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Face Blindness

Eye Care Professional Magazine
August 2012 Edition, By Jason Smith, OD MS

    

IF YOU LOOKED AT THESE TWO PICTURES, would you be able to recognize the 16th President of the United States, Abraham Lincoln? This black and white picture on the left should make visual sense to us in that he is an older man with a beard. We recognize his eyes, the ears, the receding hair line, his older age, the shape of his mouth, and his elongated head. We “see” this picture, we process this information, we draw conclusions about the picture, and we may even have memories about this picture and what it may mean to us personally as well as historically.

Do you remember seeing Lincoln’s picture when it was hung on the wall in your classroom? Did you see this picture in a museum? Do you remember President Lincoln because his picture is on the face of the five dollar bill? Do you remember seeing his picture in U.S. history books and anytime the Civil War is mentioned? His face is familiar to most of us. What about the picture to the right? This is the same picture, except it is upside down.

On March 18, 2012, CBS and 60 Minutes host Lesley Stahl narrated a segment titled “Face Blindness: When Everyone Is a Stranger.” The term “prosopagnosia” is also used to describe face blindness. According to Wikipedia, “prosopagnosia” is Greek; "prosopon" is face and "agnosia" is not knowing. This is a disorder of face perception where the ability to recognize faces is impaired, while the ability to recognize other objects may be relatively intact.

Bradley Duchaine is an associate professor of psychological and brain sciences at Dartmouth College who is familiar with this problem. He compares what these people see to looking at a picture upside down. The term originally referred to a condition following acute brain damage. However, a congenital form of the disorder has been proposed which may be inherited by about 2.5% of the population. Face blindness was first recognized in the 1940’s when soldiers who had suffered head injuries were now unable to recognize faces. It was not named until the term prosopagnosia was first used in 1947 by Joachim Bodamer, a German neurologist. He described three cases, including a 24-year-old man who suffered a bullet wound to the head and lost his ability to recognize his friends, family, and even his own face.


The Human Brain

Astonishingly, most doctors have never heard of Face Blindness.

It is estimated that 1 in 50 people may suffer from face blindness. (See video.) The specific brain area usually associated with face blindness is the fusiform gyrus located in the temporal lobe of the human brain. Some also use the term “prosophenosia,” which refers to the inability to recognize faces following extensive damage of both occipital and temporal lobes of the brain. As Eye Care Professionals, the last word that we want to hear is “blindness.” We try to prevent blindness or to reduce its negative effects by providing optical aids, prescribing medications, and referring to specialists for medical intervention when necessary.

Blindness is defined as no light perception, the inability to see anything, or amaurosis. The Dictionary of Visual Science has three pages of different forms of blindness including absolute, color, flash, night, organic, psychic, and snow, but there is no mention of facial blindness. People with the problem of face blindness can see so using the term blindness to describe this condition is misleading. The problem that exists is that they are unable to recognize faces that should be familiar to them, but are not. Their vision is fine, but they are unable to process what they see into a recognizable form.

For example, people with face blindness cannot recognize their own face, as well as the face of a daughter, son, or spouse. Famous movie actors or actresses that most of us can recognize such as Julia Roberts, Meryl Streep, or George Clooney cannot be named. Famous president’s such as Washington or Lincoln would be a total mystery. You or I could recognize familiar faces even if this same person changed their hair color, hair style, or placed a hat on their head. This would only further confuse a person with face blindness. People with face blindness who are in a business environment may use someone’s hair style, how they dress, or their chin shape as a cue to help them “recognize” someone they already know. Changing any of these cues would only complicate an already difficult situation of poor recognition. Face blindness can create serious social problems. They often use alternative routes to recognition, but these routes are not as effective as actual recognition of someone’s face.

Imagine walking into your place of work where you have been for years and not recognizing a close co-worker or your boss. They describe the experience as “a memory that has not been filed.” They can describe what they see but they cannot “micromeasure” the information in order for it to be used again and again. People who may be unaware that they are having contact with someone with face blindness may be offended with the fact that this person really does not recognize them. The face blindness person may receive a reaction of being snobbish, inattentive, or offensive. Imagine seeing the same people who you have been working with for years and not being able to recognize their faces! We recognize faces for the identity, the beauty, the character, the expression, and the emotions that are seen, perceived, and processed by us. All of these normal human characteristics are missing in the face blind person. So the term “blindness” should probably be replaced with “misperception.” But the term “blindness” catches our attention.

Recently, there has been evidence that people can be born with face blindness. The causes of face blindness are still in the early investigative stages. A woman who had a tumor removed in the fusiform area of the temporal lobe suffered face blindness after the surgery. But congenital face blindness patients who had MRI’s of this same area all had a normal functioning temporal lobe and a normal fusiform face area. Areas that are currently under research include the role of brain damage, brain injuries, seizures, tumors, nerves, the wiring within the brain, and neurochemicals. It would appear that the human eye’s ability to see is totally intact and functional in these patient’s. These people have no problems functioning in high level occupations such as a doctor or a computer analyst. Once the visualized information begins its optical, chemical, neurological, psychological, and interpretive journey to the brain, something breaks down.

Something that is still unknown to researchers and medical scientists causes the breakdown of recognition, interpretation, understanding, perception, and memory of a face that may be new or one that has been seen numerous times. There may be different causes to face blindness based on congenital, developmental, or hormonal problems compared to face blindness caused by a traumatic brain injury or a tumor. There may be a neurobiological disorder, a microbiological, or a micro-chemical problem whose causes are not yet fully understood. There may be DNA, RNA, or chromosomal abnormalities.

The study of face blindness has been crucial in the development of the theories of face perception. Face blindness is not a single disorder; different people may show different types and levels of impairment. It has been argued that face perception involves a number of stages, each of which can be caused by separately damaged areas of the brain. This is reflected not just in the amount of impairment displayed, but also in the qualitative differences in impairment that a person with face blindness may exhibit.

As difficult as it would be for an adult to suffer from face blindness, it could be more difficult for children. They may have a difficult time making friends because they cannot recognize their classmates. They may be unable to distinguish who a brother or sister may be and be unable to be certain that “mom is mom.” Teachers, school professionals, and physicians may treat these children for some other problem than that which really does exist. Medical professionals must become more aware that this is a real problem and develop some diagnostic tests that can utilized to distinguish face blindness from something more serious such as functional autism.

Face Blindness on 60 Minutes

The outlook for a cure or for more understanding of this and many other medical problems lies in the research, the dollars available for research, and the public outcry for solving these problems. Up to this point, there has been no public outcry for solving the face blindness problem compared to medical problems such as autism. With public awareness increased by the national exposure created by the 60 Minutes piece that was broadcast recently this may change. -- See How My Face Blindness Means I Can't Recognise My Mum.

See More.


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