In a pioneering new study, neuroscientists have traced the precise brain mechanisms that empower us to tell the difference between what we imagine and what we actually see—an ability fundamental to understanding our own experience and, when disrupted, central to psychiatric conditions like schizophrenia. The research, published this month in Neuron by a team at University College London (UCL), pinpoints the fusiform gyrus—a visual processing region of the brain—as a critical player in this reality-imagination divide, offering profound implications for mental health, technology, and our understanding of human perception (Neuroscience News).
From ancient Buddhist teachings on “maya,” or illusion, to modern debates about digital “deepfakes,” Thais have long grappled with the challenge of discerning what is real from what is imagined. This study’s breakthrough brings empirical clarity to such philosophical and practical questions, highlighting biological mechanisms underlying this everyday—but often unconscious—judgment. For the millions in Thailand and worldwide affected by conditions that blur this boundary, such as schizophrenia, the findings open new pathways to diagnosis, understanding, and potentially treatment.
The study recruited 26 participants and used functional magnetic resonance imaging (fMRI) to monitor their brain activity as they engaged in an intriguing experiment: they were shown simple visual patterns embedded in noise, asked to try to detect faint targets, and simultaneously instructed to imagine specific patterns, sometimes matching or differing from what was on screen. With only half the screens containing a real pattern, participants regularly had to indicate whether they sensed something truly present—or had conjured it internally.
Researchers discovered that when the fusiform gyrus was strongly activated—not just during real perceptions, but also during vividly imagined images—subjects were significantly more likely to confuse their imagination for reality. “Imagine an apple in your mind’s eye as vividly as you can,” explained a lead neuroscientist from the UCL Department of Imaging Neuroscience. “Many of the same brain regions activate as when you see a real apple. Until recently, it was unclear how the brain distinguishes between these real and imagined experiences.”
Strikingly, the results showed that the vividness of imagination could override normal perceptual safeguards, causing the brain to treat strong internal images as true perceptions—an insight that bridges neuroscience with age-old Thai proverbs such as “tidt taeng kham” (ติดแต่งคำ), which warns against mistaking fiction for fact. Further, the study unveiled that the anterior insula, a region in the prefrontal cortex associated with decision-making and metacognition, works in tandem with the fusiform gyrus to assess whether an experience is generated internally or derived from the outside world.
“We found that the strength of sensory signals—essentially, how powerfully the brain’s mid-level visual cortex is activated—determines whether an experience is classified as real or imagined,” elaborated the study’s senior author from UCL’s Psychology & Language Sciences division. “This area of the brain matches predictions from computational models about how we ‘reality-test’.” These findings resonate with recent advancements published in Neuron, which reinforce the idea that failures in this sensory monitoring process may underlie disorders characterized by hallucinations or delusions (Neuron Article Abstract).
The Thai context is especially relevant here. According to psychiatric experts from major hospitals in Bangkok, insight into the biological signatures of delusional thought and hallucinations can inform both public awareness campaigns and early-intervention health strategies, crucial for a country with rising mental health-related societal costs and persistent stigma. Public health officials have previously noted the burden of schizophrenia in Thailand, with estimates suggesting that hundreds of thousands of Thais live with some form of psychotic disorder (Thai Ministry of Public Health). The ability to objectively monitor the breakdown between internal and external realities could transform screening and help reduce the prolonged delays in accessing care that many families face due to misperceptions or denial.
The study’s experiments were straightforward yet revealing. Participants’ self-rated vividness of mental imagery directly predicted their likelihood of misattribution—mistaking imagination for reality—even when nothing was actually present. Brain scans demonstrated that only when activity in the fusiform gyrus reached high levels, whether through actual perception or vivid internal simulation, did these confusions occur. Normally, a distinct gradient separates perception (with stronger signals) from imagination (with weaker ones). When this gradient breaks down, so does the clarity between what is real and imagined.
One neuropsychologist at a leading Thai university who was not involved in the research observed, “This evidence-based approach supports what clinicians have observed for years—patients with severe hallucinations often describe their experiences as hyper-real, not vague or fleeting, which fits precisely with this finding about the intensity of sensory-region activation.”
Supporting these observations, global data suggest that vivid visual hallucinations are among the most disorienting symptoms for people with schizophrenia and related disorders, often leading to social withdrawal, impaired self-care, and significant distress for families (World Health Organization, Schizophrenia Fact Sheet). In a Thai context, the intersection of traditional belief systems and medical science can complicate both diagnosis and family response, emphasizing the need for accessible, scientific explanations of such experiences.
The collaboration between the fusiform gyrus and the anterior insula draws attention to the brain’s metacognitive capacities—our ability to think about and monitor our own thoughts. As the UCL team notes, the anterior insula’s involvement suggests that “deciding what is real” is not just about raw sensory data but about cognitive evaluation, aligning with Buddhist mindfulness practices promoting heightened awareness and emotional regulation. For Thai educators and clinicians, linking ancient wisdom with cutting-edge cognitive neuroscience may offer a culturally resonant pathway for engaging patients and the public.
Long-term, this research could impact technology as well as medicine. Developers of virtual reality platforms, for example, are keenly interested in understanding when imaginary experiences start to feel real—an issue of growing relevance as immersive technologies become more widespread in Thai schools, museums, and healthcare settings (Bangkok Post: VR in Thai Classrooms). Knowing how and when the brain confuses imagination for reality can guide safer, more effective VR design and usage, especially for young users or individuals with mental health vulnerabilities.
Moreover, the study lays groundwork for identifying a “generalized perceptual reality monitoring system” in the human brain—a concept that could spark new directions in both artificial intelligence and psychiatric research. For Thai mental health services, which are under pressure to innovate due to urbanization and demographic change, scientific advances in reality monitoring could streamline digital mental health tools for early detection or self-checks.
Nevertheless, experts caution that more research is needed to confirm these findings across larger and more diverse populations, including in Thailand, where cultural and linguistic factors may shape perception and diagnosis. “This is a major step forward, but we must remember that the mind is influenced by context. Public health campaigns must be sensitive not only to neurobiology but also to cultural attitudes toward mental illness and imagination,” a psychiatrist at Thailand’s largest psychiatric institute commented.
Looking to the future, researchers are investigating whether targeted therapies—potentially including cognitive training, mindfulness, or even non-invasive brain stimulation—could strengthen the brain’s reality monitoring systems in vulnerable individuals. Data from Thailand and other ASEAN nations highlight the urgent need for novel interventions that are both effective and culturally accessible, especially as urban stress, social isolation, and digital overload continue to rise (UNICEF: Mental Health in Southeast Asia).
So, what does all this mean for Thai readers? The research underscores the power—and the limitations—of our minds. It reminds us that what feels real is not always real, and that sometimes, the very vividness of our own imagination can fool us. For families and caregivers, being aware of how brain mechanisms work can demystify the sometimes frightening experiences of loved ones and encourage early, compassionate intervention. Clinicians and policymakers can explore how this knowledge could refine mental health diagnosis, outreach, and education—especially in schools and community settings.
Practically, if you or someone you know experiences blurring between imagination and reality—whether through vivid daydreams, intrusive thoughts, or apparent hallucinations—reach out to a mental health professional for an evaluation. Campaigns to reduce mental health stigma, improve awareness of the latest neuroscience, and provide resources in the Thai language all help to bridge the gap between research and daily life. As new discoveries emerge, integrating them with Thailand’s rich traditions of introspection and community support will be key.
For further reading, the original research can be accessed in Neuron: “A neural basis for distinguishing imagination from reality” (link), with coverage provided by Neuroscience News. Thai government mental health resources are available at the Ministry of Public Health, and global mental health information can be found via the World Health Organization.