What happens when a portrait artist can no longer recognize faces? In this fascinating episode of “Read. Talk. Grow.,” Dr. Denise Millstine welcomes New York Times bestselling author Katherine Center and Mayo Clinic neurologist Dr. Keith Josephs to explore prosopagnosia, face blindness, through Center's novel Hello Stranger. The conversation delves into the medical reality behind this rare neurological condition, where Center shares how a podcast love story inspired her to write about a portrait artist who develops acquired face blindness after brain surgery. Dr. Josephs, who praised the book's scientific accuracy, explains the different types of prosopagnosia, the brain regions involved, and how patients can adapt using other senses and coping strategies. The discussion beautifully blends fiction with medical expertise, revealing how face blindness, while challenging, can lead to unexpected connections when patients learn to recognize people through voice, gait, and other unique identifiers - and perhaps even treat everyone with the warmth of a friend.
This episode was made possible by the generous support of Ken Stevens.
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Dr. Denise Millstine
Welcome to the “Read. Talk. Grow.” podcast, where we explore health topics through books. Our topic is prosopagnosia, or face blindness, and our book is “Hello Stranger” by Katherine Center. I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine, and integrative medicine.
I am so excited about my guests today. For readers out there, Katherine Center will be no stranger. We all are familiar with her work. She’s the “New York Times” bestselling author of 12 novels. She writes a deep, nuanced laugh and cry rom-coms that brim with hope and healing. Her books have made countless “Best Of” lists, including “Amazon’s Top 100,” “Barnes and Noble Best Books of the Year,” “The Indie Next Great Reads” list, “Goodreads Best Books of the Year,” “Library Reads Hall of Fame,” “Peoples Best New Books,” and more. Two of her novels have become global top ten movies on Netflix, and a third is in production right now. Her spring 2026 book is “The Shippers,” and today we’ll be talking about “Hello Stranger.” Katherine lives in her hometown of Houston, Texas with her husband and their fluffy but fierce dog. Katherine, welcome to the show.
Katherine Center
Hi. It’s so fun to be here. Thanks for having me.
Dr. Denise Millstine
Our medical expert guest is Dr. Keith Josephs, who’s a professor of neurology and neuroscience, as well as the Ani Professor of Alzheimer’s Disease Research at Mayo Clinic in Rochester, Minnesota. He is an internationally recognized leading expert in neurodegenerative diseases with research focusing on clinical, pathological and neuroimaging aspects of the front-temporal dementia and atypical Alzheimer’s disease, who has had over 750 scientific peer-reviewed manuscripts, including the 2024 “Prosopagnosia: Face Blindness, and its Association with Neurological Disorders,” published in the journal, “Brain Communications.”
Dr. Denise Millstine
Keith, welcome to the show.
Dr. Keith Josephs
Thank you. Thanks for the invitation. Really looking forward to this.
Dr. Denise Millstine
“Hello Stranger” is a contemporary romance about Sadie Montgomery, who is finally having professional success as a portrait artist when a sudden neurological event reveals a brain lesion that is resected, or removed surgically, only to leave her with acquired face blindness. That would be distressing for anybody but is particularly upsetting given her area of work and also leads her into some confusing interpersonal entanglements.
Okay, you both know how “Read. Talk. Grow.” works; we discuss books that portray health topics in an effort to better understand health experiences through story. And in this case, we’ll talk about face blindness. Katherine, tell us your inspiration for including prosopagnosia in a novel.
Katherine Center
Well, I heard about prosopagnosia for the first time on a podcast actually, on “This American Life,” which is an “NPR” podcast. And they were doing a, like a Valentine’s Day show, and they were telling little love stories, you know, true real life love stories. And one of them was about a woman who fell in love with a man who had face blindness. And I was just like making dinner, listening to a podcast. And I was listening to the story, and I was so sort of fascinated by the dynamics of how he actually had a different kind of face blindness than Sadie in the book does, because there’s two different kinds, and the acquired kind has a lot more to do with how your perception puts faces together as you’re seeing them and the but the kind that you’re born with, the kind that people have had all their lives, has a lot to do with memory.
And so this guy had the kind that he had had all his life, and he didn’t remember her from meeting to meeting was kind of how they first met. And she actually liked the way that he looked at her, because he always kind of looked like he was seeing her for the first time in this way, and he was really kind of paying attention to what he was seeing in a way that she felt like most people didn’t.
So I thought that story was really interesting. And then, of course, as the story went on, it didn’t end well. Like they didn’t wind up staying together. And because I’m a person who writes love stories for a living, like whenever I hear, like an unhappy love story out in the world, I always have this moment where I’m like, I could fix that story.
And that was how I felt about that one. I was like, I want to give those guys a happy ending. So it just kind of stuck in my head for years. I mean, this was many years ago and many years later, you know, it was time to start thinking about a new story and that sort of burbled up into my consciousness and the story that I wound up writing turned out very different from the original inspiration.
But that’s how I first heard about the condition. And of course, it was fascinating to see when the book came out, but most people had not heard of the condition, and lots of people thought that I made it up. So that was interesting to see.
Dr. Denise Millstine
I’m certain I learned about it in medical school, and I actually was meeting with some medical students and told them I was talking with you, and they’re like, oh yeah, prosopagnosia. But when my good, one of my book besties read your book, I was like, is that really a thing? I mean, I’ve been a doctor for 25 years, and if I ever learned about it, I had forgotten.
So I am certain that you are enlightening the world to this condition, which is again speaking to the power of books. And I love those little kernels that then spark these stories that come out as full-fledged novels that get to have promised a happy ending, whatever that looks like. So I love this idea. Keith, what was your reaction to the book and what’s it like to work with people who have face blindness?
Dr. Keith Josephs
You know, I thought the book was brilliant. I actually learned a lot from the book because, you know, when we see patients, you know, as physicians with conditions, we end up spending an hour, maybe two hours. You may see them back once or twice, but you don’t get the in-depthness that I felt the book gave me as I as I read it.
And there were times where I wasn’t sure what the answer was going to be. For example, whether she would recognize Peanut. I didn’t know, you know, she worried about that, but it reminded me of, you know, I worked with a woman in London when I was training, 25 or so years ago, and so that was sort of my first scientific introduction to the term prosopagnosia and what it is.
And she’s probably in her 90s now, but the story she told me, I never forget it, was that the first patient she encountered with it was a shepherd. This is an actual shepherd who couldn’t recognize his family but could recognize his sheep. And so I assumed that she was going to recognize the dog, but I wasn’t sure. And so, honestly, I mean, I thought it was brilliant. Everything that I it made a lot of sense. I actually wondered if this was a real patient. It was spot-on, honestly.
Katherine Center
Oh my gosh. I’m like I’m like getting shivers. Thank you so much. That is great to hear. And a nervous when you started answering that question.
Dr. Keith Josephs
It’s true. Even the diagnosis which was very accurate. You know, acquired apperceptive prosopagnosia, which we can get into later. But it was very scientific. It was very accurate. And as I said, it’s very detailed, a lot more detail than I think physicians, even experts on prosopagnosia, probably would not have this detail type of information that I think that the book gave us.
Katherine Center
Well, I’ll say I got very lucky because when I started, because one, I love to do research about anything that I’m trying to write about because I never want to do sort of the TV version of a thing. I always want to try to make it as much of a real, three-dimensional, true-to-life version as I possibly can.
And I started doing all kinds of searches. I read a bunch of books, and then I found this amazing podcast that was interviewing this woman named Sadie Dingfelder, who is a science writer for…She was writing for the “Washington Post” at the time, and she had actually written an article called “My Life with Face Blindness.” And I listened to her on this podcast, and I just thought she was the most charming, whimsical, hilarious, delightful person ever.
And I just thought, I know I would be friends with this woman. And so I actually just took a shot and reached out to her, and I said, trying to write a novel about a woman with face blindness, is there any chance you might be willing to talk with me about your experience? And she was so gracious and so happy to say yes.
And then we wound up having this phenomenally great conversation about her experience. She actually has the congenital version. So she’s had it all her life, and she didn’t even realize that she had it, which is true for a lot of people who have had it all their life. They just think everybody kind of experiences the world that way. And of course, that makes sense, because if that’s how it works for you, you kind of would assume that’s how it works for everybody else.
And she I will just digress and say she wrote a book that came out, I think, last year called, “Do I Know You?” and it’s a phenomenal read. And it’s all about her discovering that she had face blindness I think in her 40s. And it’s so charming. It’s so well written. When you read it, you just feel like your funniest best friend is just telling you all about these crazy things. She actually has a bunch of super interesting neurodivergences that she talks about in the book. So and she’s a science writer, so she can talk about it in a way that’s very insightful about how it all works.
So I got very obsessed with her, and I wound up learning a lot from her. And then I came up with a plot twist for the book that has to do with her ability to sort of perceive faces. And I actually checked in with Sadie before I sort of turned in the final draft, because I was like, actually, it was before I even really written it, because I just wanted to make sure, I wasn’t going down the wrong path.
I’m pretty sure I called her and just described the idea to her and said, you know could this happen? I’ve had this idea, could it happen? And she just could totally happen. That absolutely could happen. And so it was great to have her blessing because then I could kind of just charge forward and go crazy with the plot a little bit.
Dr. Denise Millstine
I can tell you, as a physician who’s often reading novels looking for health content within them, I wish everybody would go to either an expert or a person who lives with that condition and ask them, because sometimes it’s, you know, a bit too much or that kind of thing. But it’s true that the authenticity is something that we’re always looking for on “Read. Talk. Grow.”
And you hit it out of the park with this one and were going to talk about those two different kinds, I’m going to ask you about that in a second, Keith.
But, Katherine, maybe for our listeners who have not yet read the book, will you describe the moment that Sadie wakes up in recovery and or her best friend, her very best friend, Sue is there and she doesn’t recognize her and she realizes something is off.
Katherine Center
Yeah, I mean in the reading that I did, that was kind of a common experience because it sounds like you just expect your brain to function properly. And so you kind of bring a whole framework to every experience that you’re having. And it can take a minute before it all clicks for you. I mean, you can’t even imagine that something like that could happen, right?
I take research very seriously. In fact, I’m always afraid of getting it wrong because the worst thing I think you can do as a fiction writer is to make some dumb mistake. Right? Because then what happens is the reader is kind of pleasantly lost in this sort of fictional world, sort of inner tubing down this fictional river that you’ve created for them.
And then when you get something wrong, it just rips them right out of that world and it kind of kills it. And then they have to kind of start back up and get back in, but now they don’t trust you. So I did actually interview a brain surgeon about Sadie’s brain surgery, and I have this whole chapter that we wound up taking out because the book was just getting a little long.
It was also fascinating. I just wanted to write about it. But where he does an awake craniotomy, am I remembering that term correctly? So she’s awake, but they’re doing this brain surgery on her to try and make sure that they don’t hit the wrong spot. And the place in her brain where she had a cavernoma, right?
Yeah. Suddenly I suddenly like, wait a second, am I getting that? She had this problem that needed to be fixed, but it was close to the fusiform face gyrus. And if you damage that, that’s what messes up your ability to perceive faces. And so I talked to this brain surgeon who very who very kindly gave me a lot of time.
And we talked for a good while. And then he actually texted me a bunch of videos of brain surgery from his phone, like brain surgeries he was doing. You know they were a little shocking for me. I’m not a huge blood person. So I was like, whoa, there, that’s a brain surgery. But he was saying that actually, one thing that could happen is that there could be swelling in the wake of the surgery, instead of maybe the fusiform face area isn’t damaged.
Maybe it’s just there’s some swelling for a period of time afterwards. And I was not necessarily planning on having her face blindness go away by the end of the book. I mean, I was I was kind of undecided about should she keep it, should she lose it? But he was saying, you can really go either way, because she could have some swelling in that area that eventually subsides or she could have damage in the area and that would kind of put her in that situation.
But yeah, I mean, yes, to answer your question, it takes Sadie longer than you might think to kind of realize what’s going on because we always think what we think were going to think. We always kind of think the world is going to be as we expect it to be, and then it can take us a minute to catch up.
Dr. Denise Millstine
Yeah. I loved how Sue had to tell her some details that only Sue would know. And then she’s like, wait, are you my best friend? It was so well portrayed. And we try very hard not to spoil books on read to grow. So I’ll just emphasize that Katherine just said it may or may not go away, although readers who don’t want to know maybe should pause the episode here, go read the book and come back and finish it with us.
But Keith, Sadie has acquired prosopagnosia, meaning she previously was able to recognize faces, which we know she was a portrait artist. And then with this sudden onset, actually the diagnosis is made very quickly because she’s clearly aware something has changed. So will you talk about those two different situations where it’s either acquired or where people are born with face blindness.
Dr. Keith Josephs
Right, so there are two types the developmental form and the acquired form, and honestly I don’t have a lot of experience with the developmental form, because I’m an adult neurologist and the developmental form will start really from day one from birth. And as Katherine said, oftentimes these folks won’t complain of it. You won’t. It’s not a common question you’re going to ask somebody, do you have trouble recognizing faces?
And so oftentimes you’ll hear the story that I first realized that I have this problem recognizing faces when I was in college. It’s a lot different from the acquired form because the acquired form you’ve lived your entire life, kind of like Sadie did, being able to recognize faces. And after I read the book, I contacted a friend and said, this is going to be weird, but I just look at me for a second.
And I spent five minutes, looked at her face and I was like, try to figure out what it is about a face that makes it a face. And why does the brain not recognize a face for a human being? But we can recognize the face of a sheep or the face of a dog. And I’m not sure I have the answer, but it depends on, you know, I was thinking like, if the eyes are further apart, well, you might be someone else.
So, you know, in the acquired form, what happens is you have no problems recognizing faces, but then you do and the acquired form, you can divide it many ways. You can divide it into what we call a perceptive type and diagnostic type. So you might not recognize someone’s face because you can’t put the pieces together. So the type that Sadie has is, you know, she could see the eye, she could see the nose, she could see the mouth, she could see I forgot her name, the woman that worked in the coffee shop, her hair, when it was up, when it was down.
But what she couldn’t do was put it together. So that’s why she referred to that person. I can I say this because people are going to read the book, but, you know, she refers to her like I forgot to name Nicole One or Nicole Two. Nicole One had her hair up and Nicole. And so she knew the color of her hair I think and whether it was up or down. But she just couldn’t put it together.
Now with the acquired form, it can also be what we call agnostic. And some people argue that that might not be a true prosopagnosia, but that’s where you lose knowledge about the face. So you can see the face so you can see the eyes you see, but you don’t know who the person is.
So you might show them, you know the face of somebody famous, for example, that they should know. And they can see the face and, you know, they can see the face because they can match faces. So if you can match faces, if you give somebody five faces on the right, five faces on the left, and you can match the faces, then it is not apperceptive prosopagnosia.
It’s not an apperceptive problem. Apperceptive problem they wouldn’t be able to match. Which is why she couldn’t tell the vet from Joe.
Right. So the apperceptive type, you can’t match because everything just looks. I forgot the term she used, but its distorted. So you have like distorted versus distorted and so there’s no pattern. With the other type, then you can match, but you don’t know who the person is. With the apperceptive type that Sadie has, it tends to be more posterior.
So the sort of is the fusiform gyrus. But it’s the back of the fusiform gyrus closer to the occipital lobe. And actually at the beginning when people started to study this, they weren’t sure what the anatomic, what the area of involvement was that caused prosopagnosia. They weren’t sure where they had to be on the right or on the left.
Was it the fusiform? Was it the occipital? And over time, with MRI scans and CT scans, I think we have a better understanding. We still don’t completely understand, but at least a better understanding of where the problem lies. And it was interesting here that it was it was swelling. It was post-surgical swelling, you know.
Had the cavernoma been in the fusiform gyrus and it was resected, the surgeon had taken it out, then it would not have returned. She would not have been able to, it would not have come back. It didn’t, though, because if you read the last chapter, I mean, even then she sort of said, which is, I didn’t know this, though, that the faces that sometimes she still had trouble recognizing faces.
I think you wrote that she actually went into the grocery store, put her hand around two guys and thinking it was Joe, it wasn’t. And this was after she supposedly recovered. So she had 100% recovered.
Katherine Center
Yes. I actually borrowed that story from the lovely Sadie Dingfelder, who wrote about that in her piece in the “Washington Post” about life with face blindness, where she describes a moment of being in the grocery store, shopping with her husband, walking up to him, putting her arms around him, and then him like jumping back, you know, totally shocked because it was not at all her husband, but she was completely sure that it was in the moment that she did that. And so I was like, can I just borrow that for the book?
Dr. Keith Josephs
It was great. In fact, I have had, I’ve seen a patient who actually called the cops on their spouse.
Katherine Center
Oh my gosh, wow.
Dr. Keith Josephs
You know, thinking he was somebody else. So these stories, incredible as they are, you know, are true.
Katherine Center
Well, and it does make you appreciate the creative ways that people who are coping with that condition, find to find their people right, to connect with their people. So, you know, like Sadie talked to me about how she tends to be friends with people who are very tall or people who have, like, crazy hair, you know, it’s like if you’ve got a mohawk, she’s going to want to be your friend because she will recognize you, you know, in a crowd.
One of the things she talked about is paying attention to the way people walk, their gait, because you have to find things about people that are different. And she says it can be really hard for her when people get haircuts or dye their hair or change their hair, because she’s relying so heavily on things that are not the face.
And, you know, I think for most of us who rely pretty heavily on the face to kind of have that instant recognition that we don’t even have to sort of add up mathematically. It’s just right there. It’s very different. It’s something we all, I think, take for granted. So it was really interesting to hear about all the strategies that Sadie used to kind of know who her people are.
Dr. Keith Josephs
One of the she also I think you focused a little bit too on voice. You know, people usually use voice recognition. You know, certain voices are very distinctive. One of the things I thought about after I read the book that I thought about smell because I have had patients, I had this one woman who recognized her children by their smell.
And I thought, there’s I don’t know what that even me, that one of them not smells so good and one smell great.
But then I thought, you know, one of the things that I thought is, well, being that the vet in a white coat probably smelled different if she used smell than Joe, who was sort of more working in the hotel. And so I thought, well, okay, we could argue that maybe that’s why she didn’t put two and two together because they would have also had different smells because she had to talk to them in different environments. But smell is another strategy that patients with prosopagnosia will use to help them to recognize people.
Katherine Center
Yeah. You know, that’s great. If somebody’s got a perfume that they always wear. I mean, that could really help you.
Dr. Denise Millstine
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Well, actually, her stepsister, I think, has of course, the perfume, Poison, right. And this is how she starts to recognize.
Katherine Center
I mean, I thought about all of these things a lot when I was writing because we sort of sitting back can say, okay, you don’t have the face. What do you have? You know, and then you start thinking about, here are your strategies. But I did think about it for a while and talk about it because I interviewed several people.
And one of the things that I kind of learned that I thought was really kind of fascinating is that the senses kind of function as an ecosystem. Right? And so if one of them changes radically, it’s going to kind of throw you into a period of chaos. You’re not just going to, like, immediately adjust. Or at least that’s what I was told.
And I thought that was interesting. So it does. I think she’s also in this funny kind of adjustment period too, where she’s just trying to learn how to function without this one thing that she’s always relied on so much, you know, as a portrait artist and a person who took faces for granted, there is a process of kind of learning how to employ these other strategies that I thought that I thought was really interesting.
Dr. Keith Josephs
And you’ll see that a lot in patients that do not have a degenerative condition. So what do I mean by that for example, someone can have Alzheimer’s disease, and the Alzheimer’s disease can damage the fusiform gyrus. They it would be more difficult for them to develop strategies because they’re also progressively getting into this dementia phase with time, as opposed to what Sadie had was sort of a non-degenerative cause.
Meaning it’s not so like Alzheimer’s or Parkinson’s. It was a, you know, swelling from removal of a lesion or you know where else you might see this actually something I actually didn’t know until about five years ago is that patients with migraines will get prosopagnosia just during the migraine or before the migraines will be able to recognize faces.
Those are the kind of folks that I think strategies will be very helpful for. But those who have the degenerative conditions where really getting worse over time, I think they’ll try to develop such strategies. It’s not easy because, you know, the other senses are also affected.
In fact, I spoke a little bit about the post, the back versus the front of the fusiform. And in the patients that have that, where the front of the fusiform is affected, other senses are also affected. So in addition to that, being able to recognize faces, they might not be able to recognize voices or other characteristics of the patient.
And that’s why there’s some argument that probably we shouldn’t even call that prosopagnosia or apperceptive prosopagnosia, you know, you can’t use the gait, right? So if you see some I’m sure if, you know, if you didn’t see the face but you saw, I don’t know, who has a specific gait or lead, but you might be able to recognize who that person is. But if it’s the anterior parts of the fusiform and other areas are affected, then nothing will help because everything is lost. It doesn’t mean anything.
Dr. Denise Millstine
One of the things that I thought was interesting is the different settings in which this had such an impact. Katherine, maybe you can share with our listeners some places, because even Sue, who is Sadie’s best friend who cares about her, puts her into situations where this face blindness actually makes her so anxious and distressed. Maybe you can just share a couple of those places where that was like particularly bothersome for her.
Katherine Center
The thing that pops to my mind is that her best friend, Sue, who I madly love, is trying to cheer her up and she decides to throw her like a housewarming party, and she invites all these friends, kind of without asking. And then Sadie winds up at this massive party and she has no idea who anybody is. And her, like, ex-boyfriend shows up and there’s just all kinds of weirdness about it.
And I think about this a lot about how none of us ever really knows what it’s like to be somebody else. And how people can look just fine on the outside, just look totally fine on the outside, but be struggling with all kinds of things on the inside that we are just not tuned into or even really able to kind of understand.
And, you know, this is sort of random, but I think about this a lot because my husband is deaf in one ear. He had a meningitis like infection as a child and had to have a big surgery and lost all the bones in that ear. I mean, we’ve been together for 30 years and I still cannot remember which ear it is.
I have to use like a mnemonic device, that the good ear is on the side that he parts his hair. So I will literally like, check for the part and then go over to that ear, because I just can’t remember. And I’m constantly putting him in situations where its very loud and I’ll just be yammering and talking, and then like ten minutes later, he’ll be like, I didn’t hear anything you said, but I’m sure it was great.
And I’m like, wow, you know, I’ve had 30 years to get used to this true thing about my husband. And I still haven’t gotten on top of it. Because you can’t. Because visually they look the same. And because he doesn’t talk about it. I mean, he doesn’t like, let you know. He just kind of nods and is very sweet.
Yeah, I think about that a lot about how hard it is for us to remember. And I think Sue was very used to Sadie being a certain way, functioning a certain way in the world. And it was it’s just hard to adjust when things like that change. I gave Sue a lot of grace for her good-hearted instincts, but she made well.
Dr. Denise Millstine
And there are things that you think about and things you don’t think about, like hearing you would think about, right? Like you can understand. Like if you’re maybe you’ve had an ear infection and you couldn’t hear or couldn’t hear well, out of one side. So you can imagine that sort of difference between the two sides.
But the idea that you wouldn’t recognize a face unless you’ve read this book, or you happened to be a neurologist who’s interested in this concept, there’s just no reason you would be familiar with what that could even mean. And so, yeah, I loved that surprise party.
I also thought it was impactful when Sadie was trying to hide this from her love interest. She really didn’t want to seem like she was altered or broken. And there’s this quote where she says, “My whole life my brain is always just so reliable, but now not as much. I keep getting things wrong. I can’t trust myself.”
And she’s trying to explain to him without saying I can’t see your face. Can you share with us when you have people who have a neurologic deficit, how do they usually share that with other people or are you accustomed to them really trying to keep that close and only share it with people who absolutely need to know? What’s the kind of typical that you see?
Dr. Keith Josephs
Yeah, it’s a conversation that we have quite often, and I think everyone is different. The conversation usually ends with, you need to have friends, and some people have to know, but you need to decide who those people are. And usually male or female will want to have a core of friends, for example, that they’ll go and have coffee with every morning or something like that.
And so usually I sort of encourage them to pick somebody that you feel comfortable with. But sometimes patients don’t even want family members, very close family members, children to know or children will not want their parents to know.
So it’s quite common for that discussion to a occur, you know, who should I tell? And also, how do I tell them what I have? And it usually comes down to the simplest. So, you know, if you say to somebody, I have face blindness so I can’t see your face, people might get that.
If you say I have, you know, acquired apperceptive prosopagnosia, I think Sadie repeated it three times in the book. You know, nobody’s going to get that. You know, it’s always easier to just try to give them a simple diagnosis to give to friends and explain, you know, I have this.
And sometimes most times I think patients are happy with what’s that recommendation.
And they’ll come back and say, thank you for giving me that recommendation. And now, you know, every Wednesday morning with my girlfriends, we go and we get coffee and they know that I have a problem. You know, if everybody’s talking at the same time, I am not going to hear what the conversation is about. So, you know, they understand they have to be slower in their speech if the problem relates to say, understanding if its language, for example.
Or, you know, maybe if it was a problem like difficulty recognizing faces, maybe close friends would wear something or do something that would allow them to easily recognize that face. Right? So if I know, for example. So it’s not going to be recognize my face. But if I wear a hat, they’ll know, hey, Keith is a guy in the blue hat all the time.
You know “X” is the person that has the scarf or whatever it is, then that’s helpful. It is important to share this information with close friends for sure. You can’t find this on your own, whatever it is.
Katherine Center
There was one thing that Sadie Dingfelder told me about when we were doing interviews and she said, you know, she frequently in life walks right past people who she knows, people who are actual friends of hers because she doesn’t recognize them and she doesn’t say hello. And before she knew what was going on with herself, she had no idea that was even happening.
But there were people who just thought she was snubbing them, or just cold, or just rude, or didn’t like them. Right. And so she says that she’s been trying to make a better point of sharing this with people, so they will understand that if she walks right past them in the parking lot, it doesn’t mean that she’s snubbing them. It just means that she’s not recognizing them.
So yeah, I think there’s something to kind of letting people know, even if it’s hard for them to wrap their heads around or kind of incorporate into every interaction, like to just have the basic background. And I’ve also heard from I mean, I went on, I was on a lot of forums when I was doing research for this book and reading peoples comments about the process, especially for those who had the developmental kind, that process of figuring this out about themselves, and it really was like a very kind of moving insight for people to kind of realize like, oh, it’s not just that I’m self-absorbed or I have a bad memory, or I don’t care about people or I’m, you know, a narcissist or whatever kind of explanation they had come up with in their lives to kind of try and, like, describe why it is that they didn’t remember people.
It’s an actual neurological thing going on in my brain, like to have a physiological basis for this thing in their lives.I think for a lot of people felt like a relief to know that it’s not just that I don’t care or that I didn’t bother to remember these people. So I think there was there’s a website called Faceblind.org where you can go and test yourself. And I did it. I went and tested myself. And it’s fascinating because they give you all these faces and you have to match them and, and they get grainier and grainier and you have to keep trying and trying.
But I think a lot of people have reported back after reading the book that they went to the website, because I put it in the acknowledgments so that people could go and said, you know, it turns out I have this thing like, I never knew that this was even a thing. And it turns out I’ve had it my whole life. And I think for a lot of people, that’s kind of very comforting or freeing, right? Or it just kind of shifts their framework for thinking about something that they’ve struggled with.
Dr. Denise Millstine
Another way that fiction changes lives. That’s so fabulous. You know, I have twin boys and they look like brothers, but they’re not identical by any stretch. They look very different. And people will often say to me, I can’t tell them apart. And I say, then you’re not looking. But maybe they have face blindness and I have been rude unintentionally. Okay, really can’t tell them apart.
Katherine Center
This is very interesting trivia since we’re talking about fiction, but there’s a very famous fiction writer named Emily Giffin who has face blindness.
Dr. Denise Millstine
Oh, no way.
Katherine Center
And she has two twin boys who are identical. So we talked we talked about it at a thing one time after this book came out and she was saying, you know, just the irony that she has actual face blindness and also has identical twin boys, but she’s got strategies for telling them apart. I can’t tell her two boys apart, but she can.
Dr. Denise Millstine
Well, maybe this is a good point, Katherine, to talk about some of the coping that Sadie, Sadie the character in the novel, does go through developing strategies and reading. She’s on some social media looking at how other people have turned this from something that was distressing to even something that was considered a gift, or other people who had navigated face blindness and still were successful artists, which is, of course, her profession.
Katherine Center
Yeah. Well, I did a lot of I mean, I was very interested in this question of like, here’s the thing that you love most in the world, which is, you know, painting faces and then you by like horrible bad luck, you wind up having to struggle to do that, your thing, right? Your one thing is kind of taken away from you.
And I was really curious about how she would cope with it. I mean, that part of it was really like hooked me. I was hooked because I just wanted to know, like, how she going to figure this out. So I did a lot of research on artists with face blindness and the big one that came up over and over was Chuck Close, who did lots of very, very close up pictures of faces, even though he had face blindness.
And it was by going in at this kind of microscopic level and sort of painting square by square on these people. And then he would wind up with these massive sort of ten foot high faces. So that was fascinating to learn about.
But she tries all kinds of strategies to try and figure out ways to kind of get the information in, in other ways, because there’s in the plot, there’s a competition, she’s placed in a competition, and she has to create a portrait for the competition in the sort of weeks that follow this sort of unexpected situation.
And so she’s seeing if maybe she can do tactile things right, like if maybe touch could translate in and then she could sort of see from some other direction. None of it quite gets her where she wants it to go exactly. But what it kind of does do, is force her to look at the world differently and to think about herself as an artist differently, and to grow in terms of her framework for how she thinks about what she does.
And, you know, that’s kind of part of my own personal philosophy about life as well, right? Is that our struggles sort of lead us to our strengths. If we do it right, that the hard things we have to go with force us to come up with ways of coping and different ways of seeing things. I loved watching Sadie kind of navigate this really intense moment of her life, and I loved watching all the things she got to learn.
Dr. Denise Millstine
Yeah, I love that, too. Keith, there’s a really important member of Sadie’s health care team, and she calls her Dr. Nicole. She’s a neuropsychologist who is around when the face blindness is uncovered and also stays with Sadie, helping her to navigate whether this is going to get better in what ways. Will you talk about a neuropsychologist, what that person is on a team, and maybe somebody who is working with the team that has one, what they could expect from that person in that role.
Dr. Keith Josephs
You know? Yeah. Well, I think, you know, in the traditional sense, the neuropsychologist role is more actually for testing and diagnosis as opposed to it was a little bit different in the book. You know, she was more insightful, way smarter than I would be in terms of giving her advice or actually giving her advice. I think she sort of made her figure out.
But just because of how good she was, made her figure out what were some of the problems and sort of had her think through things. I think there’s one page where she’s sort of set, she said something on this. She’s, oh, you wanted me to do this. So she didn’t say anything to her. But I think she came to that conclusion.
But in the traditional sense a neuropsychologist, they function to help with in terms of diagnosis, making that diagnosis of providing the facial recognition tests and determining what type it is, which can help in terms of localization awareness.
But also if you think about the developmental folks or the kids with epilepsy that may lose some problems, may lose the ability to recognize faces, then they’re going to have to have pre-operational tests post operational tests to determine, you know, how bad this is or how much they’re improving, etc.
So it’s a little bit different that the role that I forgot to name that the neuropsychologist had. She sort of functioned honestly more like a, you know, a neuropsychiatrist or a behavioral psychiatrist, more so than a neuropsychologist with at least how we work with neuropsychologists here and in most institutions. I wish we had someone like that for the disorders that we see, honestly I mean.
Katherine Center
I wish I had someone like Dr. Nicole too. I thought she was very helpful to all of us.
Dr. Keith Josephs
Yeah, I thought so too.
Dr. Denise Millstine
Well, and I think in, you know, in a novel, you get to portray not just the role that that person would play, but even optimizing person had as much time as they possibly needed to spend with a specific patient and could invite them into this warm, caring environment to truly care for them and help them to navigate. But I just loved how she agree, helped her come to like the concrete diagnosis, acknowledging where these deficits were, but then also working on these coping strategies.
So what if this doesn’t ever get better? You know what If it’s not just the swelling? What if the region is damaged and this is going to be how you go on? Is that disastrous or can we find ways to work around that. And I just thought it was so beautiful.
I think it wrap up. I’d love to have you both give advice to any listeners who live with prosopagnosia or who care about somebody who has face blindness. Katherine, do you want to go first and then Keith, do you want to end?
Katherine Center
Well, something that I think about a lot that has really stayed with me from my conversations with Sadie Dingfelder, is the way that she thinks about her face blindness, and she told me that she thinks of it as not a limitation but an opportunity, because her way of sort of dealing with the fact that she doesn’t recognize anybody is to treat everybody like a friend.
So anybody that she talks to in any way, she just starts out of the gate, just warm and friendly, like they’re already friends, because they might be. So for her, that’s her coping strategy. But I think what she was saying to me is that it brings all this warmth and all this connection into her life in a way that you might not if you were, you know, just kind of holding back and taking all that stuff for granted.
And I thought that was an amazing way to talk about it. That worked. It’s way into the book as well. And I saw I actually saw a bunch of people on the forums saying the same thing, that this is not a curse. It’s a blessing. It gives you this whole other way of approaching human connection that if you do it right, can be great. So I thought that was really wise and thoughtful.
Dr. Denise Millstine
Maybe we should all be a little more face blind a little more often, and just treat everybody with kindness, I love that, yeah. Keith, give us some good advice.
Dr. Keith Josephs
If you’re caring for someone with prosopagnosia or you think you might have it, you do want to get it evaluated, first of all. And the reason for that is because that there are different causes for prosopagnosia. And I think that we have to recognize that there are coping strategies, but also that there are some conditions in which the prosopagnosia may disappear and it could occur in weeks, days or even months.
And so I think it’s important that patients or carers seek out experts in that area and also recognize that if you have loss of facial recognition or knowledge or you have prosopagnosia, whatever type it is, that there are other senses that you can focus on and get as much pleasure as you would if you were using the visual set.
So a lot of patients that have trouble, for example, you know, we have a condition called posterior cortical atrophy, where you do get apperceptive prosopagnosia, but it’s progressive.
And I tend to say, well, focus on if you can’t read a book, for example, because it’s not so much there’s a part of it, but there are other things going on with these folks. So they can’t read, for example. Well, you can do books on tape and you might get as good or even better an experience.
So rather than focus on the fact that you can’t see or you can’t read, focus on the fact that, well, I can hear and so I can still get all the information that I could by reading, by listening. So there are coping mechanisms, but I think it’s important to get this evaluated because you don’t know, especially if this is a very young individual, because it could be surgically fixable problem or a medically treatable problem.
Dr. Denise Millstine
Yeah, that’s brilliant. That’s a great opportunity to remind listeners that audio is reading. So get out there and do your audiobooks and read your books visually.
Katherine Center
Agreed, agreed.
Dr. Denise Millstine
Thank you. It has been my absolute pleasure to talk about prosopagnosia with Dr. Keith Josephs and Katherine Center regarding the book, “Hello Stranger.” Thank you both for being here with me.
Dr. Keith Josephs
Thank you. Pleasure meeting you both too.
Dr. Denise Millstine
“Read. Talk. Grow.” is a product of the Women's Health Center at Mayo Clinic. This episode was made possible by the generous support of Ken Stevens. Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen.
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