Q: Have you ever heard of prosopagnosia?

A: Yes. I read “The man who mistook his wife for a hat,” written by neurologist Dr. Oliver Sacks. Great read—if you are as interested in brain function as I am! In his book, Sacks described a patient who had developed prosopagnosia and did not recognize his wife when she came to visit him in the hospital. Naturally, this was disconcerting to them both! Since object recognition was unimpaired, the doctor asked the patient’s wife to always wear a specific hat when she visited. Sacks explained to the patient that when he saw a person wearing this specific hat, he could know that it was his wife. It worked. I always wondered what might have happened when that hat wore out. Hopefully, the patient would associate the new hat with his wife just as easily. There is some indication that Dr. Sacks might have had some level of face blindness, himself.

It appears to involve—no surprise—the part of the brain involved in facial recognition. A group of cells known as the fusiform gyrus, is in each cerebral hemisphere at the junction of the parietal and occipital lobes near the back of the head. Interestingly, the right hemisphere fusiform gyrus is more often involved in familiar face recognition than the left.

Prosopagnosia has been defined as a cognitive disorder of facial perception, marked by an impaired ability to recognize familiar faces including impaired self-recognition of one’s own face. It is important to note that other aspects of visual processing such as object discrimination and intellectual functions as in decision making remain intact

There are at least two types of prosopagnosia.

• One type is congenital or developmental prosopagnosia where there appears to be no brain damage. At this point it is a lifelong facial-recognition deficit that typically manifests early in childhood. It has a prevalence rate of 2.5 percent. Studies have shown this type to be completely compatible with compatible with autosomal dominant inheritance.

• There is also an acquired form that exhibits after the brain has sustained some type of damage or injury, the type that Dr. Sacks addressed in his book. Interestingly, instances have been reported where acquired prosopagnosia spontaneously resolved on its own.

I enjoy learning about unusual brain-related phenomenon. It helps me disseminate information to assist others in being more aware. If 5 children out of every 200 have congenital prosopagnosia, imagine what life must be for them, at home and at school. It is easy to overlook this in children. An adult may put it down to a child just appearing shy or slightly off—never suspecting this is due to their inability to recognize faces. These children may also have a hard time making friends, as they may not even recognize their classmates, who often assume the other child is proud or stuck up. They may even have a hard time telling family members apart or recognizing people out of context (e.g., a teacher at a concert, a coach in a grocery store, or even the “self” in a group photograph).

No surprise, a child with prosopagnosia may make friends with children who have very clear, distinguishing features or skin color. They may prefer cartoons with simple but well-defined characters that tend to wear the same clothes but may be strikingly different in color or ethnicity. That is one reason I think an accurate diagnosis is important—along with teaching a child about the condition and playing games to help them recognize specific facial features and other recognition tips, rather than just the overall composite.

Knowing this has been of great value to me several times when a person I thought would recognize me did not. It would have been easy to do a JOT behavior: jump to conclusions that were way out in left field, overreact and possibly burn a relationship bridge, and take it personally. AAA replacement behaviors, and knowing a bit about prosopagnosia, allowed me to ask questions, act calmly while I processed the information, and alter my perception or reframe the incident so I did not take it personally. Great fun, all in all, especially when finding out later that the individual in question had a form of prosopagnosia.