When Your Mind's Eye Goes Dark: The Mystery of Acquired Aphantasia

Imagine waking up one morning and discovering you can no longer picture anything in your mind. You try to visualize your child's face, recall a favorite vacation, or mentally rehearse a golf swing—but there's nothing. Just blackness. This isn't blindness or dementia. Your mind is simply unable to create mental images anymore. This rare and bewildering condition is called aphantasia, and while some people are born with it, a 62-year-old cancer patient recently experienced something even more unusual: he acquired it suddenly during a hospital stay, and doctors had to solve the puzzle of why.

The case presented in this research paper marks the first time physicians have documented acquired aphantasia developing after an autologous stem cell transplant—a aggressive but potentially life-saving cancer treatment. The patient had refractory multiple myeloma, a blood cancer that wasn't responding to standard therapy, so doctors gave him extremely high doses of chemotherapy followed by a transplant of his own previously harvested stem cells to rebuild his immune system. It's a brutal but sometimes necessary procedure. However, his hospital course became complicated. He developed a serious bacterial infection, intestinal inflammation, a collapsed lung, and received multiple antibiotics—all within weeks of his treatment.

On Day 9 of his hospitalization, something strange happened. The patient reported that when he closed his eyes, he couldn't picture anything anymore. His mind was completely dark. When doctors tested him using the Modified Vividness of Visual Imagery Questionnaire, a standardized assessment where patients rate how well they can visualize different scenarios, he scored the absolute minimum. The diagnosis was clear: acquired aphantasia. But what caused it?

This is where the case becomes genuinely fascinating from a medical detective standpoint. The physicians identified several plausible culprits, each attacking the problem from a different angle. The high-dose chemotherapy drug melphalan itself can cause neurological side effects affecting memory and concentration—so perhaps the brain circuits responsible for mental imagery were damaged. Dimethylsulfoxide, the chemical used to preserve stem cells during storage and transport, has been known to trigger seizures and altered mental status in some patients, though this patient didn't show those dramatic symptoms. The multiple antibiotics—more than five different medications—disrupted his gut bacteria, and emerging research suggests that gut dysbiosis (the loss of beneficial bacteria) can impair brain function. Animal studies have shown that mice given multiple antibiotics for extended periods lose beneficial bacterial metabolites that support cognitive functions, leading to problems with image recognition.

But the physicians ultimately concluded that the most likely culprit was hypoxemic brain injury—essentially, his brain wasn't getting enough oxygen at a critical time. The patient had suffered both a pneumothorax (a collapsed lung) and sepsis (a life-threatening bloodstream infection), both of which prevent oxygen from reaching the brain effectively. Since both conditions developed around the same time his aphantasia appeared, the timing suggested these oxygen-starved moments might have damaged the specific brain regions responsible for creating mental imagery.

There was one more possibility worth mentioning: psychological trauma. The patient had endured an absolutely hellish hospital experience—life-threatening infections, ICU transfer, a collapsed lung requiring emergency intervention. He went from being bright and humorous to withdrawn and irritable. The stress alone might have triggered a functional, rather than physical, loss of mental imagery.

By his six-month follow-up visit, the patient showed mild improvement—his test score improved from 16 to 23—but his aphantasia persisted. He could occasionally perceive faint morphing shapes when closing his eyes, a small step forward from complete darkness. However, full recovery hadn't occurred.

The significance of this case extends beyond one patient's dramatic experience. Acquired aphantasia is extraordinarily rare, and this appears to be the first documented case connected to stem cell transplantation. The researchers acknowledged that the limited medical literature on aphantasia hampers our understanding of the condition and its causes. They recommended that future patients with suspected aphantasia should receive more extensive evaluation, including spinal fluid analysis, detailed brain imaging, EEGs, and functional MRI scans to pinpoint exactly which brain regions are affected.

This case reminds us that even in an era of advanced medicine, the human brain still guards many mysteries. Stem cell transplantation has revolutionized treatment for certain cancers, but it comes with risks that we're still working to understand. The question of how and why a person can lose the ability to create mental imagery—one of our most fundamental cognitive abilities—remains partly unanswered. What we do know is that the brain is fragile during periods of severe stress and illness, and sometimes the consequences of lifesaving treatment include unexpected neurological complications that challenge our understanding of how the mind works.

I cannot picture it in my mind: acquired aphantasia after autologous stem cell transplantation for multiple myeloma

Abstract

Authors

When Your Mind's Eye Goes Dark: The Mystery of Acquired Aphantasia

Joel Pearson

Merlin Monzel

Martin Reuter

Rebecca Keogh

Adam Zeman

Julia Simner

Juha Silvanto

Carla Dance

Zoë Pounder

Jianghao Liu