The New Yorker: How a Rare Disorder Makes People See Monsters

[SNT Gatchaman]

A mysterious neurological condition makes faces look grotesque—and sheds new light on the inner workings of the brain.

Article | Archive

PMO = prosopometamorphopsia

In 2007, Jason Werbeloff, a twenty-two-year-old graduate student in Johannesburg, South Africa, spent months in bed with a severe case of mononucleosis. Every part of his body—his joints, his skin, his swollen throat—was in pain, and he passed the time staring at the concrete ceiling of his room. Television gave him a headache; he tried to read but often forgot the names of characters by the end of each page. He saw no one except his mother, who occasionally stopped by with groceries.

After he recovered, Werbeloff was eager to be around people again, and he spent a night clubbing. In the shifting red light, he looked at a friend’s face and realized that the right side looked odd. It seemed to stretch outward, like Silly Putty being pulled, and a dark, rough patch was visible around the friend’s right eye. Werbeloff blinked and looked away, and his friend’s features briefly returned to normal. Then the distortions appeared again. “That is when people got ugly,” Werbeloff told me.

During the Zoom call, Duchaine’s Ph.D. student Sarah Herald asked Werbeloff to stare at portrait photos for longer than he was used to. Werbeloff hadn’t realized how distended a face could become: the right side stretched until it was bulging, and the dark patch became a deep concave pit encircling the eye. After the session, Werbeloff cried. “I don’t believe in demons,” Werbeloff told me. “But I can totally understand that someone who was religious would find it a deeply religiously disturbing experience.”

Distorted perceptions are not the same as hallucinations, Blom told me. If you saw an elephant appear in your home office, you would be hallucinating. But, if you looked up and perceived an elephant in an elephantine cloud, that’s more like a distortion. “There’s a cloud—it’s actually there,” he said. He views his PMO patients as very different from psychiatric patients with schizophrenia, who hear voices or see things that don’t exist. People with PMO aren’t helped by antipsychotics; they know that what they’re seeing isn’t right.

PMO may clarify the role of each side of our brains when it sees faces. The right hemisphere seems especially important for facial perception: injury-induced face blindness tends to result from damage to the right. But PMO can apparently be caused by lesions on either side. Lesions on the left can cause distortions on the right side of people’s faces; lesions on the right can cause distortions on both sides. For this reason, Duchaine believes that the left hemisphere processes the right side of faces, and vice versa—and then, he suspects, the right side puts the pieces of the image together. “They’re fused, and they go forward together for later processing,” Duchaine said. “That’s something we didn’t know.” Researchers are able to induce PMO-like symptoms by stimulating specific parts of the brain, especially on the right side. And some hemi-PMO cases involve damage to the splenium, a part of the brain that carries information between the hemispheres.

 

[SNT Gatchaman]

Visualising facial distortions in prosopometamorphopsia (2024)
Antônio Mello; Daniel Stehr; Krzysztof Bujarski; Brad Duchaine

A 58-year-old man with a 31-month history of seeing peoples’ faces as distorted and, in his words, appearing “demonic” visited our laboratory for assessment. The patient stated that the distortions—severely stretched features of the face, with deep grooves on the forehead, cheeks, and chin—were present on every person's face he encountered, but he reported no distortions when looking at objects, such as houses or cars. The patient said that even though faces were distorted, he was still able to recognise who they were.

Link | PDF (The Lancet)

Face distortions in prosopometamorphopsia provide new insights into the organization of face perception (2023)
Herald; Almeida; Duchaine

Prosopometamorphopsia (PMO) is a striking condition of visual perception in which facial features appear distorted, for example drooping, swelling, or twisting. Although numerous cases have been reported, few of those investigations have carried out formal testing motivated by theories of face perception. However, because PMO involves conscious visual distortions to faces which participants can report, it can be used to probe fundamental questions about face representations.

Here we review cases of PMO that address theoretical questions in visual neuroscience including face specificity, inverted face processing, the importance of the vertical midline, dissociable representations for each half of the face, hemispheric specialization, the relationship between face recognition and conscious face perception, and the reference frames that face representations are embedded within. Finally, we list and touch upon eighteen open questions that make clear how much is left to learn about PMO and the potential it has to provide important advances in face perception.

Link | PDF (Neuropsychologia)

 

[rvallee]

Saw a video about this not long ago. Has a few drawings from those affected showing what they see. They can tell the difference because they don't see the same thing when looking at photos, IIRC. Easy to see why they'd call what they see demonic.

I wonder if there's something similar going on with people who go through extreme facial transformations, like the Bogdanov brothers. They must see something different when looking in the mirror.

 

[Hutan]

Jason Werbeloff, a twenty-two-year-old graduate student in Johannesburg, South Africa, spent months in bed with a severe case of mononucleosis.

The right hemisphere seems especially important for facial perception: injury-induced face blindness tends to result from damage to the right. But PMO can apparently be caused by lesions on either side. Lesions on the left can cause distortions on the right side of people’s faces; lesions on the right can cause distortions on both sides.

This seems to be suggesting that EBV can cause brain damage. Perhaps supporting the hypothesis that ME/CFS is damage to a different part of the brain.

 

[V.R.T.]

This seems to be suggesting that EBV can cause brain damage. Perhaps supporting the hypothesis that ME/CFS is damage to a different part of the brain.

If it is brain damage, are we cooked? Or is there still treatment possibilites that can be trialed?

 

[Hutan]

Sorry, my post was more questions than a statement. I need to emphasise there are lots of ifs and maybes with the idea that ME/CFS is brain damage. And the rapid remissions would seem to go against the idea.

I just couldn't recall if we had seen the suggestion that EBV in the form of a standard glandular fever illness could cause brain damage, other than the link with MS.