busybee fluffy rambles

Prosopagnosia

Dr. Wolf, the main character of the show (who is based heavily on the late great Oliver Sacks), has faceblindness, more properly called “prosopagnosia.” This is an inability to distinguish people based solely on their faces, and is a thing I’ve struggled with all my life.

In most TV shows they just portray it as someone seeing a blank slate or a jumbled mess where peoples' faces should be, but that’s not even remotely accurate. It’s more like, I see that people have a face, but that alone doesn’t immediately register someone’s identity, and I have to rely on a lot of other context cues to recognize people. Things like clothing, context, hairstyle, or most often voice; I am super good at identifying voice actors in cartoons, for example.

Update: This classic article, Prosopagnosia and stones, is an amazing analogy for it. I had tried to link to it originally but couldn’t find it; many thanks to снежинки много for digging it back up!

The struggles that have been caused by this are mostly things like not recognizing people at a glance and then having them be upset that I “don’t remember” them or that I’m outright ignoring them or the like.

There’s definitely a familial component to this; my dad is also faceblind in this way.

So, how did Brilliant Minds handle it?

Pretty good, actually! From a writing standpoint it’s spot-on; Dr. Wolf’s everyday struggles with it exactly match how it’s been for me as well, such as suffering frequent humiliation by misidentifying classmates, or people taking him to be an insensitive jerk for not giving them greetings in passing or taking a while to learn peoples' names.

There are a couple of places where visually they rely on the tired trope of a “blank slate” face, or where peoples' faces are blurred out beyond recognition. This part is pretty frustrating to me, because it’s an awful trope and not even remotely reflective of how I (or most people) experience faceblindness.

There are people who experience it in that way but it’s extremely rare (the case described in Dr. Sacks' “The Man Who Mistook His Wife for a Hat” being a pretty good example!), and from the writing it’s pretty clear that Dr. Wolf’s form of prosopagnosia is the much more common one that I experience.

So, I’m not a fan of the visual representation, especially since it helps to reinforce recurring myths that people have about faceblindness and also that it might lead people who have it to believe that they don’t actually have it, which can be isolating.

My recommendation to people who want to portray faceblindness visually: use digital face replacement to change peoples' faces, either giving them all the same face as one another, or to randomize the face (and nothing else) between scenes. That would be a much more realistic depiction for the vast majority of prosopagnosia cases.

Mirror-touch synaesthesia

This is the place where Brilliant Minds really drops the ball.

In actual mirror-touch synaesthesia, the person with it experiences a feeling of touch when they see someone else being touched in some way. For me this has always been fairly mild but present. I have difficulty watching surgery footage, or seeing things where people are being injured (being punched, stubbing their toes, and so on), and the more realistic the depiction the harder it is for me. (This is a big part of why I stopped playing action games once graphics got too realistic, and why I’ve never been able to enjoy slasher films unless they’re so ridiculously over-the-top as to be cartoonishly unrealistic.) But it can also be positive; if I see two people in a loving embrace, I also feel that as well.

It’s never so overwhelming as to be debilitating in any way, but it’s definitely been ever-present in my life, and it was one of those things where I was kind of surprised to learn that other people don’t experience this.

I also suspect that this is a big part of why I experience phantom touch¹ in VR; I also experienced it even in Second Life, which primarily uses a third-person perspective! I also experience phantom touch between others in VR as well, even if the people doing the touching don’t experience it themselves (and this is key).

MTS hasn’t been portrayed in many pieces of media; the only other thing I can think of which demonstrates it was a god awful episode of House, M.D., which portrays it as some sort of psychic ability where people literally feel what’s going on inside the brain of the other person.

I am sorry to report that Brilliant Minds does this exact same thing.

We first learn of Dr. Markus' mirror-touch synaesthesia when he is unable to perform a lumbar puncture on a patient, because he feels it in himself. This is pretty realistic, although I don’t think it would be so debilitating as to prevent him from performing the procedure, it’s just something where he needs to ground himself and focus on the mechanics of what’s happening. Dr. Wolf even says as much at one point. So, at first, the portrayal is actually pretty good.

But unfortunately, it very quickly goes off the rails and veers into the realm of pure fantasy.

Dr. Markus is shown to be extremely isolated because his synaesthesia is debilitatingly overwhelming. Somehow he’s unable to exist in society because of this, and yet is able to work in a hospital? That’s pretty weird.

But it only gets way worse from there.

There is a scene where a patient blacks out due to a heart condition. Dr. Markus blacks out too — simultaneously with the patient.

There are several other scenes where he’s unable to do basic procedures such as doing an IV insertion or a blood draw, because of his perception of the patient’s pain. I’d posit that maybe he needs better phlebotomy training if this is a problem for him, especially if he’s actually perceiving their pain (like the show is trying to say he does later on), and not just projecting a visual perception onto his own senses.

(Incidentally, I always close my eyes or look away when I’m getting venipuncture, because it’s seeing the needle that goes in that hurts, not the actual insertion, most of the time.)

But then the bit that really loses me, which is the same thing that loses me in the House, M.D. episode, is how Dr. Markus' perception of pain is based purely on what the other person is actually perceiving. This culminates in the most stupefying thing in the season finale 10th episode: where he has absolutely no trouble whatsoever performing venipuncture on an autistic child, and does it without a second thought, and then this becomes the way in which they diagnose the child as having CIPA.

Do I have to explain just how asinine bonkers bananapants this is?

The show is presenting mirror-touch synaesthesia as some sort of super rare psychic power, when it’s not all that rare and certainly not psychic. It’s estimated to be 1.6% of the population, which doesn’t sound like a lot but that means that if there’s 1000 people, 16 of them will have it!

For comparison’s sake, the human population has about the same number of people with red hair.

It’s uncommon, sure, but super rare?

And of course this show romanticizes the fuck out of it, in ways that are almost infantilizing.

It isn’t even consistent about it. One of the other doctors has panic disorder (is this show just, like, a bingo card for my neurological bullshit?) and Dr. Markus never seems to have any sympathetic panic attacks. But you’d think that would be something that would be much more likely for someone with an empathy disorder to latch onto sympathetically, right? And yet…

Other things in the show

On the plus side, the show’s portrayal of panic disorder is pretty much spot-on.

On the minus side, they hint at one character being asexual/aroace but nope, she’s just super shy, and her Positive Arc is that she discovers her sexuality after all, blech.

On the plus side, a bunch of the characters are gay and this is shown as being just, like, normal? And this also culminates in a really lovely (if bittersweet) element of one of the multi-episode arcs regarding the “John Doe” patient.

I have a hard time believing that a county hospital would be so well-funded that they can just schedule people with CTs and MRIs willy-nilly, much less that the administrator would have a nice, huge, luxurious office. But at least it’s shown as being a bit dingy and dusty so maybe it isn’t so awful.

There are a couple of multi-episode arcs that involve bipolar disorder, which is portrayed all-too-realistically, at least based on the unfortunate experiences I’ve had with bipolar friends and family.

Sometimes characters make really bad decisions in the name of “So The Plot Can Happen,” and this culminates in the season finale 10th episode cliffhanger which is done in such an over-the-top way, but it’s at least refreshing that it doesn’t center the main character. It’s nice when the show remembers that things happen to other people too.

I can’t speak to the accuracy of most of the neurology in the show. A lot of it at least seems plausible to me, but I’ve also read the same books as the showrunners.

I was happy when one of the plots revolved around one of my favorite Oliver Sacks anecdotes (“The Case of the Colorblind Painter” from An Anthropologist on Mars), but disappointed that one of the most striking things from the original case study didn’t make it into the show.

Closing thoughts

Despite my frustrations with some things, I hope the show gets a second season and that they’re able to cover a lot more of the interesting cases from Sacks' body of work. There’s so much to draw on, although I worry that most of the ones that were the most interesting to me wouldn’t make for good television because there’s no Giant Spectacle of extreme peril and a sudden rapid-onset dramatic near-death moment. (Which is definitely something the show suffers from.)

But most of all I love medical shows that are aspirational and show how doctors can and should act: with empathy, kindness, and curiosity. That’s something the world needs a lot more of.