With prosopagnosia, some people can’t even recognise themselves. Yet, others never forget a face. In the cinema, I often nudge my husband and whisper “Is this chap the same one we saw in the last scene?” and he hisses back “No, of course not!”. And every time I have changed school or job, there have been a couple of people whom I continued to muddle up long after most people were as familiar to me as my family.
I’m just not very good at faces. I didn’t give it any thought until 2010, when I read an article by Oliver Sacks, professor of neurology and author of The Man who Mistook his Wife for a Hat. Sachs struggled to recognise anybody – patients, colleagues, friends, his family. When he discovered that a brother had the same problem, he deduced that this was probably a genetic trait.
In 1947 a German neurologist described three cases of a specific form of facial agnosia and coined the term prosopagnosia. Autopsies of sufferers showed that they all have lesions in the right visual-association cortex, but until recently face-blindness continued to be put down to shyness, absent-mindedness, bad manners, and that catch-all for any problem with interpersonal relationships, Asperger’s Syndrome.
As always, for sufferers, receiving a diagnosis and knowing they are not alone make living with the condition a bit less stressful. And prosopagnosia is receiving more publicity. In 2011 consultant gastroenterologist David Fine wrote in the BMJ about the difficulties face-blindness causes him and the strategies he uses to reduce them. He manages, with some difficulty, on a day-to-day basis but networking at meetings is a near-impossible task and he feels that prosopagnosia has hampered his career. There are now blogs, discussion groups and articles in the press.
Some people can’t even recognise themselves. Yet, others never forget a face. The London Metropolitan Police employs ’super-recognisers’. They scan through all that grainy CCTV footage, and from an image of a half-averted face in shadow they can recognise someone they have seen in CCTV records of crime sites, or in mug shots or even on the street five years ago. Their ability has led to the solving of 2500 crimes last year; more than fingerprinting or DNA.
People at the extremes of a spectrum stand out. Face-blindness was described 70 years ago, but it took a while to understand that between Oliver Sachs and a super-recogniser, both two standard deviations from the mean, there is a bell shaped curve, some people better, some worse, at recognising faces, but functioning well enough.
Take an on-line test to find out how good a recogniser you are. I come out as borderline prosopagnosic. I can recognise most people most of the time, under good conditions.
There are many other disease spectra. People with severe dyslexia were recognised but labelled as stupid until the condition was understood, and then it was realised that many degrees of dyslexia exist and that many people are held back by mild to moderate problems with reading and spelling, and can be helped. Autism has actually acquired the word spectrum in its definition.
The recognition of spectra comes up against our wish to understand our world by classifying things.
We label people. We label ourselves : “I can’t sing”, “I’m useless at drawing”. In reality with the right encouragement and teaching (often sadly lacking in schools), it seems that everyone can sing or draw, not brilliantly but well enough to get pleasure out of the activity.
A lot of things are turning out to be more complicated than we used to think. Male or female? Most of us live comfortably as one or the other, but these days all sorts of states in between are recognised, not just in medicine but by law. Pregnant or not pregnant? What about the time between fertilisation and implantation? And at what point are you born? Who defines it? Religion? The law? Doctors? Is someone alive or dead? From the first time you watch a patient die you realise that dying is a process. The genotype of people with haemophilia or Downs may be clear-cut, but their phenotypes demonstrate a spectrum of consequences.
There is already a view that GPs should police access to the NHS. Will the government see us as assessors of the right to enter the UK?
The closer you get to boundaries, the fuzzier they get. As quantum physics tells us, things are rarely black or white. Literally. In early 20th century USA racial supremacists defined as ‘black’ anyone who was deemed to have ‘one-drop’ of non-white blood.
If things can be defined and classified, they can be assessed and controlled. So governments need definitions.
In the old days examiners set essays, giving students the chance to roam around a topic. But essays can’t be marked by computers. Multiple choice questionnaires appear to offer a range of alternatives, but I can’t be the only person who has sat in an exam mutely arguing with the options.
Tick-box assessment hasn’t done much to improve health care either. It is a poor proxy for judging how well GPs deal with messy reality of everyday life.
The Prime Minister is currently seeking to draw a clear distinction between people fleeing persecution – refugees, to whom we as a nation may show some generosity – and economic migrants – takers of advantage whom we will certainly turn away. Who is going to decide which of these desperate people should be allowed in? There is already a view that GPs should police access to the NHS. Will the government see us as assessors of the right to enter the UK?
We are all have a mixture of qualities and abilities at everything; positioned differently on thousands of different spectra. A complex society can’t function without categories, but a humane society must recognise that life isn’t black or white.
P.S. My husband points out that film directors frequently change characters’ clothing and hairstyles in the middle of a film and for no obvious reason. Apparently even cameramen get confused, so no wonder viewers with prosopagnosia lose the plot! (I am delighted to note that he scored lower than I on the prosopagnosia test.)
Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum, an LMC chair and a long-time supporter NASGP. Her charity, Cuba Medical Link, enables medical students to go to Cuba for their electives.
Judith has now published all her articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…