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Face Blindness: ‘Hello, whatever-your-name-is’

- ‘Mum, on my way home from school I met a very nice lady. We chatted. She sent you her best wishes.’

- ‘But who was this nice lady?’

- ‘I don’t know, but she knows us all: she asked how we all were doing…’

- ‘Why didn’t you ask her name?’

‘Oh, mum, it’s so embarrassing…'

There is a neurological condition that, though not specific to autism, appears to be quite common in (at least, some) autistic individuals. It’s called prosopagnosia, or face blindness. People with this condition have trouble recognizing people’s faces. They can see a face all right but whose face it is is a mystery for them. It’s just a face – not Nick’s or Mary’s face.

There are two types of face blindness: (1) developmental prosopagnosia, which is genetic and runs in families: at least one first-degree relative (for example, a parent or a sibling has it as well), or and (2) acquired prosopagnosia that may be caused by strokes, head injuries, or severe illnesses.

The exact effects and severity may vary between people: some may be blind to all but the most familiar faces, while others (with severe prosopagnosia) cannot recognise even themselves in the mirror. Can you imagine how embarrassing it is when someone (trying to be sociable at a party) cheerfully waves her hand to her own reflection in the mirror?

Non-autistic people with prosopagnosia say that face blindness tends to isolate them from people in general, as being unable to recognise others interferes with making and maintaining relationships. They work out their own recognition system. Most common features that help them to recognise the person are: casual clothes, movement, long hair and facial hair (as the inability to recognise faces does not extend to hair, particularly if it is long enough to extend out of the face area). Visually, they perceive hair differently and can see a pattern in hair texture and process hairlines. Interestingly, some autistic children are fascinated by people’s hair, and many do not recognise their relatives if they wear unfamiliar clothes.

Another problem prosopagnostic individuals experience is the difficulty to understand and express emotions. The main ‘tools’ to express emotions are not words but facial expressions, gestures and tone of voice. For people who cannot ‘read’ faces because of face blindness or/and cannot ‘hear’ emotions in voices because of their auditory processing problems, it is extremely difficult not only to understand emotions in others but also to express emotions themselves otherwise than using words. It’s sort of ‘emotion blindness’.

There is a striking similarity of emotional expressions of blind people and individuals with prosopagnosia: not seeing what emotions are supposed to look like when coming in, both the blind and prosopagnostics don’t acquire a large repertoire of emotional expressions to send out. It is no wonder, therefore, that autistic people experiencing all sorts of sensory processing problems find it very hard to understand (conventionally expressed) emotional states of other people and those of their own. (However, they often sense emotions of others in their own bodies without interpretation what they mean.)

In addition to their difficulties in ‘reading’ facial expressions, some individuals with prosopagnosia have problems with understanding gestures and sign language, which involves a lot of facial expressions.

Face blindness may co-occur with autism. Hans Asperger reported the example of an astronomer with Asperger syndrome who could not recognise his friends and relatives. Some researchers even suggest that prosopagnosia may be an essential symptom in ASD, perhaps a specific subgroup of Asperger syndrome. A teenager with Asperger syndrome often got into embarrassing situations because she did not remember faces unless she had seen the people many times or they had a very distinct facial feature, such as a big beard, thick glasses or a strange hairstyle. An autistic boy with prosopagnosia, despite knowing the names of his classmates, often calls them ‘a boy’ or ‘a girl’. Interestingly, when one of the girls had her hair cut short, he ‘moved’ her to the ‘boy’ category.

Some experimental studies of autistic people’s capacity to process faces suggest that they use abnormal processing strategies and experience less difficulties when faces are presented to them upside-down. (Whether it is true for their perception of the whole environment needs further investigation.)

Next time, meeting someone with prosopagnosia, please introduce yourself (even if you encounter him/her several times on the same day). Remember about the little girl who was too embarrassed to ask that nice lady what her name was. Help them feel at ease in social situations.

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