Thursday, 20 December 2012

What's it like to be face-blind?

Most of us take the ability to recognise each other for granted. What must it be like to go through life unable to identify and distinguish people based on their facial appearance?

Some idea comes from a new, candid first-person account written for the journal Cognitive Neuropsychology by a doctor about his life-long face-blindness (known formally as prosopagnosia). It's a problem he didn't even realise he had for 30 years, and which he only discovered was a neuropsychological condition in 2006, when he was diagnosed for the first time. "It now seems remarkable that I lived at least half my life with a socially disabling condition of which not only myself, but also those around me, seemed unaware," writes Dr David Roger Fine, a gastroenterologist at the University of Southampton.

Looking back at his childhood, Fine realises that he can remember school buildings with detail, the clothes worn by his male friends, the hairstyles of the girls - but no faces. He got into difficulties in the playground confusing "high- and low- status boys", and was admonished for not raising his cap to his form teacher when he encountered her out of context and so failed to recognise her.

At senior school he made friends with a close-knit group, all of whom were physically distinctive and so easy to distinguish. In his professional life, Fine describes how there are some situations where his condition doesn't matter - such as committee meetings, where everyone keeps the same seat, and when he's giving a conference presentation. His job as a hospital doctor also involves distinct spatial areas of work and he uses these environmental contexts to help him judge who he is likely to encounter at any given time. Nonetheless, he often walks right past colleagues, earning him a reputation as capricious and aloof. More than once he's been accused of having Asperger's.

In his personal life, before marriage, romantic liaisons were especially problematic. Although women often dress in more distinctive ways than men, they also vary their appearance more often, for example changing their hair style and make-up after work. "It seemed to me that girls popped out of the Ether in one place then disappeared perhaps for months or even years before reappearing in another place, often disgruntled," he says.

Before his wife became his companion and minder, parties were particularly awkward and stressful. "I once met and had a long conversation with a man at a Christmas party," Fine recalls. "We circulated until we met again at the other side of the room and I introduced myself [again]. He looked puzzled until my wife came to my rescue." Making friends is nigh on impossible. "Recognising" strangers is a constant embarrassing risk.

Fine has had a successful career in spite of his prosopagnosia, but he feels his success was "blunted" by the condition. Now aged 60 he has highly developed strategies for coping - he has a better sense of people's age, which is one of the criteria he uses to distinguish people. The ethnic mix of modern Britain also helps. And he tries to focus on distinct items of jewellery, such as people's rings, that tend to be worn at all times. The increased popularity of tattoos is another help, although it can cause problems too - one female colleague with a tattoo low on her chest visible in summer clothes "caused consternation in the corridor [one winter] as she unbuttoned her blouse by way of identification."

Looking to the future, Fine is worried that his confusion about people's identity could lead to him being misdiagnosed with dementia. "During a recent hospital stay I asked the nurses to introduce themselves every time, as I was concerned that I might be misdiagnosed as confused if I muddled them up."

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Experts used to think that the inability to recognise faces was a problem that nearly always arose after brain injury. In recent years, however, it's become apparent that many people are born with face-blindness (or develop it early in life), with the prevalence estimated at two per cent of the population. Do you have the condition or know anyone who has? How do you/they cope?

_________________________________ ResearchBlogging.org

Fine, D. (2012). A life with prosopagnosia. Cognitive Neuropsychology, 1-6 DOI: 10.1080/02643294.2012.736377

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

10 comments:

  1. A very interesting post.

    I was interested in the sentence: "More than once he's been accused of having Asperger's".

    Autism (and Asperger syndrome) are conditions which are finding some research favour with faceblindness in mind; some commentators even speculating that part of the sensory-perceptual side of the condition(s) might be impacted by such issues.

    Indeed, faceblindness as part of a wider series of ophthalmologic disorders is an area deserving of a lot more inquiry with autism in mind.

    I posted about it recently - sorry for the blatant self-publication: http://questioning-answers.blogspot.co.uk/2012/12/the-eyes-have-it-for-autism.html

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    1. hi Paul, thanks for this - I should point out that the doctor ends his piece by dealing with the Asperger's suggestions head on. He believes that there is no link. Regards his own case, he says he scored close to the control mean score on Baron-Cohen's autism spectrum questionnaire. He also cites the fact that he has a reputation for great skill at dealing with distressed patients with embarrassing and disabling afflictions.

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    2. Thanks for the update.

      A couple of further points to be made:

      1. A diagnosis of autism / AS is seemingly protective of nothing (as far as we know). Indeed the whole comorbidity side of things is still an area desperate for further study. No investigation does not equal no connection. This includes face-blindness or anything else.

      2. The AQ (which I assume is the instrument in question) is a subjective screening instrument, nothing more. It does not replace professional (and objective) screening and diagnosis.

      3. The whole empathy issue with regards to autism has in my mind been overgeneralised and overplayed. Take for example the recent tragedy at Sandy Hook and speculation on the 'shooter' potentially have a spectrum diagnosis (not confirmed at this point, I might add). Lots of people have suggested that people with autism "lack empathy" and this somehow contributed to what happened. I'm minded to say that this is (a) a sweeping generalisation which does a great disservice to many people with autism/AS and (b) in many cases is just not true. The communication of empathy for example, and issues with it, does not mean that someone lacks empathy.

      I'm not trying to make a big deal out of this. Merely that just because someone believes there is no link in their particular cases, does not mean there is no link!

      (I hope I've not come across as ranting in this follow-up... I am honestly getting into the Christmas spirit!)

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  2. I have problems recognising people I've met recently, but not those I've known for some time. If I know someone well I can re-identify them with ease, even after not seeing them for twenty years. On the other hand I can watch someone give a talk at a conference, make a mental note that I need to speak to them, and fail to recognise them twenty minutes later. Name badges are a godsend!

    Wondering if I have prosopagnosia, I took an online screening test for a research study, and scored highly on the face recognition test - no hint of a problem at all. Evidently I can recognise faces when I focus on the task.

    I don't know whether most people simply pay more attention to physical features than I do or whether I have a disorder that I am able to overcome with conscious effort if I really work at it. I suspect the latter. Certainly the experience of identifying someone based on conscious effort is qualitatively different from the experience of recognising someone I know well.

    Since this only affects newly-encountered people, the problem is relatively limited. The most difficult situation I have to deal with currently is selling tickets to music events in a venue that has a bar next door. I see between 20 and 100 people who I don't know, very briefly, then have to avoid accosting them again every time they go out to the bar and return. I rely on a combination of distinctive features (dreadlocks help, but only if no-one else has them), social cues (there's a look in the eye that says, "You know I bought a ticket just now, don't you?"), asking my husband for help, and if I get really stuck, apologetically checking tickets.

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    1. hi Rachel, thanks for describing your face-recognition experiences. Would be interesting to have your face-recognition abilities tested more thoroughly to find out exactly what's going on.

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    2. Anonymous1:57 pm

      Doesn't sound like face blindness to me. I have it and definitely can NOT identify people over time - even my children's younger selves. Can't tell which one is which is baby pictures, though their spouses who did not even know them then, can. And, though I have your same problem in situations such as selling tickets, no amount of trying will enable me remember their distinctive features a few minutes later to know if I have already approached them so I avoid putting myself in those kinds of situations!

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  3. I had an English professor with prosopagnosia and I have no idea how he got around it. Backpacks maybe?

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  4. It was very strange to discover a few years ago (when I was in my late forties) that people recognise other people by their faces.

    I use context, hair styles, body differences if present, recognition on other people's faces and just winging it until I discover who the person I am talking to is. It takes hard work.

    I don't recognise my children in the street especially when meeting them unexpectedly straightaway and other time there's always the doubt that I might be wrong until I see the recognition. If they are wearing a hoodie I have no chance - luckily they sometimes tell me who they are.

    My ex had red hair - I remember following another red-haired lady to her seat at a kids carol service because that was my recognition pointer. My teenage daughter.... that was interesting - they change hair and fashion styles every few minutes.

    I'm also on the Autistic Spectrum. It doesn't seem that uncommon a condition with people on the spectrum, but that's maybe too anecdotal.

    Never been officially diagnosed with prosopagnosia though. I never though about it, but might go that route now that it is getting more recognised.

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  6. I know this comment is late but I can highly relate to the doctor who wrote this. I was always in schools with uniforms and when I was young I stuck to just a small group of friends. Usually easily physically identifiable. When I switched schools, from a small private school to a slightly larger one, I almost went into shock. I could not tell anyone apart. Two sisters(who I'm told look very different) I was not sure were even a different person until two months after I started attending. I've had best friends who id known for years approach me out of context and am conpletely at a loss to who they are. I've learned to recognize mainly in context to a time or location but that doesn't work when I am out places. Ive never been diagnoised but I have had people suggest I might have aspergers. People think I'm rude and arragont if I don't speak to them. I started college and am misreable. Everyone looks differemt and the same every day, it's so stressful it makes me sick to even think about.

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