WSJ: Mysteries of the 'Faceblind' Could Illuminate the Brain

IDENTITY PROBLEM
Mysteries of the 'Faceblind' Could Illuminate the Brain
Strange Deficit Impairs Ability to Recognize;
'Are You My Mommy?'

By HEATHER WON TESORIERO

The Wall Street Journal
July 5, 2007; Page A1

Several years ago, when Margaret Mitchell picked up her son Duncan
from his Seattle school, he looked at her curiously and asked, "Are
you my mommy?"

Ms. Mitchell, an attorney by training, was taken aback. When she
answered, " 'Yes, I'm your mommy,' " he recognized her voice and was
reassured.


MEDICAL MYSTERY
· What's New: Research into 'faceblindness' is examining links to
brain functions, as well as improved ways to test for the condition.
· Coping: Patients say they compensate by recognizing people by their
speech, hair or walking gait.
· Treatment Possibilities: Exercises used with autistic children are
now being tested with prosopagnosia.
A short while later, Duncan, then 4 years old, was diagnosed with
prosopagnosia -- a so-called selective developmental condition often
referred to as "faceblindness." Although his eyesight is perfectly
fine, he can't always identify people by their faces. In school, for
instance, Duncan has trouble matching the faces and names of teachers
and pupils.


Like many other prosopagnosics, Duncan, now 8, has a memory that
functions normally in other ways. He can visually distinguish between
cars and houses and toys. He knows his dog and cat and other
neighborhood pets. He's a sociable child and likes being around
people. But the frustration of not being able to discern faces has
made everyday life -- from attending school to making friends --
unbearably difficult. His parents engineer much of his social life
around one-on-one playdates so he can try to remember classmates.

An elusive and unsettling medical mystery, prosopagnosia may offer
clues to the delicate interworkings of personality and the brain. Some
researchers believe that studying it could help illuminate other
developmental aberrancies that scientists haven't yet identified.

Research into the condition "has legitimized the search for other
brain mechanisms that may also be designed to process information
about very specific aspects of the world," says Brad Duchaine, a
cognitive neuroscientist at University College London. "It's possible
that these selective deficits are sometimes major contributors to
people's personalities and may even account for the little personality
quirks that so many of us have."

Prosopagnosia was first coined in 1947 by a German neurologist who
observed that a young man who suffered a bullet wound to the head lost
his ability to recognize people. But it's only in the past decade that
researchers began focusing on developmental prosopagnosia, or people
born without the ability to recognize faces. Studies suggest that up
to 2.5% of the population might suffer from some degree of
faceblindness.

As faceblind children get older, their challenges shift. Toby Scheib,
14 years old, says he's reluctant to tell his peers about his
condition. "Either they ask, 'Are you making this up?' They're like,
'I've never even heard of this.' At first they don't believe me," he
says.

Toby and his mother, Elaine, who is also faceblind, once lost each
other at an Easter egg hunt. Eventually, the police had to look for
Toby because mother and son couldn't recognize each other in the sea
of parents and children.

Adult prosopagnosics say that their condition can be socially
alienating. Nicky Hoberman, 39, is an Oxford graduate and an
accomplished London artist whose work, ironically, includes paintings
of faces. She says one time she was at the gym and noticed a man
staring intently at her. "He just stood there staring at me while I'm
doing my ab crunches and I thought, 'You pervert,'" she says. She
ignored him. Shortly after the incident, her brother mentioned that
his best friend saw her at the gym, wanted to say hello and was
waiting for her to finish her exercises. "I'd met him countless
times," she says.

Like other prosopagnosics, Ms. Hoberman relies on other
characteristics to recognize people, including their hair and walking
gait. She's also a very keen listener. "I never forget a thing anyone
ever tells me," she says.

Much of the research on faceblindness takes place at the University
College London's Institute of Cognitive Neuroscience. There, Dr.
Duchaine runs the Social Perception Lab, where he and his staff are
working to identify prosopagnosics. Those diagnosed with the disorder
are asked to come back for more advanced tests that look at their
ability to perceive identity, emotion and gender while looking at
faces.

Dr. Duchaine's early work sought to establish that parts of the brain
specialize in face processing. Through a series of experiments, some
involving scanning people's brains while showing them images,
researchers identified two regions in the brain's temporal lobe, the
fusiform face area and the occipital face area, that appear to be
critical for face recognition.

"The best way for normal people to have a sense of how a prosopagnosic
sees faces is to look at images of inverted faces," Dr. Duchaine says.
His research shows that normal people can identify upright faces, but
do very poorly identifying upside-down ones. Prosopagnosics, on the
other hand, often score the same on both.


As a student, Dr. Duchaine was always interested in face processing.
When he was in graduate school at the University of California at
Santa Barbara, a family friend mentioned a teenager who was unable to
identify faces. "I put together a bunch of tests, hopped in my car and
drove to Los Angeles to test the kid," he recalls. Even using the
crude tests he'd developed, Dr. Duchaine was confident the teenager
was prosopagnosic.

He went on to do a four-year postdoctoral fellowship with Harvard
psychologist Ken Nakayama, an expert in visual perception. The duo
developed the Cambridge Face Memory Test, which was published in 2006
in the journal Neuropsychologia and has become a standard face test.
It is now recognized as a standard diagnostic tool for the condition.
(Take the test1.)

During a recent hospital lecture, Dr. Duchaine showed a slide of Elvis
Presley, with the hair cropped off. During his talk, he said he once
asked a woman if she could identify the image and she replied, "Is it
Brooke Shields?"

Research also suggests that developmental faceblindness is often
genetic and comes in degrees. Last year, Dr. Duchaine and Dr. Nakayama
flew to Las Vegas to screen 19 members of Toby Scheib's family,
ranging in ages from 13 to 76. Of the group, seven were prosopagnosic,
but not equally so. Toby's grandmother, an aunt and he were the three
most severe cases; his mother, Elaine, scored near the middle of the
afflicted.

A common question is whether prosopagnosia is somehow related to
autism, since people with that disorder can also often struggle with
faces -- in both recognizing them and reading people's emotional
facial expressions. Based on some early tests, Dr. Duchaine says he
believes that the research will show that facial identity, emotional
facial expression and social cognition aren't consistently linked.

"A lot of our prosopagnosics also have trouble with facial expression,
but they do well in everyday life and show no hint of autistic
traits," he says. "The only reason they have trouble in social
interactions is because they have trouble extracting information from
the face."

Before learning that Duncan was prosopagnosic, his mother recalls a
number of incidents that offered clues into his condition. As soon as
Duncan learned to talk, he would often ask people he'd seen many times
before, "How do you know me?" or "How do you know my name?"

When he was 3 and attending a Montessori school, his teacher told Ms.
Mitchell that Duncan didn't call any of the children in the class by
their names. "I thought it was odd that he would refer to another kid
as 'that guy or that person over there,' " recalls Gina Lauvstad, his
former teacher. While he struggled to place his classmates, he was
learning other things on schedule, singing songs and recognizing
numbers.

The following year, Duncan still couldn't name the children in his
class. His vision and hearing were tested, and found to be fine. He
scored high on an IQ test.

A psychologist who saw Duncan three times first used the term
"faceblind." Ms. Mitchell says that she went online to find
information. "I just started to cry and cry," she says.

Duncan at first did well in kindergarten last year at his local public
elementary school largely because a special-education aide worked with
him, Ms. Mitchell says.

But last February, the school brought in a new aide, explaining they
didn't want Duncan to become dependent on one person.

"Things went bad really fast," says Ms. Mitchell. Within a week, she
started getting calls about Duncan's behavior and was often summoned
to pick him up from school.

Since November, Duncan has been attending a small private school with
roughly 40 children. On a recent day, he could name two children in a
group, a girl with long brown hair and boy with a shaggy haircut. He
said he couldn't remember the other children's names.

While researchers are looking to study prosopagnosia in children,
other efforts are being made to understand how children with autism
process faces, since they often struggle with face recognition and
emotional expression. Psychologists Jim Tanaka of the University of
Victoria and Robert Schultz of Yale Child Study Center are wrapping up
a five-year National Institutes of Health study of a computer game
they created for children with autism to try to improve their face
recognition skills. Dr. Tanaka says he's eager to see if the game can
help prosopagnosic children.

After initial face-recognition tests, autistic children ages 7 to 18
played games on a computer program called "Let's Face It" for 20
hours. Half participated in the game and half didn't. The ones who did
saw improvement. The researcher likened the experiment to giving
patients a drug in a clinical trial.

"I won't say it's a slam dunk, but we're getting good results," says
Dr. Tanaka. The key, he says, is early intervention. "The earlier, the
better, because of what we know about the plasticity of the brain."

Ms. Mitchell says she's open to allowing Duncan to participate in
research, and the family plans to send Duncan to a one-day "Face Camp"
that Dr. Tanaka is sponsoring for children.


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