Coping with Prosopagnosia

The last post I made about face blindness described many negative social situations that I've experienced since I acquired prosopagnosia from a head injury in 2001. In this post I want to describe how I've been handling the condition.

The first thing I noticed after the accident was that I couldn't recognize my own face in the mirror. Even after I understood intellectually this was me, I still was met with an unfamiliar face in the mirror, which was unnerving and surprising. So I avoided looking at my face in the mirror. It was just too jarring to see such a stranger. If I accidentally caught a glimpse of myself in the mirror, I might for a split-second think, who's this that's come to visit me? So in a way, it was like I always had company.

So that's the first thing, I try to have a sense of humor about it.

I had a huge, widescreen tv, and although I preferred watching nature shows, I tried to watch tv shows that had people in them. For me, watching tv was a little like Sesame Street for prosopagnosiacs. It took time. Even after a few years, in 2003, I still couldn't follow characters or plots very well, and I totally biffed it when asked what happened in the Matrix sequels. I don't know why references to pop culture serve as a handy measuring stick for rehab, I guess that's just the kind of post-modern grrrl I am. But over time I did improve. I understood and followed many of the last movies I've seen.

One thing I did while watching faces on tv was pretend I was looking at the side of a mountain, instead of a face. I remember going to Yosemite and seeing the waterfalls and the vertical rock formations at different times of the year. I remember that after staring at natural features for a while, I would see climbers with ropes making their way. I also remember scrambling around on some rocky surfaces there myself. I remember physically touching the cliff with my hands, feeling the warmth the rock was holding from the sun, and using my hands to help me scoot around. And I also remember when I was younger I saw several photographs of vertical rock formations at Yosemite, including some by Ansel Adams and the f/64 group. When I was a young student, the work of those photographers really drew me in and impressed me. It caused me to love, to value, and to abstract so much from lines, crevices, shadows, and shades.

So one trick I tried while looking at faces was to imagine I was looking at some other vertical surface, like El Capitan in Yosemite. I might visualize a small area on the face where tiny climbers would choose to rappel. The climbers would have to be ant-size! And I might remember how my own hands physically touched the rock surfaces I scrambled on. I might imagine an Adams-styled, f/64-styled, black-and-white image of the person's face, but particularly where a face area could be abstracted.

The combination of these effects might allow me to create a shaft, or a lane, or an angle of recognition on some part of some faces. I was still not able to really see the whole face. But if you can create a familiar pattern on say 15% of a face, it can really help in identification, especially when you consider that gait, body type, hair, and other cues are still in play.

I don't recommend staring intently at people on the downtown bus. It was easier to do this if the person didn't know I was staring at them, so if the face was on tv, great. My tv even allowed me to make a freeze frame, and I would make several, as I didn't want to get locked into one image of a character. It was just easier to try this technique if the faces were larger than life, and didn't move around too much. It was also easier to do this if the faces were older, and had wrinkles. And certain dramatic lighting conditions would make it easier to do this. This technique didn't work well on smooth faces, or where the lighting was fairly even.

Once I started getting out more, I needed more techniques. If I were in a small group of three to eight people, and everyone was sitting or not moving much, I would almost always make a cheat sheet that described general physical characteristics, accoutrements, non-physical identifiers, and some face features of each person. Sometimes the cheat sheet would be in the form of a seating chart, other times it would be a list in the order people talked, other times it would be in an order reflecting who was more socially dominant.

After my accident it was difficult to determine who the alpha women were in any given situation. I hate to make it sound like we're all a bunch of monkeys, because we're not. Nevertheless we are primates, and social hierarchy is no trifling matter. After the accident, my status went from one of the alpha mammals to something like circus dung sweeper. And I was one of the last people to find out. Even the cats knew it before I did.

I sensed it was important for me not to piss off the alphas, yet I also didn't feel comfortable schmoozing with folks who were perhaps too raw or uncouth. I had to really concentrate in order to navigate the social hierarchy in any given situation. This is no easy task, since the truth of hierarchy is hidden in plain view. That's the one place I really can't see. To navigate social terrain after becoming newly face blind, is like waking up and finding yourself to be an African American student in Arkansas in the 1950s, who's been bussed to an all-white school, and told to study calculus without knowing trigonometry first. Just pack me a lunch and I'll be fine, right? Sure.

If you can't see faces properly, you are missing the emotions that are signaled and reflected in faces. Emotions give important information about what's intended and what's received. What's actually happening is so much more than what's being said. I recall telling my partner at the time that she wasn't showing any emotion, and I remember thinking her face was impassive, like a cardboard box. We're no longer together. My point is, faces matter on so many levels. Otherwise our brains wouldn't have evolved with a dedicated region devoted to understanding faces.

Back to the cheat sheet. First I would jot down gross physical characteristics, and by that I mean body shape, posture, that type of thing. I would pay great attention to people's hair, and use details to describe hair. Nowadays many people carry backpacks, and so I would try to notice that. I would also pay very close attention to any accoutrements like hearing aid, cane, wheelchair, etc., because these often are perceived as extensions of the body, and are not discarded easily. I may notice an unusual phone, and be able to describe the manner in which the person uses the phone. The way a human body interacts with iphones, flip phones, and the treo-blackberry form factors is quite distinctive, however people tend to switch phones every year or two. Sometimes people have a favorite hat or scarf, but these things often are easily swapped.

Then I'd write non-physical identifiers on my cheat sheet. Examples would be "lives in Napa" or "works second shift" or "was an early organizer for Obama" or "always talking about surfing" or "her mother has frequent attacks of mild pancreatitis." This has come in very handy. It works like this. Perhaps I have a friend who knows both me and, say Megan, and the friend launches into an update about Megan. It's no use unless I know who Megan is. And for me, I need some kind of "peg" to make Megan an actual person, and not just a meaningless or random name. Then I can hang the story on its proper Megan peg. If my friend knows my problem and describes the physical features of Megan in order to tell a story, my friend may use physical descriptors that I can't follow, like "cute face." Now, what does that mean? I don't know cute face. Have I been dating beautiful or ugly people without realizing it?

Or the friend may use general descriptive words that apply to half the population, like "brown hair." I mean, how is that specific? Pets, coats and carpets can all have brown hair.

So I may ask, "wait, you mean the woman who had the bunions removed, and plays softball with Helen's friends, and wears the turquoise rings, and brought fish to last weekend's potluck?" This may identify Megan to my friend, as people often have common knowledge of each other. And now I get to learn from my friend that Megan is actually cute, and that people view her wavy, shoulder-length hair parted on the side, as brown, and not as chocolate drifting toward red.

When it comes to noting purely facial characteristics on my cheat sheet, I didn't always have much to say about that. I tend to dismiss cute face, beautiful face, and ugly face as having little meaning for me. However, as the years rolled by following the accident, and with repeated exposure to someone, I've been able to describe areas or planes of a face, such as a narrow forehead, or a high forehead. I'm also able to see freckles. I just don't see the whole face at the same time.

I can also see basic face outlines. I can tell if a face is oblong-shaped or if it's unusually round. I can tell if someone looks like they have the mumps, as in a face like John Goodman's. I believe the more polite term for that is square-jawed. This brings up the subject of unusual features, such as Jay Leno's chin. I really can't see it well enough to know whether he's square-chinned, although I remember him well enough from before the accident to know something's going on with that chin. Ditto with a weak chin. Knew about it before the accident, but can't use it much these days. Today, I don't see chins as clearly.

Still on the lower face, if someone has taken their dentures out, I'll bet I could tell, but that doesn't mean I know who the person is. Folks don't often do that in polite company, anyway. And braces can be tough for me; sometimes I see them and sometimes not. People don't always like it if you say "are you wearing braces?" More often than not, they respond with, "Why, is there food in them?" Even with that giant clue, it took me some time to realize two things: one, they must have braces if they go digging around in them looking for stray lettuce, and two, this isn't polite social chitchat.

With lips I can see if they're glossy from lipstick, but not much else. It will take me lots of effort and exposure to determine full lips from thin lips.

For me, noses sometimes can be seen in profile. My father had a classic Roman nose, very straight and rather like a triangle. Michelangelo's David has a similar nose and so did Robert Reed of the Brady Bunch. After the accident this type of nose seems very average, and for me, it's not easily assigned to particular faces that are new faces. Sometimes curved noses are easier for me see in profile, but it requires a bit of staring. Rather flat noses or rather large noses don't really register very well for me, and again, it's risky to be caught staring.

Everyone loves the eyes, they're the window to the soul. And that used to be true for me, too. Post-injury, I'm not sure if eyes are narrow, or widely spaced, or set close to each other, or are almond shaped. I suppose I stay away from eye contact more than I should.

However, I will try to pick up someone's eye color for my cheat sheet. People who are Asian, Latina, or African-American often have brown eyes, and if I don't see race in their face, I could always look at their forearms. However, I live in an urban area and many people are multi-racial, so guessing eye-color or race isn't really the best plan. Come to think of it, I live in an area with a lot of trannies who demonstrate that even gender can be fluid; some people aren't into the binary gender categories at all.

Back to the eyes, if I can't pick up eye color quickly, I might just ask, "are your eyes blue, or is it just the light in here?" Or, "my goodness your eyes are so striking" might be enough for them to tell a story, and if you listen they will say the color. Or I might try asking if they're wearing tinted contacts, but I would add something like, "I was thinking of getting a pair, and I heard they take some getting used to." If she's not wearing contacts, she will laugh and say those are her real eyes. And then you can relax and peer into them, and maybe she'll tell a story and say the color. You have to use caution here and take care not give the appearance that you want romance.

It's kind of funny, but because I look a little like a soft butch, when I talk about eyes to a butch lesbian, she might react in the manner of a straight man being approached by a gay man. Just imagine all the ways that can go awry. And if I talk about eye color with a more femme woman, and her butch "husband" gets wind of it, I'm sure you can see how that might play out. Oh, the joys of lesbian community. Or identity. Or whatever it's called these days. Of course, the butch-femme dynamic would be different if I'm talking to people in the younger generation, or if I were in a different part of the country. But that's another story.

By looking at face parts one at a time, I have a good chance of recognizing face features in a Mr Potato Head sort of way. Though I see the parts, I struggle to see the whole. But I still see a lot, in a close-enough-for-government-work sort of way.

Getting back to the cheat sheet, it's not enough to write stuff down, I hafta review my notes. A lot. Otherwise the person just fades. If I'm meeting people around the circumstances of a new project, then in the beginning I might keep the cheat sheet handy at all times. I might write something very descriptive, similar to a cast of characters list, like what you might see before a play's script.

I would practice my cheat sheet or character list at home, and out loud. That way more pathways wake up: verbalizing, listening, possibly using mimicry to act something out, physically touching a piece of paper, and maybe even retracing my own handwriting. I know this sounds weird, but sometimes I can practically smell the ink on the paper. I'm just trying to enlist all the senses.

Since the accident I'm not the best at writing with an ink pen on paper, so sometimes I might use a dry-erase marker to write notes on a hand-held, dry-erase board. The trouble is the board is going to be erased. This is the entire concept of the dry erase board. And that's uncomfortably close to the way my own mind works. So I might take a photograph of the notes on the dry erase board.

Using the dry erase board kinda calls to mind the pioneer days when kids attended one-room schoolhouses and learned to write and cipher with chalk on slates. Makes me feel a little like Abraham Lincoln in a prairie schoolhouse.

In comparing low tech writing to the revolution of technology, I'm not always convinced new is better. For example, I often make reminders about a new person in my phone or PDA, rather than do a full cheat sheet. But how do I remember to look her name up and not another? Remember, I have a head injury. Really tracking someone new in a PDA might require a second entry on the calendar section of the PDA. Extra steps. And it can be a little conspicuous to enter the names of several women into your phone/PDA right there in public. People will think you're a playboy.

Another drawback to writing notes for cheat sheets or PDAs is you can't do this in a synagogue on shabbat, or in the middle of yoga class, or at a party crammed full of schmoozing lesbians all milling about.

There's plenty of times when neither a cheat sheet nor PDA will work. If I'm with a group that's eating, I might take extra notice of a few of the dishes ordered. I might ask very specific questions about some meals. If the person says the feta cheese omelette is too soggy, or there's not enough salt on the fish, or that the olives were Greek and not green, I might repeat the information out loud, and then imagine tasting the dish as described by the person's description, while looking at their body language, or posture, and noting their psychological attitude. The more senses used the better. This only works with unusual dishes, and unusual complaints, or if the person has a distinctive eating trait, like being terrible with chopsticks. So any butches that use the table to start playing field hockey with the fortune cookies likely will be forever emblazoned in my mind.

During a meal, I can't absorb information from too many people, only a few at the most. So tracking lesbian grazing habits at a buffet or potluck where a couple dozen women are in attendance is way, way too much. And in general, eating isn't a situation where I have the privacy to retreat and make a cheat sheet. When you whip out the writing utensils during a meal, people don't think "prosopagnosia." They think you're a food critic, or they think you're writing love notes to the hostess, or they think you're trying to reverse-engineer their recipes or something.

Despite all of these strategies, if the person gets a totally new hairstyle, or if I don't see them for a while, then whatever I recall of their face is likely to disappear faster than a shook-up Etch A Sketch.

No worries, I still use gait, posture, hair, body type, psychological attitude, and vocal tone to feel my way around social terrain. And humor. It can be slow, and it's prone to error, but it's how I live.

That's pretty much the strategies I've tried to implement by myself. Next I'll talk about how others can help the prosopagnosiac.