Revealing the Mind’s Eye: Bringing (Mental) Images Into Psychiatry
2012; American Psychiatric Association; Volume: 169; Issue: 12 Linguagem: Inglês
10.1176/appi.ajp.2012.12040499
ISSN1535-7228
AutoresMartina Di Simplicio, Josephine McInerney, Guy M. Goodwin, Mary-Jane Attenburrow, Emily A. Holmes,
Tópico(s)Psychotherapy Techniques and Applications
ResumoBack to table of contents Previous article Next article PerspectivesFull AccessRevealing the Mind's Eye: Bringing (Mental) Images Into PsychiatryMartina Di Simplicio, M.D., Ph.D., Josephine E. McInerney, Guy M. Goodwin, M.D., D.Phil., F.R.C.Psych., F.Med.Sci., Mary-Jane Attenburrow, M.D., F.R.C.Psych., and Emily A. Holmes, B.A., Ph.D., D.Clin.Martina Di Simplicio, M.D., Ph.D., Josephine E. McInerney, Guy M. Goodwin, M.D., D.Phil., F.R.C.Psych., F.Med.Sci., Mary-Jane Attenburrow, M.D., F.R.C.Psych., and Emily A. Holmes, B.A., Ph.D., D.Clin.Published Online:1 Dec 2012https://doi.org/10.1176/appi.ajp.2012.12040499AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Everything you can imagine is real.—Pablo PicassoMental images are part of every individual's internal world. We remember the past and simulate the future through them (1). Imagery is therefore inextricably linked to emotion, and paintings allow artists to communicate their emotional experience evocatively but often ambiguously, as in the image above by Josephine McInerney.Experiments have demonstrated that generating mental imagery elicits a greater emotional response than verbalizing the same material. This has been attributed to direct neural pathways connecting brain areas responsible for visual and emotional processing. The brain recruits the same regions when viewing either the real or the imagined world. So material that generates imagery can have an additional psychological impact, "as if" reality (2).Historically, clinical training in psychiatry is biased toward eliciting patients' verbalization of experience, rather than their mental imagery. Yet powerful and intrusive mental imagery, in the form of flashbacks, is a hallmark of posttraumatic stress disorder, and emotionally significant imagery is now recognized to be common in many other psychiatric disorders (3). Thus, intrusive images of the future, or flash-forwards, commonly accompany suicidality (4). Moreover, some diagnoses are more imagery-prone than others. Compelling mental imagery of the future is strongly associated with bipolar disorder and predicts interepisode mood instability (5). The extension of the bipolar diagnosis toward a spectrum disorder and its common comorbidity with anxiety, substance misuse, and impulse control problems (6) imply a much wider potential significance for imagery in psychopathology than is currently understood.Images are often ambiguous: the same mental image can unfold to reveal a scenario of disaster or victory, and mood will follow the image's changes. Using words explicitly to accompany mental images can disambiguate them in order to construct helpful meanings. Adopting this approach, Josephine McInerney transposes mental imagery in her drawings and at the same time helps illustrate how mental states can change. For example, if a blue circle represents sadness and a red shape represents excitement, an alternative image can be developed that alters the prominence of either raw emotion. Thus, the blue can be "caged" or the red image "shrunk" mentally: controlling the mental picture provides a functional tool to regulate mood, so that "the blue circle is remaining small and out of the way" (as shown in the figure). To "imagine positively" may be more effective for many individuals than trying to "think positively" by using words.There are currently not enough "images in psychiatry," in either clinical assessment or treatment. For example, checking the presence of suicidal flash-forwards, not just "suicidal ideation," could aid the risk assessment of bipolar patients in crisis (4). If, as we believe, our clinical focus is too much on what can only be spoken, we disregard a crucial aspect of many individuals' internal world and a cognitive process critically linked to dysfunctional emotions.Opening our eyes to the mind's eye could cast light on psychopathological mechanisms underlying emotional disorder and offer us new instruments for treatment.Drawings are from the series Ward Southern Comfort by Josephine Ellen McInerney (2011, work on paper), Warneford Hospital, Oxford, U.K.From the Department of Psychiatry, University of Oxford, Oxford, U.K.; and the MRC Cognition and Brain Sciences Unit, Cambridge, U.K. Ms. McInerney is an artist in Oxford.Address correspondence to Dr. Di Simplicio (martina.disimplicio@psych.ox.ac.uk).Dr. Holmes is also supported by a Wellcome Trust Clinical Fellowship (WT088217), the Lupina Foundation, and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre based at Oxford University Hospitals Trust Oxford University. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health.References1 Schacter DL, Addis DR, Buckner RL: Remembering the past to imagine the future: the prospective brain. Nat Rev Neurosci 2007; 8:657–661Crossref, Medline, Google Scholar2 Kosslyn SM, Ganis G, Thompson WL: Neural foundations of imagery. Nat Rev Neurosci 2001; 2:635–642Crossref, Medline, Google Scholar3 Holmes EA, Mathews A: Mental imagery in emotion and emotional disorders. Clin Psychol Rev 2010; 30:349–362Crossref, Medline, Google Scholar4 Hales SA, Deeprose C, Goodwin GM, Holmes EA: Cognitions in bipolar affective disorder and unipolar depression: imagining suicide. Bipolar Disord 2011; 13:651–661Crossref, Medline, Google Scholar5 Holmes EA, Deeprose C, Fairburn CG, Wallace-Hadrill SM, Bonsall MB, Geddes JR, Goodwin GM: Mood stability versus mood instability in bipolar disorder: a possible role for emotional mental imagery. Behav Res Ther 2011; 49:707–713Crossref, Medline, Google Scholar6 Angst J, Cui L, Swendsen J, Rothen S, Cravchik A, Kessler RC, Merikangas KR: Major depressive disorder with subthreshold bipolarity in the National Comorbidity Survey Replication. Am J Psychiatry 2010; 167:1194–1201Link, Google Scholar FiguresReferencesCited byDetailsCited byDevelopment of the motivational thought frequency scale for alcohol abstinence ( MTF‐A )30 September 2022 | Alcoholism: Clinical and Experimental Research, Vol. 46, No. 11The IBER study: study protocol for a feasibility randomised controlled trial of Imagery Based Emotion Regulation for the treatment of anxiety in bipolar disorder15 June 2020 | Pilot and Feasibility Studies, Vol. 6, No. 1The essential role of mental imagery in cognitive behaviour therapy: What is old is new again12 November 2020 | Australian Psychologist, Vol. 54, No. 4CNS Spectrums, Vol. 24, No. 1The Cognitive Behaviour Therapist, Vol. 12Frontiers in Psychiatry, Vol. 10Cortex, Vol. 105International Journal of Environmental Research and Public Health, Vol. 14, No. 7An investigation of mental imagery in bipolar disorder: Exploring "the mind's eye"20 December 2016 | Bipolar Disorders, Vol. 18, No. 8Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology15 March 2016 | Journal of Psychopharmacology, Vol. 30, No. 6Mental imagery and bipolar disorders: Introducing scope for psychological treatment development?18 November 2015 | International Journal of Social Psychiatry, Vol. 62, No. 2Bipolar risk and mental imagery susceptibility in a representative sample of Chinese adults residing in the community13 August 2015 | International Journal of Social Psychiatry, Vol. 62, No. 1Psychiatry Research, Vol. 246Applications of time-series analysis to mood fluctuations in bipolar disorder to promote treatment innovation: a case series26 January 2016 | Translational Psychiatry, Vol. 6, No. 1Visualizing Trumps Vision in Training Attention11 May 2015 | Psychological Science, Vol. 26, No. 7Mental Imagery in Psychological Disorders15 May 2015Journal of Affective Disorders, Vol. 187Analytical Psychology, Indian Healing Traditions, and the Emerging Frontiers of Neuroscience29 May 2014 | Jung Journal, Vol. 8, No. 2Journal of Affective Disorders, Vol. 166Cognition and Emotion, Vol. 28, No. 6 Volume 169Issue 12 December 2012Pages 1245-1246 Metrics PDF download History Accepted 1 July 2012 Published online 1 December 2012 Published in print 1 December 2012
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