Bioethics in the Making: “Ideal Patients” and the Beginnings of Face Transplant Surgery in Mexico

Medical teams around the world are increasingly gaining ethical clearance to utilise face transplant surgery as a reconstructive surgical procedure. Analysis of the beginnings of the operation in Mexico vis-à-vis the early uptake of the procedure in France reveals that this controversial experimental medical field has become loaded with national significance. The primary issue of dispute has been the dependence on life-threatening immunosuppressant therapy in a procedure that treats otherwise biologically healthy people. Attempts to resolve related debate has resulted in the emergence of what my interlocutors refer to as an “ideal patient”, a person whose particular state of health and suffering render them operable within the current biomedical constraints. Drawing together the idiom of coproduction with the concept of sociotechnical imaginaries shows how this imagined patient category was refracted and stabilised as it entered into the Mexican context whilst producing patients and surgical experts as particular types of bioethical subjects. The flexibility and normative value of the “ideal patient” mobilises and is mobilised by surgeons, who themselves emerge as national bioethical subjects responsible for saving the face of nations in the midst of broader changes surrounding how State's should respond to medical advancement.     

Conscious awareness is required for holistic face processing

Investigating the limits of unconscious processing is essential to understand the function of consciousness. Here, we explored whether holistic face processing, a mechanism believed to be important for face processing in general, can be accomplished unconsciously. Using a novel “eyes-face” stimulus we tested whether discrimination of pairs of eyes was influenced by the surrounding face context. While the eyes were fully visible, the faces that provided context could be rendered invisible through continuous flash suppression. Two experiments with three different sets of face stimuli and a subliminal learning procedure converged to show that invisible faces did not influence perception of visible eyes. In contrast, surrounding faces, when they were clearly visible, strongly influenced perception of the eyes. Thus, we conclude that conscious awareness might be a prerequisite for holistic face processing.     

Effects of facial expressions on visual short-term memory in relation to alexithymia traits

We examined dysfunctional memory processing of facial expressions in relation to alexithymia. Individuals with high and low alexithymia, as measured by the Toronto Alexithymia Scale (TAS-20), participated in a visual search task (Experiment 1A) and a change-detection task (Experiments 1B and 2), to assess differences in their visual short-term memory (VSTM). In the visual search task, the participants were asked to judge whether all facial expressions (angry and happy faces) in the search display were the same or different. In the change-detection task, they had to decide whether all facial expressions changed between successive two displays. We found individual differences only in the change-detection task. Individuals with high alexithymia showed lower sensitivity for the happy faces compared to the angry faces, while individuals with low alexithymia showed sufficient recognition for both facial expressions. Experiment 2 examined whether individual differences were observed during early storage or later retrieval stage of the VSTM process using a single-probe paradigm. We found no effect of single-probe, indicating that individual differences occurred at the storage stage. The present results provide new evidence that individuals with high alexithymia show specific impairment in VSTM processes (especially the storage stage) related to happy but not to angry faces.     

Dissociation between the behavioural and electrophysiological effects of the face and body composite illusions

Several studies have reported similarities between perceptual processes underlying face and body perception, particularly emphasizing the importance of configural processes. Differences between the perception of faces and the perception of bodies were observed by means of a manipulation targeting a specific subtype of configural processing: the composite illusion. The composite face illusion describes the fact that two identical top halves of a face are perceived as being different if they are presented with different bottom parts. This effect disappears, if both halves are laterally shifted. Crucially, the effect of misalignment is not observed for bodies. This study aimed to further explore differences in the time course of face and body perception by using the composite effect. The present results replicated behavioural effects illustrating that misalignment affects the perception of faces but not bodies. Thus, face but not body perception relies on holistic processing. However, differences in the time course of the processing of both stimulus categories emerged at the N170 and P200. The pattern of the behavioural data seemed to be related to the P200. Thus, the present data indicate that holistic processes associated with the effect of misalignment might occur 200 ms after stimulus onset.     

The role of holistic face processing in acquired prosopagnosia: evidence from the composite face effect

Faces are processed more holistically than other objects, and it has been suggested that the loss of holistic face processing causes acquired prosopagnosia. Support for this hypothesis comes from several cases who failed to show holistic face effects as well as the absence of reports of prosopagnosics with unequivocally normal holistic face perception. The current study examines the relationship between holistic face processing and prosopagnosia by testing seven acquired prosopagnosics with the face composite task, a classic measure of holistic face processing. To enhance the robustness of the findings, each prosopagnosic was tested with two versions of the composite task showing upright faces. We also tested an inverted condition to exclude the possibility that more general factors account for composite effects for upright faces. Four of the seven acquired prosopagnosic participants showed consistent upright face composite effects with minimal inverted face composite effects. We conclude that severe face processing deficits can co-occur with intact holistic face processing and that factors other than a loss of holistic processing contribute to the perceptual and recognition deficits in acquired prosopagnosia.     

The “parts and wholes” of face recognition: A review of the literature

It has been claimed that faces are recognized as a “whole” rather than by the recognition of individual parts. In a paper published in the Quarterly Journal of Experimental Psychology in 1993, Martha Farah and I attempted to operationalize the holistic claim using the part/whole task. In this task, participants studied a face and then their memory presented in isolation and in the whole face. Consistent with the holistic view, recognition of the part was superior when tested in the whole-face condition compared to when it was tested in isolation. The “whole face” or holistic advantage was not found for faces that were inverted, or scrambled, nor for non-face objects, suggesting that holistic encoding was specific to normal, intact faces. In this paper, we reflect on the part/whole paradigm and how it has contributed to our understanding of what it means to recognize a face as a “whole” stimulus. We describe the value of part/whole task for developing theories of holistic and non-holistic recognition of faces and objects. We discuss the research that has probed the neural substrates of holistic processing in healthy adults and people with prosopagnosia and autism. Finally, we examine how experience shapes holistic face recognition in children and recognition of own- and other-race faces in adults. The goal of this article is to summarize the research on the part/whole task and speculate on how it has informed our understanding of holistic face processing.     

Judging trustworthiness from faces: Emotion cues modulate trustworthiness judgments in young children

By adulthood, people judge trustworthiness from appearances rapidly and reliably. However, we know little about these judgments in children. This novel study investigates the developmental trajectory of explicit trust judgments from faces, and the contribution made by emotion cues across age groups. Five‐, 7‐, 10‐year‐olds, and adults rated the trustworthiness of trustworthy and untrustworthy faces with neutral expressions. The same participants also rated faces displaying overt happy and angry expressions, allowing us to investigate whether emotion cues modulate trustworthiness judgments similarly in children and adults. Results revealed that the ability to evaluate the trustworthiness of faces emerges in childhood, but may not be adult like until 10 years of age. Moreover, we show that emotion cues modulate trust judgments in young children, as well as adults. Anger cues diminished the appearance of trustworthiness for participants from 5 years of age and happy cues increased it, although this effect did not consistently emerge until later in childhood, that is, 10 years of age. These associations also extended to more subtle emotion cues present in neutral faces. Our results indicate that young children are sensitive to facial trustworthiness, and suggest that similar expression cues modulate these judgments in children and adults.     

Dissecting the time course of person recognition in natural viewing environments

Person recognition often unfolds over time and distance as a person approaches, with the quality of identity information from faces, bodies, and motion in constant flux. Participants were familiarized with identities using close‐up and distant videos. Recognition was tested with videos of people approaching from a distance. We varied the timing of prompted responses in the test videos, the amount of video seen, and whether the face, body, or whole person was visible. A free response condition was also included to allow participants to respond when they felt ‘confident’. The pattern of accuracy across conditions indicated that recognition judgments were based on the most recently available information, with no contribution from qualitatively diverse and statistically useful person cues available earlier in the video. Body recognition was stable across viewing distance, whereas face recognition improved with proximity. The body made an independent contribution to recognition only at the farthest distance tested. Free response latencies indicated meta‐knowledge of the optimal proximity for recognition from faces versus bodies. Notably, response bias varied strongly as a function of participants’ expectation about whether closer proximity video was forthcoming. These findings lay the groundwork for developing person recognition theories that generalize to natural viewing environments.     

Adolescents coping with the COVID-19 pandemic: ‘every day is like another Sunday’

COVID-19 has upended the way analysts and psychotherapists practice. Many use the phone for their sessions, many are using video platforms, and many use a combination of the two. Work with adolescents is very challenging in this new modality because of the loss of in-person connection and immediate non-verbal cues. The public health restrictions put in place to manage COVID-19 spread are at odds with the adolescent tasks of adventuring, experimenting and gaining new experiences. In addition, increased anxieties about infection, contamination and invasion are often manifest and adolescents can regress in the face of them. Using seminal ideas from Bion, this article looks at two process examples from adolescent boys who struggled with parts of themselves that felt disturbing and unacceptable. The author discusses the clinical exchanges in detail and offers ideas about the difficulty of creating psychic space when working virtually.