It is difficult to think of a facet of human interaction in which the face does not play an important role. In the construction of self-identity, of emotions, and in weaving the fabric of the social matrix, facial signaling figures centrally. The important role of the human face in communication is revealed already at birth. As newborns, our facial expressions are finely adapted to elicit responses. Caregivers interpret these signals as signals of our inner states, and respond to them as such, helping to insure that our basic needs are met. And just as our faces are the predominant focus of others’ attention, so are theirs the focus of ours. While certain features of infants’ faces seem specially designed to attract and hold the attention of adults, infants prefer looking at faces to looking at most other visual stimuli. Once engaged in this mutual attention, adult caregivers typically mimic, model, and regulate the emotions of infants in protracted mutual gazing. With so much shared attention on faces, the infant’s ability to decode the facial expressions of others develops rapidly, and they enter effortlessly into the fluid, nonverbal tete-a-tete of facial communication. Throughout development, our reliance on facial cues is revealed in phenomena like social referencing and empathic mirroring that occur in close relationships. These abilities appear to be largely innate, as suggested by evidence of their universality, early emergence, and similarity to capacities of other species.

While language dominates adult human communication, the face remains an active channel through which subtle (and sometimes not so subtle) signals are silently exchanged. In parallel to verbal communication, facial cues are used to gauge agreement or interest. These signals can be too quick and fleeting to be registered consciously, yet they influence our judgments of others’ feelings and intentions. Our lack of awareness of this facial signaling most likely arises from its being partly involuntary and partly an over-learned skill. Nonetheless, its continued use seems to depend crucially on social reinforcement and reciprocation. For example, the social smile presented by blind infants disappears in childhood, probably due to its lack of reinforcement.

In About Face, Jonathan Cole visits the lives of individuals who for various reasons have lost important aspects of facial communication. He takes an uncommon approach; instead of teasing apart the interpretative capabilities of individuals through experiments, he delves into their inner lives. He asks, “What was it like to live without representation of self externally, and internally, on the face, and not to have the reassurance of others reflecting your worth back to you by their smile?” (p.181). His hope is that in discovering what is different about the lives of individuals for whom this channel has been closed off, we will discover something important about the role of the face in shaping our sense of self as private and as social beings.

About Face takes us on a moving journey into the inner worlds of individuals who by either birth or accident have been deprived of this primary mechanism for social interaction. We meet Peter, blind from birth, who never knew the face as a communication channel, but for whom the face remains the focus of the personality – the place from which the person communicates and toward which one orients communication. We meet John, who became blind as an adult, and for whom the world has gradually become a faceless gallery filled with individuals he now knows only through their voices. We encounter Donna, an autistic, who reveals her fear of looking into the faces of others, lest the signals there overpower her fragile sense of self-integration. Sufferers of Möbius Syndrome, Bell’s Palsy, and Parkinson’s Disease, all of which affect the muscular control of facial expression, are also introduced, and their unique and disturbing experiences are touchingly related. Cole examines the effects of these various “losses of face” on these individuals’ capacity for emotional experience and expression, on their ability to understand their own and others’ emotions and to feel similarly understood, and on their most basic understanding of self and other.

A Theory of Mind

We have much yet to learn about the many cognitive and affective processes mediating facial communication. Yet it seems clear that the face, more than any other body part, is that which indicates to us the presence of another being like ourselves. In the face we read the mental state of others, whether they are happy or sad, tired or bored, interested or afraid. We rely on others’ gaze to tell us whether we have their attention, or to direct our attention to other things. We seek in the face an indication of personality and of ongoing thought. In animals to which we attribute consciousness, it is often the face that makes the strongest appeal to this intuition. The eyes, in particular, seem to hold a clue to the inner life inside.

The book revolves around Cole’s central argument that facial communication plays a central role in our development of the understanding of ourselves and others as mental agents – what has been called a ‘theory of mind’. Cole suggests that it is largely by expressing our emotions in a social context that we come to understand ourselves and others. We experience our emotions, in part, by expressing them, and this expression relies largely on the face, which embodies and differentiates our emotional states. We feel ourselves smiling, and project this smile outward, signaling it to others and inviting response. It is in the social context in which others respond to our expressions of feeling that our understanding of our own emotional experiences is refined. We learn the appropriate range of our expressions in the process of learning what particular emotions mean, by situating them in the social contexts in which they are evoked. By giving us access to others’ inner states, facial signals communicate to us that they too share this inner world. Throughout life, this overt nonverbal signaling supports our interpretations of others and theirs of us. Cole’s hypothesis is that this process must somehow be different in those who cannot use the face as a primary source of information about others or as a channel for communication, with the implication that the entire sense of self or of other can be disrupted.

The Method

The book is a compilation of case histories, set against a broad, if somewhat incomplete background of neurological, evolutionary, and developmental research. The lay reader will find much in the background chapters to whet the appetite, and the citations are full of further references. Experts in facial expression may find little new here. For them, Cole’s real contribution lies in his method, for he has ventured to ask his subjects about their inner lives, and in asking, brought forth sometimes new, if occasionally controversial data about the first person experiences of life without normal facial communication.

The interviews are both touching and personal, revealing the inner struggles of individuals whose lives have been cut off from the normal, effortless flow of emotional communication. As interviewer, Cole casts his investigative net broadly. Though he makes an effort not to lead his subjects, he occasionally encourages them to entertain notions consistent with his theoretical intuitions, seeking to weave together threads of support for his theory about the role of the face in the development of a theory of mind. For the most part, his gentle and sensitive questioning makes it possible for his subjects to reveal secrets obscured by more traditional investigations. Herein lies the gem of the work. For these secrets suggest new avenues for research and encourage us to think about more systematic approaches to collecting first person data.

By relating his own experiences both during the interviews and in the periods leading up to and following them, Cole reveals to us the importance of developing a relationship of trust between the subject and the investigator, as well as the investment of time and empathy it requires. Without that trust, much that is personal and sensitive may be filtered from subjects’ reports. Though it is difficult to ask questions that do not lead, an interviewer who helps subjects to frame their thinking by asking questions that force them to consider aspects of their experience they have under-explored can bring forth buried truths and features of experience otherwise unavailable to us. The intimacy of these encounters is captured in Cole’s writing style and in his willingness to reveal himself as a humble and curious explorer into his subjects’ inner worlds. Several of his subjects appear to have been touched by this process and moved to reexamine their lives in new ways. This raises the question whether the interview – this mediated approach to first person investigation – may not also change the experience and lead to an understanding not present before.

The Data

But what of this lack of face? What is it like to be unable to use the face to express one’s feelings, to be deprived of the ability to decode others’ experiences through their facial signals, to be cut off from such a centrally human channel of communication? Cole explores the lives of his subjects from the inside and the outside, speaking both to them and, in some cases, to the family members who form their closest social network.

From the inside (the first person perspective), the face is the vehicle for our presentation of ourselves to the world. Through the face we signal our engagement with the other and express the pattern of feelings evoked in communication. Meanwhile, the proprioceptive effects of our facial expressions constitute a component of our experienced emotional state. Not being able to feel one’s expressions, reports Oliver, who suffers from Bell’s Palsy, is like being in an “emotional limbo. I still feel happy to see or hear something I like, but I don’t think that I feel it as much because I am not actually smiling. I have started to write a diary … Writing it out helps a lot. Such and such has happened and I feel this. Writing allows me to express” (p. 150).

In blindness, the visual consciousness that so dominates the mental life of the normal individual is lacking, leaving the blind person with a world constituted largely of auditory and tactile sensory information to which the sighted do not always attend. Peter White, blind from birth, describes the importance of voice for his appreciation of others: “I’m very aware of my wife’s moods — aren’t we all? I can talk to her on the phone and I say ‘What’s wrong?’ … It is not only in the voice, there are also different qualities of silence. A contented silence when you know that she’s just been talking to you and that she is doing something else, and a silence when you know she’s quiet because if she said something it would be absolutely appalling” (p.14). For John, who became blind as an adult, constructing a faceless social world out of sound and touch is more difficult. Yet new sources of information have opened up to him. He speaks of feeling the face of his young son: “What does continually strike me,” he says, “is the lack of commensurability between what it looks like and what it feels like. You see my little boy’s face, my five-year-old, is such a beautiful face, and I often touch it… I rest my hand lightly on his forehead at night sometimes, or I rest it over his face and the puckering of the childlike cheeks and nose and lips, and the fact that it’s still small enough to be felt in the hand, somehow is curiously roselike. It is soft and flabby, there’s a curious significance in all these knobs and little bits and pieces. It’s a curious tactile thing that I don’t think I ever enjoyed as a sighted person” (p 32.).

An awareness of the social importance of face is not absent even in the congenitally blind. According to Peter White, “The face is not doing something that’s very conscious. It’s not doing something that’s vital to my existence, but it is dong something that I want to communicate. You are aware at some level that in order to interact and talk with people you present your face to them. It’s not just a place where your voice comes out of. I think it’s possibly a reflection of wanting to make contact with them. … It’s to say I’m interested in you. It’s you I’m directing this at. I don’t think anyone taught me to do this” (p. 15-16).

Many interviewers, therapists, and teachers rely heavily on facial communication, training themselves to keep this channel never far from focal awareness. For others, awareness of facial signaling often seems to have faded into the background. Even less conscious is our own automatic use of the face to send emotional information to others. Not until an unanticipated or undesirable expression is sent, do we notice and consciously adjust our responses to the other. Yet our mostly unconscious use of face can break down in the absence of social reinforcement and continued use. An unreciprocated smile is like the comment that falls on deaf ears – it eventually stops being sent. This phenomenon is common both among the blind, who lacking feedback from others must make a conscious effort to use facial expression, and among companions of those who lack facial expressions, who often cease responding to them facially (and even verbally) as a result of their disability.

From the outside, the face of a person suffering from Möbius Syndrome, Parkinson’s Disease, Bell’s Palsy, or of someone blind from birth who has not learned the proper facial signals appears to lack expression, to be unresponsive, to indicate an absence of interest, or possibly the presence of an emotion incongruous to the situation. As a result, such individuals can be systematically ignored or misunderstood. Mary, who suffered from a gradual worsening of a condition known as bilateral seventh nerve paresis (damage to the cranial nerve that innervates the facial muscles) saw her social contacts slowly slip away as her own ability to respond verbally or with facial expression worsened. Her only remaining contacts were with immediate family, who mourned the loss of the intimacy provided through facial and vocal communication.

Cole’s narratives poignantly chronicle the struggles of those whose profound losses we can only imagine – individuals whose losses of face have cast them into deep depressions and social isolation. Some of them have emerged with a renewed sense of self; others are struggling through. The journey, invariably, has been an arduous one. What these stories of courage and persistence suggest is that facial loss can lead to a dramatic alteration of social interaction and of self-integration.

The development of systematic approaches to the collection of first person data is currently a central issue in the science of consciousness. We need to use subjective reports as a source of information about conscious experience, and to use them as a guide in our investigations at other levels (e.g., conceptual, neural, behavioral, or computational). Some worry about the objectivity of the data. Reports of experiences can be altered due to forgetting or other memory distortions, and the process of reporting itself can be subject to filtering and interpretation on the part of the subject. A science of experience should strive to strike a balance between first and third person data, allowing each to inform the other. About Face is an exclusively first person sort of investigation. It is perhaps best viewed as an exploration of a method, and of what is required of the investigator. Cole is an adept mediator for the reports of his subjects’ experiences of facelessness. At times, his questioning is overly suggestive, though he seems generally aware of the occasions when this is the case. Much that we learn from his subjects’ narratives seems fresh and new and points to the need for systematic investigation of the phenomena that are disclosed here. One particular case study seems especially problematic, however; Donna, a high functioning autistic has studied psychology at university and has written extensively on her own experiences. Her commentary is rife with interpretations and is couched in a peculiar psychological language that renders it difficult to separate the experience from the interpretation. In this regard, her narrative stands alone, and one may wish to be cautious in drawing general conclusions from her case.

About Face is lucidly written and quickly draws the reader into the lives of its subjects. It gives us access to a hidden side of blindness, autism and neurologic illness, and underscores that there is much beneath the visible surface that warrants telling. Cole treats his subjects with admirable respect and his case studies emphasize the importance of establishing an environment of trust and sympathy in which subjects feel free to tell their experiences. For this he is to be highly commended.

Categories: Philosophical, General, Memoirs

Keywords: neuropsychology, neuroscience, medical