Horrors of nature: Face blindness

[Bharat Muslim]

Forget Western racism/imperialism. Forget wicked individuals of South Asia. Nature can cause graver and greater tragedy.

Facing problems?

New York Times News Service

Neurology

Researchers at the Max Planck Institute for Human Cognitive and Brain Sciences in Germany recently found evidence that face and voice recognition may be linked in a novel person-recognition system, writes Karen Barrow

Close your eyes. Picture your closest friend. Maybe you see her blue eyes, long nose, brown hair. Perhaps even her smile. If you saw her walking down the street it would match your imagined vision. But what if you saw nothing at all? James Cooke, 66, of Islip, NY., can’t recognise other people. When he meets someone on the street, he offers a generic “hello” because he can’t be sure if he’s ever met that person before.

“I see eyes, nose, cheekbones, but no face,” he said. “I’ve even passed by my son and daughter without recognising them.” He is not the only one. Those with prosopagnosia, also known as face blindness, can see perfectly well, but their brains are unable to piece together the information needed to understand that a collection of features represents an individual’s face. The condition is a neurological mystery, but new research has shed light on this strange malady. One of the keys to understanding face recognition, it seems, is understanding how the brain comes to recognise voices.

Some scientists had believed that faces and voices, the two main ways people recognise one another, were processed separately by the brain. Indeed, a condition parallel to prosopagnosia, called phonagnosia, similarly leaves a person unable to distinguish a familiar voice from an unfamiliar one. But by testing for these two conditions simultaneously, researchers at the Max Planck Institute for Human Cognitive and Brain Sciences in Germany recently found evidence that face and voice recognition may be linked in a novel person-recognition system.

Using MRI, the scientists looked at the brain activity of 19 healthy volunteers as they were led through tasks that tested their ability to recognise both faces and voices. The researchers found that regions of the brain already associated with facial recognition, like the fusiform face area in the occipital lobe, are directly linked to regions responsible for voice recognition, mostly in the temporal lobe.

This research helps explain why a person with prosopagnosia may still have difficulty determining who a person is even after she has begun to speak. “People with prosopagnosia don’t have the benefit of learning voices with faces,” said Katharina von Kriegstein, author of the study, which was published in September in The Journal of Neuroscience.

What scientists need to crack...
The challenge for scientists is to find out where this system breaks down. Are these connections in the brain missing entirely, or are people unable to recognise faces and voices simply unable to use these links in some way? It is unclear how many people have these conditions.

Many don’t even realise they have problems with facial or voice recognition. While some develop these difficulties after a brain injury or trauma, others develop it in childhood. For Cooke, who lives with his two grown children, face blindness first surfaced after brain surgery for an unrelated condition. Three physicians stood by his bed in the hospital the day after surgery to ask how he was feeling. Cooke didn’t think he had met the doctors before, so he gave some generic responses. Cooke discovered later that he was speaking with his own doctor.

He went home, and the face blindness continued. Months later, he still couldn’t recognise his son, let alone his son’s friends when they visited. The cashiers at the grocery store had turned into strangers. Neighbours’ faces were completely foreign. He went from neurologist to neurologist until one recognised that he had prosopagnosia, most likely a side-effect of his surgery. While there is no treatment or cure for Cooke, figuring out why he was no longer able to recognise his own children was a relief.

Dori Frame, 51, of New York, is less certain about the cause of her face blindness, as she doesn’t remember having difficulty recalling faces as a child. She did suffer a severe head injury at age 16 while horseback riding, but it is unclear whether that caused her prosopagnosia as an adult. “My eyes see just fine,” said Frame. “But when I look away, I can’t recall the picture in my mind.” Frame didn’t realise she had a problem until she learned about prosopagnosia in a psychology class.

Brad Duchaine, who researches face blindness at Dartmouth, says that after giving talks about prosopagnosia, he is often approached by audience members who have just realised that their difficulty keeping movie characters straight or identifying co-workers on the street may be more than just a quirk. With no treatments, those with face blindness have to rely on simple coping strategies. “They use all those other cues that everyone else uses, just to a greater degree,” Duchaine said.

Social consequences
For example, Frame can recall a person’s hairstyle and body type and how they move. “But when my husband gets a haircut, it takes me a while to reconcile that,” she said. Cooke has his own strategies. He knows that if he sees a tall, blond man in his kitchen, it’s most likely his son.

A tall, blonde woman cleaning the house is probably his daughter. The condition has unexpected social consequences. How do you explain to everyone you meet that you may not recognise them later? “I live in fear of making people feel unimportant by not recognising them,” Frame said.

Cooke was once on a date with a brunette who knew about his condition, he said, when he excused himself to use the restroom. Returning, he saw a pretty, brown-haired woman sitting alone, so he slipped into the chair across from hers. “My date came running across the restaurant to tell me I was at the wrong table,” he said.

Frame isn’t as open about her face blindness. Whenever she is meeting someone,
she arrives early, so her friend has to find her. Still, even with prosopagnosia often at the forefront of her mind, Frame often forgets her difficulties.“It still seems bizarre to me,” she said. “You mistake yourself for someone else in the mirror, and you feel so silly when you realise it’s you.”

Facing problems?

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When the face doesn’t ring a bell

The hall was brimming with the crowd and Neelam and Sanjiv were virtually running to make it to the birthday party in time. But as they darted in, Sanjiv was confused, and so was Neelam. Had they come to the right place? For, not a single face they could recognise. With the guests staring at them for the couple’s ‘un-guestly’ demeanour, Sanjiv practically had a hard time recalling the face of Goutam, his childhood pal who was throwing the party at his son’s fifth birthday.

A majority of the invited had been friends or colleagues of Sanjiv for years though!
Like Sanjiv, many of us might face that disquieting feeling that some things have slipped out of our minds and it could be faces of persons, who have stood by us through thick and thin. Researchers at the University of Harvard are studying a neurological disorder known as prosopagnosia, or “face blindness,” a disease many of us suffer from, but are not exactly aware of.

People with prosopagnosia cannot remember faces. Millions of people in the world may unknowingly suffer from this little-known disorder.

A seven-year-old boy walked out of his classroom and entered another classroom without realising his mistake. Soon his parents noticed that he always played with the same girl who wore a pink skirt. Prosopagnosia may not be a term that most people hear every day, but a surprising two per cent of the world population is believed to be living with the disease at various degrees.

Characterised by the inability to recognise faces or to distinguish one from another, the condition can be embarrassing and socially disabling. People with severe prosopagnosia may fail to recognise family members or close friends or mistake complete strangers for acquaintances. Some face-blind people have trouble watching TV shows or movies because they cannot remember characters or plots. In some extreme cases, persons having symptoms of severe deficiencies could even greet strangers, taking them to be their siblings.

Shocked by a real life incident in which a young woman could not identify her son during the pick-up time at the school, a city student, after completing her MBBS from the Calcutta Medical College, decided to pursue the disease ‘in depth’ abroad. “And I found very little is known about it except some pioneering research at Harvard,” said Soma Chatterjee. She joined Harvard University at Boston in the US under Dr Ken Nakayama and Richard Russell at the Vision Science Laboratory of the Department of Psychology, to study the likely reasons behind the syndrome.

Ken Nakayama and Richard Russell at the University of Boston and Dr Bradley Duchaine at University College, London, have been engaged in researching the genesis, diagnostic tests and some possible cures of the ailment for more than a decade. According to them, there are two types of prosopagnosia.

Acquired prosopagnosia develops in adults from brain damage caused by head trauma, stroke, and degenerative diseases. Developmental prosopagnosia, occurs in minors with no initial evidence of brain damage. This group may be the most common across the world, they have found. But there is no concrete conclusion so far behind the exact reason of the syndrome.

Hence, the two universities have been experimenting with and looking for children suffering from developmental prosopagnosia in order to develop a screening mechanism that will allow for earlier diagnosis. This, in turn, will facilitate treatment to begin earlier and be more effective.

Chatterjee is perhaps the only student from India who plans to bring the fruits of her research into the country in a big way and plans to extend her research in India. How?
As part of their research into prosopagnosia, Dr Nakayama and Dr Russell
besides Dr Duchaine developed a diagnostic test, which led to the identification of hundreds of face-blind individuals over the past several years - far more than had been identified previously. Following their footsteps, Chatterjee intends to conduct an identical study at Regional Institute of Ophthalmology (RIO) laboratory in the premises of Calcutta Medical College through application of the same test.

“We’ll request people from all strata of life to visit our lab at RIO and they will
include medical professionals and teachers besides security personnel among others,” explains Chatterjee. She has already held a preliminary discussion about launching the project with senior teacher in Ophthalmology at RIO Himadri Dutta. And, there are plans to collaborate with the researchers of the Harvard University as well.

The test the researchers have developed involves looking at a series of pictures of
objects such as cars, tools, guns, houses, and landscapes, along with close-up cropped black and white pictures of faces. Some of the images are repeated in cycles in the computer while some are not. Subjects are asked to identify, as quickly as possible, whether each image they see is new or repeated.

“Until a few years ago, only 100 cases of prosopagnosia had been documented worldwide, but it now appears that the condition is much less rare than had previously been assumed,” Nakayama said in a university statement. “Testing of 1,600 individuals found that two per cent of the general public may have face-blindness and a German group has recently made a similar estimate. But we think developmental or congenital prosopagnosia is much more common.”

Many with this disorder have no apparent brain damage; but they have not been able to recognise the faces well, Chatterjee points out. Unless exposed to the test, they would not know they have the disorder. “It’s like colour-blindness; many people don’t know they are colour blind until they are tested.”

The area of concern stems from the fact that there isn’t any treatment presently available for face-blindness. “Researchers are in the process of trying to understand what prosopagnosia is and raise awareness about it in the medical community and public at large,” Chatterjee contends and adds that the “cure may take some more time”.

Those keen on testing their level of deficiency may log on to Prosopagnosia Research Centers at Harvard University and University College London and complete a questionnaire. At the moment, the diagnostic test for the disorder is not available online, but that’s one goal, Chatterjee and other researchers
aim at.

When the face doesn’t ring a bell