Prosopagnosia or face blindness

According to Benedetti (2011), prosopagnosia is a syndrome characterized by a person's inability to identify persons based on their appearance. While face recognition is meant to be a quick and easy procedure, regardless of how many times a person changes their hairdo or apparel at different times, people who suffer from prosopagnosia usually can't tell if they've seen a particular face before or not. Bate (2012) and Esins (2015) make similar points. Bate (2012) goes on to note that a human being has an impressive ability to identify people unlike other animals something that people with prosopagnosia do not have, even though they do not have any problems with their vision, object recognition or their memory. The two scholars Benedetti (2011) and Bate (2012) continue to argue that this condition results from a particular brain damage and developmental forms which do not have any structural lesions. This paper is going to look at prosopagnosia at length, as a defect, how it affects people at a social and financial level, its etiology, procedures which are used during diagnosis, its consequences, the RX concept, and the implicit bias.

Prosopagnosia as a defect

According to Andrew W. Ellis, (2013) and Eysenck, (2004), prosopagnosia is a condition which can be acquired or developmental. They also educate that the first case of this situation to ever be recorded was in 150 years ago and a modern study of the same was initiated in 1947 and reported by Bodamer. Andrew, (2013) states that the Bodamer's report identified this condition which was studied in wounded soldiers. He educates that the condition could arise from trauma, stroke, encephalitis, tumors, degenerative atrophy and temporal lobe resections. In recent time, developmental prosopagnosia is not well understood because patients with this condition do not have a vision or memory problems but fail in face recognition. Developmental prosopagnosia is therefore in current times mostly associated with genes and runs in families. Andrew, (2013) also argues that the acquired form of this condition is rare but developmental forms are quite common. Bate, (2012) shares that same sentiments and adds that adults who suffer from this condition report that they fail to recognize people and this has led them to record a series of traumatic social experiences which leads them to have chronic anxiety, feeling embarrassed and always guilty and they normally maintain a limited social circle of friends. Even though children suffer from the same effects of the condition, theirs possess further implications which may include safety even in their learning environments.

Using Bruce Young's model of face recognition to understand prosopagnosia

According to Bate, (2012) Bruce Young suggests that face recognition is a process which starts with creating a facial percept where there is a general encoding of the structural information about a face. A person then ties the information collected to stores of face memories also known as the face recognition unit which gives information to the individual about the faces they have seen before. When there is a correct match, it activates the individual's identity node which gives information on semantic information, giving information of which the face belongs to. The person can then name the face. Bate (2012) goes on to argue that this is different when it comes to people with prosopagnosia because given that it is a disorder in face recognition, those suffering from the disorder; can see it is a face and know it is a face but cannot identify whom the face belongs to. Eysenck, (2004) adds to these views and educates that those who suffer from this disability are unable to know the person by looking at the face because they can recognize features, but have a problem in putting the features altogether. A person with Prosopagnosia will be capable of seeing a face and recognize that it is made out of different objects, but will not be able to identify the face as unique. The problem may be some subtle problems that those suffering from prosopagnosia have, problems either in connecting the areas that make it possible for an individual to recognize a face or in having those regions smaller.

Aetiology

According to Calder, (2011), and David P. Moore, (2012), prosopagnosia is thought to be the outcome of abnormalities, impairment or damage in the right fusiform gyros, a crinkle in the brain that coordinates the neural systems that regulate memory and the facial expression. They also note that it occurs in male, female and children of all ages. Prosopagnosia can occur due to traumatic brain injury, stroke, or certain neurodegenerative illnesses. In some cases, it is present at birth as a congenital failure that occurs in the absence of any brain injury. Congenital prosopagnosia appears as result of a genetic mutation or deletion which runs in several families. Some level of prosopagnosia is commonly found in children with autism and Asperger's syndrome and may be the reason for any form of impairment in social development Esins, (2015) adds.

Diagnosis

Whitaker, (2010) argues that since the Prosopagnosia is the inability of a patient being able to realize if they have seen a particular face or not, the primary diagnostic test is to determine the sense of familiarity for people who have been in a patient's life. In this test, the physician is to use a test like Cambridge Face Memory Test which is reliable. It has been customized to meet the needs of various types of patients. For example, there is the CFMT_C and CFMT-Kids. The same views are held by Andrew W. Ellis, (2013) who goes on to educate on exclusionary tests. He argues that once it has been determined that the patient has prosopagnosia; the physician needs to establish that vision and memory failures are not causing the problem. There then needs exclusionary tests to be carried out on the patient to determine if the impairment is being caused by these factors. Conditions like autism, Turner's syndrome, Alzheimer's disease and schizophrenia can easily cause these conditions in an individual.

On the same, John, (2013) states that there are numerous theories concerned with patterns of presentation, and it is believed that the face recognition impairment is a disorder that can be attributed to a lack of social interest in faces, and a perceptual processing strategy or impaired vision-spatial skills. However, while some individuals with prosopagnosia report severe social consequences resulting from their face recognition difficulties, they are not an indicator of a concurrent neuron-developmental disorder. O'Brien, (2007) on the other hand state that there have been reports of misdiagnosis with the aim of curing high-functioning autism when the real disorder is prosopagnosia alone. It is important to note that many people with developmental prosopagnosia do not fulfill the diagnostic criteria for autism spectrum disorder, and this confirms the independence of the two disorders.

According to Andrew W. Ellis, (2013), another way of diagnosing this condition is using a self-report control. The shortcomings of this method are that most individuals have less insight of their face recognition techniques especially when they cannot do a comparison. Some other signs were seen among people suffering from prosopagnosia range from difficulty in making friends, being clingy in public places and difficulty in following plots on television shows to failure in recognizing familiar people when encountered unexpectedly.

The consequences of prosopagnosia

Effects of prosopagnosia on the patient

According to Andrew W. Ellis, (2013), the level of impairment of the disorder varies from average, severe to incapacitating. Rivolta, (2013) shares the same views and adds that some people suffering from prosopagnosia may be having difficulty in identifying a familiar face, while other people suffering from the same will be unable to differentiate among unknown faces. Others may be totally unable to separate a face from an object, while some people with the same disorder cannot even recognize their faces. Apperceive and associative prosopagnosia explain how severe the condition can be.

According to Leather dale, (2013), people suffering from prosopagnosia complain of being unable to recognize characters in movies and TV shows and therefore cannot keep up with the plot. The majority has problems in face processing and finds it hard to judge gender, recognize emotional directions and following directions of people. Besides, some experience navigational difficulties because of impaired sense of direction. Researchers have sought cures for the disorder, but so far no therapies have shown lasting improvements

Rivolta, (2013) and Bourne & Hole, (2010) argue that apperceive prosopagnosia is a more severe type of face blindness than associative; this is because it shows incapability to name, place or people who sufferers can see. More apperceive variants of prosopagnosia are associated with fusiform damage. Even though associative prosopagnosia is a more common among individuals, it is a less severe type compared to apperceive. It affects the anterior temporal damage, and even though associative prosopagnosia patients are not able to recognize a face, a limited understanding of the significance of a face is still remembered.

Bate, (2012) together with Benedetti, (2011) argue that as Face Blindness affects human communication through recognition, face perception, and individuation, it forces individuals who suffer from it to employ secondary cues to enable them to retain the same information about those whom they interact with for example the body size and voice. Such replacement tools for communication affects the prosopagnosics daily, and for some patients, the condition causes severe social consequences for the individual, friends, and family at a very fast rate. Esins, (2015) who has the same sentiments also educates that some patients also find it hard to use the secondary cues hence tend to avoid the social interaction all together which lead to depression because of lack of interpersonal relationship. He also argues that face blindness has an adverse impact on friends, society, and the medical units and mostly among family members. These views have also been put forward by Bate, (2012), who also argues that face blindness affects people mainly from the day of birth, and an individual can suffer from this illness throughout their lifetime. Many individuals suffering from prosopagnosia are unable to recognize their family members, partners, friends or even other members of the society. This leads to avoidance of social interaction and social anxiety that makes it difficult to form social relationships.

Bate (2012) also argues that prosopagnosia affects a person's ability to recognize objects like cars or places, many of them have a problem and difficulties in processing angles or distances and the problem to remember landmarks and places. Most of the worry of those suffering from prosopagnosia is that they appear not interested and rude when they fail to recognize a person or place. Ellis & Young ( 2013) and Rugg, (2013) explain that some people cope up well with their difficulty in face recognition, and even go ahead to employ elaborate secondary cues such as voice, body size and even clothing to help them effectively operate in everyday life mostly while communicating. For others, the condition has a greater impact on their daily functioning. To some, it leads to avoidance of social interactions, damage to careers and problems with interpersonal relationships. This is because prosopagnosia has effects that create a feeling of being discriminated against which in some cases lead to depression. In extreme cases, people with prosopagnosia develop a social anxiety disorder, caused by avoidance of social situations and fear that may lead to humiliation.

Social

David, (2012) and Tantam, (2012) agree that Prosopagnosia affects both personal and social level of an individual. For instance, according to Tantam, (2012), these individuals have been presented with scenarios which test the level of face perception and can be socially crippling because individuals with the disorder have difficulties in recognizing even close friends and family members. This leads to using other ways of understanding and identifying people, for example, relying on clothing, voice, and unique physical attributes. These alternative ways are in most cases not useful as face recognition. On the other hand, David, (2012) argue that Children with prosopagnosia are in most cases born with the disability and not at any time have they been able to recognize any faces.

Another consequence as suggested by Bate, (2012) is greater awareness about the autism spectrum, and autism disorders are likely to make prosopagnosia less overlooked in the future. Rapp, (2015) argues that additional studies of face blindness have occurred in more recent decades. This is because of the prominence of neurological disorder within society that is greater than ever predicted. Specifically, available data show that approximately 2% of the entire human population suffers from prosopagnosia (Rivolta, 2013). In support of Rivolta's views, Finger, (2001), argues that face perception is the most possible developed visual skill in human beings. It is the process by which the mind and brain understand and interpret the human face. Social communication amongst individuals is mostly facilitated by the information in the faces. Visual skills give identity through various facial structures such as nose, mouth, ears, eyes and many others. Besides, it gives identity in the way each structure operates to demonstrate a feeling or expression, for example, the way an eye gazes. However, difficulty occurs when the capability of an individual to physically interpret the information presented by faces is diminished.

In properly processing facial expressions and proportions, one can select social details of someone else's health qualities, origin, and emotional tendencies. Therefore, the concept of face recognition and perception is tangled with the benefits of face individuation. A scenario whereby one can identify an individual's facial features in most cases leads to the identification of the person. However, regular face individuation, recognition, and perception are frequently not taken serious, and the processes can simply be affected by some genotypic and phenotypic factors, thus hindering social communication (Temple, 2014).

Clinical elements of prosopagnosia

Prosopagnosia may be classified into two, acquired or heterogeneous developmental disorder. It has variable, severe, selective and neuron basis (Groome, 2013). In support of these views, Finger, (2001) argues that acquired Prosopagnosia occurs as results of damage in the occipital lobe and ventral temporal lobe of the brain. The commonly affected areas are the occipital face area or fusiform face area. Calder, (2011) agrees with their views and adds that these regions can be affected in several ways, but normally they are affected by trauma and stroke. Acquired prosopagnosia fluctuates both in social appearances and location to the extent of underlying cuts which rise due to brain damage. Calder, (2011) on the same issue educates that Developmental Prosopagnosia is a difficulty in recognizing faces of different individuals that is established in the early stages of the childhood of an individual and it is not attributed to damage of acquired brain. However, functional deficits in DP both by FMRI measures and EEG have revealed that the condition arises due to genetics. Hereditary prosopagnosia occurs if Developmental Prosopagnosia affects more than one member of a family, basically accepting the possible genetic factor leading to this condition Benedetti, (2011).

RX of Prosopagnosia

Gillespie & O'Neill, (2014) and (Hugh Foley, 2015) agree on the fact that the numerous negative impacts of the disorder, for example, individuals feeling socially inept brings in the need for therapy. Currently, there is no formal treatment for prosopagnosia. However, laboratory tests have made attempts to find solutions to face recognition problems, either through the use of temporary pharmaceutical intervention or training programs. There has been some success, though most techniques are currently being investigated and developed. But there are thorough research going on in the United Kingdom and Bournemouth to find a formal treatment for prosopagnosia.

Management

Eysenck, (2004) argues that individuals with prosopagnosia can use various strategies to overcome this difficulty. For example, teachers cannot remember each and every pupil but get an alternative by arranging them in the classroom for easy remembrance. Some patients use jewelry, clothing, or gait to recognize a familiar person. These strategies do not work perfectly because at some point they break down when a person is met out of circumstance, and system of logic cannot be combined with external cues used in recognition. The same views are shared by Tantam, (2012) who adds that the focus of any form of treatment should be aimed at helping an individual with prosopagnosia to develop strategies that compensate him or her by finding alternative ways of recognition. Adults who have the condition can be restrained to use of secondary cues in the identification of individuals (Moore & Puri, 2012). Moore & Puri, (2012) also argue that there are minimal successful therapies but no cure for prosopagnosia and that there are strategies that can be used through employing various secondary cues. They add that success in using secondary cues is made possible by understanding how individuals identify faces on what kind of information is being processed. Knowledge of the different types of Prosopagnosia creates a well understanding of the positions and critical functions of the different parts of the brain which are involved in normal face recognition, individuation, and perception. Research is objectively carried out to focus on finding out better ways to treat, prevent and finally cure disorders like prosopagnosia Calder, (2011).

Implicit balance

According to Bate, (2012), implicit bias is a situation where people consciously reject stereotypes and also join in anti-discriminatory efforts. However, they inwardly hold a negative association with the situation in their minds. Implicit balance occurs without one noticing and can affect one's reasoning and decisions. According to Winn, (2003) who holds the same views, in this context, many people with patients who suffer from Prosopagnosia are likely going to discriminate them unconsciously. Implicit bias also dictates how these patient's relatives and friends act when they are around them. Winn, (2003) gives a vivid example of this phenomenon and states that some people might not be very welcoming while others might feel immensely uncomfortable being around people who suffer from this condition.

Conclusion

In conclusion, prosopagnosia is thought to be the outcome of abnormalities, impairment or damage in the right part of the brain that coordinates the neural systems which are responsible for regulation of memory and facial expression. It affects personal and social aspects of life because of the inability of those suffering from prosopagnosia to recognize faces of even close friends and family. The effects and extent vary and affect people differently. This requires individuals suffering from the disorder to come up with strategies aimed at overcoming the problem of face recognition. Though the strategies do not work most times, those suffering from the disorder use objects like jewelry and clothing to recognize a familiar person. Despite numerous research and tests, scientists have not succeeded in inventing a formal cure for the disorder. The use of these strategies is successful based on how different individuals process information. Having information about the different types of prosopagnosia creates an understanding of the different functions of parts of the brain involved in perception and face recognition. Currently, research is objectively carried out to focus on finding out better ways to treat, prevent and finally cure the disorder.

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