Uncontrollable Mental Imagery: a Mysterious Neurological Condition - Psychiatry

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Unknown disease, tightness in the head, and abnormal perceptions?


I am unable to control the images in my mind.
For example, when I close my eyes and try to imagine a cup, that cup uncontrollably spins.
I attempt to make it stop, but then my head starts to feel tight.
Everything I try to imagine behaves this way; I cannot present a clear image.
When I read articles silently in my mind, my thoughts jump around erratically, as if there is a force repeatedly punching, which disrupts my ability to concentrate.
It becomes very strenuous to silently recite, and I struggle to articulate certain sounds, especially words with tonal variations.
I am particularly sensitive to certain texts, like the "Three Character Classic," where my silent recitation becomes very loud and uncontrollable.
When my mind is tight and I try not to think, there is an uncontrollable urge and sensation that flits around in my brain.
When I attempt to control it, my head tightens again.
Although I don't want to think, the urge continuously manifests in my mind as sensations of punching or exertion.
When that feeling moves, the imagined images and the sounds of my silent recitation also shift.
I cannot restrain the images during meditation; for instance, when I visualize a crowd, their faces appear angry.
I try to imagine smiling faces, but they automatically revert to angry expressions.
These images appear involuntarily, rather than being what I originally intended to think about.
Sometimes, the imagined people forcefully turn into the face of my ex-girlfriend (though I have managed to eliminate this over time).
Occasionally, I am compelled to have negative thoughts and words that I cannot control, and they keep appearing.
The tightness feels like cramping, radiating from my head (not my scalp) to my nose bridge or the area above my mouth.
Recently, when facing specific groups of people (like shopkeepers), I experience tension and difficulty breathing.
Generally, my emotions are calm, with no anxiety or worry, yet I cannot control the tightness in my mind and head.
I had a brain wave test at Chi Mei Hospital's neurology department, and the doctor said the results were normal, adding that I would never fully recover.
Previously, doctors prescribed medications for anxiety and depression.
I have tried various medications, including one for bipolar disorder and another for Tourette syndrome, but none have been effective.
I used to be able to control the images in my mind, but after taking medication from a certain clinic, on the third day after a sleep, I lost that control.
I remember one of the medications was called Akin.
One doctor suggested it was similar to trauma stress and internalized pressure, another said it was anxiety, one claimed it was not anxiety but a special situation, and another noted symptoms of obsessive-compulsive disorder.
I have seen six doctors.
The article on neurasthenia I read is about 80% similar to my experience, except I do not have insomnia and my appetite is good.
In the three years leading up to the onset of my condition, I was very excitable; even minor incidents had a significant impact on me, requiring over three hours to calm down.
My thoughts were also very intense and extreme.
When I was agitated, my blood pressure was high, around 150.
My ex-girlfriend and my childhood family background have greatly influenced me.
My ex would constantly argue with me, leading to an instinctive panic whenever I saw her, as if something was about to happen.
I began to feel immense pressure.
During multiple arguments, she would threaten me with a knife, which had a profound impact on me.
When she was not around, I experienced conflicting emotions, feeling extremely weak and unable to muster energy.
Logically, I wanted to escape, but after we broke up, that feeling completely disappeared, as if a heavy burden was lifted.
However, three months later, I became ill.
In March of last year, I began experiencing headaches that felt like a continuous pressure on my arm.
In May, I became very sensitive and agitated when reading text.
By July, I felt tightness in my head, extending from the back of my skull to my forehead and the center of my brain.
In October, unable to bear it any longer, I sought medical help.
On the first day of taking medication from the second doctor, I clearly felt its effects, as if my brain slightly lost control.
By the third day, due to side effects of drowsiness, I woke up completely unable to regain control.
This is an article I have spent many days writing, and it is the most comprehensive description of my situation.
I have been off medication for over a month now and am unsure where to seek medical help or what exactly my condition is.

ku ku ku, 20~29 year old female. Ask Date: 2018/04/15

Dr. Zhang Fangrong reply Psychiatry


Dear Sir/Madam,
From your letter, it is evident that you are experiencing discomfort and anxiety.
I am glad to hear that you have begun seeking treatment in the field of psychosomatic medicine.
Although your discomfort has not yet been alleviated, it is difficult to determine the exact nature of your condition based solely on your description.
It is likely that you may be dealing with anxiety combined with depression or a related disorder such as obsessive-compulsive disorder.
In addition to EEG testing, the psychosomatic department can arrange for an evaluation by a psychologist, which may provide insights into your mental state and potentially lead to psychological therapy.
Regarding pharmacological treatment, there are many options available; however, there may also be instances of unsuitable medications or side effects.
I encourage you to discuss these matters with your outpatient physician.
I believe there is a good chance that your discomfort can be improved.
Wishing you good mental and physical health.
Sincerely,
Zhang Fangrong, General Psychiatry

Reply Date: 2018/04/15

More Info


Uncontrollable mental imagery, as you described, can be a perplexing and distressing experience. It seems that you are grappling with a complex interplay of neurological and psychological factors that manifest as intrusive thoughts and imagery, tension in the head, and difficulty in controlling your mental processes. This condition can be associated with various underlying issues, including anxiety disorders, obsessive-compulsive disorder (OCD), or even post-traumatic stress disorder (PTSD), especially given your history of trauma and stress.

From a neurological perspective, the brain is a highly intricate organ that regulates thoughts, emotions, and sensory perceptions. The phenomenon of uncontrollable mental imagery may be linked to dysregulation in certain brain regions responsible for processing thoughts and emotions. For instance, the prefrontal cortex, which is involved in executive functions such as decision-making and impulse control, may not be functioning optimally, leading to difficulties in managing intrusive thoughts. Similarly, the limbic system, particularly the amygdala, plays a crucial role in emotional responses and could be hyperactive, resulting in heightened anxiety and fear responses.

Your description of feeling tightness in the head and experiencing involuntary sensations, such as the feeling of "punching" or "exerting force," may indicate a somatic response to psychological stress. This tension can be a physical manifestation of anxiety or stress, where the body reacts to perceived threats, even if they are not present. The fact that you have experienced significant emotional distress in the past, particularly related to your previous relationship and family dynamics, suggests that these unresolved issues may still be influencing your mental state.

The medications you have tried, including those for anxiety and bipolar disorder, indicate that your symptoms may overlap with multiple diagnoses. It's not uncommon for individuals with complex mental health issues to receive various diagnoses as clinicians attempt to understand the underlying causes of their symptoms. The lack of response to medication can be frustrating, but it is essential to recognize that not all individuals respond to pharmacological treatments in the same way. Some may require a combination of therapies, including cognitive-behavioral therapy (CBT), exposure therapy, or mindfulness-based approaches, which can help in managing intrusive thoughts and improving emotional regulation.

Given your experience with multiple healthcare providers and the complexity of your symptoms, it may be beneficial to seek a specialist in neuropsychology or a psychiatrist with expertise in trauma and anxiety disorders. A comprehensive evaluation, including neuropsychological testing, could provide further insights into your cognitive functioning and help tailor a treatment plan that addresses your specific needs.

In the meantime, practicing mindfulness and relaxation techniques may help alleviate some of the tension and anxiety you are experiencing. Techniques such as deep breathing, progressive muscle relaxation, or guided imagery can be beneficial in managing stress and improving your ability to control your mental imagery. Additionally, engaging in regular physical activity and maintaining a healthy lifestyle can positively impact your mental well-being.

It's crucial to remember that you are not alone in this struggle, and seeking support from mental health professionals can provide you with the tools and strategies needed to navigate these challenges. Your journey towards understanding and managing your condition may take time, but with the right support and interventions, improvement is possible.

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