "frontal parietal networks high in the brain which are important for working memory and for attention, they tend to activate together" with high-level visual areas. Their activation patterns were temporally correlated.

In aphantasic individuals, "we saw the same activations - frontoparietal plus temporal - but they were apparently not correlated temporally."

Barolo's interpretation:

"Perhaps aphantasic individuals use less efficiently their attentional network to read out activity in high-level visual cortex, so that this activity - it is there, it can access information, but it doesn't reach a conscious level of processing."

The Two Types of Aphantasia

This research revealed a crucial distinction that had been overlooked: the difference between congenital and aquired aphantasia.

People born with aphantasia can still answer questions about visual properties of objects from memory. But stroke patients who lose their visual imagery abilities "cannot answer this kind of questions - they do not know."

"This is a very important difference between congenital aphantasia, which is not a disease absolutely - it's just a normal variation, probably variation in the normal functioning of the brain - and neurological, lesion-based aphantasia where there is a clear deficit."

The Spectrum of Mental Experience

Barolo's work reveals that mental imagery exists on a spectrum, "like most human cognitive abilities." He envisions "a Gaussian distribution with an average at the center" where most people cluster, "and then the extremes which are less frequent."

This applies across all senses too. While some people experience aphantasia across all modalities, others maintain rich auditory or other sensory imagination while lacking visual imagery.

"There have been dissociation described in the literature of patients who could not imagine, for example, the visual form of letters and words but could very well imagine all the other - faces, colors, spatial relationships."

The Mystery of Imaginal Neglect

One of Barolo's most intriguing hypotheses remains untested: whether people with less vivid mental imagery or aphantasia might be protected from imaginal neglect.

"Perhaps people with less vivid mental images or people with aphantasia would be less liable to show signs of imaginal neglect," he theorizes, because "right-sided visual mental images are able to capture patient attention so that the patient cannot go towards the left side of their mental images."

If true, this would mean people with aphantasia have a natural protection against certain types of attention-related disorders - their different brain connectivity conferring unexpected advantages.

The Future: Can We Change Mental Imagery?

Perhaps most exciting for people with aphantasia, Barolo believes the connectivity differences his team discovered might be modifiable.

"If it is a functional connectivity problem, then theoretically it is possible to influence brain connectivity." He suggests several approaches: transcranial magnetic stimulation, neurofeedback, or even real-time fMRI feedback.

"We can record your electrical activity in the brain and give you some feedback - a bar which goes up or down - according to the modifications of your activity. That way you could be able to change your brain activity by following the bar."

The goal would be "to increase the functional connectivity, the temporal correlation between frontal parietal activation and activity lower in the brain, and see whether this can perhaps bring some mental images to consciousness."

The Window to Consciousness

For Barolo, aphantasia research addresses one of neuroscience's biggest questions: "the brain basis of consciousness, conscious experience."

"Two individuals with more or less the same performance, same cognitive performance, have very different subjective experiences. How is that possible?" This remains "the big question of aphantasia in general."

He believes "aphantasia could be a window to understand why we all have different subjective experiences and perhaps how to modulate them."

What This Means for Understanding the Mind

Barolo's decades of research reveal that the brain's approach to mental imagery is far more complex and varied than anyone imagined. The same information can be accessed through different neural pathways, leading to vastly different conscious experiences.

For people with aphantasia, this research offers both validation and hope. Your brains aren't broken - they're accessing the same visual information through different neural routes. The knowledge is there; it's just not reaching consciousness in the same way.

More broadly, Barolo's work suggests that consciousness itself might be more fragile and variable than we assume. The difference between experiencing a vivid mental image and accessing the same information without imagery might be as simple as whether certain brain networks synchronize their activity.

As neuroscience continues probing the mysteries of consciousness, researchers like Paulo Barolo are revealing that our inner mental worlds are far stranger, more varied, and more malleable than we ever dreamed. The mind's eye, it turns out, is just one window into the vast landscape of human consciousness - and it's a window that not everyone needs to see clearly through.

Same Brain, Different Reality: The Neuroscience Behind Aphantasia's Hidden Mechanisms