What is Faceblindness?

My first attempt at therapy, at age 22, was a bust. It was entirely my fault. I lied constantly—to my therapist, but also to myself. I was so invested in my facade of cheerful perfection (“Everything is going great! Thanks for asking!”) that I couldn’t bring myself to admit I was crying all the time.

Ten years and a lot of self-reflection later, I gave therapy another try. At this point, I was working for the American Psychological Association as a science writer, so I was quite the informed consumer. I interviewed several therapists and picked the one I had the best rapport with. She saw through my jokey exterior, and we went through many boxes of tissues in her office.

We didn’t, however, always see eye-to-eye. One day, I accidentally ignored her when we passed on the street. At our next session, she wanted to talk about it, but no matter how much I insisted that I simply hadn’t seen her, she didn’t believe me. “You looked right at me,” she said.

How could I possibly fail to recognize a person I’d spent dozens of hours in intense conversation with? We never resolved this, and I wondered at times if she thought I was playing some sort of strange game with her. But what had seemed weird to my therapist was pretty normal for me. Once, for instance, I thought my boyfriend, Steve, had gone rogue in the grocery store, filling up our cart with junk food and other surprising items. “Since when do you buy generic?” I said, plucking a jar of peanut butter from the cart. His terrified expression alerted me to the fact that this Steve-shaped guy was not, in fact, Steve. I’d been faster to notice the wrong label on a jar of peanut butter than the wrong face on my boyfriend!

Years later, it finally occurred to me that something weird might be going on. Other people don’t make this kind of mistake this often, I thought. I could’ve scheduled a consult with a neurologist, but I’m a science writer, so my first instinct was to start downloading journal articles and emailing neuroscientists. One of them invited me to join a study, and a few months later, I got the verdict: I have a condition called prosopagnosia, colloquially known as faceblindness. My ability to recognize faces is, according to one Harvard scientist, on par with “a mediocre or below-average macaque.”

How did I go so long without realizing I can’t do something that comes naturally to most people? Easy: I didn’t understand how good other people are at recognizing faces. It had never occurred to me to wonder why my brother could recognize our piano teacher wildly out of context, while I couldn’t. If anything, I’d chalked it up to general absent-mindedness.

At 39, I thought I knew myself! What else didn’t I know? As it turns out, a lot. I did more research, joined more studies, and discovered that I’m neurodivergent in a variety of ways. Specifically, I can’t visualize at all, a condition known as aphantasia. Relatedly, I don’t have Proustian “madeleine” moments, where a smell or taste can suddenly transport you to an important moment from your past. My brain only records my experiences semantically, as stories, a condition called severely deficient autobiographical memory (SDAM). People on the opposite side of the mnemonic spectrum remember every mundane moment of their life in vivid sensory detail, a condition known as highly superior episodic memory. Neurotypical people strike a balance between semantic and episodic memory.

Aphantasia and SDAM aren’t disorders: they just describe unusual brain architecture that confers just as many advantages as disadvantages. One area where I, and many people with SDAM and aphantasia, have clear disadvantages is in therapy. To push past my tendency to intellectualize, my second therapist asked me to do visualization exercises—and no matter how hard I tried to squeeze my eyes closed and imagine myself “in a safe place” or “at the beach,” I never saw anything more than the insides of my own eyelids.

So much of therapy involves mental time travel, but while I’ve got some good stories about my past, they are just that: stories, told in words. It’s only a slight exaggeration to say remembering my past feels like reading a biography someone else wrote about me. My therapist was baffled by this phenomenon, and she wondered if my sensory and emotional memories might be repressed. What neither of us realized is that my weird memory isn’t evidence of trauma, it’s just how my brain works.

While I’m rare, I’m certainly not alone. About one in 20 people have aphantasia, and there’s a growing mound of evidence that it’s due to a real brain difference, not just metacognitive errors. If you put a neurotypical person in an fMRI machine and ask them to picture a familiar place, their brain’s occipital lobe lights up. Mine, not so much. Visualizers’ pupils contract in response to imaginary light, while aphants’ do not. And if you ask neurotypical people to read a scary story, they get stressed and sweaty, while my fellow aphants and I remain cool as cucumbers.

The ability to visually recall one’s own past seems to be the key to unlocking old emotions and reinterpreting formative experiences, which is why it’s a central part of many therapy approaches. So how do therapists work with people like me? There’s no official answer yet, as scientists only discovered aphantasia in 2015. I can, however, offer some anecdotal feedback from people who share my neurological disorders and differences.

Some of my fellow aphants report that they can relive past moments through other senses. They can’t visualize, but they can summon up old sensations, tastes, and sounds. Mental health professionals should also be aware that aphants may lack some of the classic symptoms of mental health problems. An aphant with PTSD, for instance, might have flashbacks that seem more like panic attacks due to the lack of mental images. And an aphant with an eating disorder or OCD won’t experience intrusive visualizations. Instead, they might report inchoate feelings of unease or disgust. For aging aphants, a lack of visual imagination and poor autobiographical memory may be incorrectly seen as evidence of dementia.

As for me, I’m happy to report that my third stab at therapy is going much better than my first two. Early on, my therapist told me to picture my inner child and give her a hug, and I explained that’s something I just can’t do. Saying that out loud was tough for me: I’ll never shake my need to be an A+ client. But now that I and my therapist understand so much about my unusual mind, we can work together to discover effective interventions. One trick we recently happened upon: while I can’t visualize an inner child, I can conjure her up by looking an old photo of myself while hugging a body pillow.

The first time I told my body pillow she was safe and loved, I felt slightly ridiculous, but something inside me shifted when I did. The scared little girl relaxed and melted into my strong adult arms. For the first time, she heard me, and she believed that everything was going to be okay.