Prosopagnosia, often known as face blindness, is a severe cognitive condition in which an individual's capacity to recognize one's own or familiar faces is damaged, while the rest of the cognitive functioning and visual processing object discrimination remain unaltered (Rugg, 2013). Some persons may report a little impairment that only affects facial recognition in select cases. Those suffering from prosopagnosia may fail to distinguish non-human things such as cars, animals, or buildings in severe situations. In some situations, patients with this cognitive disease have difficulty recognizing or identifying emotional expression, age, and gender; in the worst cases, they have navigational issues. The paper will incorporate the clinical, social, and psychological issues that surround this cognitive disorder. The paper will also discuss the diagnostics of the disorder, its risk factors, co-morbidities, and the current trends. Additionally, the work will explain the treatment of the cognitive disorder incorporating the negative and positive aspects to the treatment options as well as the barriers to seeking treatment or rather its access. The paper will further look at the impact of the condition on the individuals, health care system, the paramedics, and the society in general. Lastly, the paper will tackle the implicit bias of the disorder and then make a conclusion on the subject.
Prosopagnosia
Cases of prosopagnosia were first reported in the 19th century. However, the first published book about this mental condition was in 1947 (Finger, 2001). Two types of the disorder were identified: acquired and developmental prosopagnosia. The disorder was further classified into appreciative and acquired. A 2012 research showed that developmental prosopagnosia results in a poor integration of high and low frequency information processing (Temple, 2014). The prominence of the neurological disorder in recent decades has led to additional studies by researchers. Studies show that about 2% of the total population in the world suffers from this disorder (Esins, 2015). The disorder is thought to be as a result of impairment or damage, or abnormalities in the right fusiform gyros which is a crinkle in the brain that coordinates the neural system that regulates facial expression and memory.
Cause
Prosopagnosia can be as a result of various parts of the anterior temporal cortex, fusiform gyrus (fusiform face area), and inferior occipital areas (occipital face area) having lesions. Position emission topography scans and fMRI identified that the anterior temporal cortex, fusiform gyrus (fusiform face area), and inferior occipital areas for individuals that do not suffer from prosopagnosia were acticitaed (Liu, Harris, & Kanwisher, 2010). This is common, especially in response to face stimuli. Integration of particular information about voice, face, familiar individual, and name is done by anterior temporal structures.
The development of acquired prosopagnosia is a result of damaged nervous system. This includes the hemorrhages in the temporo-occipital area specifically the infero-medial part. Posterior cerebral artery infarcts (PCA) is a vascular cause of prosopagnosia. Prosopagnosia can also be induced by the damage of the right hemisphere specifically in the temporo-occipital areas. MRIs scan carried out on prosopagnosia patients identified that lesions where isolated to the right hemisphere. However, fMRI scan identified that the left hemisphere was normally functioning (Liu, Harris & Kanwisher, 2010). Object agnosia can be caused by unilateral left temporo-occipital lesions. This however spares face recognition. A few cases have been documented for this type of prosopagnosia. Researchers suggests that impairments on face recognition caused by left hemisphere are as a result of semantic defect that blocks the retrieval processes which is involved in obtaining information from the visual modality.
Diagnostics
Few neuropsychological assessment that can definitively diagnose prosopagnosia have recently sprung up. One of the common tests that are used is the famous faces test. The test involves a patient being asked to recognize the faces of famous people (Axelrod & Yovel, 2015). The demerit of this test is that it has proved difficult to standardize. Another test that has been used to diagnose prosopagnosia is The Benton Facial Recognition Test (BFRT). This test assesses a person’s face recognition skills. A person is given a target face (Heering & Maurer, 2014). The faces should have more than six test faces. An individual is then requested to match the target face with the test face.
One of the characteristic of this test is that the clothes and hair are cropped out of the picture. It is known that people suffering from prosopagnosia use face and clothes to recognize a person more than any other aspect of that individual. Both female and male faces are used for this test. Only one face matches the target face for the first six items. For the next seven items, three test faces match the target faces. In the seven items, the faces have different poses so that it can challenge the patient. This can then be used to determine the severe nature of the prosopagnosia in such an individual. A research conducted by Nakayama and Duchaine showed that the reliability of the BFRT is questionable. The research showed that the average score was in the normal range for 11 self-reported prosopagnosics (Axelrod & Yovel, 2015). The BFRT test is suitable for individuals that suffer from apperceptive prosopagnosia. The reason for this is that the test is primarily a matching test. It is therefore unable to recognize both unfamiliar and familiar faces. People suffering from apperceptive prosopagnosia would therefore be unable to pass this test. The test can also be useful for diagnosing individuals with associative prosopagnosia. People suffering from those conditions are able to match the faces.
The Cambridge Face Memory Test (CFMT) is another test for prosopagnosia that was developed by Nakayama and Duchaine (Croydon et al. 2014). The test was developed as a result of the shortcomings of the other two tests. These two neuropsychologists developed this test so that it could diagnose people with prosopagnosia better. The test uses three images of six different target faces initially (Croydon et al. 2014). The people with prosopagnosia are then presented with many three-image series. The three-image series have two images that are distractors and one target face. The two neuropsychologists argued that this test is more accurate than the other two as well as being efficient in diagnosing patients with prosopagnosia. However, this test is not used frequently and it still needs further testing to ascertain its efficiency and accuracy. Apart from the other tests, there is the 20-item prosopagnosia Index (P120) (Nichols, Betts, & Wilson, 2010). The test has been validated with Famous Faces Test and Cambridge Face memory because of its effectiveness in identifying individuals suffering from prosopagnosia (Gray, Bird & Cook, 2017).
Co-Morbidity and Trends of Prosopagnosia
Research has shown that people that suffer from autism spectrum disorder also experience difficulties in face recognition. People that suffer from development disorders such as Turner’s syndrome and William’s syndrome face problems of face –processing (Raman, 2016). Various theories have sprung up explaining this pattern. Researchers with the help of neuropsychologists have established that face recognition impairment can be attributed to the lack of social interest in faces. Conversely, a lack of visuo-spatial skills and perceptual-processing strategy may be the vital factor that leads to face recognition impairment. It can however be noted that while some people that suffer from prosopagnosia as a result of face recognition difficulties report severe social consequences, this is not an indicator of concurrent neuro-developmental disorder (Finger, 2001). Reports have showed that there has been a high case of misdiagnosis of high functioning autism especially when the underlying issue is prosopagnosia alone. The two disorders have been confirmed to be independent of one another as exemplified by the fact that developmental prosopagnosia does not fulfill the autism spectrum disorder diagnostic criteria.
Acquired prosopagnosia is rare among the population. On the contrary, developmental prosopagnosia seems to be common. Generally, there is a rising number of people being diagnosed with this disorder (Calder, 2011).Recently, a burst in media has created awareness of the disorder, and thousands of individuals who believe they have the disease have approached doctors (Whitaker, 2010). Research has been carried out to estimate the exact number of individuals suffering from prosopagnosia. A study done in Germany revealed that between 2% to 2.5% of the total population was suffering from prosopagnosia. Further, the study revealed that a test carried out of 50 people one was found suffering from the condition (Shah, 2016).
Treatment of Prosopagnosia
People that have prosopagnosia have encountered negative impacts such as feeling socially inept as well as feeling as a social outcast due to their problem of remembering friends. Currently, there is no formal treatment for prosopagnosia (Gillespie & O’Neill, 2014). Since 19th century when selective inability to recognize faces was documented, treatment advancement has not resulted in any positive result. Recent published laboratory reports showed that it is has faced difficulties in getting the right treatment for this kind of disorder. Some of the remedies for face recognition difficulties that have been tried include temporary pharmaceutical interventions and the use of training programmes (Harris & Aguirre, 2008). Research is being done in countries such as the United Kingdom to find a formal treatment for the disorder.
Other strategies have been formulated for people that struggle with this disorder so that they can overcome the difficulties they face. Some of the strategies that have been formulated are for their loved ones to wear a particular clothing or jewelry. The person suffering from the disorder can therefore identify them easily. Other elements include teaching the individuals with the disorder the common gait of some of the people as well as the way they talk DeGutis et al. 2014). This remedy has however failed to address the concerns of the people with prosopagnosia. The main problem has been the combined external cues recognition and system of logic of the person with prosopagnosia. If these two aspects fail to combine especially when the person breaks down, the remedy does not function or rather the strategy (Eysenck, 2004).
Researchers have argued that facial perception process for the people suffering from prosopagnosia is more holistic than featural. The reason is that it is for perception of most of the objects. In a holistic approach of perception, the face does not involve any common representation of the local features (Hugh 2015). These local features include the eyes, mouth and nose. A holistic perception considers the whole face. As such, it is a better strategy than using featural perception. The disadvantage of using featural approach to face recognition is that the prototypical face usually has the same features or rather specific spatial layout in that the nose is located above the moth and the eyes above the nose. When people come from a specific group of similar layout, a holistic approach is necessary from people suffering from prosopagnosia.
The strategies used for remedying prosopagnosia do not have any negative features. It can also be argued that they do not have any positive effects. The reason is that these strategies rarely work effectively. Researchers are still trying to figure out what can be the best strategy or treatment for the people with this disorder. Having an extensive knowledge of the different types of prosopagnosia is essential for the practitioners and the patients. By having a proper knowledge, they can select an approach that suit that disorder rather than using the ones that can be unworkable for them (Leatherdale, 2013). The reason why people suffering from this disorder do not seek medical action is that most do not even know that they are suffering from this disorder. It is because of this reason that people are encouraged to go for tests often.
Impact of Prosopagnosia
Prosopagnosia affects both the social and personal level of an individual. A study was conducted to determine the level of face perception and its influence on an individual (Tantam, 2012). The results showed that the disorder can be socially crippling for a person. People with this kind of disorder have difficulty recalling the faces of their friends as well as their close family members. Usually, this leads to different ways of recognizing friends and family members. On a daily basis, this cannot be effective due to the dynamic of everyday activity. As such, the disorder is frustrating for the person suffering form it due to the constant questions one has to ask about the identity of close friends and family members. The alternative methods are not effective as well. In worse scenarios, people who are born with the disorder fail to grasp the identity of their loved ones. The reason is that they could not have the chance to recognize the faces initially.
The disorder also impacts friend and family members in a negative way. In most cases, the family members or friends have to introduce themselves frequently. It is frustrating knowing that the person that you live together does not recognize who you are especially if such a person is parents. Playing games with friends can as well be problematic. The person with the condition may forget their friend’s mid-way the game resulting in introducing oneself once gain. Family members and friends also have the issue of explaining to other people what afflicts such an individual. This can be issue in school especially when such a person fails to recognize the teachers and other subordinate staff. Friends and families also have to dress themselves in a particular way every day so that they can easily be identified. This can include wearing a particular jewelry in a certain part so that the person can recognize that particular person.
The disorder has proved problematic to the healthcare system. For decades, neuro-psychologists have been trying to find the remedy for this disorder. Funds have been sourced extensively in most part of the world so that a remedy can be found for the issue. SO far this has proved futile with zero results. Only a few strategies have been made and so far they are not effective in combating the issue. For paramedics, their greatest problem has been identifying the various forms of prosopagnosia in patients. Due to the unavailability of treatment, they have been relegated to using strategies to combat the issue which to some extent is ineffective. The disorder has also impacted the society negatively. People still do not understand what can be used to combat this issue. Studies show that the disorder is continuing to increase among the population. However, the main problem is that most people have not gone to be tested. As such, various individuals have been miss-diagnosed. Research is being done so that the treatment for the disorder can be found and in return, help millions of people worldwide.
Implicit Bias
Implicit bias is the bias in behavior or judgment that results from subtle cognitive processes, for instance, implicit stereotypes and implicit attitudes (Hofmann et al. 2005). The judgment often operates without intentional control and below conscious awareness. Studies show that observing faces by social category can activate the implicit social biases of a person. For people suffering from prosopagnosia, implicit attitudes exist. Research shows that when a group of patients were asked to categorize faces explicitly by political affiliations, gender, and race, the patients were marginally slower in categorizing black faces. When it came to white faces, they could easily categorize the faces. The patients also showed congruency effects in celebrity and races in the implicit association tests (IAT) (Hahn et al. 2014). However, congruency effects could not be identified in the political affiliations and gender tests. The results showed that people that suffer from prosopagnosia had an implicit social sensitivity to some particular facial stimuli although they do not have the ability to overtly recognize faces that are familiar. The results of the study showed that social biases can be retrieved among people suffering from prosopagnosia based on facial stimuli through the pathways of bypassing the fusiform gyri (Kanwisher, Stanley, & Harris, 1999).
Conclusion
Prosopagnosia is a disorder that is continuing to prove a challenge for many neuropsychologists. No treatment has been found for this disorder and many people are continuing to suffer. The disorder in some instances has also been misdiagnosed due its rarity.
Prosopagnosia is as a result of the outcome of abnormalities, impairment or damage in the right part of the brain which coordinates the neural system. Prosopagnosia has a big impact on an individual as well as the society in general. Family members and friends also suffer greatly as a result of failure to get recognized. Few neuropsychological assessments have recently sprung recently resulting in various strategies that can aid a person with prosopagnosia. Additionally, tests have been created to evaluate the disorder. Some of these tests include the Benton Facial Recognition Test (BFRT), the Cambridge Face Memory Test (CFMT) and the 20-item prosopagnosia Index (P120) test. Despite numerous research and tests, scientists have not succeeded in inventing a formal cure for the disorder. Currently, research is objectively carried out to focus on finding out better ways to treat, prevent, and finally cure the disorder.
References
Axelrod, V., and Yovel, G. (2015). Successful decoding of famous faces in the fusiform face area. PloS One, 10(2), 117-126.
Brian O'Neill, A. G. (2014). Assistive technology for cognition: A handbook for clinicians and developers. Milton Park: Psychology Press.
Calder, A. (2011). Oxford Handbook of Face Perception. Oxford: OUP Oxford.
Croydon, A., Pimperton, H., Ewing, L., Duchaine, B. C., and Pellicano, E. (2014). The Cambridge face memory test for children (CFMT-C): A new tool for measuring face recognition skills in childhood. Neuropsychologia, 62, 60-67.
DeGutis, J. M., Chiu, C., Grosso, M. E., and Cohan, S. (2014). Face processing improvements in prosopagnosia: successes and failures over the last 50 years. Frontiers in Human Neuroscience, 8, 561.
Esins, J. (2015). Face processing in congenital prosopagnosia. Berlin: Logos Verlag Berlin GmbH.
Eysenck, M. W. (2004). Psychology: An international perspective. Milton Park: Taylor & Francis.
Finger, S. (2001). Origins of neuroscience: A History of explorations into brain function. Oxford: Oxford University Press.
Gray, K. L., Bird, G., & Cook, R. (2017). Robust associations between the 20-Item Prosopagnosia Index and the Cambridge Face Memory Test in the general population. Royal Society Open Science, 4(3), 160923.
Hahn, A., Judd, C. M., Hirsh, H. K., and Blair, I. V. (2014). Awareness of implicit attitudes. Journal of Experimental Psychology: General, 143(3), 1369.
Harris, A., & Aguirre, G. K. (2008). The representation of parts and wholes in face-selective cortex. Journal of Cognitive Neuroscience, 20(5), 863-878.
Heering, A., & Maurer, D. (2014). Face memory deficits in patients deprived of early visual input by bilateral congenital cataracts. Developmental Psychobiology, 56(1), 96-108.
Hofmann, W., Gawronski, B., Gschwendner, T., Le, H., and Schmitt, M. (2005). A meta-analysis on the correlation between the Implicit Association Test and explicit self-report measures. Personality and Social Psychology Bulletin, 31(10), 1369-1385.
Hugh Foley, M. M. (2015). Sensation and Perception. Milton Park: Psychology Press.
Kanwisher, N., Stanley, D., and Harris, A. (1999). The fusiform face area is selective for faces not animals. Neuroreport, 10(1), 183-187.
Leatherdale, L. (2013). Prosopagnosia, face blindness explained. prosopagnosia types, tests, symptoms, causes, treatment, research and face recognition. Essex: IMB Publishing.
Liu, J., Harris, A., and Kanwisher, N. (2010). Perception of face parts and face configurations: An fMRI study. Journal of Cognitive Neuroscience, 22(1), 203-211.
Nichols, D. F., Betts, L. R., and Wilson, H. R. (2010). Decoding of faces and face components in face-sensitive human visual cortex. Frontiers in Psychology, 1, 28.
Raman, S. (2016). Adverse childhood experiences and theory of mind. The British Journal of Psychiatry, 208(1), 94-94.
Rugg, M. D. (2013). Cognitive neuroscience. Milton Park: Psychology Press.
Shah, P. (2016). Identification, diagnosis and treatment of prosopagnosia. The British Journal of Psychiatry, 208(1), 94-95.
Tantam, D. (2012). Autism Spectrum Disorders Through the Life Span. London: Jessica Kingsley Publishers.
Temple, C. (2014). Developmental cognitive neuropsychology. Milton Park: Psychology Press.
Ulrich, P., Wilkinson, D. T., Ferguson, H. J., Bindemann, M., and Johnston, R. A. (2014). Perceptual and memorial impairment in developmental prosopagnosia. London. Springer.
Whitaker, H. A. (2010). Concise encyclopedia of brain and language. Amsterdam: Elsevier.
