Friday, March 30, 2012

A Little Background Is in Order...

So what is prosopagnosia, you may ask? That's a legitimate question, because most physicians have never seen a case of the condition, if they've even heard of it.

The term is literally from the Greek -- "proson" for face, and "agnosia," for not knowing. When my husband, Chuck, developed the condition as a complication of epilepsy surgery 19 years ago, his neurologist and neurosurgeon accurately interpreted his symptoms but could offer little additional help. In 300 epilepsy surgeries performed at the center, they had never seen a case of prosopagnosia, and studies on the condition were few and far between. Members of the team conducted follow-up neuropsychological testing, confirming Chuck's face blindness, and handed us a photocopy of the first chapter from The Man Who Mistook His Wife for a Hat and Other Clinical Tales, the book of classic case studies from renowned neurologist Oliver Sacks. Awesome, I remember thinking. Will Chuck now see me as a hat?

Well, it turns out Chuck still viewed my face as a face -- albeit a confusing collection of features. That's what people with prosopagnosia see: eyes, nose, cheekbones, brow, mouth, hair, and ears, but with no way to assemble those features into the single, distinctive image of a face they can recognize and store in memory.

That's one of the major losses Chuck has suffered since the day of his surgery. Since he can't recognize faces, he's been unable to snap a mental photograph of the faces of people he's met since December 28, 1993 -- friends, colleagues, neighbors. He has a memory of my face and those of siblings and close friends as adults, but our children were just eight and ten when Chuck developed prosopagnosia so he cannot "see" their faces as adults. That's caused practical challenges, as he sometimes has trouble discriminating between me and our daughter, Kathleen, since we're both tall and slender. Fortunately, her hair is longer and darker than mine, but most differences -- except for age -- end there.

And age is not a terrific differentiator for people with prosopagnosia. Neither is skin tone. Chuck has trouble distinguishing between a light-skinned African American and a dark-skinned Caucasian. He can identify a child from a short adult, but beyond that he struggles to categorize a person's age. He tends to focus on other attributes: voice, gait, a distinctive perfume, and the like. Unlike the unique image of a person's face, those characteristics aren't terribly reliable, which has caused more than one uncomfortable situation. More on that to come.

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