Monday, August 30, 2010

Face Blind

Discovering Oliver Sacks's Awakenings many years ago has had a great influence on my thinking about psychiatry. Over the years I have tried to keep up with Sacks' work, though he seems to write faster than I read. Having recently enjoyed reading his  Uncle Tungsten, which is part autobiography and part history of chemistry, this piece on face blindness in the current issue of the New Yorker [August 30, 2010]  caught my eye. It is also part autobiography, -- Sacks suffers from face blindness-, part review of high points in the history of the neurosciences and part report on recent  research developments on this condition. It is also, poignantly, part advocacy, as Sacks makes a plea for considering face blindness with the kind of concern that we now give to dyslexia. In addition to the article you can also listen to Sacks talk about living with face blindness.

ABSTRACT: A NEUROLOGIST’S NOTEBOOK about prosopagnosia, or the inability to recognize faces and places. Writer describes his own difficulties recognizing and remembering faces. He also has the same difficulty with places and often becomes lost when he strays from familiar routes. At the age of seventy-seven, despite a lifetime of trying to compensate, he has no less trouble with faces and places than when he was younger. He is particularly thrown when seeing a person out of context, even if he was with that person five minutes before. Writer gives several examples of his inability to recognize familiar people out of context, including his therapist and his assistant. After learning that his brother suffered from the same problem, the writer came to believe that they both had a specific trait, a so-called prosopagnosia, probably with a distinctive genetic basis. Mentions several other people who have the same trait, including Jane Goodall and the artist Chuck Close. Face recognition is crucially important for humans, and the vast majority of us are able to identify thousands of faces individually, or to easily pick out familiar faces in a crowd. People with prosopagnosia need to be resourceful, inventive in finding strategies for circumventing their deficits: recognizing people by an unusual nose or beard, or by their spectacles, or a certain type of clothing. Describes research done on the way the brain recognizes faces. Tells about the work of Christopher Pallis, Charles Gross, Olivier Pascalis, Isabel Gauthier, and other scientists. Above all, the recognition of faces depends not only on the ability to parse the visual aspects of the face—its particular features and their over-all configuration—and compare them with others, but also on the ability to summon the memories, experiences, and feelings associated with that face. The recognition of specific places or faces goes with a particular feeling, a sense of association and meaning. Briefly discusses déjà vu and Capgras syndrome. Considers the difference between acquired prosopagnosia—through stroke or Alzheimer’s for example—and congenital prosopagnosia. Discusses the work of Ken Nakayama and Brad Duchaine, who have explored the neural basis of face and place recognition. They have also studied the psychological effects and social consequences of developmental prosopagnosia. Severe congenital prosopagnosia is estimated to affect two to two and a half per cent of the population—six to eight million people in the United States alone.

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Monday, August 09, 2010

Spinal-Fluid Test Is Found to Predict Alzheimer’s

Gina Kolata seems to grow more enthusiastic and less critical with each article she writes about recent advances in the diagnosis and treatment of Alzheimer's Disease. It is hard not to hope that progress is being made. I do have my concerns, however, about the blessings of knowledge. Advances, such as she describes, in diagnosis, without comparable advances in treatment remind me of poignant episodes in the history of General Paresis of the Insane. This disease, which we now know is caused by syphilis, was, in some ways, the Alzheimer's of the nineteenth century. In an article on General Paresis I wrote that, "General paresis most often struck people (men far more frequently than women) between twenty and forty years of age. Within a matter of months to a few years after the appearance of the first symptoms, it reduced its victims to a state of dementia and profound weakness. No treatment was known, and patients uniformly died." In doing my research I ran across a number of cases where people learned that a loved one would become demented and die from  this incurable disease. As Joel Braslow has shown doctors' attitudes towards these patients, when they were thought to be incurable, were sometimes less than charitable. While I wouldn't argue against people being able to learn what they want about the illnesses that afflict them, I do hope that physicians will be able to help with the emotional aftershocks of such knowledge.