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July 22, 2006

BehindTheMedspeak: Prosopagnosia


Say what?

I'd never heard of it before I read Nicholas Bakalar's fascinating article in the July 18 New York Times Science section.

Long story short: It means "face blindness" — if you have it you cannot remember people by their faces; they might as well all look alike.

It can result from a stroke, brain injury or be inherited as a congenital anomaly, in which case the rest of the brain works normally and compensates for the missing function.

How very curious, mysterious and altogether strange.

Here's the Times piece.

    Just Another Face in the Crowd, Indistinguishable Even if It’s Your Own

    Some people never forget a face. Heather Sellers never remembers one.

    She finds it almost impossible to recognize people simply by looking at them. She remembers the books she reads as well as anyone else, but movies and TV shows are impossible to follow because all of the actors' faces seem so similar. She can recall a name or a telephone number with ease, but she is unable to remember her own face well enough to pick it out in a group photograph.

    Dr. Sellers, a professor of English at Hope College in Holland, Mich., has a disorder called prosopagnosia, or face blindness, and she has had it since birth. "I see faces that are human," she said, "but they all look more or less the same. It’s like looking at a bunch of golden retrievers: some may seem a little older or smaller or bigger, but essentially they all look alike."

    Face blindness can be a rare result of a stroke or a brain injury, but a study published in the August issue of The American Journal of Medical Genetics Part A is the first report of the prevalence of a congenital or developmental form of the disorder.

    The researchers say the phenomenon is much more common than previously believed: they found that 2.47 percent of 689 randomly selected students in Münster, Germany, had the disorder.

    Dr. Thomas Grüter, a co-author of the paper, said there were reasons to believe that the condition was equally common in other populations. "First," he said, "our population was not selected in terms of cognition deficits. And second, a study done by Harvard University with a different diagnostic approach yielded very similar figures."

    Dr. Grüter is himself prosopagnosic. His wife and co-author, Dr. Martina Grüter of the Institute for Human Genetics at the University of Münster, did not realize he was face blind until she had known him more than 20 years. The reason, she says, is he was so good at compensating for his deficits.

    "How do you recognize a face?" she asked. "For most people, this is a silly question. You just do. But people who have prosopagnosia can tell you exactly why they recognize a person. Thomas consciously looks for the details that others notice unconsciously."

    Dr. Thomas Grüter's experience in this respect is typical of people with face blindness. They develop alternate strategies for identifying people — they remember their clothes, mannerisms, gait, hairstyle or voice, and by using such techniques, many can compensate quite well.

    This may be one reason why cases of prosopagnosia have so rarely been reported — people simply do not know they have it. For face-blind people, adaptations like these are the only choice; there is no known cure.

    "Until very recently, not remembering faces was not considered to be a medical condition," Dr. Thomas Grüter said. "It was not even known to most physicians as such. The term 'prosopagnosia' was not taught to students of medicine or psychology." Most people "would consider it a bad habit," he said, "much like forgetting the names of people you are introduced to, or being unable to find your way around town."

    Dr. Martina Grüter said many considered her husband and his father, who is also face blind, to be simply "absent-minded professors" who occasionally may not recognize someone because they are preoccupied with higher thoughts.

    People with face blindness can typically understand facially expressed emotions — they know whether a face is happy or sad, angry or puzzled. They can detect subtle facial cues, determine gender and even agree with everyone else about which faces are attractive and which are not. In other words, they see the face clearly, they just do not know whose face they are looking at, and cannot remember it once they stop looking.

    Even familiar faces can be unrecognizable. Dr. Sellers, for example, said she could summon no picture in her mind of her own mother’s face.

    Dr. Sellers discovered her own problem only a year ago, at the age of 40. She was doing research for a novel involving a character with schizophrenia. "I kept coming across the term 'face recognition,' " she said. "It kept ringing a bell, although the phenomenon is quite different for people with schizophrenia. But once I had the term, I searched for it on the Internet. The minute I knew the concept of face blindness existed, I knew I had it."

    The phenomenon has been investigated with functional MRI brain scans, a form of imaging that shows in real time which parts of the brain are active, and it is known that a part of the brain called the fusiform gyrus responds much more strongly to faces than to other objects.

    Researchers have detected differing responses in this part of the brain among people with face blindness compared with normal subjects.

    "If you show a normal person two different faces in a row," said Bradley Duchaine, a lecturer in psychology at University College London, "their brain response is different with each one. With some prosopagnosics, you don't see this different response. It looks like something is not working in those areas of the brain involved with faces."

    Dr. Duchaine and Ken Nakayama, a psychology professor at Harvard, published a review of developmental prosopagnosia in the April issue of Current Opinion in Neurobiology. They run a Web site devoted to the disorder (www.faceblind.org).

    Face blindness differs from pervasive cognitive disorders like autism because it usually involves only one specific symptom. Still, face blindness is sometimes accompanied by other problems, especially difficulty in finding one’s way around or, for example, distinguishing one car or dog from another.

    Although the specific gene for the disorder has not been found, evidence is mounting that the trait is inherited. "All pedigrees that we've been able to establish so far were compatible with autosomal dominant inheritance," Dr. Thomas Grüter said.

    If this turns out to be true, it means that everyone with the disorder will have at least one affected parent, that men and women will be equally likely to inherit the trait, and that the risk for each child of an affected parent will be one in two.

    "But we haven't found the gene, yet," Dr. Grüter said, "so we can't be 100 percent sure."


Here is a link to a test of your face recognition ablities.

Here is a link to the abstract of the article published in the August, 2006 issue of the American Journal of Medical Genetics.

July 22, 2006 at 04:01 PM | Permalink


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Ok ...have to laugh @ Skip today....think my husband has this too. Actually though I do believe we all have some form of this. There are kind faces that we seem to remember then there are faces that hold sorrow that we want to forget. The kind, happy faces bring life to the soul. The unhappy sorrowful faces put us on guard and make us think there is something wrong all the time. I try to remember the happy faces. But most of all I will remember the eyes. Always look that person in the eye. Make total eye contact. The eyes are the windows to the soul. If you cannot see happy in the eyes then the face forsure cannot be happy. Oh my I sound like Mary Poppins here. Actually a spoonful of sugar makes the medicine go down...medicine go down...lol Ok..enough silliness...What really gets me CRAZY is the fact that when I see a certain face I KNOW that person. AND yet I haven't really even met them. Maybe a casual hello or hey...a wave here and there...Anyone else with this same disease?? Tell me there is a cure...please. Maybe there are some faces that you could just go up and either A) Kiss the heck outta them B) Slap them silly C)or just feel like you know them?? D) or all the above. Lets just go with all the above and forget I even asked....=)

Posted by: Rhonda | Jul 24, 2006 10:35:46 AM

Shawn, I seriously doubt that stupid is a word that could EVER be applied to you under ANY circumstances. Your brain was just firing faster than your fingers.

Me, I suffer from the opposite problem.

Posted by: Flutist | Jul 23, 2006 8:51:55 PM

I reckon I've got it! I walked past my father in the street while looking for him outside the Royal Acadamy. Eventually he tapped me on the shoulder as I walked past /again/ and said hello. "Oh, Dad, how long have you been there?" "Oh, just the last three times you've walked past". I didn't reognise my neighbour in the shop the other day - now I know with some neighbours you might not know them well, but Sharon has a key so she can feed our cats while we're away so it's not like she's a stranger!

I now have a strategy for it. If someone acts like I know them I just explain that I'm sorry but I haven't a clue who they are. Works and breaks the ice. Takes a bit of nerve though, particularly if it's the wife.

Posted by: Skipweasel | Jul 23, 2006 5:12:37 PM

Actually, Flutist, I was just being utterly stupid at that moment...you are right, I was wrong. It should have been utterly forgettable. (But I do appreciate that you gave me the benefit of the doubt and assumed that I was just being facetious. Thank you.) ;)

My only excuse is that I did not get in my nap yesterday after my Saturday morning run - which seems to be required these days for my brain to function properly after we started running past six miles in this heat and humidity.

Posted by: Shawn Lea | Jul 23, 2006 11:35:26 AM

Okay, okay, it just occurred to me that it was probably meant facetiously. Whew. That's okay, then. I can handle my being an asshole -- I just can't handle coming down with Alzheimer's quite yet.

Posted by: Flutist | Jul 22, 2006 7:09:54 PM

Now hang on a minute here, Shawn Lea. Are you testing us? You are, aren't you, to see if we have word recognition problems. Or maybe to see what smart-alecky know-it-all would be first to point out an innocent little brain fart. Just yanking us a little. I could just be having massive spell/vocab failure, but it sure seems like if your face is utterly UNforgettable wouldn't that mean it's really memorable? Like not forgettable? Nat King Cole even sang a whole song about "UNforgettable, that's what you are, UNforgettable though near or far," etc.

When you get older, see, like I keep doing, this kind of thing gets worrisome to a person. Not trying to be a smarty-pants, here.

Posted by: Flutist | Jul 22, 2006 6:24:56 PM

The opposite can be a problem too. I can remember faces so well I sometimes think I know the person when I've only seen them in the grocery store a few times or seen them at the gym or the park. I can't remember names at all, but faces I remember too well. I think I just really look at faces instead of just glancing over them as some people tend to do.

But I, on the other hand, seem to have an utterly unforgettable face. No one ever remembers my face. I'm serious. I'm not just being pitiful. ;)

My son's art teacher this year and I had gone to the gym together years back, had been in the same water aerobics class when we were pregnant at the same time, were in the same Spinning classes afterwards AND she lived down the street from us then so I saw her while I was out walking in the neighborhood and spoke to her regularly in passing then. When I went up and said hi, I could tell she had no idea who I was. I told her about all the classes, where she lived, etc. etc. and she looked at me like I was psychic. She had no recollection of me at all. And I really wish I could tell you it was just her but it's happened over and over again.

Utterly unforgettable face, I tell you. Maybe I should be a spy. ;)

Posted by: Shawn Lea | Jul 22, 2006 4:44:56 PM

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