Behind the mask

Face blindness, or prosopagnosia, is probably quite rare in its extreme form, when people cannot even recognise a close relative, but perhaps less so in its milder variants. I’ve never found it easy to recognise people’s faces, and tend to rely instead on build, hair, posture and the like, at least until we start to speak. It’s like anything – you compensate. I’ve wondered about it more recently, and I think, for me, it’s about memory, in that I can’t lay down a reliable visual memory of a face. In my attempts to do so, I have to make a very conscious effort, otherwise nothing will remain; but even then the results are patchy. I usually try to memorise the different parts of the face, but when I look into my mind’s eye, I can’t put any of it together, it just doesn’t stick. Sometimes I try to visualise the faces of my family, and I can remember bits, but not the whole. When I see my daughters, I can’t always tell straight away which one they are – although as soon as they talk or even gesticulate, it’s immediately obvious.

I put this down to being extremely short sighted from childhood. I couldn’t see faces clearly, so the bit of my brain required to assemble a face may not have learned to function properly, such that I use other ways to recognise people, even now my sight is corrected. This works pretty well, although I try to avoid certain situations. For example, large gatherings where I may or may not know people are uncomfortable, as is meeting with someone I only know vaguely in a coffee shop. I am quite skilfully avoidant of such situations, or just stick with people I am sure about – you won’t catch me working a room at a conference. The changing of a hairstyle, or lopping of a beard, even in someone I know well can throw me badly, leaving me with an odd feeling of seeing a changeling. My mother altered her hairstyle when I was very small, and I remember feeling terror when I saw her. Who was she, really?

It is a family joke that I cannot follow films well – no-one wants to have to sit next to me and to have to answer my ongoing questions about who is who. This is probably why most of my attempts to watch Netflix have failed so miserably; I can retain a plot easily when reading, far less so on a screen. It’s disappointing, as I really love the idea of watching Netflix.

I have heard that a poor sense of direction can be linked with face blindness, and this also resonates. I don’t even like going to the toilet in a large restaurant, because I find might it difficult to get back. I just don’t seem to remember the landscape with any accuracy.

In my job, I am lucky to work with a nursing team who, at the very least, humour my problems, and will guide me towards the correct patient. Often people are very distinctive for reasons other than their face, but occasionally this is not the case, and I don’t want to offend or upset patients whom I’ve met before. I’m not sure my explanation that I remember lots about you, just not your face, would go down very well.

So how has the advent of face masks changed things? Many people are now interacting with mouth, cheeks and nose entirely covered, and the usual mechanisms we use to recognise must be interrupted. I met two new trainees on the ward last week, and we all started off masked. It didn’t seem too odd. One was taller, one had lighter hair, and they talked differently. I could tell them apart. I don’t like wearing a mask myself, mainly because my face gets very hot, but I felt quite comfortable not knowing what they looked like. I was no longer at a disadvantage. Later, I saw them both unmasked, when we were appropriately social distanced, and I realised that this actually made me feel quite anxious – because I knew I would be unable to remember what they looked like afterwards. I think I do know roughly what they look like, but I can’t visualise them at all. This has, in fact, been even worse than usual, because much of the time we are wearing masks, and it subsequently feels very odd when they come off.

Rapport and communication matter in psychiatry, and, quite apart from my own feelings, I think that it must be very hard for many. For me as a patient, it would be the unknown beneath that mask, the certainty that I would not recognise them later, which would be both a relief and a threat. Even seeing someone I knew well – what if they’d changed, and were quite different if the mask came off?

I suppose it’s down to knowing your friends and your enemies. I think I can read emotion fairly well, despite not remembering faces. And you don’t necessarily need to recognise someone to tell whether they are kind or cruel. A face covering takes away the stress of prosopagnosia, but it also removes much of the expression and the feeling, and I can usually read that. In the last week, masked, I have smiled at patients, looked at them, tried to reassure them, and only afterwards realised that they may have picked up very little of this. I have tried childish things, like pulling a face in a ward meeting, that I am fairly confident no-one saw. My face is hidden.

I really hope that masks are a short-term necessity, as I want people to see me, and I don’t want to hide behind one. There are so many ways that we communicate, and we are probably largely unaware of them. If this does go on for longer, we are going to have to relearn how to look and express ourselves. I may not do well with faces, but that doesn’t mean I want them hidden.

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