One of the more unusual neurologic disorders, prosopagnosia, also known as facial blindness is something that the actor, Brad Pitt, has admitted he may have.
In a recent interview, Pitt vented his frustration. “So many people hate me because they think I’m disrespecting them…I took one year where I just said, This year, I’m just going to cop to it and say to people, ‘OK, where did we meet?’ But it just got worse. People were more offended. …You get this thing, like, ‘You’re being egotistical. You’re being conceited.’ But it’s a mystery to me, man. I can’t grasp a face, and yet I come from such a design/aesthetic point of view. I am going to get it tested.”
Different forms of prosopagnosia exist, and it is believed there are acquired and developmental forms. In the acquired form, the individual may have had lesions to specific portions of the brain on one or both sides. The developmental form remains an object of research interest since it’s unclear exactly how it might arise and what might cause it.
The defining feature of this disorder is a degraded sense of familiarity for the identity of the face, both for previously known faces and newly encountered ones. When someone with prosopagnosia fails to recognize that a face is familiar, they also have trouble putting a name to the face or recalling other information about the person until prompted by some other cue to the person’s identity.
Prosopagnosia has been reported with macular degeneration, and neurodegenerative disorders such as Alzheimer’s, Huntington’s disease, Parkinson’s disease, autism spectrum disorders, Turner syndrome, and schizophrenia.
In addition to prosopagnosia, other types of face-processing failures include impaired expression processing, impaired lip-reading, false familiarity of faces, and people-specific amnesia. Attempts in rehabilitation research studies appear to have gained a modest ability to improve this facility through several types of perceptual training.
How many types of human faces can most of us recognize? It has been estimated that the number is around 4000, but it is a very demanding form of perception, considering how the face can change with emotion, development, or aging.
The most obvious problem that this type of perception might cause is in social situations where the person has difficulty recalling who a person is, their name, or even where they may have met them. This can lead to awkward social interactions where some form of personal remediation might be required.
In other words, the person with the disorder might casually ask for a clue that might be meaningful in placing the face. This may seem to be a normal social interaction, but it is seeking behavior to help identify the face and the person in this individual’s life.
Persons with the disorder will generally be unwilling to reveal it freely and will attempt to monitor their lives so that it is not apparent or discovered. Obviously, there is an element of shame, a disability, and a sense of inferiority associated with it, which then brings on a level of social anxiety disorder in some. Avoidant behavior would be in the service of keeping this disorder secret because it isn’t something anyone would shout from the rooftops.
One in 50 persons may have the disorder, and it is estimated that in the UK, 1.5 million people have it and there is a center for diagnosing the disorder in the UK. In other parts of the world, they may use the 20-item Prospagnosia Index, a self-report instrument for developmental prosopagnosia. Another test is the Cambridge Face Memory Test.
Interestingly, many persons with the disorder have never been tested because they never believed they had the disorder, ruling it out as a minor memory lapse. It is thought that there is a family connection to the condition, and first-degree relatives may be affected.
How might the deficit in perception found in prosopagnosia be corrected in treatment in rehabilitation? One route has been suggested in developmental types.
Various approaches have been tried, primarily of a learning type identifying different faces over weeks. Among the learning techniques that researchers incorporated for patients included mnemonic tricks to enhance recall and focus on facial features. However, those involved in the research have determined that much more work is needed to optimize the protocols, and some consideration should be given to pharmacologic agents that may address certain developmental aspects of the disorder.