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How does prosopagnosia affect an individual's ability to recognise friends & family?

The inability to recognise the faces of friends and family members was for many years believed to be a minority affliction that affected less than 1% of the population. However, recent studies have suggested that Prosopagnosia may in fact be a far more widespread condition that exists, to varying degrees, in more than twice as many people. Prosopagnosia occurs when defects in the fusiform gyrus lead to imbalances in the occipital and temporal lobes of the brain, making it impossible for the individual to put together the pieces of a human face in such as way as to be able to recognise the particular features of a known individual. Sufferers are fully able to see the faces of those around them, but the process of distinguishing between friends, families and strangers is in some way disrupted.

Facial recognition is a key element of memory, and helps to define the ways in which individuals react to one another. Jane Atkins notes that "when you walk down a busy street, you may scan up to fifty or sixty faces ever minute, and if someone you know walks past you can usually spot them. Prosopagnosia renders this ability ineffective, and all the people you pass could be friends or family members and although you'd see their faces perfectly clearly, you wouldn't recognise them" (Atkins, 2005, p. 140). This doesn't mean that an individual forgets about the existence of these people, rather that they require further prompting, for example 'I'm your brother', which would immediately trigger the memories and associations that would enable normal conversation and interaction.

Some analysts suggest that since prosopagnosia is not unitary (i.e. it affects different people to different degrees), it is the result of cumulative damage to a number of parts of the brain that provide different facial recognition mechanisms. Atkins goes on to suggest that this indicates "the existence of a specific sub-system within the brain that processes facial recognition, and can be impaired if one or more elements of that sub-system are damaged" (Atkins, 2005, p. 141). In many cases, prosopagnosia presents with few or no other symptoms: the sufferer is able to recognise an individual by his or her clothing, for example, and is able to recognise everyday items. In other words, prosopagnosia affects only the ability to recognise characteristics of the face and process them in such a way as to be able to identify the individual.

Prosopagnosia was extensively documented by Oliver Sacks in 'The Man Who Mistook His Wife For a Hat', in which he relates the case of Dr. P, who was unable to recognise his wife from her appearance but could recognise her from her voice. Dr. P also showed an ability to recognise people by a specific feature, for example his brother's chipped tooth, but such processes were unreliable and prone to error. Dr. P had other perception-related problems, and suffered from a more wide-ranging visual agnosia of which prosopagnosia was merely one part; other elements of visual agnosia include achromatoposia (the inability to recognise colour) and prosopamnesia (the inability to remember human faces, which is distinct from prosopagnosia because it allows for limited recognition for short periods). Sacks' book arguably helped draw attention to a condition that had previously been ignored by many sufferers, who put their problems down to simple forgetfulness.

In the United Kingdom, meanwhile, some experts believe that up to 1.5m people (2.5% of the population) suffer from some form of prosopagnosia (Epstein, 2008), and the condition is increasingly being recognise as a major problem for a significant part of the population. Some clinicians worry that the increasing rates of diagnosis are not due to better detection rates but, rather, to some kind of genetic or environmental change that is causing a greater number of cases. However, most experts argue that prosopagnosia and other forms of visual agnosia are genetically-transferred conditions, passed down through multiple generations of the same family, and that there is no clear mechanism whereby environmental factors could cause such a problem to develop.

There is no cure for prosopagnosia, but the conditions appears not to be degenerative and for the most part sufferers are able to develop systems that allow them to recognise those close to them. For example, a sufferer might ask his wife to always wear a certain necklace, which would greatly improve his ability to recognise her even in a crowded room. Many sufferers use such mechanisms would realising that their problem is actually a medical condition, and develop their own individual methods of living with prosopagnosia. With treatment having no effect, the best that can be offered to sufferers is training that will help them (and those around them) understand the problem and deal with it in such a way that makes their lives easier. Many psychiatrists worry that people with undiagnosed prosopagnosia and other forms of visual agnosia suffer major problems in terms of social interaction, and some believe that the condition could explain the inability of some people to make friends and form functional social bonds. Clearly, therefore, while prosopagnosia can't be stopped, effective therapy can help to improve the lives of sufferers.

BIBLIOGRAPHY

Atkins, Jane (2005). 'Recognitions Disorders'. London: Denverdale Press

Epstein, Angela (2008). The Bizarre Nightmare of Face Blindness

Sacks, Oliver (1985). 'The Man Who Mistook His Wife For a Hat'. New York: Summit Books

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