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Sunday, April 22, 2018

Facial Recognition and Multiple Sclerosis

Not long ago, I was talking to my ex-wife, Louis, about a strange experience I had at the massage parlor. On my previous visit there, about a week before, a woman named Ayu had given me a back massage with what I felt was considerable expertise. She seemed to know by touch where the problems were located and worked at those specific areas. I told her I would return next week for another massage and she said 'See you then'. 

I did return the next week, but Ayu was not there. I needed to get some meds anyway (as this is primarily a pharmacy with one massage room and one masseuse), and doing so, asked the pharmacist to have Ayu send me a message so that I could set up an appointment. A couple days later, i did receive a message which read: Hi. This is Ayu at Bali Organic Pharmacy. I am here tomorrow morning. 

Looking forward to getting relief for my back pain, I went down to the pharmacy in the morning and was met at the door by a woman, who straightaway ushered me into the massage room.

I knew immediately, in the back of my mind, that something was amiss. I just couldn't put my finger on it. And as the woman began the massage, I came to understand, little by little, that this was not Ayu. It was not the woman who had massaged my back the week before. The touch was different, the pressure was too light, the entire process was different.

At this point, Louis interrupted my story. 

"Why didn't you just tell her from the beginning that you had come to see Ayu?"

"Well ..." 

Why, indeed--for that, as I now realized, had been what was wrong in the back of my mind from the very start, that knowledge that something was amiss, and yet the inability to identify exactly what. This woman was not Ayu at all. Or rather, she was Ayu, but an altogether different Ayu. (Ayu is a common name in Bali). 

"The thing is ... I seem to have a problem with facial recognition," I finished.

Louis gave me a look, as if to say, 'Yeah, what else is new?'

Ah, little does she know, I thought--for the fact is that the last two times Louis happened to come into Starbucks, I did not immediately recognize her. I saw a woman walk in the door, noted vaguely that she was pretty, saw that she was smiling, watched as she walked toward me, and only then, upon sitting down in the chair opposite mine, did I realize who she was. 

Now, suddenly, I had named the thing: Facial recognition. I had been aware of it before, but I thought it was maybe just a lack of attention, or maybe all Asians look alike, or maybe I'm just self-centered and fail to fully appreciate identities outside my own, or maybe it's poor vision. But maybe, as it now occurred to me, this had something to do with MS. Can it be? Ridiculous, right? Absurd. But then again, when you think about it, the disease, MS, kind of specializes in the absurd. 

So I typed a phrase into Google: Multiple sclerosis and facial recognition. And lo and behold, a number of articles concerning the phenomenon showed up on the screen--and not just on the screen, but at the top of the list of associations. 

In an article written for MSFocus magazine, author and PwMS Jeffrey N. Gingold described failing to recognize his own wife, Terri, as a manifestation of this kind of cognitive dysfunction. He calls it “delayed recognition,” which can occur randomly. The episode with his wife happened while they were sitting on their couch and he suddenly felt what he called a “loss of presence.” He looked over at the woman seated next to him and struggled to figure out who she was. It took several minutes to re-orient himself and complete the connection between his wife’s face and its historical/emotional context that ultimately made her familiar and endearing.

How odd. 

I recall another time when I was sitting at JCO Donuts and a woman sat at the table next to mine. She struck up a conversation, we talked for a time, and when she got up to leave I told her it had been nice to meet her. "Meet me?" she said. "You already know me. I'm Ani, your neighbor."

Good grief. 

I think back now on the many times this has happened, the many times I have had to ask who someone is, and the many times I have simply pretended to know who someone is, and I realize, with perhaps an odd sense of relief, that this failure to connect is not a flaw in my heart but a dysfunction in cognition. 

Articles concerning this difficulty with facial recognition also address an associated impairment in the ability to recognize emotion in facial expressions. So, you may know who the person is, but you may not be picking up the signals and nuances of what he or she is feeling--which is bound to make you seem dull-witted or careless or clueless!

What to do? Well, I think that recognition of the deficit is the best start. Yes, it is a real thing. Just like all those other weird symptoms that you've long been used to are 'real things'. It's not you, it's not a failing in personality or compassion, it's an injury, a dysfunction in the brain caused by multiple sclerosis. Recognize it, and admit to it. Help others understand it. And maybe look at it this way--If everyone seems new, even one's own wife, maybe that's a good thing--for there is no blessing in the world to match the blessing of starting out new!  

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