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